Chronic Care Across the Lifespan A


Chronic diseases are the conditions that lasts for at least 3 months in the patients. These diseases are persistent in nature and comes to the humans with time (Seijo&Zulueta, 2017). There are a number of chronic diseases that impact the normal life style of a person. These diseases involve asthma, cancer, diabetes, COPD and AIDS. It has been seen that these conditions often comes hand in hand with some comorbidities that impact the patients in number of ways. For example: diabetes comes hand in hand with heart failure.

Purpose of the assignment is to investigate the case scenario of Gladys who is a 76 years old female suffering from COPD and right sided heart failure. Firstly, the assignment will discuss the chronic and presenting condition of the patients followed by pathophysiology, signs and symptoms and physiology of the conditions. Then the assignment will discuss relevant diagnosis and ongoing tests to manage the conditions followed by the potential problems and developmental, cultural and health literacy considerations in patient care.

Chronic Disease and Presenting Condition

Gladys has been presented to the GP clinic with complaints of breathlessness, swollen legs, and wheezing. Moreover, she complaints about her inability to walk for longer duration. This indicate that the patient is suffering from chronic condition of COPD. And, swollen legs and inability to walk for longer duration indicate the presenting condition to be right sided heart failure. According to Ekstrom et al., (2016), COPD is one of the most common type of chronic disease and it impact the lungs of the patients. This often makes it difficult for the patients to breathe and lead to signs and symptoms such as breathlessness, wheezing, chest tightness and persistent cough. The patient is presented with right sided heart failure which is usually a result of long terms COPD exposure to the patients. It results in signs and symptoms such as swollen legs, inability to walk for longer duration, fatigue, breathlessness and chest pain (Seijo&Zulueta, 2017).

Pathophysiology Associated with The Chronic Disease and Presenting Condition

COPD or chronic obstructive pulmonary disorder is a serious lung condition that lead to breathlessness, increased inflammation in lungs, mucus secretion, persistent cough, wheezing sound while breathing and chest congestion (Lareau et al., 2019). Gladys complained about severe breathlessness and wheezing which indicated that she has been suffering from COPD. COPD is a chronic condition because it is not completely treatable in patients. However, the signs and symptoms of the disease can be managed (Lareau et al., 2019).

The condition is usually a result of exposure to pollutants, smoke and recurrent lung infection. It starts with increased inflammation and secretion of mucus in the alveoli of the lungs. Accumulation of mucus in the lungs makes it hard for the patients to breathe and this can thus lead to breathlessness. Moreover, the body has to make a number of efforts to ease the breathing in the congested alveoli which results in the wheezing sound (Ekstrom et al., 2016). Gladys lungs were basically filled with mucus due to her prolonged exposure to COPD which resulted in wheezing sound during breathing and conditions of breathlessness.

Right sided heart failure in patients with COPD is very common. This is because of the pathophysiological and anatomical relationship shared by the lungs and heart. Patients with COPD have accumulated mucus in the lungs which lead to a V/Q mismatch (Ostenfeld et al., 2016). This lead to alveolar hypoxia that ultimately lead to pulmonary hypertension. Pulmonary hypertension lead to the back flow of blood in right side of the lungs which cause right sided heart failure (Braman& Poor, 2019). This has an anatomical relationship of decreased strength of the heart muscles to bear the overload of blood demand in the body. It can lead to signs and symptoms such as edema and swelling in the legs. Edema or swelling in the legs of the patient is basically accumulation of water in the tissues which is a common symptom of right sided heart failure (Braman& Poor, 2019).

Relevant Diagnosis and Ongoing Tests

Patients with COPD are often prescribed with lung function tests, chest X-rays, CT scans and Arterial blood gas analysis process in order to diagnose COPD. The lung function test measures the amount of oxygen that can be inhaled and exhaled (Gershon et al., 2017). Moreover the tests checks if the lungs can deliver required amount of oxygen to the blood. A six minute walk test can also be used check the functioning of the lungs. It is important for the patients with COPD to undergo timely X-rays because it can help identify emphysema. Emphysema is a common cause of COPD and it lead to reduced lung function due to excess of mucus related obstructions (Fenker et al., 2018). Some patients can be benefited from a lung surgery for COPD but a CT scan must be followed prior to the surgery as it identifies the emphysema and success rate of the surgery. Lab tests are generally not used to diagnose and manage COPD.

Diagnosis and ongoing tests for right sided heart failure involve several blood tests, chest X-rays, electrocardiogram, echocardiography and exercise stress tests. (Joly et al., 2019) The blood tests are perform to analyze the presence of substances such as sodium, potassium, creatinine, and albumin in the blood. Fluctuations from the normal amount will represent the level of damage to the heart. The chest X-rays are taken from the sides, back and front of the chest. This reveals if the heart is enlarged or if there is any type of congestion in the lungs. The ECG is used to investigate the heart rhythm and the Echocardiography is performed to check the ejection fraction of the heart (Joly et al., 2019).

Potential Problems Associated with Chronic Disease

Chronic conditions comes with a number of complications and these complications can have greater adverse effects on the patients. Long term exposure to COPD can result into complexities such as lung cancer and acute exacerbations of COPD. According toSakai et al., (2020), COPD is considered as an independent risk factor for lung carcinoma. Moreover, squamous cell carcinoma is the most prevalent type of carcinoma in patients with COPD (Javed et al., 2019). It has been seen that COPD patients that smoke are five times more likely to experience lung cancer in their future. Exacerbations of COPD is considered as another common complication of COPD. It is sudden outburst of the COPD symptoms such as breathlessness, cough with sputum and chest tightness (Wedzicha et al., 2017). COPD exacerbations can be serious and fatal if not treated on time.

Developmental, Cultural and Health Literacy Considerations

Gladys is significantly concerned about her future and she does not have much awareness about the right sided heart failure and how it would impact her future. Moreover, she is concerned about her coping abilities to the disease. According to the standard 3 of registered nurse standards for practice NMBA (2017), a registered nurse must provide relevant patient education to the patients in order to provide them an inclusive care. It is important for the nurse to help the patient in her developmental process. One of the main criteria of imparting effective education for the patient will be maintaining cultural integrity for the patient (Giger & Haddad, 2020). Since the patient lives alone so it is important for the nurse to develop confidence in the patient.

Encouragement strategies that develop hope in the patient must be followed in order to keep the patient motivated. It is important for the nurse to maintain proper cultural integrity and health literacy for the patient. Health literacy allows the patient to have information about her health condition and maintenance of cultural competence through empathy, cooperation and respect can keep the patient motivated and hopeful (Gabay, 2019). The nurses must inform the patients about the best possible strategies that can help patients regulate and monitor their health on an individual level. For example, the patient must be informed to download electronic health monitoring apps such as Kardiamobile for better management of the heart function.

Nursing Management Priorities

It is important for the nurses to set priorities in order to provide effective care to the patients. It is required for the nurse to manage the clinical symptoms of the patient with proper pharmacological and non-pharmacological interventions. The patient will be provided with both short and long acting bronchodilators such as Ipratropium and Tiotropium respectively (Halpin et al., 2017). These bronchodilators comes as inhalers and it ease breathlessness and wheezing in the patient.

Since, the patient in the case study is unaware of right sided heart failure so the nurse must educate the patient about the condition. The nurse must exhibit empathy and respect toward the patient while communicating about the condition.

Non-pharmacological interventions such as selective pulmonary vasodilators can be recommended for the patient (Briganti&D'Ovidio, 2017). This technique helps the reversal of conditions that heighten pulmonary vascular tone. It can be effective for the patient if kept close to the right ventricle systolic pressure.


In conclusion it can be stated that COPD is a serious chronic condition which comes hand in hand with right sided heart failure. Pathophysiological findings from the assignment revealed that COPD lead to increased mucus in the lungs which contribute to pulmonary hypertension that push back the blood back in the heart. This ultimately led to right sided heart failure. Patients with COPD and right sided heart failure require a number of diagnostics and ongoing tests such as CT scan, X-rays, and Blood tests for heart function test, and lung function tests for COPD. Bronchodilators can relieve symptoms such as breathlessness in the patient and patient education can help the patient feel motivated and hopeful.


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