A Case of Pulmonary Rehabilitation

Many of the risk factors for cardiovascular disease cause problems because they lead to atherosclerosis. Atherosclerosis is the narrowing and thickening of arteries and develops for years without causing symptoms. It can happen in any part of the body. Around the heart, it is known as coronary artery disease, in the legs it is known as peripheral arterial disease. The narrowing and thickening of the arteries is due to the deposition of fatty material, cholesterol and other substances in the walls of blood vessels. The deposits are known as plaques. The rupture of a plaque can lead to stroke or a heart attack. (World Heart Federation).

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

Atherosclerosis is the process in which substances known as plaques, which are made up of cholesterol and platelets, adhere to tears in the walls of arteries. Over time these plaques build up to the point where they occlude blood flow in the arteries. When this happens in the coronary arteries, either directly, as the result of buildup in the arteries themselves, indirectly in the form a clot from another part of the body breaking loose and becoming lodged in the coronary arteries, the usual result is a heart attack.3

     Atherosclerosis is one of a group of health problems that define coronary artery disease, oftentimes referred to as heart disease. Atherosclerosis is the leading cause of heart disease in the United States. The following is the definition provided by the American Heart Association:

According to the American Heart Association, cardiovascular disease or heart disease is one of the leading causes of death in America. Cardiovascular disease refers to a disease of the heart and/or blood vessels. It is also known as heart disease. The term cardiovascular disease covers many conditions and is extremely dangerous. Atherosclerosis is one of the major conditions that falls under the cardiovascular disease category. Atherosclerosis is a condition that develops when plaque, made from various substances that circulate in your blood, builds up on the walls of the arteries. The buildup narrows the arteries and makes it difficult for blood to flow through. The major risks of atherosclerosis are heart attack or stroke (American Heart Association, n.d.).

D.Z.is a 65-year-old man admitted to medical ward with an exacerbation of chronic obstructive pulmonary disease (COPD; emphysema). Past medical history (PMH) indicates hypertension (HTN), well managed with enalapril (Vasotec) past six years, diagnosis (Dx) of pneumonia yearly for the past three years. D.Z. appears cachectic with difficulty breathing at rest. Patient reports productive cough with thick yellow-green sputum. He seems anxious and irritable during subjective data collection. He states, he has been a 2-pack-a-day smoker for 38 years. He complains of (c/o) insomnia and

States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.

Patient “DD” is a 56-year-old woman who was admitted to a nearby hospital for respiratory failure. With the only previous medical history being chronic bronchitis, she was diagnosed upon admission with COPD, anemia, hypoxia, moderate anxiety, and dyspnea.

Nevertheless, there is an understandable and noticeable link between circulatory related diseases and lifestyle diseases, such as Coronary Heart Disease. Coronary heart disease can occur when fatty acids, such as cholesterol in an inadequate diet, build up in the walls of the coronary artery. These fatty deposits collect minerals and harden to become a plaque. Eventually, this plaque grows and can swells up, forming an aneurism. In some cases, this aneurism may burst leading to instant death. As it continues to grow and swell up, it finally blocks the artery completely and forms blood clots. This is known as coronary thrombosis. A myocardial infarction, or in other words as heart attack, occurs when no oxygen is able to reach the coronary artery and thus it is unable to fulfil its role in providing the heart muscle with a sufficient supply of blood. Heart attacks are very common in the society nowadays, especially occurring in smokers or obesity related diseases (Millar, June 2014)

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

HPI: Pt presents with c/o increased SOB that has worsen over the last few months. Chronic cough that is occasionally productive with whitish sputum. Hinders his ADLs.

Atherosclerosis is associated with the major killer ailments in America, which include strokes, heart attacks, as well as peripheral vascular disease. The condition arises when there are a narrowing and hardening of the arteries. This is usually a gradual process, and it slowly blocks the arteries. When this happens, it will impede smooth blood flow. It is estimated that at least one million Americans lost their lives to a condition associated with atherosclerosis for the past few years.

The patient is a 61-year old female who has a history of Chronic Obstructive PulmonaryDisease (COPD), hypertension, Coronary Artery Disease (CAD), and anxiety. The patient is familiar with the diagnosis and illnesses that have been contracted over the years and is knowledgeable about the disease processes, medications, and signs and symptoms of each disease. The patient came into the emergency department presenting with dyspnea, chest pain, weakness, and severe wheezing. The patient was diagnosed with an onset of a COPD exacerbation. During the hospital, stay chest x-ray and respiratory panel was done, showing positive for pneumonia. The patient continued to stay at the hospital until oxygenation status improved and the course of IV antibiotics

Pulmonary rehabilitation has been clearly demonstrated to reduce dyspnea, increase exercise capacity, and improve quality of life in individuals with chronic obstructive pulmonary disease. There has been an increased evidence of the effcicay of pulmonary rehabilitation for COPD and other related respiratory diseases such as interstitial lung disease, bronchiectasis, cystic fibrosis, asthma, pulmonary hypertension, lung cancer, lung volume reduction surgery, and lung transplantation (Spruit et al., 2013).

Disease of the arteries called atherosclerosis is medical condition characterized with accumulation of fatty material on the internal walls of the blood vessels that has impact on the blood flow. Medical experts warn that this medical condition is quite severe as it may lead to cardiac arrest, brain hemorrhages or even death.