pathophysiology and assessment data

MAJOR pathophysiology
• Acute exacerbation of COPD (Concept: Gas Exchange)
The COMORBID pathophysiology
● Type 2 diabetes

1. Section 1: Pathophysiology
a. Provide a relevant and concise summary of the selected MAJOR disease process (Maximum 250 words).
Chronic obstructive pulmonary disease is a term refer to 2 types of airway obstruction disease, emphysema and chronic bronchitis.
Etiology or risk factor: smoking is a major etiology. Also, exposure to air pollution.
Pathophysiology
• Emphysema; lung loss its elasticity, plus alveolar walls and capillary bed destruction. Proteases enzyme (protein digestive enzyme) breakdown elastin in the lung. Inflammatory cells move into the lung when stimulated by smoke or irritants increasing elastase (elastin digestive enzyme) as well as other protases.

• Chronic bronchitis; inflammation and obstruction of airway. Hypersecretion of mucus in the large airways leading to overproduction of sputum.

Clinical manifestation
• For both emphysema and chronic bronchitis; cough with sputum, shortness of breath, exercise intolerance, frequent exacerbation.
• Descriptors used to differentiate emphysema and chronic bronchitis
o “pink puffers” = emphysema; dyspnea, use of accessory muscles and pursed lip. No cyanosis in emphysema patient. Due to the loss of elasticity, airway collapse during expiration lead to air being trapped in the alveoli and lungs, barrel chest is seen.
o “blue bloaters” = chronic bronchitis; decreased PaO2 and increased PaCO2 (low oxygen and high carbon dioxide in the blood) leading to hypoxemia and cyanosis. Patient also seen with fluid retention or edema from right sided heart failure.

b. Briefly describe how the COMORBID condition (or its treatment) potentially complicates the treatment of the MAJOR disease process. (Maximum 250 words).
Type 2 diabetes or non-insulin dependent diabetes mellitus, (NIDDM). The body cannot use insulin appropriately
Insulin plays a role in pulling glucose (sugar) into the cells for energy and nutrient. When the body does not know how to use insulin, sugar is not pulled into the cell, resulting in hyperglycemia or high blood glucose (glucose stays in the blood because it cannot get into the cells). Patient with COPD are treated with corticosteroid medications which is synthetic Cortisol hormone, hormone that is produced by adrenal gland to response to stress of the body. Steroid drugs are known to raise blood sugar when taken orally (systemic effect). When patient has diabetes and taking steroid would make the treatment more complicate as we need to be aware of blood sugar is raising when taking steroid. Monitoring and consulting with prescriber may be necessary.

2. Section 2: Assessment Data including Health History, Physical and Holistic Examination of Data (Maximum of 750 words):
a. Identify the 5 most relevant pieces of health history and holistic examination data that are provided or will be required to inform your care. Relevant things you want to know about the client given the diagnoses they were admitted with. Provide rationales using evidence of why that assessment data is important and why it would manifest with the pathophysiology you have selected (the COPD).
I have selected 5 relevant health history questions. Please help elaborate in detail
1. Smoking history, when did the client start to smoke, how much cigarette they have per day? Have they quit? Exposure to second-hand smoke? Rational: smoking is a major etiology/risk factor of COPD
2. Exposure to air pollution e.g., working in construction or farm or living in high polluted environment. Rational: also a risk factor of having COPD
3. Allergies? History of asthma? What is allergen? What are signs and symptoms? Rational: chronic inflammation could lead to destruction of the airways and lungs.
4. What medication client is taking, how well the client follow prescribes medication regimen?
5. Family history of respiratory concerns e.g., cystic fibrosis (CF), tuberculosis (TB)?