NURS 6501 Case Study Analysis
Case Study Analysis
Respiratory disorders are among the health problems that contribute to high disease burden among the population. Diseases such as chronic obstructive pulmonary disease (COPD) affect the functioning, health, wellbeing, and quality of life of patients. Nurses and other healthcare providers implement evidence-based interventions that optimize outcomes among the affected populations. Therefore, the purpose of this research paper is to analyze the cardiovascular and cardiopulmonary pathologic processes contributing to the symptoms reported by the assigned client. It also examines any racial or ethnic variables that contribute to the processes and their interaction.
Cardiovascular and Cardiopulmonary Pathophysiologic Processes
The assigned case study is of a 45-year-old woman that presents the hospital with chief complaint of a 3-day duration of shortness of breath, productive cough, and fevers. The patient has history of COPD. She complains that the sputum is thicker and harder for her to expectorate with chest x-ray showing flattened diaphragm and increased AP diameter. Auscultation shows hyper-resonance and coarse rales and rhonchi throughout the lung fields.
The patient in the case study has COPD with bacterial bronchitis based on the symptoms. COPD is a respiratory disorder characterized by the limitation of airflow to the lungs. The disease develops following persistent exposure to harmful substances such as smoke. It affects the pulmonary vasculature, lung parenchyma, and the airways. The destruction of the alveolar air sacs results in emphysema, which is characterized by air obstruction. The persistent exposure to hazardous substances in the environment triggers inflammatory response where there is release of macrophages, neutrophils, excess proteases, and oxidants that destroy the air sacs. Over time, the elastic recoil of the air sacs is lost leading to airway collapse when exhaling (Agarwal et al., 2022). Deficiency of lapha-1 antitrypsin may also cause emphysema.
The obstruction and inflammatory processes in COPD cause a decrease in the normal forced expiratory volume, which limits impaired gaseous exchange. There is also tissue destruction, which when combined with decreased FEV1 volume causes collapse in lung function. There is also hyperinflation in the lungs secondary to the trapping of air from the collapsed airways during exhalation. Air trapping cause accumulation of carbon dioxide, impaired ventilation, and pulmonary hypertension from hypoxemia, which develops from continued vasoconstriction. Often, triggers such as bacterial or viral pneumonia or environmental irritants exacerbate COPD, as seen in the patient in this case study (Agarwal et al., 2022). The triggers produce hyper inflammation of the lung tissue, which leads to COPD exacerbations.
Interaction of the Processes
The above physiological processes contribute to the development of the patient’s symptoms in several ways. Firstly, the inflammatory processes that cause release of macrophages and neutrophils stimulate increased mucus production and productive cough as experienced by the patient. The destruction of the alveolar sacs leads to loss of their elasticity to facilitate gaseous exchange. The collapse also result in the trapping of air within the air sacs, which is evidenced by the hyperinflation of the lungs. The reduction in body tissue perfusion results in severe hypoxemia and hypoxia. Pulmonary hypertension develops as a physiological response to severe inflammatory process and hypoxemia (Dunican et al., 2021; Rodrigues et al., 2021). As seen from the case study, the patient reports fever and thick green sputum, which are indicative of a bacterial infection. This could be bacterial pneumonia or bronchitis, which exacerbate COPD. The inflammatory processes associated with these conditions trigger the development of COPD in patients with a history of the disease. The patient in the case study also presented to the clinic with complaints of shortness of breath. The shortness of breath arises from the obstruction of airflow during exhalation. The air sacs have also collapsed resulting in the trapping of the air within the lungs (Agarwal et al., 2022). As a result, the patient feels the urge to increase the respiratory rate to compensate for reduced gaseous exchange and overcome hypoxemia and respiratory acidosis from the high levels of carbon dioxide in the blood.
Racial/Ethnic Variables
According to the Centers for Disease Control and Prevention (CDC), women have a high prevalence rate of COPD as compared to men in the United States (CDC, 2022). The mortality rate due to COPD is high among White Americans (85.78%) as compared to the other ethnicities. Black Americans rank second in mortality rates, with 8.10% as per the COPD deaths of 2020. The ethnicities with the lowest mortality rate include American Indian and Alaska Natives at 0.56%. Asian Americans (1.43%) and Hispanics (3.90%) follow them. Of all the races, Hispanics have the least death rate of 9.7 in every 100,000 while White Americans lead with 65.3 deaths in every 100000 people. The risk of Whites developing COPD is 4.1 times higher than Hispanics (Julia, 2022).
The utilization of the available treatments for COPD also varies based on race or ethnicity. For example, Black Americans are less likely than the White patients to receive the required medications for COPD. As a result, the risk of poor outcomes among the Black Americans is high. Minority ethnic groups such as Blacks and American Asians also have the lowest rate of referral for pulmonary rehabilitation as compared to the American Whites. Social determinants of health such as race, gender, income, level of education, and employment status contribute to these observed differences among the races. The factor that contributes to the high rate of COPD among American Whites as compared to other ethnicities or races is the number of cigarettes smoked (Gaffney et al., 2022). Cigarette smoking the leading cause of COPD. Therefore, the risk of COPD increases as more cigarettes are smoked per given period. In addition, genetics may play a role in the development of COPD among individuals different ethnic or racial backgrounds. For example, Mendelian syndromes that include the deficiency of alpha-1 antitrypsin predispose individuals to COPD (Silverman, 2020).
Conclusion
In conclusion, the patient in the case study suffers from COPD. Bacterial infections such as bacterial pneumonia or bronchitis may have triggered it. Alveolar collapse due to destruction by inflammatory processes caused air trapping, symptoms, and chest x-ray findings. Ethnic or racial variations exist in the rates of COPD in a population. Genetics also play a role in the development of the disease. Treatments should aim at eliminating the cause and increasing respiratory functioning of the patient.
References
Agarwal, A. K., Raja, A., & Brown, B. D. (2022). Chronic Obstructive Pulmonary Disease. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559281/
CDC. (2022, July 20). National Trends—Chronic Obstructive Pulmonary Disease (COPD) | CDC. https://www.cdc.gov/copd/data-and-statistics/national-trends.html
Dunican, E. M., Elicker, B. M., Henry, T., Gierada, D. S., Schiebler, M. L., Anderson, W., Barjaktarevic, I., Barr, R. G., Bleecker, E. R., Boucher, R. C., Bowler, R., Christenson, S. A., Comellas, A., Cooper, C. B., Couper, D., Criner, G. J., Dransfield, M., Doerschuk, C. M., Drummond, M. B., … Fahy, J. V. (2021). Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers. American Journal of Respiratory and Critical Care Medicine, 203(8), 957–968. https://doi.org/10.1164/rccm.202006-2248OC
Gaffney, A. W., Hawks, L., White, A. C., Woolhandler, S., Himmelstein, D., Christiani, D. C., & McCormick, D. (2022). Health Care Disparities Across the Urban-Rural Divide: A National Study of Individuals with COPD. The Journal of Rural Health, 38(1), 207–216. https://doi.org/10.1111/jrh.12525
Julia, N. (2022, December 30). COPD Statistics & Facts (2023): How Common Is COPD? CFAH. https://cfah.org/copd-statistics/
Rodrigues, S. de O., Cunha, C. M. C. da, Soares, G. M. V., Silva, P. L., Silva, A. R., & Gonçalves-de-Albuquerque, C. F. (2021). Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Disease. Pharmaceuticals, 14(10), Article 10. https://doi.org/10.3390/ph14100979
Silverman, E. K. (2020). Genetics of COPD. Annual Review of Physiology, 82(1), 413–431. https://doi.org/10.1146/annurev-physiol-021317-121224
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Case Study Analysis
An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.
Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.
An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
learning resources
Required Readings
- McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 32: Structure and Function of the Cardiovascular and Lymphatic Systems; Summary Review
- Chapter 33: Alterations of Cardiovascular Function (stop at Dysrhythmias); Summary Review
- Chapter 35: Structure and Function of the Pulmonary System; Summary Review
- Chapter 36: Alterations of Pulmonary Function (stop at Disorders of the chest wall and pleura); (obstructive pulmonary diseases) (stop at Pulmonary artery hypertension); Summary Review
Note: The above chapters were first presented in the Week 3 resources. If you read them previously you are encouraged to review them this week.
Required Media
- Alterations in the Cardiovascular and Respiratory Systems – Week 4 (15m)
Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 32, 33, 35, and 36 that relate to cardiorespiratory systems and alteration in cardiorespiratory systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment
In your Case Study Analysis related to the scenario provided, explain the following
- The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
- Any racial/ethnic variables that may impact physiological functioning.
- How these processes interact to affect the patient.
By day 7 of Week 4
Submit your Case Study Analysis Assignment by Day 7 of Week 4
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates
Links to an external site.). All papers submitted must use this formatting.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as MD2Assgn_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NURS_6501_Module2_Case Study_Assignment_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning Outcome Develop a 1- to 2-page case study analysis, examing the patient symptoms presented in the case study. Be sure to address the following:Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Explain how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Explain any racial/ethnic variables that may impact physiological functioning. |
|
25 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||