Unit 1 Case Study
R.S. is a long-time smoker who developed bronchitic chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral vascular disease. His arterial blood gas (ABG) values are pH = 7.32, PaCO2 = 60 mm Hg, PaO2 = 50 mm Hg, HCO3 - = 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is taking an inhaled ß agonist and theophylline to manage his respiratory condition. At his clinic visit, it is noted that R.S. has an area of consolidation in his right lower lobe thought to be consistent with pneumonia.
Discussion Questions
1. In what position would R.S. have the worst ventilation-perfusion matching?
Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases and makes it very difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus, and Emphysema, which involves destruction of the lungs over time. Most people with COPD have a combination of both conditions. Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people may smoke for years and will never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop COPD at an early age. Other risk factors that put a person at risk for COPD are: exposure to certain gases or fumes in the workplace, exposure to heavy amounts of secondhand smoke and pollution, and frequent use of cooking fire without proper ventilation.
1. R.S will show the classic symptoms of bronchitic COPD which are very similar to the symptoms of emphysematous COPD; these symptoms vary depending on the severity of the disease and are as follows. In patients such as R.S. with bronchitic COPD a productive cough, prolonged expiration, cyanosis, hypoventilation, polycythemia, cor pulmonale, fatigue, multiple recurrences of respiratory infections, trouble catching your breath, wheezing, and shortness
Discussion Questions
1. In what position would R.S. have the worst ventilation-perfusion matching?
Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases and makes it very difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus, and Emphysema, which involves destruction of the lungs over time. Most people with COPD have a combination of both conditions. Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people may smoke for years and will never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop COPD at an early age. Other risk factors that put a person at risk for COPD are: exposure to certain gases or fumes in the workplace, exposure to heavy amounts of secondhand smoke and pollution, and frequent use of cooking fire without proper ventilation.
1. R.S will show the classic symptoms of bronchitic COPD which are very similar to the symptoms of emphysematous COPD; these symptoms vary depending on the severity of the disease and are as follows. In patients such as R.S. with bronchitic COPD a productive cough, prolonged expiration, cyanosis, hypoventilation, polycythemia, cor pulmonale, fatigue, multiple recurrences of respiratory infections, trouble catching your breath, wheezing, and shortness
Cited: Andrea Gershon, MD. (2011). Comparison of Inhaled Long-Acting Beta Agonist and Anticholinergic Effectiveness in Older Patients Wtih COPD. Annals of Internal Medicine, 583-592; W-204-W-215. Deglin, J. H. (2009). Davis 's Drug Guide. F.A. Davis Company. Retrieved January 2012 Golden, Christy RN, MSN, ACNP, AOCN. (2008). Polycythemia Vera: A Review. Clinical Journal of Oncology Nursing, 553-556. Huether, Sue E. , McCane, Kathryn L. (2012). Understanding Pathophysiology 5th Ed. St. Louis, MO: Elsevier Mosby. National Heart Lung and Blood Institute . (2012, June 08). What Are the Signs and Symptoms of COPD? Retrieved from National Heart Lung and Blood Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/copd/signs.html