Cardiovascular and Respiratory System: Case Studies

The cardiovascular and respiratory systems are closely linked in physiological function and terms as it is the two units that enable gaseous exchange to occur in the body. Deoxygenated blood from the body comes into the right side of the heart and is then pumped into the pulmonary vasculature through the pulmonary artery. Once gaseous exchange occurs, the oxygenated blood comes back to the left side of the heart via the pulmonary vein into the left atrium. Then it is pumped into the left ventricle that then empties the oxygenated blood into the aorta for distribution to the body tissues (Barrett et al., 2019). It is this close proximity in anatomy and function that means when one system is affected by disease the other also usually almost invariably suffers. The purpose of his paper is to analyze three case studies provided and to provide answers on the pathophysiology of the cardiovascular and pulmonary or respiratory systems as present in the case patients. Cardiovascular and Respiratory System Case Study Essay  

Case Study 1: A 70 Year-Old Male with a History of DM II, COPD, Hypertension & Hyperlipidemia

1. Comparing and Contrasting Hospital & Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) is lower respiratory tract infection contracted from the community when one is not hospitalised. On the other hand, hospital-acquired pneumonia (HAP) is contracted from other patients when one is admitted in hospital (Hammer & McPhee, 2018; Huether & McCance, 2017).

2. What is the Ventilation Perfusion Matching Required for Good Gas Exchange?

The normal ventilation (V) rate for a healthy adult male should be about six litres every minute. On the other hand, the matching perfusion is the optimal volume of blood to reach the alveolar capillaries of the lungs in a specified period of time which is usually one minute. Thus for good gaseous exchange the optimal V/Q ratio should be between 0.95 and 1.0 for the most efficient pulmonary physiology (Hammer & McPhee, 2018; Huether & McCance, 2017).

3. Increasing FIO₂ will Improve Hypoxia. Why?

Increasing FIO₂ improves hypoxia because the action causes an increase in the PAO₂ or pulmonary partial pressure of oxygen (Hammer & McPhee, 2018; Huether & McCance, 2017).

4. How does Emphysema Differ from Pneumonia?

Emphysema is part of COPD which is a chronic inflammation and loss of elasticity of the lungs. Emphysema is not caused by an infection although it may complicate it. Pneumonia on the other hand is an acute infection of the lungs caused by microorganisms (Hammer & McPhee, 2018; Huether & McCance, 2017).

Case study 2: A 64 Year-Old Obese Female with Hyperlipidemia

1. Explain Poiseuille Law and Ohm’s Law.

Poiseuille law defines the relationship that exists between fluid pressure in an enclosed vessel and its flow rate as well as resistance against the vessel’s walls. Ohm’s law is a reflection of Poiseuille law but refers to current instead of fluid. For the current, it is the voltage (pressure), the resistance, and the current/ impulse (flow rate) (Zhang et al., 2016).

2. Is there an Inverse Relationship between HDL and Atherosclerosis? Explain.

Yes there is an inverse relationship between high-density lipoprotein or HDL cholesterol and atherosclerosis. This is because HDL is the “good” cholesterol that prevents the formation of atherosclerotic fatty plaques in arteries (Hammer & McPhee, 2018; Huether & McCance, 2017).

3. Explain Arteriosclerosis.

Arteriosclerosis is the gradual calcification of the inner lining of arteries due to ageing. With time the arteries become hardened and lose elasticity causing an increase in the blood pressure (Hammer & McPhee, 2018; Huether & McCance, 2017).

4. What do the Individual Lab Values Represent?

The individual lab results show that the LDL cholesterol (250 mg/dL) and triglycerides (210 mg/dL) are both elevated. This is bad for the patient’s hyperlipidemia and cardiovascular risk. The normal values should be 60-130 mg/dL and <150 mg/dL respectively. The levels of HDL are also borderline low at 79 mg/dL. This is an impending cardiovascular risk as the levels of this “good cholesterol” need to be much higher than 60 mg/dL to be protective (Hammer & McPhee, 2018; Huether & McCance, 2017).

Case Study 3: Heart Failure in a 78 Year-Old Male

1. Three Symptoms Exhibited by the Patient and the Associated Pathophysiological Principles

The case study is that of a 78 year-old patient who is diagnosed with heart failure at the facility. This means that the heart cannot effectively pump blood to the tissues as it was doing previously (Hammer & McPhee, 2018; Huether & McCance, 2017). The 78 year-old would present with a number of symptoms. The symptoms are usually difficult to manage because of the lack of self care experienced with the elderly that requires education (Charteris & Pounds, 2020; Chava et al., 2019). The patient presents with significant shortness of breath that will worsen especially when lying flat on a surface or bed. They would not be able to breathe well if not propped up in a semi-recumbent position. Pulmonary edema causes a disturbance in the efficiency of the gaseous exchange process and so the result is shortness of breath. The other symptom is edema of the extremities (just like the pulmonary edema only that the pulmonary edema is not visible to the eye).

The third symptom is persistent cough. This is related to the pulmonary edema that has been described above. As the blood moves back into the pulmonary vasculature, the serous fluid seeps into the pulmonary interstices as well as the alveoli. This seepage not only compromises gaseous exchange in the alveoli but also causes blockage in the small airways of the lungs (Hammer & McPhee, 2018; Huether & McCance, 2017). Removal of the extra fluid by diuretics produces relief from this symptom.

2. The Role of Hypertrophy

            Hypertrophy in heart failure is a compensatory mechanism that attempts to increase the force of myocardial contractility as the heart fails. This is why the heart muscle hypertrophies or enlarges. However, as it hypertrophies, the muscle becomes bigger as the heart chambers become smaller. This is because the heart is enclosed in the pericardial sac that is fibrous and strong and does not allow for any expansion. For this reason, the hypertrophy will ultimately only serve to worsen the shortness of breath of heart failure.  Cardiovascular and Respiratory System Case Study Essay

3. Ischemic Heart Disease (IHD)

This patient has heart failure and may indeed be suffering from ischemic heart disease. Ischemic heart disease means that there is occlusion of one or more of the arteries of the heart supplying the myocardium. If not enough blood can reach the heart muscle, some parts of it will die making the remaining myocardial cells unable to fulfil the pumping action well. This then causes heart failure (Hammer & McPhee, 2018; Huether & McCance, 2017). It is however unlikely that the old man has IHD since this usually presents with extreme chest pains as well.

4. Virchow’s Triad

The phenomenon known as the Virchow’s triad consists of three factors. These are hypercoagulability of blood, damage to the interior walls of the blood vessels, and stagnation of blood (Hammer & McPhee, 2018; Huether & McCance, 2017). Usually, these factors are present in cardiovascular conditions such as deep vein thrombosis (DVT), atherosclerosis, and heart failure.

Cardiovascular and Respiratory System: Heart Failure in a 78 Year-Old Male

The cardiovascular and respiratory systems are closely linked in physiological function and terms as it is the two units that enable gaseous exchange to occur in the body. Deoxygenated blood from the body comes into the right side of the heart and is then pumped into the pulmonary vasculature through the pulmonary artery. Once gaseous exchange occurs, the oxygenated blood comes back to the left side of the heart via the pulmonary vein into the left atrium. Then it is pumped into the left ventricle that then empties the oxygenated blood into the aorta for distribution to the body tissues (Barrett et al., 2019). It is this close proximity in anatomy and function that means when one system is affected by disease the other also usually almost invariably suffers. The purpose of his paper is to analyze a case study provided and provide answers on the pathophysiology of the cardiovascular and pulmonary or respiratory systems.

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Three Symptoms Exhibited by the Patient and the Associated Pathophysiological Principles

The case study is that of a 78 year-old patient who is diagnosed with heart failure at the facility. This means that the heart cannot effectively pump blood to the tissues as it was doing previously. In other words, the heart is failing in the performance of its pump duties and a pathophysiological process must be behind that. With advanced age, it is not uncommon to have elderly persons suffering from heart failure. This is due to the normal deterioration in tissues that accompanies old age (Hammer & McPhee, 2018; Huether & McCance, 2017). The 78 year-old would present with a number of symptoms. The symptoms are usually difficult to manage because of the lack of self care experienced with the elderly that requires education (Charteris & Pounds, 2020; Chava et al., 2019). Three of these heart failure symptoms are described below together with ther pathophysiological connotations. They are shortness of breath, a persistent cough, and peripheral edema.

The patient presents with significant shortness of breath that will worsen especially when lying flat on a surface or bed. They would not be able to breathe well if not propped up n a semi-recumbent position. The reason for the persistent dyspnea is that as the heart fails, the action of pumping the oxygenated blood from the lungs into the aorta for distribution to the tissues gets compromised. The heart muscle (myocardium) becomes weaker and so the blood does not fully empty into the aorta. Some of it remains in the left ventricle and with the next cycle more and more accumulate. With time, there would be no space any more in the left ventricle and the only way the excess blood will be able to move is backwards into the pulmonary vein. It is this backwards movement that finally causes the blood straining the pulmonary vasculature to seep into the interstitial tissues causing pulmonary edema (Hammer & McPhee, 2018; Huether & McCance, 2017). Pulmonary edema causes a disturbance in the efficiency of the gaseous exchange process and so the result is shortness of breath.

The other symptom is edema of the extremities (just like the pulmonary edema only that the pulmonary edema is not visible to the eye). The insufficiency of the left ventricle if not treated will finally also affect the right side of the heart and blood will begin to slow down and accumulate in the veins of the body. Since the vascular network can only hold a certain amount or volume of blood at any given time, the backflow seeps into the interstitial spaces and this causes edema in the hands and feet but more pronounced on the feet due to the effect of gravity (Hammer & McPhee, 2018; Huether & McCance, 2017). This will continue until and unless the patient receives diuretics to remove the excess water in the tissues and the lungs. Cardiovascular and Respiratory System Case Study Essay

The third symptom is persistent cough. This is related to the pulmonary edema that has been described above. As the blood moves back into the pulmonary vasculature, the serous fluid seeps into the pulmonary interstices as well as the alveoli. This seepage not only compromises gaseous exchange in the alveoli but also causes blockage in the small airways of the lungs. The result is a difficulty in breathing or shortness of breath that does not allow the patient to lay down flat on ther back (Hammer & McPhee, 2018; Huether & McCance, 2017). Removal of the extra fluid by diuretics produces relief from this symptom.

The Role of Hypertrophy and Ischemic Heart Disease

The role that hypertrophy plays in heart failure is immense. It is a compensatory mechanism that attempts to increase the force of myocardial contractility as the heart fails. This is why the heart muscle hypertrophies. However, as it hypertrophies, the muscle becomes bigger as the heart chambers become smaller. This is because the heart is enclosed in the pericardial sac that is fibrous and strong and does not allow for any expansion. For this reason, the hypertrophy will ultimately only serve to worsen the shortness of breath of heart failure.

This patient has heart failure and indeed may be suffering from ischemic heart disease. Ischemic heart disease means that there is occlusion of one or more of the arteries of the heart supplying the myocardium. If not enough blood can reach the heart muscle, some parts of it will die making the remaining myocardial cells unable to fulfil the pumping action well. This then causes heart failure (Hammer & McPhee, 2018; Huether & McCance, 2017). It is however unlikely that the old man has IHD since this usually presents also with extreme chest pains.

The phenomenon known as the Virchow’s triad consists of three factors. These are hypercoagulability of blood, damage to the interior walls of the blood vessels, and stagnation of blood (Hammer & McPhee, 2018; Huether & McCance, 2017). Usually, these factors are present in cardiovascular conditions such as deep vein thrombosis (DVT), atherosclerosis, and heart failure.

Conclusion

Heart failure is common in old age. This is due to the deterioration in cells in the elderly. Symptoms include shortness of breath, edema, and a persistent cough. IHD can also be a cause of heart failure.

References

Charteris, E.J., & Pounds, B. (2020). A nurse practitioner–led effort to reduce 30-day heart failure readmissions. Journal of the American Association of Nurse Practitioners, 32(11), 738-744. https://doi.org/10.1097/JXX.0000000000000470

Chava, R., Karki, N., Ketlogetswe, K., & Ayala, T. (2019). Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients: A community hospital based retrospective study. Medicine, 98(27), 1-4. https://doi.org/10.1097/MD.0000000000016233

Barrett, K.E., Barman, S.M., Brooks, H.L., & Yuan, J. (Eds) (2019). Ganong’s review of medical physiology, 26^th ed. McGraw-Hill Education.

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6^th ed. Elsevier, Inc.

MSN570 Week 3 Case Studies

A 70-year-old female presents with dyspnea and cough.  Medical history includes: COPD, DM II, Hypertension and dyslipidemia. The labs are as follows:

T:   102.3

HR:  102

O2: 84% on room air,  90% nasal cannula

Bicarb: 23

X -Ray:  Focal consolidation Left Lower Lobe

1. Compare and contrast hospital vs. community acquired pneumonia
2. What is the ventilation perfusion matching required for good gas exchange?
3. Increasing FIO2 will improve hypoxia. Why?
4. How does Emphysema differ from Pneumonia?

A 64-year-old obese female presents for a routine medication check. Her diagnosis is hyperlipidemia with lab values:  HDL 79,  LDL 250, Triglycerides  210.

1. Explain Poiseuille Law and Ohm’s Law.
2. Is there an inverse relationship between HDL and atherosclerosis? Explain.
3. Explain arteriosclerosis.
4. What do the individual lab values represent?

A 78-year-old male presents with a diagnosis of heart failure.

1. List 3 symptoms the patient exhibits and the patho principles.
2. What role does hypertrophy play in heart failure?
3. Does this patient have Ischemic disease?  Why or why not?
4.  What is Virchow’s Triad?

Cardiovascular and Respiratory System Case Study Essay