Patient Interaction Report
Patient Interaction
A full medical history and examination was taken from this patient suffering from recurrent acute exacerbations of COPD and heart failure.
This 79 year old female has suffered with what she describes as a bad chest for over ten years frequently experiencing dyspnoea and chest infections. She recalls suffering many exacerbations and put this down to experiencing asthma attacks. The patient admitted she had smoked 10 cigarettes a day for 64 years- a 32 pack year history. She was experiencing recurrent exacerbations of shortness of breath, unable to walk without fatigue and sputum production.
My initial thoughts were that she did not seem to be able to breathe well at all. This was quite alarming to me however she told me that this was usual for her. I felt somewhat reassured but I noticed that it was difficult to make conversation with her properly because of the degree of dyspnoea. She was diagnosed with COPD in 2000 and put on …show more content…
an inhaled corticosteroid and bronchodilator along with oral steroids. Her exacerbations were attributed to chest infections and she was given antibiotics to combat them. However, as the exacerbations kept coming back, the cause could be something more than respiratory infection. A cardiac cause was suspected, and more precisely- congestive cardiac failure. She showed symptoms of right sided or biventricular failure as she has peripheral oedema and symptoms of left sided heart failure heart failure such as, shortness of breath together with a reduction in mobility and fatigue. She was diagnosed with cardiac failure. She was prescribed a diuretic- Frusemide, it is possible that pulmonary oedema could have been triggering the attacks. She has received stents for ischaemic heart disease. The patient describes symptoms of paroxysmal nocturnal dyspnoea - unable to sleep lying down and needing the aid of pillows to prop her up. She reports sleeping with three pillows but is still unable to sleep well.
This was a particularly upsetting point for the patient and it really made me appreciate how much the disease impacts her life. It is a common thing to read in books that patients are unable to sleep and need propping up but it has a new meaning to hear it from a patient who is so upset about it.
I performed a respiratory and cardiovascular examination on the patient. On inspection the chest seemed to be barrel shaped, looking visibly hyperinflated. She was using accessory muscles to breathe. This was not a sight I was very used to seeing because most patients we see and examine have fairly normal shaped chests and breathing. So it was a good experience to see a chest after several years of struggling with COPD. I could see clearly how much she was struggling with her breathing which was not nice to see.
There was no finger clubbing.
Her tongue was slightly blue in colour signifying central cyanosis.
Her radial pulse was 84 beats a minute with a regular pulse. Respiratory rate was 15 breaths per minute.
On auscultation, she had normal heart sounds with no murmurs. There was an expiratory wheeze throughout both lungs. I could hear crepes bilaterally, more on the right than left- crackly on inspiration and wheezy on expiration, which could possibly suggest pulmonary oedema.
On palpation, percussion was more resonant on the left, as was vocal and tactile fremitus. There was also more chest expansion on the left than right.
She showed signs of peripheral oedema bilaterally at the ankles. This patient appears to suffer from right sided heart failure as there is peripheral oedema, although there were no signs of ascites or hepatomegaly. From her medical records, the first documented chest infection was when she was 70 years old- an acute respiratory infection, and such chest exacerbations have recurred ever
since.
Her latest lung function tests revealed an FEV1 of 0.53L/s 27% of that expected and her FEV1/FVC was 66% therefore stage IV COPD according to the GOLD classification where patients are at risk of cardiac complications such as cor pulmonale. On the MRC dyspnoea scale this patient scores a grade 5 which is severe dyspnoea as she reports this breathlessness at all times and is unable to walk distances and complete household tasks. If classified in the New York Heart Association classification for congestive heart failure she would be at stage III, moderate.
Overall, I feel this was a very useful encounter for me as I really got the chance to see how a chronic disease can affect a patient physically and how much it can affect them in their daily living. Also I was able to examine her and see signs that most patients do not show so it was very good for learning.
A full medical history and examination was taken from this patient suffering from recurrent acute exacerbations of COPD and heart failure.
This 79 year old female has suffered with what she describes as a bad chest for over ten years frequently experiencing dyspnoea and chest infections. She recalls suffering many exacerbations and put this down to experiencing asthma attacks. The patient admitted she had smoked 10 cigarettes a day for 64 years- a 32 pack year history. She was experiencing recurrent exacerbations of shortness of breath, unable to walk without fatigue and sputum production.
My initial thoughts were that she did not seem to be able to breathe well at all. This was quite alarming to me however she told me that this was usual for her. I felt somewhat reassured but I noticed that it was difficult to make conversation with her properly because of the degree of dyspnoea. She was diagnosed with COPD in 2000 and put on …show more content…
an inhaled corticosteroid and bronchodilator along with oral steroids. Her exacerbations were attributed to chest infections and she was given antibiotics to combat them. However, as the exacerbations kept coming back, the cause could be something more than respiratory infection. A cardiac cause was suspected, and more precisely- congestive cardiac failure. She showed symptoms of right sided or biventricular failure as she has peripheral oedema and symptoms of left sided heart failure heart failure such as, shortness of breath together with a reduction in mobility and fatigue. She was diagnosed with cardiac failure. She was prescribed a diuretic- Frusemide, it is possible that pulmonary oedema could have been triggering the attacks. She has received stents for ischaemic heart disease. The patient describes symptoms of paroxysmal nocturnal dyspnoea - unable to sleep lying down and needing the aid of pillows to prop her up. She reports sleeping with three pillows but is still unable to sleep well.
This was a particularly upsetting point for the patient and it really made me appreciate how much the disease impacts her life. It is a common thing to read in books that patients are unable to sleep and need propping up but it has a new meaning to hear it from a patient who is so upset about it.
I performed a respiratory and cardiovascular examination on the patient. On inspection the chest seemed to be barrel shaped, looking visibly hyperinflated. She was using accessory muscles to breathe. This was not a sight I was very used to seeing because most patients we see and examine have fairly normal shaped chests and breathing. So it was a good experience to see a chest after several years of struggling with COPD. I could see clearly how much she was struggling with her breathing which was not nice to see.
There was no finger clubbing.
Her tongue was slightly blue in colour signifying central cyanosis.
Her radial pulse was 84 beats a minute with a regular pulse. Respiratory rate was 15 breaths per minute.
On auscultation, she had normal heart sounds with no murmurs. There was an expiratory wheeze throughout both lungs. I could hear crepes bilaterally, more on the right than left- crackly on inspiration and wheezy on expiration, which could possibly suggest pulmonary oedema.
On palpation, percussion was more resonant on the left, as was vocal and tactile fremitus. There was also more chest expansion on the left than right.
She showed signs of peripheral oedema bilaterally at the ankles. This patient appears to suffer from right sided heart failure as there is peripheral oedema, although there were no signs of ascites or hepatomegaly. From her medical records, the first documented chest infection was when she was 70 years old- an acute respiratory infection, and such chest exacerbations have recurred ever
since.
Her latest lung function tests revealed an FEV1 of 0.53L/s 27% of that expected and her FEV1/FVC was 66% therefore stage IV COPD according to the GOLD classification where patients are at risk of cardiac complications such as cor pulmonale. On the MRC dyspnoea scale this patient scores a grade 5 which is severe dyspnoea as she reports this breathlessness at all times and is unable to walk distances and complete household tasks. If classified in the New York Heart Association classification for congestive heart failure she would be at stage III, moderate.
Overall, I feel this was a very useful encounter for me as I really got the chance to see how a chronic disease can affect a patient physically and how much it can affect them in their daily living. Also I was able to examine her and see signs that most patients do not show so it was very good for learning.