Hypertension and Type II Diabetes Mellitus Pathophysiology

Introduction

The patient under consideration is an adult woman aged 45. She is obese with a BMI of 37.4 and a 22-year history of smoking. Also, the patient has type II diabetes mellitus and primary hypertension. Moreover, she has been diagnosed with chronic bronchitis. Currently, she observes clinical manifestations typical of her conditions. Clinical tests also support the existing diagnoses. The patient takes medication for hypertension and type II diabetes mellitus.

Clinical Findings Correlating with Chronic Bronchitis and Appropriate Treatment

According to the information provided in the case, some of the clinical findings are associated with chronic bronchitis. First of all, the diagnosed chronic bronchitis correlates with such test results as abnormal blood gasses in the artery. They are indicated due to partial blood pressure of oxygen with 40mmHg and partial blood pressure of carbon dioxide with 52 mmHg. In its turn, bronchitis causes chronic lung inflammation that results in the reduction of lung sufficiency. Limited lung sufficiency is associated with low partial oxygen pressure. In the case under analysis, this indicator is 40 mmHg compared to the normal range of 75-100 mmHg. At the same time, the level of carbon dioxide is increased (52 mmHg compared to the normal rates of 38-42 mmHg). This patient condition is the result of ineffective gaseous exchange that is weakened because of chronic bronchitis. Moreover, the patient’s blood pressure is higher than the normal limits for her age. Finally, hematocrit concentration is 57%, which is also above the normal levels of 35-46% for females.

The first recommendation for the patient is to cease or give up smoking since it is one of the causes of bronchitis (“What is bronchitis?,” 2018). This step will increase the efficiency of further treatment. Treatment of bronchitis will comprise some steps. To manage clinical manifestations such as cough, symptomatic treatment should be applied. It is possible to use such central cough suppressants as codeine, dextromethorphan, etc., to provide short-term relief (Fayyaz, 2018). For chronic bronchitis as in the patient’s case, bronchodilators such as ipratropium bromide and theophylline can be used to control bronchospasm and chronic cough. In case the signs of COPD are revealed, mucolytics can be prescribed. However, it is important to consider the comorbidities of the patient. Therefore, since the patient has diabetes mellitus and heart failure is suspected, antibiotic therapy is recommended.

The Suspected Heart Failure Type

The clinical findings and physical examination of the patient provide evidence that proves the development of right-sided heart failure. It is the condition when the right ventricle of the heart fails to pump enough blood to the lungs. It causes the back up of blood in the veins and results in pushing fluid into the surrounding tissue. Such clinical manifestations experienced by the patient as light-headedness, distended neck veins, excessive peripheral edema, and increased urination at night also identify right-sided heart failure. For example, peripheral edema usually causes swelling in the lower limbs, which is characteristic of this type of heart failure.

Hypertension

The patient has been also diagnosed with hypertension. The blood pressure during the physical examination was measured and fixed at 158/98. It is the stage I hypertension which is indicated by blood pressure readings between 140/90 and 159/99 (Fuchs, 2018). It means that the patient is at risk of developing more severe conditions related to blood pressure. Still, the woman attempts to manage this condition by taking Lotensin and Lasix. Both medications are oral and are expected to improve the patient’s condition. Thus, Lasix (furosemide) is applied to reduce the volume of extra liquid in the body. Therefore, it can reduce such symptoms as swelling and shortness of breath. At the same time, Lotensin (benazepril) is expected to treat hypertension. Its action is directed at blood pressure reduction, which also helps to reduce the risks of stroke, heart attack, and kidney problems.

On the whole, hypertension is a global burden. According to the Centers for Disease Control and Prevention (2016), 32% of American adults or about 75 million people have high blood pressure. One in three American adults has prehypertension that is characterized by slightly increased blood pressure. The situation is dangerous because only 54% of people with hypertension can manage their condition and take medication to control the disease (Centers for Disease Control and Prevention, 2016). Moreover, hypertension was a primary or contributing cause of death for over 410,000 American citizens in 2014. In addition, researchers claim that hypertension prevalence is not likely to decrease. On the contrary, the estimated increase in the period from 2008 to 2025 is 10% (Poulter, Prabhakaran, & Caulfield, 2015).

Possible Risks for the Patient

While hypertension is a dangerous condition by itself, it also increases the risks of hypertensive patients developing other undesirable conditions. The major risks faced by patients with high blood pressure are those for coronary heart disease, stroke, and cardiovascular mortality (Fuchs, 2018). Other risks that are frequently reported among patients with high blood pressure are hypertensive cardiomyopathy, heart failure, aortic syndromes, chronic kidney disease, dementia, diabetes mellitus, etc. According to the patient’s lipid panel, the patient is at risk of cardiovascular complications due to low HDL cholesterol levels (Jewel, 2017). At the same time, LDL cholesterol levels are almost twice higher than the desirable norm, which increases the risk of heart disease. Finally, the level of triglycerides is extremely high. With 1000 mg/dl it exceeds the normal level of less than 150 mg/dl more than six times thus increasing the risk for pancreatitis. The patient receives Glucophage for type II diabetes mellitus, which is usually prescribed in overweight patients who fail to provide glycemic control through dietary management and exercise.

Interpretation of HbA1c Laboratory Value

The value of Glycosylated Hemoglobin (HbA1c) indicates if a person has diabetes. The revealed 7% mean that the average blood sugar of the patient is 152 mg/dl. Considering the fact that the normal range for the level of A1c hemoglobin is between 4% and 5.6%, the patient has an increased blood glucose level. Levels of 6.5% and higher are considered to be the results of abnormal body function and the indicators of diabetes. Therefore, this test proves that the patient has diabetes as it is stated in her history.

Conclusion

To summarizing, it should be mentioned that the patient is at high risk for serious heart problems. In addition to already diagnosed diabetes and primary hypertension, the patient has been recently diagnosed with chronic bronchitis. Moreover, the patient is suspected of heart failure that can be a result of her health problems. Still, the majority of conditions are caused by her lifestyle. Long-term smoking, the lack of a healthy diet, and probably poor activity led to obesity and chronic bronchitis, which increase the risks for developing more serious heart problems.

References

Fayyaz, J. (2018). Web.

Centers for Disease Control and Prevention. (2016). High blood pressure fact sheet. Web.

Fuchs, F. D. (2018). Essentials of hypertension. The 120/80 paradigm. Cham, Switzerland: Springer.

Jewel, T. (2017). Health Line. Web.

Poulter, N., Prabhakaran, D., & Caulfield, M. (2015). The Lancet, 386(9995), 801-812. Web.

(2018). Web.

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