Case Study

Assessment 1:Case Study 1250 words (40%)

Overview
You are required to complete a pathophysiological template for chronic obstructive pulmonary disease (COPD) in relation to a case study and answer three questions.

To complete the template you must summarize the relevant information for each component. This summary may consist of a combination of sentences, flow diagrams and dot points where relevant. The information in the template must be accurately referenced using the APA referencing style.
The questions are to be answered using correct sentence structure, paragraphs, grammar and spelling. Your answers must be accurately referenced using the APA referencing style.
Details
Length: Pathophysiology template 400 words
Answers to questions 850 words
Date due: Friday 31st August, 2012 at 17.00 hours.
CASE STUDY
Mr Lewis White, a 67year old man, is brought to the emergency department by his son. he presents with worsening dyspnoea, cough and increasing sputum production over the past three days.
On examination Mr White is severely dyspnoeic, centrally cyanosed and exhibits pursed-lip breathing. he is alert and oriented but very anxious. Mr White is using accessory muscles and on auscultation has decreased breath sounds, prolonged expiration and an expiratory wheeze.
Observations on admission
Temperature: 38.2° C
Pulse: 96 beats/minute
Respiration rate: 28 breaths/minute
BP: 140/90mmHg
Oxygen saturation: 91%
Patient history
Mr White, a retired officer, began smoking when he was 17 and smoked between 20 and 25 cigarettes a day until 10 years ago when he was diagnosed with pulmonary emphysema. Mr White lives with his wife and is experiencing more difficulty with his usual activities due to increasing breathlessness. The medications that he has been taking are tiotropium bromide (Spiriva®) inhaler once daily and salbutamol inhaler every 4-6 hours when required.
Results of tests and investigations
Pulmonary function tests
FVC 1.8L (75% of predicted)
FEV1 1.0L (55.5% of predicted)
FEV1/FVC 55% (Normal >70%)
TLC 4.5L (109% of predicted)
Chest X-ray
The chest X-ray shows a flattened diaphragm and lung hyperinflation with a translucent appearance of the lungs and no cardiac enlargement. The AP (anterior-posterior) diameter of the chest is increased. These changes are suggestive of COPD.
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Blood gases pH: 7.30 (7.35-7.45)
PaO2: 45 mmHg (80-100 mmHg)
PaCO2:51 mmHg (35-45 mmHg)
Bicarbonate: 36 mmHg (21-28 mmHg)
Sputum culture and sensitivity
Awaiting results.
Mr White was diagnosed with an acute exacerbation of chronic obstructive pulmonary disease resulting from a respiratory infection.
Management
Oxygen 2L/minute via nasal prongs.
Salbutamol 400 micrograms and ipratropium 80 micrograms via metered dose inhaler and spacer 4th hourly prn.
Prednisolone 40 mg orally daily for one week.
Doxycycline 100mg orally daily.
Mrs White is transferred to a medical ward.
PART 1 – Pathophysiology template
Complete a pathophysiology template related to the case study (400 words).
PART 2- Questions related to the case study
Question 1 (400 words)
Explain the pathogenesis that leads to the structural and functional changes resulting from Mr White’s chronic obstructive pulmonary disease.
Question 2 (225 words)
Explain how three of Mr White’s clinical manifestations are related to the structural and functional changes of his chronic obstructive pulmonary disease .
Question 3 (225 words)
Select two drugs that have been used to treat Mr White’s chronic obstructive pulmonary disease. Discuss the rationales for the administration of these drugs. Relate your discussion to the pathophysiological process.

PATHOPHYSIOLOGICAL PROCESS TEMPLATE

DISEASE:

DEFINITION:

AETIOLOGY:

PATHOGENESIS:

CLINICAL FEATURES:

COURSE OF DISEASE:

COMPLICATIONS:

PROGNOSIS:

DIAGNOSIS:

TREATMENT:

PREVENTION: