Pathophysiology and the Role of Race/ Ethnicity in a 45 Year-Old Woman Presenting with Dyspnea, Productive Cough, Fever, Hyperresonance, and a History of Chronic Obstructive Pulmonary Disease (COPD)
The GOLD guidelines state that a diagnosis of COPD is true when there is shortness of breath, a chronic productive cough, and a history of notable risk factors such as cigarette smoking. Typically, the patient is usually in their mid-life. The 45 year-old female patient in the case study fits this bill. In all likelihood, the woman must be suffering from an exacerbation of her COPD due to one or several of many exacerbating factors. The majority of these exacerbating factors are environmental in nature, such as industrial smoke. With COPD, however, the definitive diagnosis is made by means of spirometry. The forced expiratory ratio (FER) post-bronchodilator has to be below 0.7 on spirometry (GOLD, 2017). This paper is about determining the pathophysiologic processes and any ethnic or racial contributing factors in the symptomatology of the 45 year-old female patient.NURS 6501 Week 2 Case Study Assignment
The Cardiovascular and Cardiopulmonary Pathophysiologic Processes Causing the Presenting Symptoms
The main pathophysiologic processes that define COPD are a loss of alveolar elasticity and an inflammation of the airways with resultant overproduction of mucus. The former is emphysema and the latter is bronchitis (Kennedy-Malone et al., 2019; Hammer & McPhee, 2018; Huether & McCance, 2017). The symptoms of COPD such as the 45 year-old is presenting with usually show a mixture of bronchitis, emphysema, and small airway disease. Typically, there is a productive cough with purulent sputum, rhonchi and wheezing due to the increased secretions of mucus, a marked reduction in the respiratory volumes such as the FER, and a derangement of the ventilation-perfusion ratio (Hammer & McPhee, 2018; Cannizzaro, 2017). All these symptoms result from the pathophysiologic processes inside the patient.
The cardiopulmonary pathophysiologic processes that cause most of these symptoms result from the hypertrophy or enlargement of the bronchial mucus glands. The result of this is that the glands start producing excessive amounts of tenacious mucus that is not easy to expectorate. The cough cannot clear the mucus fast enough and the same accumulates in the airways causing blockage. There is an accompanying inflammatory process mediated by lymphocytes and leucocytes that happen to infiltrate the mucosal lining of the airway. A combination of the inflammatory process and the hypertrophied mucus glands causes the airways to narrow significantly. This narrowing coupled with the tenacity of the mucus compromises the normal mucociliary clearance. A vicious cycle ensues and the airways blockage worsens requiring suctioning and urgent anticholinergic and beta2-adrenergic intervention. Hyperinflation also occurs as a result of the narrowed airways. Lung parenchyma is destroyed, expiratory time is increased, and alveolar elastic recoil is lost. Compliance increases. This increase in compliance is what makes the lungs appear larger in terms of the AP aspect on chest X-ray. The diaphragm is flattened because expiratory time is increased and elastic recoil is lost. The narrowed airways cause the shortness of breath and the excess mucus and lowered mucociliary clearance cause the productive cough, wheezing, rales, and rhonchi (American Thoracic Society, 2019; Singh et al., 2018). With these pathophysiologic processes representative of bronchitis and emphysema, it is not unusual for comorbid infections to be present and cause the fever that the patient has.
Possible Racial/ Ethnic Factors that May Affect Physiological Functioning and How Processes Interact to Affect the Patient
In a study by Lee et al. (2018), they found that non-Hispanic Blacks suffered the most severe forms of COPD at 9.2% compared to Hispanics who were the least affected in terms of severity at only 3.6%. This important racial disparity means that if the 45 year-old female patient is African American or Black, they will be expected to have a worsening of symptoms. Being Black apparently has the effect of making the pathophysiological processes more pronounced and unmitigated resulting in worse symptomatology. The importance of this is that therapy must be planned in a timely manner and the goal should be to restore cardiopulmonary function or physiology as soon as possible. The fact of being Black or African American also should inform the health education and health promotion decisions in the management of this patient. This is because Lee et al (2018) also found out that non-Hispanic Blacks were most likely to be active current smokers at 42.4%. Smoking is one of the most important risk factors for COPD (American Thoracic
Order this paper