Scenario 4: 45-year-old Woman With a History of COPD
The case study portrays a 45-year-old female who have been experiencing dyspnea, cough, thick green sputum, and fever present for three days. She is a know COPD patient having a history of chronic cough, however, she reports the coughing has worsened causing sleeping difficulties. The sputum is thick and difficult to expectorate. Her chest x-ray shows a flattened diaphragm and a widened antero-posterior diameter. Besides, she has hyper resonance, rhonchi, and coarse rales in all lung fields. This paper will discuss the cardiovascular and cardiopulmonary pathophysiologic processes causing these symptoms and how they affect the patient.
Cardiovascular and Cardiopulmonary Pathophysiologic Processes of Why the Patient Presents These Symptoms
COPD exacerbation is characterized by limitation in airflow, which explains the patient’s dyspnea. The patient has limited airflow in and out of the airways due to the airways and alveoli losing their elasticity. It can also be due to the walls between the alveoli getting destroyed (Hikichi et al., 2019). The limitation of airflow in COPD is continuous due to abnormal lung inflammatory responses to harmful gases or particles. The inflammatory response takes place all through the airways, parenchyma, and pulmonary vasculature (Hikichi et al., 2019). Due to the chronic lung inflammation and the efforts by the immune system to resolve it, the small peripheral airways get narrow, limiting airflow and resulting in shortness of breath (Anzueto & Miravitlles, 2017). Furthermore, in COPD, the walls of the airways get thick and inflamed, and they produce more mucus than usual, which clogs them and becomes hard to expectorate.
Racial/Ethnic Variables That May Impact Physiological Functioning
COPD is attributed to lifestyle and environmental factors such as smoking, and thus ethnic/racial factors have no major influence.
However, some racial/ethnic communities are at a high risk of being undiagnosed due to limited healthcare resulting in worse consequences (Gim et al., 2020). According to a study by Mamary et al. (2018), African Americans have a greater likelihood of failing to be diagnosed with COPD despite having airflow obstruction than non-Hispanic whites due to health disparities. Furthermore, ethnic minorities are at a higher risk of developing COPD since air pollution, tobacco smoke, ad exposures to environmental and occupational hazards occur unequally in ethinc/racial minority populations.
How These Processes Interact To Affect the Patient
The pathophysiologic processes in the cardiovascular and cardiopulmonary systems interact to cause cough, sputum production, and dyspnea. The dyspnea can be severe and often interfere with a patient’s activities, such as eating (Gundry, 2019). The COPD symptoms often worsen over time and progressively lower the patient’s quality of life. As COPD worsens, shortness of breath occurs even at rest. As the burden of breathing increases over time, the accessory muscles are used to breathe (Gundry, 2019). COPD puts patients at risk for respiratory difficulties and infections, which increase the odds of developing acute and chronic respiratory failure.
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The patient’s dyspnea is attributed to airflow limitation from narrowed small peripheral airways. The cough and thick sputum result from the bronchioles losing their shape and being clogged with mucus. Ethnic minorities are at a high risk of developing CPOD due to poor environmental conditions and air pollution. The COPD processes adversely affect a patient’s performance of daily living activities and their quality of life.
Anzueto, A., & Miravitlles, M. (2017). Pathophysiology of dyspnea in COPD. Postgraduate medicine, 129(3), 366-374. https://doi.org/10.1080/00325481.2017.1301190
Gim, J., An, J., Sung, J., Silverman, E. K., Cho, M. H., & Won, S. (2020). A between ethnicities comparison of chronic obstructive pulmonary disease genetic risk. Frontiers in genetics, 11, 329. https://doi.org/10.3389/fgene.2020.00329
Gundry, S. (2019). COPD 1: pathophysiology, diagnosis and prognosis. Nursing Times, 27-30.
Hikichi, M., Mizumura, K., Maruoka, S., & Gon, Y. (2019). Pathogenesis of chronic obstructive pulmonary disease (COPD) induced by cigarette smoke. Journal of thoracic disease, 11(Suppl 17), S2129–S2140. https://doi.org/10.21037/jtd.2019.10.43
Mamary, A. J., Stewart, J. I., Kinney, G. L., Hokanson, J. E., Shenoy, K., Dransfield, M. T., Foreman, M. G., Vance, G. B., Criner, G. J., & COPDGene® Investigators (2018). Race and Gender Disparities are Evident in COPD Underdiagnoses Across all Severities of Measured Airflow Obstruction. Chronic obstructive pulmonary diseases (Miami, Fla.), 5(3), 177–184. https://doi.org/10.15326/jcopdf.5.3.2017.0145