Pathophysiology of Presenting Features - Assignment Example

Case-Based Assignment Pathophysiology of Presenting Features Conventionally, the sensation of uncomfortable or difficulty in breathing experienced by John is normally referred to as Dyspnea. The Dyspnea on exertion (DOE) that John reports normally is considered an indication of disease because it occurred at a level of activity that he usually tolerates. In this regard, the two common cases of Dyspnea that John may have are treponema that occurs when one is in a certain lateral decubitus position contrary to another, and Platypnea which is associated with breathlessness occurring in the upright position and is generally relieved using recumbence (West, 2011). Further West (2011) states that the Dyspnea on exertion is due to the failure of the ventricular of the left output rising during and also results in an increase of pressure on the Pulmonary vein. In the case of one having cardiac asthma, the pulmonary congestion is associated with bronchospasm that is normally precipitated by the action of edema fluid in the walls of bronchi to the external receptors. John has the above-named symptoms for cardiac asthma, but a further examination of the presented features may provide other possibilities. Moreover, the gain of weight and increased breathing rate may indicate the possibilities of blood pressure issues. The evidences of occasional coughing increase the chances of Bronchial Asthma. Research has shown that there is an overlap between the chronic obstructive pulmonary disease and asthma. Rosto (2009) predicts the typical symptoms for asthma to include wheezes, shortness of breaths, tightness of the chest and coughing. The specific features common for asthma in adults may be identified if the above-mentioned symptoms are worse at night and early in the morning, occur during exercise, cold air, and allergen exposure or aspirin. All these symptoms can be identified in the case of John. On the other hand, coughing up of blood especially from the respiratory tract is referred to as hemoptysis (Leigh & Marley, 2013). Among the various other causes of hemoptysis that is relevant to John is that it may be the origin from the bronchitis. In this regard, the main features of the hemoptysis include a productive cough for three months of the year for two successive years in smokers. Furthermore, the saliva of patients with asthma may at times appear pink when it contains large amounts of a type of blood cells called eosinophils. Another possible cause for the occasional blood streak could be lung cancer which mostly affects smokers above the age of 40. Interpretation of the Vital Signs and Physical Examination Notably, Lazaro, Girbau and Villarino (2010) summarize the vital body signs to include measuring the body temperature, blood pressure, respiratory rate and the pulse rate and they all provide critical information concerning the patients health status. In addition, there are some cases that require the measurement of the oxygen circulation in the blood as a vital sign as well. Further, the vital body signs provide a way for quantifying the illness magnitude and how the body is adapting to the physiologic stress. John’s body temperature of 370C is within the normal range for healthy adults. The body temperature of an individual may vary depending on food and fluid consumption, a recent activity, gender, time of the day and in women the stage of the menstrual cycle (Borson et al, 2000). This highlights that there is a significant chance for measurement of error and hence repetitive determinations of the temperature, as well as other signs, may provide more accurate information. Typically, the normal body temperature is expected to range from 36.5 degrees Celsius to 37.2 degrees C. In this consideration, John’s temperature is within range assuming the measurement is error free. Conventionally, when measuring the blood pressure two numbers are recorded both in “mmHg” or millimeters of mercury. Therefore, Johns pressure of 115/65 mm Hg may be considered normal. The NHLBI, however, warns that the ranges for normal blood pressure should only be used as a guide (2015). In this regard, a single elevated blood pressure or low blood pressure should not be used as a proof of the existence or non-existence of a problem (Lazaro, Girbau and Villarino, 2010). Setting aside all this considerations and assuming John’s pressure numbers as accurate, then his blood pressure is normal and does not indicate any illness. According to (Al-Shura, 2014), the pulse rate is the number of times the heart beats in one minute. It is measured externally because as the heart beats it pushes blood through the arteries and the arteries expand and contract. The normal pulse for healthy adults ranges from 60 to 100 beats in one minute. Johns rate of is high at 110 beats per minute and hence eliminating the other causes of fluctuation in heart beat rates it implies John is ill (Al-Shura, 2014). On the other hand, the respiration rate is the number of breaths taken by an individual in one minute. Normally, healthy adults have their heart beats range from 12 to 16 breaths in one minute. In comparison to the 28 breaths recorded by John in one minute, it implies that he has some respiratory problem and probably is ill. In consideration of the physical examinations, the BMI calculates the ideal body weight for a male of 177cm as 71kg’s and hence John is overweight by 17 kilograms. The neck situation is due to the wheezing often associated with asthma (Shah & Braverman, 2012).The inability to breathe unless well unless sited properly is due to Dyspnea. On the other hand, bluish skin color indicates a lack of oxygen in the skin cells. Further, Rabbetts (2007) suggests that the pitting edema and the swollen abdomen are because left ventricle to pump blood to all parts of the body and also is unable to pump blood out to the body than it is returning from the lungs. Consequently, the distress in breathing is the blood vessels of the lungs leak more than normal fluid into the air sacs that carry oxygen and the lungs don’t fill with air meaning that there is less oxygen in the blood and the tissues. The excessive fluid in the lungs is the cause for the coarse crackles while the wheeze is due to forced air flow through narrowed airways and the corresponding residual air trapping. The sounds of the heart are associated with the palpation of the heart in a logical manner over four areas in the interior chest (Rabbetts, 2007). Interpretation of Common Blood tests Test Meaning Interpretation Hb200 g/L Hemoglobin test The Normal hemoglobin level should be 130-170 g/L. Johns hemoglobin is high may occur to people with a chronic lung disease. RCC6.8*1012/L Red Cell Count Normal RCC for adult males is 4.5-5.5*1012/L John’s may indicate some lung diseases or congenital disease of the heart. Hct57% Packed cell volume/ Haematocrit-% of red blood cells to the total blood volume For adult males its 40-50% High hematocrit like Johns case may indicate dehydration or polycythemia Vera. WCC8*109/L White Cell Count Normal white cell count for adults is 4-10*109/L John’s WCC is therefore within range and as such does not indicate any disease. MCV84 fL Mean Cell Volume is an estimate of the volume of red blood cells Aids in determining the type of anemia a patient might have Typical MCV range for adults is 83-101 fL. John’s MCV is within the normal range MCHC340 g/l Mean Corpuscular Hemoglobin Concentration- refers to the average hemoglobin concentration in a particular volume of packed red cells. Normal MCHC for an adult ranges between 315 and 345 g/L John’s MCHC is within the expected range hence no chances of specific anemia. MCH29.4 pg Mean Corpuscular Hemoglobin- is the hemoglobin content for the average red cell. Normal MCH for adults is 27-32 pg John’s MCH is within the normal range. Reticulocytes3% Reticulocyte count- measures the % of slightly immature red cells (Reticulocyte) in the blood. Determines if the red blood cells are being manufactured in the bone marrow and at the required rate Normal percentage for healthy adults is 0.5-1.5% High percentage like John’s may indicate red blood cells are being destroyed by anemia, bleeding, kidney disease with increased production of erythropoietin hormone. Platelets280*109/L Estimation of the number of platelets per liter of blood. The normal platelet count for adults is 150-400*109 /L Platelet count monitors medications that can have some toxic effects on the bone marrow or problems associated with abnormal bruising or bleeding. John’s platelet count is within the normal range. CRP5.5 mg/L C-reactive protein (CRP) - used to detect tissue injury or infection somewhere in the body and is not specific (Christie, 2005). People with CRP levels of 1.0 and 3.0 mg/L are at an average risk of developing a cardiovascular disease CRP higher than 3.0mg/L like John’s implies a high risk of cardiovascular disease. A positive test indicating an inflammation in the body may be due to cancer or heart attack. Pulse Oximetry 86% This is a non-invasive method for measuring a person’s O2. The normal pulse Oximetry is 95-100% and values under 90% are considered very low. John’s Oximetry is below 90 percent hence is very low. John may be considered to have respiratory problems. Summarized from (Wallach, 1998) List of Possible Conditions Condition Reason Heart disease Due to the red color count, Due to C-reactive protein test, low Pulse Oximetry Lung cancer Because of the Hemoglobin test Asthma Incidents of coughing, low pulse oximetry and CRP test. Bronchial Asthma Incidents of coughing, low pulse oximetry and CRP test. Rationale for Further Diagnostic Tests Heart Disease Soni, Ansari, Sharma and Soni (2011) assert that the diagnosis of the heart disease is influenced by the condition of the patient. In this regard, besides the tests already done, it’s important to find John’s family and medical history. A chest X-ray is also necessary and various other tests will confirm the case of a heart disease. First, an Electrocardiogram (ECG) test can unveil irregularities in the hearts structure and rhythm. Secondly, the ECG is followed by a Holter monitoring that helps in detecting heart rhythm irregularities that are not easily recognizable by ECG examination. In addition, a cardiac catheterization will be necessary to measure the pressures in the heart chambers and see the flow of blood through the vessels, valves of the heart. Fourthly, a cardiac computerized tomography (CT) scan checks any heart problems by collecting different images of the heart and chest. Lastly, a cardiac magnetic resonance imaging (MRI) needs to be performed on John. This last process will produce pictures with a magnetic field that are helpful in evaluating the heart (West, 2011) Lung Cancer The following tests that are specific to cancer should be done on John. The imaging tests of the X-ray may reveal an abnormal mass or small lesion in the lungs (Rivera, Mehta & Wahidi, 2013). Alternatively, sputum cytology, or examining the sputum under a microscope can show the lung cancer cells that may be present. Lastly, a tissue sample may be removed for a biopsy procedure. Bronchial Asthma According to Leigh and Marley (2013) the physical examinations and the pathophysiology eliminate the chance of respiratory infection or Chronic Obstructive Pulmonary Disease (COPD). Further, lung and pulmonary tests are necessary and determine the air moving out as John breathes. These tests may include spirometry or/and peak flow. The spirometry test checks the much air one can exhale after a deep breath and how fast they can breathe out to estimate the narrowing of bronchial tubes (Leigh & Marley, 2013). Peak flow determines how hard a patient breath out. References Al-Shura, A. (2014). Physical Examination in Cardiovascular Chinese Medicine. Burlington: Elsevier Science. Borson, S., Scanlan, J., Brush, M., Vitaliano, P., & Dokmak, A. (2000). The mini-cog: a cognitivevital signs measure for dementia screening in multi-lingual elderly. International journal of geriatric psychiatry, (15), 1021-7. http://www.cpnstudy.org/wp-content/uploads/2010/05/Mini-Cog.pdf Christie, R. (2005). Understanding your medical laboratory tests and surgical biopsy reports. Philadelphia: Xlibris Corp. Lazaro, A., Girbau, D., & Villarino, R. (2010). Analysis of vital signs monitoring using an IR-UWB radar. Progress In Electromagnetics Research, 100, 265-284. http://onlinewww.jpier.org/PIER/pier100/18.09120302.pdf Leigh, D., & Marley, E. (2013). Bronchial asthma: a genetic, population and psychiatric study. Elsevier. Nhlbi.nih.gov,. (2015). What Is High Blood Pressure? - NHLBI, NIH. Retrieved 31 March 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/hbp Rabbetts, R. B. (2007). Bennett & Rabbetts clinical visual optics. Elsevier/Butterworth Heinemann. Rivera, M. P., Mehta, A. C., & Wahidi, M. M. (2013). Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 143(5_suppl), e142S-e165S. http://182.18.0.170/download_zhinan/%E6%8C%87%E5%8D%97/Establishing%2Bthe%2BDiagnosis%2Bof%2B%2BLung%2BCancer.pdf Rosto, E. (Ed.). (2009). Pathophysiology Made Incredibly Easy!. Lippincott Williams & Wilkins. Shah, N. R., & Braverman, E. R. (2012). Measuring adiposity in patients: the utility of body mass index (BMI), percent body fat, and leptin. PloS one, 7(4), e33308 http://dx.plos.org/10.1371/journal.pone.0033308 Soni, J., Ansari, U., Sharma, D., & Soni, S. (2011). Predictive data mining for medical diagnosis: An overview of heart disease prediction. International Journal of Computer Applications, 17(8), 43-48. http://ijcaonline.net/volume17/number8/pxc3872860.pdf Wallach, J. (1998). Handbook of interpretation of diagnostic tests. Philadelphia: Lippincott-Raven. West, J. B. (2011). Pulmonary pathophysiology: the essentials. Lippincott Williams & Wilkins. Read More