Mr. Harding's Chronic Illness Case Study

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Assessment Task Two
Case Study

Question 1
Mr. Harding has a number of ‘pre-morbid’ chronic conditions that may be impacting on his admission and the care you will need to provide. Choose two (2) of Mr. Harding’s chronic diseases, explain the pathophysiology. What organs are affected by each disorder? (20 marks/10 per disorder)

Asthma

Asthma is a chronic syndrome related to the inflamed airways of the lungs (Rogers 2010). This is due to the constriction of the airways from an exaggerated response to triggers that lead to “episodes of wheezing, chest tightness, dyspnea and coughing” (Rogers 2010). Asthma can start at any age. Atopic asthma, in most cases starts in childhood, and is often related to an inherited predisposition to identifiable
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Explain why the signs and symptoms occur (link back to the pathophysiology discussed in your previous answer). (10 Marks/5 per disorder)

Asthma: Signs and Symptoms

The signs and symptoms of an asthmatic patient can differ from another patient. They can occur frequently and become more severe over time. The most common signs and symptoms are:
- Coughing which can become worse during the night time and during times of exercise (National Heart, Lung, and Blood Institute 2014)
- Wheezing
- Dyspnoea: patients describe this as either feeling out of breath or not being able to release air from the lungs (National Heart, Lung, and Blood Institute 2014)
- Chest tightness/pain

When a substance is inhaled by a patient who is hypersensitive to it, IgE antibodies cause mast cells in the pulmonary interstitium to release both histamine and the slow reacting substance of anaphylaxis (SRS-A) (Fuchs 2013). During this phase, no signs and substances are detected until the next stage.

When Histamine binds to the receptor sites of the larger bronchi, it results in swelling and inflammation of the smooth muscle, irritation and swelling of the mucous membranes (Fuchs 2013). This is what results in the symptoms of dyspnoea, prolonged expiration and an increase in the respiratory
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Blood, shunted to alveoli in other parts of the lung, still can’t compensate for diminished ventilation (Fuchs 2013). Respiratory acidosis results leading to the signs of hypoxemia, decreased PaO2, increased PaCO2 and decreased serum PH (Fuchs 2013).

Congestive Heart Failure: Signs and Symptoms

When the heart is damaged, the body uses three compensatory mechanisms (increased sympathetic activity, renal retention of fluid and tissue repair to increase cardiac output and venous return to the heart (Taylor 2013). When these mechanisms fail and congestive heart failure occurs along with its specific sign and symptoms.

Increased work load and end diastolic volume enlarge the left ventricle in left-sided failure (Taylor 2013). However, due to oxygen deficiency it enlarges with scar tissue rather than functional tissue. This results in the signs and symptoms of the heart rate increasing, pallor skin, paresthesia in the extremities, reduced cardiac output and arrhythmias (Taylor 2013).

Weakened function of the left ventricle results in blood to build-up in the ventricle and the atrium, and finally reverse into the pulmonary veins and capillaries (Taylor 2013). This results in fatigue, dyspnea on exertion, confusion, dizziness, postural hypotension, decreased peripheral pulses, pulse pressure and cyanosis (Taylor

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