Pathophysiology Case Study: Analyzing Patient MK's Medical History

This case study delves into the complex medical history and current health conditions of patient MK, a 45-year-old female with a history of smoking, poor diet, type II diabetes mellitus, primary hypertension, and a recent diagnosis of chronic bronchitis. The analysis examines her symptoms, including chronic coughing, sputum, lightheadedness, distended neck veins, peripheral edema, and increased urination. The case study explores the pathophysiology of her conditions, focusing on arterial blood gas assessments, elevated CO2 and decreased O2 levels, and the implications of her lipid profile, including elevated cholesterol, LDL, triglycerides, and decreased HDL, placing her at high risk for stroke and myocardial infarction. The study discusses the impact of her hypertension, the medications she is currently taking, and the risk factors associated with her age, smoking history, and diabetes. The analysis also covers the importance of controlling her HbA1c levels and the need for lifestyle modifications, including diet, exercise, and smoking cessation, to improve her overall health outcomes. The case study emphasizes the necessity for treatment strategies such as bronchodilators, antibiotics, and oxygen therapy for chronic bronchitis, as well as medications like Lovastatin to manage her lipid profile. The document concludes by highlighting the primary health issues identified for MK: elevated blood pressure, lipid profile, and HbA1c levels, advocating for comprehensive management to mitigate future health complications.

Running head: CASE STUDY ON PATHOPHYSIOLOGY
CASE STUDY ON PATHOPHYSIOLOGY
Name of the Student:
Name of the University:
Author’s Note:

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Introduction:
This paper deals with the case study of the client MK. The patient MK is a forty five
year old female who weighs 225 lbs. The medical history of the client indicates that she had a
22 year old smoking history and had been previously diagnosed to suffer from Diabetes
mellitus type II with hypertension. She had been on a poor nutritional diet and at present is
diagnosed with chronic bronchitis. The patient’s symptoms comprises of severe chronic
coughing with sputum in the morning, distended neck veins, light headedness, increased
urination, and excessive peripheral edema. Presently, the patient’s medications contain
Glucophage for TIID and Lasix and Lotensin for hypertension. This paper would discuss the
pathophysiology of the current medical health condition of the client in the below mentioned
section.
The clinical findings that correlate with the client’s medical health condition of
chronic bronchitis is the data of the arterial blood gas assessment. The partial concentration
of carbon dioxide has been recorded to be 52mm Hg. The partial concentration of oxygen has
been recorded to be 48 mm Hg. Studies reveal that the normal PaCO2 concentration should be
in between 40mm Hg to 45mm Hg. Also, the normal PaO2 concentration should be in
between the range 75 mm Hg to 100 mm Hg. Thus, it can be commented that the PaCO2 level
is considerably elevated and the PaO2 level is significantly lower than the normal range.
Therefore, the treatment goals for M.K would include a combination of different
therapies. The administration of bronchodilator medications such as aerosol sprays or oral
administration would help in dilating the air passage within the lungs (Chauhan & Ducharme,
2014). This would ensure relief from the symptoms of chronic bronchitis. The administration
of antibiotics would help in fighting infections within the respiratory tract (Chauhan &
Ducharme, 2014). The administration of oxygen therapy would serve as a reservoir of

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supplementary oxygen that would help M.K to breathe and overcome the symptom of
shortness of breath due to pertinent coughing. As it has been mentioned, that the coughing
increases at night, the supplementary oxygen could be used by the patient at her home so that
she could conveniently inhale oxygen and breathe (Chauhan & Ducharme, 2014). In addition
to this, the patient would be enrolled for a pulmonary rehabilitation program where she would
be educated about the health condition and trained self-management strategies such as
breathing techniques and encourage to quit smoking and lead a healthy lifestyle in order to
recover from the disease condition. In addition to this, MK would also be educated about the
inclusion of a healthy diet and exercise regimen for an accelerated health recovery.
The patient is at a high risk of suffering from stroke or a Myocardial Infarction (MI),
which is also known as a condition of Cardiac arrest. This is because the vital signs of the
patient reveals that the Triglyceride level is 1000mg/dL which is considerably higher than the
normal level 500 mg/dL. Also, the level of LDL and Cholesterol is elevated against the
normal range. The normal range of LDL cholesterol should be lesser than 100mg/dL and that
of cholesterol should be lesser than 200mg/dL (Varbo et al., 2014). Also, the normal range of
HDL should be 59mg/dL, however, the cholesterol profile of the patient suggests that her
HDL level is significantly lower than the normal range (32mg/dL) (Varbo et al., 2014). Also,
her high blood pressure reading of 158/98 mm Hg and past medical history of TIIDM as well
as excessive smoking indicated that she is at a high risk of developing a stroke. Further, M.K
is 45 year old and researchers have stated that the age range between 45 years to 55 years has
been associated with a high risk of developing a stroke or a heart attack (Lim et al., 2013).
The pathophysiology of a heart attack or a myocardial infarction can be explained as a
condition where the artery responsible for supplying blood and oxygen to the heart is
blocked. The condition generally occurs due to the accumulation of fat deposits in the arteries
(Tham et al., 2015). Usually, the substances accumulated include cholesterol and other fatty

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substances that form a plaque within the coronary arteries. The plaque gradually degrades and
forms a clot which interrupts the blood flow and leads to the condition of a cardiac arrest
which could even lead to death.
The ‘Seventh Report of the Joint National Committee ON Prevention, Evaluation and
Treatment of High Blood Pressure’ was published in 2003 and was updated in the year 2017
(American College of Cardiology, 2019). It should be noted in this context, that the updated
guideline of the year 2017 includes input from research studies so as to enhance the quality of
hypertension treatment. The guidelines critically suggests that the blood pressure of the
patients s=must be categorized under three stages that include, Normal Blood pressure and
elevated stage 1 and stage 2 blood pressure. While the normal range of blood pressure has
been mentioned as (<120/<80mm Hg), the reading for the elevated blood pressure has been
mentioned as (120-129/<80mm Hg) (American College of Cardiology, 2019). The range of
blood pressure for stage 1 hypertension has been mentioned as (130-139/80-89mm Hg)
(American College of Cardiology, 2019). On the other hand, the blood pressure range for
stage 2 hypertension has been mentioned as (>140/>90mm Hg) (American College of
Cardiology, 2019). On the basis of the vital assessment of the patient, it can be said that the
blood pressure reading of the patient (158/98 mm Hg) can be compared to the stage-2 of
hypertension. Hence, it can be said that she is suffering from type-2 hypertension.
The current medications of the patient for hypertension include the administration of
Lotensin and Lasix. The generic name of Lotensin is benazepril hydrochloride which acts as
an ACE inhibitor. The drug typically acts by synthesizing an Angiotensin-converting enzyme
which inhibits the production of angiotensin in the body and lets the blood vessels relax and
dilate. This helps in lowering the blood pressure. On the other hand, Lasix which is
generically known as furosemide acts as a diuretic. It helps in eliminating excess sodium and

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water from the body and this helps in regulating the blood pressure. However, Lasix is best
effective when it is administered with another prescription drug.
Hypertension in US has emerged out to be a serious health condition which is
amongst one of the foremost reasons of death. Statistical evidences reveal that approximately
75 million American adults are diagnosed with high blood pressure which is equivalent to
32% of the total U.S population (Delacroix et al., 2014). Also, studies indicate that in the year
2014, almost 410,000 Americans died because of hypertension. Also, the medical expense
related to hypertension in US is equivalent to $ 48.6 billion dollars which includes the cost of
health care services along with medications and interventions for the health issue (Delacroix
et al., 2014).
On critically evaluating the lipid panel of the patient, the following conclusion can be
made. The cholesterol level has been recorded as 242 mg/dL. The normal level of cholesterol
should be less than 200 mg/dL. The HDL level has been recorded to be 32 mg/dL which is
significantly lower than the normal level which is recommended to be equivalent to 59
mg/dL. The LDL level has been recorded to be equivalent to 173 mg/dL which is again
higher than the normal level which should be equivalent to 100 to 129 mg/dL. Finally the
Triglyceride level has been recorded to be 1000mg/dL, which is significantly elevated
compared to the normal level which should be lesser than 150mg/dL or less than 1.7
millimoles per Litre. Therefore, from the documented lipid profile, it can be said that the
patient is at a high risk of developing coronary artery disease and a cerebral stroke apart from
heart attack. Blood and therefore, oxygen supply to the heart is executed by these coronary
arteries and blockage within these arteries can lead to a condition of chest pain or angina.
Also, blockade of blood or oxygen flow to a part of the brain can lead to a condition of
cerebral stroke which can result in brain stroke that could paralyze the body.

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In order to treat the condition, the inclusion of Lovastatin would help in lowering the
LDL level of cholesterol and also help in reducing the Triglyceride level which would
ultimately help in reducing the possibility of a cardiac arrest. In addition to this, using a
combination of Niaspan and Lovastatin would effectively help to diminish the risk of
developing a heart attack.
It can be said that the high triglyceride level of the patient can directly be linked to the
condition of Type II Diabetes of the patient along with hypertension. In addition to this, the
unhealthy lifestyle of the patient in terms of lack of a nutritious diet, excessive smoking and
lack of any physical activity indicates that the patient has elevated blood pressure. Studies
further reveal that the condition of TIIDM is worsened by excessive smoking (Jeon et al.,
2013). Research studies have indicated that smokers were placed at a 30-40% higher risk of
developing TIIDM compared to non-smokers (CDC, 2019). Further, it also increases the risk
of developing other health problems such as heart and kidney disease, improper blood supply
to the legs and feet resulting in the manifestation of infections and ulcers. It further increases
the risk of developing retinopathy a disease synonymous to the case of causing blindness in
the eye and peripheral neuropathy that leads to excessive pain and numbness within the arms
and legs.
The haemoglobin A1c is an average estimation of the blood glucose level within the
body for the past 2 to 3 months. It can be mentioned in this regard that this test predicts the
amount of glucose that is bound to the haemoglobin within the body. Since the life span of
the red blood cells is equivalent to 3 months, the test clearly indicates an average of 3
months. The normal level for the HbA1c varies from patients who are affected with Type II
Diabetes to those who are non-Diabetic. The normal range for patients who are non-diabetic
is in between 45% to 5.6% (Sherwani et al., 2016). On the other hand, for Diabetic patients,
the normal range is considered to be lesser than 7% (Sherwani et al., 2016). A test result

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higher than 7% indicates a high risk of developing complications related to Type-II Diabetes.
The case study states that the HbA1c level for the equivalent to 7.3% which is again slightly
higher than the normal recommended level for patients who are suffering from TIIDM.
Ideally, the patient must ensure that the HbA1c level is controlled and is maintained at 6%
(Sherwani et al., 2016). This could be fostered with the inclusion of dietary and lifestyle
modifications. The modifications could include the inclusion of physical activity,
medications, balanced meal and a combination of all these factors. Therefore, the present
value indicates an abnormal body physiology of the patient and increase in risks pertaining to
type II Diabetes. Thus, regulating the HbA1c level would help in ensuring a normal
physiological functioning and risk free health complications.
Conclusion:
Therefore, to conclude it can be mentioned that the primary health issues that can be
identified for MK would include elevated blood pressure, elevated lipid profile, elevated
arterial blood gas assessment and slightly elevated HbA1c. At present, the patient is taking
medication for TIIDM and hypertension. However, the patient at present is suffering from
chronic bronchitis. Therefore, inclusion of medication for chronic bronchitis and medication
to lower triglyceride and LDL level would help in controlling the elevated blood pressure that
would help in reducing the risks of developing a heart disorder. Also, the inclusion of a
change of lifestyle factors and dietary modifications would help in promoting an accelerated
recovery.

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References:
American College of Cardiology (2019). 2017 Guideline for High Blood Pressure in Adults -
American College of Cardiology. American College of Cardiology. Available at:
https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2
017-guideline-for-high-blood-pressure-in-adults [Accessed 17 Feb. 2019].
Centers for Disease Control and Prevention (2019). Smoking and Diabetes. Centers for
Disease Control and Prevention. Available at:
https://www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html [Accessed 17 Feb.
2019].
Chauhan, B. F., & Ducharme, F. M. (2014). Addition to inhaled corticosteroids of long‐
acting beta 2‐agonists versus anti‐leukotrienes for chronic asthma. Cochrane
Database of Systematic Reviews, (1).
Delacroix, S., Chokka, R. G., & Worthley, S. G. (2014). Hypertension: Pathophysiology and
treatment. J Neurol Neurophysiol, 5(250), 2.
Jeon, J. Y., Ko, S. H., Kwon, H. S., Kim, N. H., Kim, J. H., Kim, C. S., ... & Jang, M. J.
(2013). Prevalence of diabetes and prediabetes according to fasting plasma glucose
and HbA1c. Diabetes & metabolism journal, 37(5), 349-357.
Lim, S., Park, Y. M., Sakuma, I., & Koh, K. K. (2013). How to control residual
cardiovascular risk despite statin treatment: Focusing on HDL–
cholesterol. International journal of cardiology, 166(1), 8-14.
Sherwani, S. I., Khan, H. A., Ekhzaimy, A., Masood, A., & Sakharkar, M. K. (2016).
Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomarker
insights, 11, BMI-S38440.

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Tham, Y. K., Bernardo, B. C., Ooi, J. Y., Weeks, K. L., & McMullen, J. R. (2015).
Pathophysiology of cardiac hypertrophy and heart failure: signaling pathways and
novel therapeutic targets. Archives of toxicology, 89(9), 1401-1438.
Varbo, A., Benn, M., & Nordestgaard, B. G. (2014). Remnant cholesterol as a cause of
ischemic heart disease: evidence, definition, measurement, atherogenicity, high risk
patients, and present and future treatment. Pharmacology & therapeutics, 141(3),
358-367.