Comorbid Manner In Context To A Case Study-Myassignmenthelp.Com

Question: Discuss About The Comorbid Manner In Context To A Case Study? Answer: Introduction The report aims to discuss the pathophysiology of different chronic complex diseases occurring in a comorbid manner in context to a case study. The concerned case study is of a 69 year old lady, Angela who is suffering with three different comorbid condition namely Chronic Obstructive Pulmonary Disorder, hypertension and arthritis. We first discuss the pathophysiology of COPD and hypertension and then move on the defining certain terms such as comorbidity, chronicity and complexity of diseases in general and finally establish a probable link between the comorbid conditions. Pathophysiology and related clinical manifestation of COPD and Hypertension Chronic Obstructive Pulmonary Disorder is an inflammatory disorder of the lungs that progressively grows and induces clinical manifestations such as chronic bronchitis, emphysema and marketing of the airway passage. Worldwide studies have revealed the disorder to be the third largest cause of mortality making it one of the emergent diseases requiring management in the recent future. The most potent risk factors identified are exposure to tobacco. Indoor and outdoor air pollutants, genetics, gender, socioeconomic status and reduced lung volumes due to certain previously occurring diseases. There is an elaborate pathophysiology associated with the disease that has been studied widely studied. A number of inflammatory cells are associated with COPD including CD8+, T-lymphocytes, B-cells, and macrophages. When activated by some foreign particles inflammatory cascades are activated in these cells eventually producing inflammatory mediators, cytokines, chemokines and chemoattractants such as interferon gamma, tumour necrosis factor-alpha, fibrinogen, C-reactive protein, matrix metalloproteinases and so on (Zakynthinos, Daniil, Papanikolaou Makris, 2011). These mediators sustain the inflammation inducing severed tissue damage to the lungs eventually hindering airflow. Further pathological changes can be medicated by imbalance in oxidant-antioxidant levels resulting in oxidative stress, which may lead to inactivation of antiproteases and surfactants, hyper secretion of mucus, sub-epithelial fibrosis, bronchoconstriction and membrane lipid peroxidation. There are three major clinical manifestations of the underlying cellular events. Elastic recoil pressure and movement of air in bronchioles primarily depend on elastin proteins, which undergo proteolysis in COPD patients. Consequently, air-flow in the lungs is reduced due to narrowing of the passage and air-trapping occurs. Prolonged inflammation causes enlargement of the mucus glands lining the inner walls of the lungs and disruption of the mucocilliary transport system responsible of clearing mucus from the airways, resulting cumulatively into blocking airflow due to the presence of excess mucus (Higginson, 2010). Further, narrowing of airways is caused by fibrotic remodelling, which increases airway resistance. Factors causing structural remodelling are build-up of scar tissue, peribronchial fibrosis and overproduction of epithelial cells lining the airways. Lastly, surface area of the alveoli is substantially reduced due to alveolar and bronchiolar epithelial cell apoptosis causing reduced gaseous exchange and disrupted ventilation-circulation, resembling histological features of Emphysema (Brashier Kodgule, 2012). Hypertension is the long-term chronic elevation of the blood pressure that may eventually result into organ damage and increased mortality. Major disorders caused due to hypertension are coronary heart disease, renal failure, and cerebro-vascular diseases. To study the pathophysiology behind hypertension we first look into the physiological mechanisms that control the blood pressure in human body. Normal blood pressure largely depends on the cardiac output and the peripheral vascular resistance of the small arterioles surrounded by smooth muscles. Prolonged concentration of the smooth muscles due to increased levels of intracellular calcium ion concentration may lead to thickening of the arterial walls causing irreversible rise in peripheral resistance. It has been postulated that initially hypertension is caused by increased cardiac output due increased sympathetic activity; consequently to compensate for increased pressure in the capillary bed peripheral resistance is increased. Re nin-angiotensin system is the most important endocrine system controlling blood pressure. Renin secreted from the juxtaglomerular apparatus of the kidney converts angiotensinogen into angiotensin I which is rapidly converted to active angiotensin II in the lungs. Angiotensin II is a potent vasoconstrictor and also induces release of Aldosterone which further raises blood pressure by water and sodium retention (Delacroix, Chokka Worthley, 2014). In patients with hypertension there is a decreased sensitivity to the baroreceptors and the baroreflexes are disrupted to varied extensions suppression the effect of the renin-angiotensin system. Lastly, stimulation of the sympathetic nervous system can cause both constriction and dilatation of the arteriolar walls. Increased release of norepinephrine and increased peripheral sensitivity to the same has been widely observed in patients with hypertension. However, studies have shown that hypertension results from the interaction of sympatheti c and renin-angiotensin system with other related factors such as sodium and water retention and action of certain other hormones like eicosanoids, atrial natriuretic peptide, and nitric oxide and so on. (Safar O'Rourke, 2012) As a consequence of increased vascular stiffness and peripheral vascular resistance the load on the left ventricle is substantially increased causing left ventricular hypertrophy and diastolic dysfunction. Ventricular dystrophy may lead to severe cardiovascular disorders and sudden deaths in certain instances. Chronic hypertension often leads to myocardial infraction and myocardial ischemia which further disrupts normal functioning of the heart. Strokes are the most common clinical manifestations of chronic hypertension mostly due to thrombosis, thrombo-embolism and intracranial haemorrhage (Humbert, 2010). However, acute renal diseases are diagnosed in later stages of the hypertension and its progression is comparatively slower. Co-morbidity, Chronicity and Complexity Comorbidity is defined as the occurrence of two or more distinct disorders in a same patient either at the same time or in a certain sequential pattern. Furthermore it implies the interaction between the diseases, which often results in condition much worse than that caused by a single disease. However, the appropriate definition for the term comorbidity is widely argued. Although all definition are based upon a single concept of occurrence of more than one distinct clinical condition in a single patient, distinction are often made based upon the nature of the health condition of the patient, significance of the co-occurring condition, the time span and sequence of the conditions and the patient complexity (Parekh Barton, 2010). Clinical management and healthcare costs are often higher for patients suffering from comorbid diseases. Several underlying causal links can be present that leads to comorbidity in a patient. A disorder may be directly responsible for causing another disease d condition. Indirect effects of one disorder on another may cause comorbidity. Further, one disorder can be associated with certain risk factors of another disorder and lastly comorbid diseases may be caused due to common causal factors for both of them. In simple terms chronic diseases are defined as those that last on a long term basis. Chronic condition are often more complex than acute ones in that they are still less understood and do not strictly follow the cause-effect relationship. It often involves a multiple complex factors that come together to cause unpredictable adverse effects on the patient. Further, social, cultural and environmental factors play a pivotal role in manifestation and treatment of the diseased condition. It has been argued that success in the medical and pharmacological sectors have increased life expectancy by reducing mortality but have failed to manage chronic diseases efficiently, on the contrary has increased vulnerability towards accidents and risk factors for chronic disease (Allotey, Reidpath, Yasin, Chan Aikins, 2011). Chronic diseases require a prolonged period of treatment intervention and medical supervision. Along with long term medical supervision, management of chronic disease may depend on several other factors such as sociocultural factors, accessibility of healthcare services, cultural views of the illness, governmental policies and programs related to the diseased condition, and the socioeconomic status of the patient. Complex diseases are those which are caused by a cumulative effect of several genetic, environmental and lifestyle factors that are yet to be identified distinctively. As such diseases do not exhibit any straightforward pattern or inheritance they are difficult to diagnose and treat. The contributing factors of complex disease are mostly non-detectable and occur in a comorbid manner which makes it impractical to impose a single factor as a disease causing one. On the other hand complexity of a chronic disease is defined as multiple morbidities in a patient at the same time. It often requires person centred care involving more than one healthcare provider. The higher the number of morbidities associated, higher is the complexity of the patient. Each complexity demands a unique set of needs and limitations according to which unique intervention programs must be designed. Self-management and social support plays an important role in tackling such diseases. Chronicity and Complexity of patients condition Angela is a 69 year old patient suffering from Chronic Obstructive Pulmonary Disorder with an FEV1/FVC ratio of 52%, which is substantially lower than a normal value of 75-85% implying chronic obstructive airway blockage. She has a smoking history of 24 packs per year. Although she has quit smoking 6 years ago her husband still smokes affecting her clinical condition in a passive manner. She suffers from arthritis and uses paracetamol to manage her pain. Further, she is diagnosed with hypertension and weight gain on her last visit to her general physician. All the clinical symptoms of Angela show high chronicity and complexity. Her unusually high FEV1/FVC ratio is a clear sign that her COPD has turned highly chronic. Her arthritis developed from working as a cleaner for many years, which is also considered as one of the most common chronic diseases prevalent worldwide. Lastly along with being COPD comorbidity her recent weight gain has resulted in chronic hypertension. From the case study of the patient it is evident that Angela suffers from a number of complex comorbid chronic diseases that is impeding her quality of life and is proving hard to be managed with medication. COPD is the fifth ranking cause of mortality worldwide (Rabe et al., 2007). It is often difficult to attenuate the consequences of the disease by therapeutic interventions because often COPD is not the only chronic disease a patient suffers from; it is almost always associated with other debilitating chronic conditions. The most common comorbidities of COPD are hypertension, diabetes mellitus and osteoporosis (Divo et al., 2012). COPD patients suffer from hypoxia due to airway obstruction, which may increase production of free radical and signal that increases blood pressure causing systemic hypertension. On the other hand patients with arthritis often develop lung diseases. Arthritis is an autoimmune disease that affects the joints of the body, however, its effect is not limited to the joints, sometimes it may affect the respiratory airway causing blockage in airflow. Thus patients with arthritis have an increased risk of developing COPD than patients without the disease. Conclusion The discussion of the pathophysiology of the clinical conditions that Angela is suffering from clearly indication she needs holistic care immediately to reduce adverse consequences. The underlying cellular mechanisms responsible for COPD, hypertension and arthritis work in a cumulative manner and increase augment the effect of each other further worsening the situation for the patient. The prior history of the patient and old age makes the clinical condition highly chronic and complex. All the comorbidities must be considered before providing therapeutic and medical intervention to the patient. 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