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    Case Study

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    Case Study Assignment Help


    Introduction

    According to medical science, co morbidity is an occurrence of one or two disorders or diseases that occur simultaneously with one disease being the primary one. Co morbidity can also comprise of mental disorders or behavioral problems that are interlinked to various issues. This concept is indicative of occurrence of other disorders that act as a prerequisite of one (Adir & Harari, 2014). In the case of chronic obstructive pulmonary disease it is very complicated to understand the occurrence of hypertension or whether it is the co morbidity of the first disease. In this case study the researcher’s main objective is to understand and identify the co morbidities of COPD based upon a case study.
     

    Over View of the Case Study

    The case study that has been provided is about a 69 year old lady, Angela who lives in Australia. She is married and stays with her husband who is 74 years of age. Angela has three daughters and seven grandchildren who she looks after when her daughters work. She has been a smoker from the past 24 years and has been diagnosed with COPD or Chronic Obstructive Pulmonary Disease. However she quit smoking 6 years ago but since her husband smokes she is still a passive smoker. She is on Symbicort and Spirivia for her COPD inhalers and a salbutamol inhaler for emergencies.  She is also suffering from arthritis due to her occupation as a cleaner and takes paracetamol occasionally to manage the pain. Recently Angela has been diagnosed with Hypertension as well. Thus has now begun to take an angiotensin inhibitor called perindopril arginine daily. She has had a noticeable gain in weight as well thereby causing her mobility to be reduced drastically and has breathlessness while walking.
     

    The patho physiology of chronic and complex conditions and their related clinical manifestations

    COPD or chronic obstructive pulmonary disease is the most commonly occurring chronic disease that occurs in over 20% of senior citizens above the age of 70 years. It is responsible for over 4 deaths taking place every minute in the world. According to the WHO, COPD will become the third most common cause of death by the year 2020.  Development of hypertension is one of the most poorly noticed symptoms in patients suffering from COPD that can be fatal. According to study it has been found that pulmonary hypertension is an effect of the smoke of tobacco upon the intrapulmonary vessels that leads to an uncontrolled production of mediators which are responsible for vasoconstriction and leads to vascular remodeling. The remodeling of the airways also leads to an increment in the resistance of the airways that do not come back to normal even after consuming bronchodilators. The epithelial cells of the alveolus and the bronchioles have a lesser surface area as well for carrying out exchange of gases and ventilation. The occurrence of emphysemas also causes a decline in the elastic recoil pressure of the lungs thus leading to a low driving pressure in the airways that are poorly supported where the resistance of the airflow is high.
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    COPD has numerous pathological consequences well. The proteolysis of elastic causes a decrement in the elastic recoil pressure that is found in the lungs. The movement of the air flow in the bronchioles of the lungs thus causes damage to the elastin thereby causing the airway to constrict and become narrow. Hence leading to a lower air flow rate and causing trapping of air in the lungs as well (Naeije & Boerrigter, 2013). Exacerbations in COPD are events that are very acute in nature and one worsen the respiratory symptoms of the patients on a daily basis. The symptoms comprise of an increment in the production of sputum and purulence. These symptoms can be started off by an infection in the upper respiratory tract that is one of the most common forms of exacerbations in patients suffering from COPD. 
     

    Co morbidity

    Co morbidity is the occurrence of more than one disease or ailment that is concomitant with the primary disease that the patient is suffering from. It is the existence of diseases apart from the main disorder and usually arises due to the consequences of the primary disease. Patients suffering from COPD or Chronic obstructive pulmonary diseases are often suffering from other ailments and diseases. The persisting ailments or occurrence of two or more diseases at the same time is known as co morbidities. These co morbidities often have the same concerning risk factors and work together to have a harmful impact on the health of the patient. With patients aging the occurrence of chronic conditions increases (Clark et al., 2014). COPD occurs mostly in older patients its common to see patients report other conditions that are of chronic nature as well. These co morbidities and their risk factors can prove to be fatal as well in the later stages of COPD. Hospitalization incidences also rise for patients suffering from COPD as they can suffer from non respiratory problems and the time period of hospitalization also increases significantly.
    The chronic conditions that are specific for the case study and COPD comprise of asthma, diseases of the cardio vascular system, mental issues, arthritis and cancer. These are the most commonly occurring ailments. While chest infections sleep apnea, arthritis and osteoporosis can also have a devastating impact on COPD (Nozzoli et al., 2015). In the case study that has been provided the patient Angela is suffering from arthritis and Hypertension that are one of the most commonly seen co morbidities of COPD hence they have arisen out of the aggravation of COPD in the first place.
     

    A discussion of the complexity and chronicity of the patient’s condition

    For patients suffering from multiple chronic conditions it is imperative to have a case management plan in place. It one of the most efficient forms of support that can be provided to the patient because with the rise in the chronic condition of the patient the encounters with health care also raises simultaneously. The term Chronicity means to be in a state that is chronic in nature or has been going on for a long time duration for instance in our case the patient Angela has been a chronic smoker from the past 24 years while complexity is the degree of severity of the patients illness.

    Management of a disease can become complicated due to the occurrence of co morbidities and it enhances the chronic condition as well. Health care providers need to provide more medication for conditions in order to suppress the existing condition. Bronchodilators can have an impact or ever further aggravate glaucoma in patients suffering from COPD or can cause Urinary tract infections in men as well (Tzanakis, Hillas, Perlikos & Tsiligianni, 2015). One of the most common side effects of using steroids for treatment of COPD makes bones weaker and causes arthritis. The patient Angela is suffering from Arthritis co morbidity due to usage of steroids for treatment of COPD. Cardio vascular disease is one of the most commonly occurring in patients suffering from COPD. Beta blockers are prescribed for the management of hypertension and Cardio vascular ailments. These beta blockers can give rise to asthma and cause flare ups in patients suffering from COPD a well (Cruse, 2011). 
     
    It is imperative to have a complete understanding of the complexity and chronicty of the patient’s condition. Beta blockers are extremely useful for management of COPD. Coronary artery diseases are commonly seen in patients suffering from Chronic Obstructive Pulmonary disease and are mostly under diagnosed ("Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society", 2012). COPD has a limited option for therapy and thus evaluation of the co morbidities is essential. By understanding the involving risks and challenges the prevention of COPD and early diagnosis of the disease can be carried out. Some of the most common risk factors associated with COPD are smoking tobacco, lack of nutrition, lung infection and pollution in the air.
     

    The patient’s co morbidities

    According to the case study that has been provided Angela has been suffering from Chronic Obstructive Pulmonary Disease from the past few years along with a recent diagnosis of hypertension as well. Due to her nature of work as a cleaner she is also suffering from Arthritis. As a professional nurse after analyzing Angela’s condition it can be concluded that there are several reasons for this decrement in health of Angela and it alone cannot be due to COPD but also the co morbidities that come along with this disease. It is found that Angela is already suffering from hypertension that is a co morbidity of COPD and pain in her joints. As she was a chronic smoker for 24 years she has another risk factor that gives rise to coronary heart disease and lung cancer as well. She is at a risk of acquiring pulmonary artery disease and systemic venous thromoembolism as well.  These co morbidities are the are basically provided facilitation because of the primarily occurring disease. However it is not imperative that one individual suffers from all the co morbidities as well. In this case Angela is suffering from over two of the co morbidities (Franssen & Rochester, 2014).
     

    Impact of these conditions on the health of the patient and his family

    According to Adir & Harari, (2014) the occurrence of COPD and Hypertension along with arthritis can have a severe impact on the patient’s health along with a significant effect on the social life of the patient? As it causes a hindrance in the day to day activities. Angela was not able to care for her grandchildren as much as she wanted due to limited mobility and breathlessness thus having an impact on her relationship with the family. The load that COPD brings along with it for the patient is substantial in nature, with the progression of the disease completion of tasks become difficult to attain hence diminishing the life quality of the patient. One of the most impending symptoms of Chronic Obstructive Pulmonary Disease is Dyspnea that only becomes worse as time passes by. As COPD progresses the patients can fail to understand the limitations of their disability that is brought upon by the diseases. Hence it is very crucial for health care providers to conduct a complete evaluation of the patient’s respiration condition along with their ability to carry out daily tasks. Educating the patients about COPD and its management is of grave importance as well. As early diagnosis of COPD can help in lowering its detrimental consequences.
     

    Clinical manifestations and medications of the patients 

    The impact of COPD is varies from patient to patient as it is largely influenced by the airflow limitation along with the symptoms that are presented. The most commonly seen symptoms of COPD comprise of dyspnea, production of excessive sputum and tightness in the chest.  Exacerbation is one of the most prominent symptoms of an increment in COPD and it causes immense burden on the patient ("Lung Institute | COPD and Hypertension", 2017). 
     
    Dyspnea is one of the most imperative reasons for patients suffering with COPD to seek medical care. This is due to the fact that COPD causes hyperinflation of the lungs thereby in turn lowering the inspiration capacity of the lungs and a significant increment in the residual capacity. It makes breathing difficult for the patient especially while walking and exercising, thus explaining the reason for Angela’s breathlessness. This occurrence of hyperinflation is due to the air that gets trapped during the process of expiration. Limitations in the airflow also occur gradually. Hypertension is another common occurrence for a patient suffering from Chronic Obstructive Pulmonary Disease ("Signs and Symptoms - NHLBI, NIH", 2017). Some antihypertensive aggravate the exacerbating effect as well, for instance usage of beta blockers needs to be done very carefully as these ACE inhibitors can cause coughing that is often confused to be asthma instead of COPD. The patient is one Symbicort 400 12mcg and Spiriva 18mcg along with a salbutamol inhaler for management of COPD while she is one Perindopril arginine for hypertension treatment.

    Conclusion

    After reviewing the case study that has been provided, the condition of the patient has been critically analyzed. Angela is suffering from chronic obstructive pulmonary disease along with hypertension. This disease has certainly created a harmful impact on her social life as she is unable to spend time doing the things she enjoys. She is 69 years of age that makes her less equipped to deal with such a chronic disease. The co morbidities of COPD and hypertension have also had an impact on her lifestyle. The main reason behind her failing health is not just COPD but the co morbidities that comprises of asthma, cardiovascular disease, back problems, mental health problems, arthritis, diabetes and cancer. She also needs to convince her husband to quit smoking so that they both can follow a proper diet regime and recover from this ailment.
     
    Recommendations
    After analyzing the current state of Angela it is recommended that she follows a healthy diet plan along with gradual exercise. It is essential to stick to the medication for COPD and Hypertension, however it is imperative that she loses weight and sticks to her diet regime for managing the co morbidities that come along with COPD. She needs to control her blood pressure levels significantly as it could cause a coronary heart attack if she does not take care. In patients suffering from COPD beta blockers help in removing the obstruction in the bronchial pathway. These beta blockers are rendered safe for patients suffering from COPD and can help significantly to lower the rates of mortality.