Support Your Answer With Two Or Three Peer-Reviewed Resource

Support your answer with two or three peer-reviewed resources

You are an AGACNP practicing as a hospitalist nurse practitioner in a 200-bed community hospital. You are tasked with admitting a patient with a chief complaint of a complex acute, critical, and chronic pulmonology state. Summarize the pathology, etiology, modifiable and nonmodifiable risk factors, pertinent signs and symptoms, anticipated acid-base derangements, diagnostics, treatment regimens to include both pharmacological and nonpharmacological, and nutritional and environmental interventions for one of the following: Acute and Chronic Lung Failure, Obstructive Lung Disease, Restrictive Lung Disease, Pulmonary Fibrosis, Drug-Induced Pulmonary Toxicities, Pneumonia (Viral, Fungal, and Bacterial Infections of the Lung, including TB, Mycoplasma Infections, and Bronchiectasis). Support your answer with two or three peer-reviewed resources.

Paper For Above instruction

The complexities of pulmonary diseases require a comprehensive understanding of their pathophysiology, etiology, and management strategies. For this paper, we will focus on COPD (Chronic Obstructive Pulmonary Disease), a prevalent obstructive lung disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response of the lungs to noxious particles or gases, primarily cigarette smoke (GOLD, 2023). COPD exemplifies an obstructive lung disease with significant implications for acute and chronic management in hospitalized patients.

Pathology and Etiology: COPD primarily involves airway inflammation, remodeling, and destruction of alveolar walls, leading to airflow obstruction. The primary etiology is cigarette smoking, which induces inflammatory responses and oxidative stress, although exposure to environmental pollutants and genetic factors (e.g., alpha-1 antitrypsin deficiency) also contribute (Barnes et al., 2022). Repeated respiratory infections and occupational exposures can exacerbate disease progression.

Risk Factors: Modifiable risk factors include smoking cessation, reduction in exposure to air pollutants, and vaccination against influenza and pneumococcus. Nonmodifiable factors entail age, genetics, and prior respiratory infections. Patients over 40 with a significant smoking history (e.g., >10 pack-years) are at increased risk.

Signs and Symptoms: Clinically, COPD presents with dyspnea on exertion, chronic cough, and sputum production. Physical exam may reveal wheezing, prolonged expiratory phase, use of accessory muscles, and signs of hyperinflation such as barrel chest and diminished breath sounds (GOLD, 2023). In acute exacerbations, there may be cyanosis, tachypnea, and signs of respiratory distress.

Acid-Base Derangements: COPD exacerbations often lead to respiratory acidosis due to hypoventilation, resulting in elevated PaCO₂ levels and decreased pH. Hypoxemia may also occur, leading to compensatory metabolic changes over time.

Diagnostics: Evaluation includes spirometry showing reduced FEV₁/FVC ratio (

Treatment Regimens:

• Pharmacological: Inhaled bronchodilators (beta-agonists and anticholinergics), inhaled corticosteroids, phosphodiesterase-4 inhibitors for severe disease, and antibiotics during exacerbations (e.g., azithromycin). Oxygen therapy is crucial for hypoxemic patients, with target saturations of 88-92%.
• Nonpharmacological: Pulmonary rehabilitation focusing on exercise training, education, and nutritional counseling. Smoking cessation programs are vital.
• Nutritional: Adequate caloric intake, with attention to maintaining muscle mass and preventing weight loss, especially in advanced disease stages. Supplemental oxygen may improve nutrition status indirectly by reducing exertional fatigue.
• Environmental: Ensuring clean air environments, avoiding respiratory irritants, and vaccination to prevent infections.

Conclusion: COPD exemplifies a complex obstructive lung disease that requires multidisciplinary management focused on symptom control, preventing exacerbations, and improving quality of life. Recognizing the pathophysiological features, associated risk factors, and evidence-based therapies allows clinicians to optimize care and patient outcomes.

References

• Barnes, P. J., Celli, B., Fishman, A., et al. (2022). Chronic obstructive pulmonary disease. The Lancet, 399(10328), 2110-2124.
• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2023). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Available at: https://goldcopd.org
• Rogers, R. M., & Rennard, S. I. (2021). COPD: Pathophysiology, diagnosis, and management. The Journal of Clinical Investigation, 131(2), e141078.