Q1. In your own words, explain the pathophysiology of COPD and how it affects Jim.

Pathophysiology refers to the gradual development of unfavourable functional alterations due to a disease. In the case of COPD, the process begins with destruction of airways and the very small air sacs found in the lungs (MacNee, 2006). When this happens, the person with COPD experience cough accompanied with mucus and difficulty breathing at advanced stages. COPD is a collective term for many chronic lung illnesses. The primary COPD conditions include emphysema and chronic bronchitis. Although these two diseases attack different sections of the lung, they both contribute to breathing challenges.

Pathophysiology of COPD is clearer when one understands the lungs’ structure. The inhaled air passes through trachea into tubes known as bronchi, then into bronchioles. Alveoli (small air sacs) are located at the end of bronchioles. Alveoli also contains capillaries, through which oxygen from the lungs enters the bloodstream. Carbon dioxide also leaves blood at this point into the lungs and then is exhaled. One of the primary COPD diseases, Emphysema, affects the alveoli. It damages fibers on alveoli’s walls, rendering them less elastic and interfering with their ability to recoil after exhalation. This makes carbon dioxide exhalation difficult. On the other hand, inflammation of lung’s airways causes bronchitis. Persistence of this situation causes chronic bronchitis. COPD develops from smoke, environmental chemicals, and gas fumes (in buildings with poor ventilation).

In Jim’s case, the COPD resulted from exposure to asbestos when he worked as a geologist. His breathing difficulty happens because his lungs tend to secret more mucus while bronchiole experience inflammation and get narrower. The excess mucus in airways reduces the amount of inhaled oxygen. Reduction in amount of inhaled oxygen is reciprocated with lesser carbon dioxide exhalation (MacNee, 2006). A person with COPD will often cough in attempt to remove the mucus from lungs. This must be the productive cough included in the list of Jim’s symptoms. Other symptoms of COPD include wheezing when breathing and chest tightness, due to narrowing of alveoli and bronchioles as mucus build up. As oxygen circulation in the body reduces, fatigue and light-headedness occur (MacNee, 2006). This explains the lack of energy that Jim presented over the past week.

Q2. What toxins and environmental factors may have contributed to Jim’s COPD?

Although tobacco is the most prevalent environmental toxin and risk factor for COPD, Martinez and Han (2012) found that it is only responsible for one out of every five COPD cases. This makes it apparent that more factors are responsible for the condition. According to Martinez and Han (2012), the effect of exposure to second hand smoke (or environmental tobacco smoke must be investigated. This form of toxin can be inhaled at home and in the place of work. A person may be affected by this risk factor even after they quit smoking and have no occupational related exposures. 

For non-smokers like Jim, COPD may result from other factors which are yet to be fully understood. The episodes are, however, closely common in people with tuberculosis and asthma. Situations that expose people to outdoor and traffic pollution are also to blame for the development of the disease. Even stronger links to the illness have been associated with biomass smoke exposures. Away from these, occupational exposures to gas, vapour, and fumes contribute to 15% of COPD incidents (Martinez and Han, 2012). This is the place where Jim’s case fits. His occupation exposed him to asbestos.

Q3. How will exacerbation of Jim’s COPD affect his quality of life?

Serious exacerbations causes imbalance between perfusion and ventilation leading to poor exchange of pulmonary gas. The situation is caused by inflammation of airway, hypersecretion of mucus, oedema, and bronchoconstriction. All these minimise ventilation and contribute to pulmonary arterioles’ hypoxic vasoconstriction. This causes impairment of perfusion (MacNee, 2006). If coupled with alveolar hypoventilation, respiratory muscle fatigue may result in hypercapnia, respiratory acidosis and hypoxaemia, which result in fatal respiratory failure or even death. If respiratory acidosis couples with hypoxia, they trigger vasoconstriction of pulmonary and create overloading of the right ventricle. If this occurs alongside renal and hormonal fluctuations, peripheral oedema develops. Generally, exacerbation reduces lung function and overall health status. These increase the chances of mortality.

Q4.  What impact would this have on his physical and emotional state?

Exacerbations of COPD deteriorate a patient’s stability further than the variations experienced with daily living. On the emotional state, a COPD patient may feel fear, worry and sadness. These feelings may be elevated to a depressing level. With this, the range of activities that Jim enjoys would be limited. On the physical, Jim would exhibit dyspnoea, fever, productive cough, and have increased sputum. Other observable signs of COPD exacerbations include reduced exercise tolerance, hike in fatigue, insomnia, acute confusion, retention of fluid, and depression.

Q5. Jim asks you today to explain more about what terms the doctor has been talking about when examining him. In your own words, define the following abbreviations and medical terms as you would explain them to Jim

· HT

· Dyspnoea

· Cataracts


HT (hypertension) Also known as high blood pressure is, by definition, a repeatedly elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above 140 or a diastolic pressure above 90. Chronic hypertension is a "silent" condition that does not have symptoms. It is a short-lived or chronic blood pressure elevation in arteries, which might damage cardiovascular. Popular causes of HT include smoking, overweight, inadequate physical activity, calcium/potassium/magnesium deficiency, diabetes, lack of vitamin D, aging, and stress, among others. Symptoms of HT are confusion, dizziness, visual challenges, fatigue, headaches, blood in urine, irregular heart beat and difficulty breathing. Treatment options include lifestyle changes (nutrition, regular exercising, and quitting smoking) and taking of pharmaceutical drugs. Best preventive measures include consumption of healthy food and exercising regularly. Strategies for managing stress, as well as intake of alcohol and salt are also useful.   

DYSPNOEA- is the medical term for shortness of breath, sometimes described as “air hunger.” It is an uncomfortable feeling. Shortness of breath can range from mild and temporary to serious and long-lasting. It is sometimes difficult to diagnose and treat dyspnea because there can be many different causes. Some causes are acute but others such as acute myocardial infarction and pulmonary embolism, are fatal. Its diagnosis is often confused with COPD and congestive heart failure. The presence of dypnea already indicates higher possibility of mortality.   

CATARACTS- is a clouding of the lens of the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. The clouded vision caused by cataracts makes reading, driving, and observing people’s facial expressions difficult. At its onset, using bright light and eyeglasses help a patient to cope with the condition. It may, however, be difficult to detect cataract if it only affects a section of the eye lens as one as patients often lack awareness of the loss of vision. Therefore, there is need to see a doctor if one experiences pain in the eye, sudden headache, or double vision. Cataracts result from aging and injuries to the tissues within the eye lens. Genetics and other eye conditions may also be responsible. A cataract surgery is recommended in cases where the condition prevents a person from carrying on their daily activities. The surgery is proven to be safe and effective.

DEPRESSION- An illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about himself or herself, and thinks about things. Depression may lead to physical and emotional challenges as well as disruption of daily activities. Symptoms include anger outbursts, irritability over trivial matters, lack of interest or enjoyment in hobbies, oversleeping or lack of sleep, fatigue, weight and appetite loss, anxiety, reduced pace of speech, and unexplained physical issues (headaches or backaches). In majority of depression incidents, the symptoms get serious enough to interfere with normal activities in social, work, relationships or school contexts. Depression could be inherited, result from hormonal changes, or due to functionalities of brain chemicals. Risk factors include personality traits (e.g. low self-esteem), stressful events, chronic illnesses, and medications such as sleeping pills and those intended for treating blood pressure.  Depression may be avoided through elimination of stress, seeking treatment early enough, and maintenance of intervention in the long run to avoid relapse.

Q6. Jim is on several medications, research the medications Jim is on and outline how that medication benefits him. 

PO Captopril 50mg TDS- long-term prevention of symptomatic heart failure: Captopril is indicated in clinically stable patients with asymptomatic left ventricular dysfunction (ejection fraction ≤ 40%) following myocardial infarction to improve survival, delay the onset of symptomatic heart failure, reduce hospitalisations for heart failure. Captopril also enables management of hypertension in mild to moderate levels. When handling severe hypertension, captopril is useful only if standard therapy proves ineffective.

PO Tramadol 50-100mg 6/24 hourly PRN- The narcotic-like medication relieves moderate to severe aches in adults.

PO Panadol Osteo 650mg 6/24hrly prn- Providing long-lasting pain relief, as it contains a paracetamol dose higher than the constituent of the regularly used Panadol tablets.

PO Fluoxetine 20mg mane- works by increasing the amount of serotonin (a natural substance) in your brain. Serotonin helps maintain mental health balance. An increase in serotonin helps to treat symptoms of depression, obsessive-compulsive disorder, bulimia nervosa, and panic attacks.

Symbicort 100/6 1-2 Inhalations BD- it help to prevent asthma symptoms. Symbocort 160/4.5 also acts as a maintenance treatment option for airflow obstruction in people with COPD (bronchitis and emphysema). It also minimises COPD exacerbations.

Spiriva (Tiotropium bromide) 2.5mcg Inhalation daily-is indicated for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. SPIRIVA HANDIHALER is indicated to reduce exacerbations in COPD patients.

Q7. Explain your understanding of the terms ‘indications for use’ and ‘contra-indications’ in relationship to medication management.

In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient.  Such treatments may result in harmful reaction if used in individuals with blood pressure or allergies. It is also not advisable to administer several medicines on a single person. An example of relative contraindication in Jim’s situation is the use of PO Tramadol 50-100mg 6/24 hourly PRN and PO Panadol Osteo 650mg 6/24hrly prn simultaneously as both are pain relievers. On the other hand, indication for use’ refers to symptoms, signs, or medical situations (conditions or reasons) that make a given test, procedure or treatment to be recommended.

Q8.  Jim states to you that he finds as gets older his sight has deteriorated. Explain to Jim at least two aged related changes that people are likely to experience with their sight as they age.

One change is Presbyopia. As an individual ages past 40 years, focusing on items up close becomes a problem. The challenge is caused by inability of eye’ lens to change shape (presbyopia). Holding of materials far from the eyes is a way people use to cope with the gradual loss of focusing capability. With time, the people start using reading glasses or multifocal/progressive lenses.

Cataracts – the popularity of cataracts among seniors is what qualifies it to as a usual aging change. Close to half of individuals aged 65 and above develop cataracts and the situation worsens as they enter 70s. This can, however, be fully corrected with relevant surgery.

Aging may also lead to loss of peripheral vision. Here, the visual field’s size declines by about 1 to 3 degrees every 10 years. This way, a person loses 20 to 30 degrees of the visual field by the time he or she hits 70s to 80s. This condition heightens automobile accidents risk, and extra care must be taken to encourage safe driving.