NURSING 3: Analysis of COPD and Right-Sided Heart Failure Case Study

This report presents a comprehensive analysis of a nursing case study involving a 76-year-old woman named Gladys, diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and presenting with right-sided heart failure. The report delves into the pathophysiology of both conditions, exploring the mechanisms of lung inflammation, airflow limitation, and right ventricular dysfunction. It outlines the relevant symptoms, diagnostic tests, and potential complications, including heart failure and respiratory failure. Furthermore, the report emphasizes the importance of considering developmental stages, cultural values, and health literacy when planning care. It identifies three key nursing priorities: managing shortness of breath, addressing complications of right-sided heart failure, and promoting patient function and mobility. The study highlights the significance of pharmacological interventions, such as bronchodilators, statins, and pulmonary rehabilitation, in improving patient outcomes and enhancing quality of life. Finally, the report underscores the need for nurses to consider individual patient needs and contexts when providing care for patients with COPD and related conditions.

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Patients with chronic health condition present with many health related
complications during their life span. To promote optimal health and quality of life of such
patient, examining pathophysiology behind the condition and implementing proper
disease management strategy is important This essay will look into the case study of
Gladys, a 76 year old woman who is suffering from the chronic disease of Chronic
Obstructive Pulmonary Disease (COPD) and presenting health issue of right sided heart
failure. The essay will look into the pathophysiology, symptoms, anatomy and
physiology linked to the chronic health condition and the presenting health issue. The
essay will outline relevant diagnostic tests for the patient’s condition and identify two
potential problems linked to the disease. The essay will also discuss about
development, cultural and health literacy consideration for the care of Gladys and
discuss three priorities for the nursing management of the patient.
The case scenario is about Gladys, who attended the GP clinic with complaints
of increased breathlessness, wheeziness and swollen leg. Her symptoms are similar to
the symptoms of COPD. COPD is a severe lung disease associated with airflow
limitation and interference in normal breathing pattern of patient. Common symptoms
found in patient include chest tightness, shortness of breath, wheeziness and chronic
cough (State of Victoria, 2020). Some patient with COPD may have swelling in the
ankles or leg which occurs due to pulmonary hypertension. Swelling of the leg was one
of the symptoms for Gladys too. The main organ affected in this disease is the lungs
and it mainly affects the smaller airways in the lung such as the bronchi and alveolar
walls. Two important phenomenon involved in the pathophysiology of COPD includes
chronic bronchitis and emphysema. Emphysema is a condition that is associated with
permanent enlargement of the respiratory space and damage of the airway walls.
People with emphysema are found have damaged alveoli and bronchi. Accoridng to
Berg and Wright (2016), exposure to noxious particles and gases contribute to the
pathological changes of COPD. It results in inflammation of the lungs which is
associated with increase in number of neutrophils and eosinophils and progressive
airflow limitation. Other pathological change that takes place following lung inflammation
includes mucous hypersecretion, pulmonary hyperinflation, ciliary dysfunction and gas

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exchange abnormalities (Kim, 2017; Berg & Wright, 2016). Hence, several mechanisms
appear to play a role in the pathogenesis of COPD.
Another presenting condition found for Gladys was right sided heart failure and
she was found to be worried about it. Right sided heart failure is a pulmonary heart
disease which occurs due to the failure of the right ventricle to pump blood properly.
Common symptoms found in patient include distended abdomen, weight gain and cold
and sweaty skins. Many conditions like diabetes, lung disease, congenital heart defects
and hypertension increase risk of congestive heart failure. In case of Gladys, her
presenting condition of right sided failure is due to COPD. According to de Miguel Díez,
Chancafe Morgan and Jiménez García (2013), COPD and congestive heart failure often
exists together because of shared risk factors such as cigarette smoking, advancing
age and systemic inflammation. The risk of heart disease increases for COPD patient
because of severe airflow obstruction and high concentration of circulating C-reactive
protein (CRP). CRP is an inflammatory marker of cardiac risk and the concentration of
CRP changes with changes in vascular structure function in COPD patients (Konstam et
al., 2018). Pulmonary hypertension (PH) is a cause behind right sided heart failure too.
It occurs when the oxygen level decreases and pulmonary hypertension occurs. PH
increases right ventricular load leading to right sided heart failure and inability to adapt
to peripheral demand during exercise. It is seen in 5-10% of patient with advanced
COPD. During exercise and movement, pulmonary hypertension worsens (Zangiabadi,
De Pasquale & Sajkov, 2014). For this reason, Gladys might be having difficulty during
mobilization.
Gladys was suffering from the chronic condition of COPD. Some of the
diagnostic test that helps to detect or diagnose COPD includes spirometry test,
pulmonary function test, FEV1/FVC ratio and vital capacity. Spirometry is a breathing
test that measures lung function of an individual. Spirometry test is important for those
patients who have symptoms of dyspnoea, chronic cough and sputum production (State
of Victoria, 2020). Other test includes chest x-ray and CT scan, which can help to detect
the extent of emphysema in the lungs. Medical history and physical examination of
patient is also done to diagnose COPD. Arterial blood gas analysis result can help to

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detect the efficiency of lungs in promoting gas exchange. Moreover, the role of lung
volume test like FEV1/FVC ratio is that it helps to track changes in lung capacity.
FEV1/FVC ratio is between 70-80% in normal adults and the value less than 70% is a
sign of airflow limitation and COPD. In case of severe COPD, FEV1/FVC is less than
70% and FEV1 (forced expired volume in one second value) is between 30-50%
(advantage.ok.gov, 2020). The above mentioned test can be done for Gladys too.
Moreover, to confirm right sided heart failure, diagnostic test like blood test, chest x-ray,
electrocardiogram and echocardiogram is necessary.
Gladys is suffering from COPD. Two potential complications that she faces due
to the disease include heart failure and high risk of respiratory failure. There is an
important connection between COPD and heart failure because both share common
pathophysiological mechanisms like lung hyperinflation and systemic inflammation. In
addition, both the disease condition has similar risk factors too. This includes ageing,
tobacco smoking and sedentary lifestyle (Rabe, Hurst & Suissa, 2018).. The risk of
heart failure is high in severe COPD because of severe airflow obstruction and increase
in CPR protein. COPD leads to activation of the inflammatory process and inflammation
is a factor that increases CRP and cytokine level in patient. This change is a marker of
cardiac risk and heart failure (de Miguel Díez, Chancafe Morgan & Jiménez García,
2013). Hence, considering the fact that COPD and CVD can co-exist together and
worsen outcome of Gladys, it is crucial that this co-mborbid condition is identified at an
early stage so that early intervention and appropriate treatment could be provided.
Gladys is also at risk of respiratory failure due to COPD. Acute exacerbation is a marker
of respiratory failure and significant perfusion mismatching and increase in hypercapnia
is found to play a role in the physiology of respiratory heart failure in patients (Siela,
2018). Hence, active management of COPD is important to prevent the above two
complications.
While planning care priorities and health education for Gladys, it will be
necessary to consider the developmental stage and cultural value of Gladys. Gladys is
a 76 year old patient with COPD and she might be suffering from other developmental
issues such as poor cognitive and intellectual functioning. Hence, instead of giving

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verbal instruction on care, it will be crucial to provide written and visual instruction to
Gladys. This would be more appealing for her. In addition, while trying to educate
patient, it will be important to assess learning ability and cultural values of patient. The
advantage of culturally appropriate audiovisual education is that it can lead to better
integration of the health message (Poureslami et al., 2016). Physical, socio-cultural and
psychological changes due to ageing may affect the learning process and these factors
must be considered while educating about COPD and its self-management. Gladys was
anxious and worried about her current health state. Proper understanding of her state of
mind and her interest in seeking more information may help to promote health literacy
process (Maia & Costa, 2019). Hence, consideration of learning ability and functionality
of elderly patient can help to facilitate proper health literacy for patient.
The first care priority for the management of advanced COPD symptom in
Gladys is to reduce her symptom of shortness of breath. This will depend on
pharmacological intervention such as use of bronchodilator medication or corticosteroid
drug. Both the drugs have the potential to reduce inflammation and promote opening of
the lung tissue. In addition, her sign and symptoms should be regularly assessed.
According to Siela (2018, use of short-acting bronchodilators and oral corticosteroid ca
reduce risk of respiratory failure in patient. The second care priority will be to address
complications due to right sided heart failure. This will depend on treatment with
angiotensin converting enzymes, statins and angiotensin receptor blockers. This drug
has the potential to reduce risk of hospitalization and morbidity and mortality due to
COPD (de Miguel Díez, Chancafe Morgan & Jiménez García, 2013). The third care
priority will be to promote usual function and enhance mobility function of Gladys. This
can be done by implementary pulmonary rehabilitation that will help her to engage in
supervised exercise and education training. It is a multidisciplinary approach to care that
increases exercise capacity, impaired breathing pattern and health related quality of life
of patient. It can significantly improve exercise tolerance in case of Gladys (Corhay et
al., 2014).
To conclude, the essay discussed about the pathophysiology of COPD and right
sided heart failure. Lung inflammation and chronic airflow limitation was found to be a

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factor leading to COPD. The risk of heart failure was identified because of common risk
factors and pathophysiology of the both the disease. The essay identified bronchodilator
use, use of statins or ACE inhibitors and pulmonary rehabilitation as three intervention
to promote recovery of Gladys, improve her symptoms and enhance her quality of life.
This study gives nurse the lesson to consider developmental stage and cultural factors
of patient before educating or providing care to patient with COPD too.

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References
advantage.ok.gov (2020). Stages of COPD and Spirometric Classifications. Retrieved
from: http://advantage.ok.gov/CHCC/Publications/Spirometric%20Classifications
%20of%20COPD.pdf
Berg, K., & Wright, J. L. (2016). The pathology of chronic obstructive pulmonary
disease: progress in the 20th and 21st centuries. Archives of pathology &
laboratory medicine, 140(12), 1423-1428.
https://www.archivesofpathology.org/doi/full/10.5858/arpa.2015-0455-RS
Corhay, J. L., Dang, D. N., Van Cauwenberge, H., & Louis, R. (2014). Pulmonary
rehabilitation and COPD: providing patients a good environment for optimizing
therapy. International journal of chronic obstructive pulmonary disease, 9, 27–39.
https://doi.org/10.2147/COPD.S52012
de Miguel Díez, J., Chancafe Morgan, J., & Jiménez García, R. (2013). The association
between COPD and heart failure risk: a review. International journal of chronic
obstructive pulmonary disease, 8, 305–312.
https://doi.org/10.2147/COPD.S31236
Kim, E. K. (2017). Pathophysiology of COPD. In COPD (pp. 57-63). Springer, Berlin,
Heidelberg. https://link.springer.com/chapter/10.1007/978-3-662-47178-4_5
Konstam, M. A., Kiernan, M. S., Bernstein, D., Bozkurt, B., Jacob, M., Kapur, N. K., ... &
Raval, A. N. (2018). Evaluation and management of right-sided heart failure: a
scientific statement from the American Heart Association. Circulation, 137(20),
e578-e622.https://doi.org/10.1161/CIR.0000000000000560
Maia, A., & Costa, A. (2019). O28 Health literacy in elderly population. European
Journal of Public Health, 29(Supplement_2), ckz098-007.
https://doi.org/10.1093/eurpub/ckz098.007
Poureslami, I., Kwan, S., Lam, S., Khan, N. A., & FitzGerald, J. M. (2016). Assessing
the effect of culturally specific audiovisual educational interventions on attaining

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self-management skills for chronic obstructive pulmonary disease in Mandarin-
and Cantonese-speaking patients: a randomized controlled trial. International
journal of chronic obstructive pulmonary disease, 11, 1811–1822.
https://doi.org/10.2147/COPD.S105408
Rabe, K. F., Hurst, J. R., & Suissa, S. (2018). Cardiovascular disease and COPD:
dangerous liaisons?. European Respiratory
Review, 27(149).DOI: 10.1183/16000617.0057-2018
Siela, D. (2018). Acute respiratory failure and COPD: Recognition and
care. Nursing2019 Critical Care, 13(1), 28-37.doi:
10.1097/01.CCN.0000525926.13357.c0
State of Victoria (2020). Lung conditions - chronic obstructive pulmonary disease
(COPD). Retrieved from:
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lung-
conditions-chronic-obstructive-pulmonary-disease-copd
Zangiabadi, A., De Pasquale, C. G., & Sajkov, D. (2014). Pulmonary hypertension and
right heart dysfunction in chronic lung disease. BioMed research
international, 2014, 739674. https://doi.org/10.1155/2014/739674