2. Chapter 6: COPD
Question 1
The patient should be asked if she is currently smoking, is around someone that is smoking or has a closely-related person (a parent in particular) that does. The patient should be asked if she or anyone in her family has a history of heart issues (due to the ankle swelling combined with the shortness of breath). Should be asked if there have been any notable changes in weight in either direction and whether there is any sputum or other symptoms (Brasher, 2012).
Question 2
The patient should be asked how long she smoked and whether anyone smoked in her presence, especially family. Ask her if smoking improved her condition or if it made no difference (or got worse). The variation and quantity of the sputum should also be asked about. Whether there was any blood or other coloration would be relevant. Would also be a good idea to question whether occupational exposure occurred and the family history of pulmonary issues (heart issues were already addressed)
Question 3
The patient could have a pulmonary disorder like COPD but it could also be heart-related. Both should be checked out thoroughly as both could be quite deadly. At this point, it seems to be a pulmonary issue (Brasher, 2012).
Question 4
The yellowed teeth are not a good sign. If the patient quit smoking five years ago, it is odd for her to still have yellowed teeth unless she's made no attempt to clean up the teeth after she stopped. The barrel chest is also a negative. Her pursing of her lips when she breathes is not a good sign and neither is the distention. Her dyspnea when climbing the table was also a bad sign. The dyspnea along with the accessory muscle use would indicate COPD or something along those lines. Having a shortness of breath when just climbing a table is a sign of strong lack of breathing function, whatever the reason for it may be. Plus signs include the fact that she has no cyanosis or clubbing and that she's alert. She has no rashes or masses and her strength seems to be good overall (Brasher, 2012).
Question 5
Testing of the sputum contents should be done to confirm no presence of PMN's or bacterial cells....
Blood work to determine whether levels are within proper specifications should also be done (Brasher, 2012).
Question 6
The bicarbonate not being normal in addition to PMN's and bacteria being present in the sputum is a sign that COPD is in full effect (Brasher, 2012).
Question 7
The gradient would be approximately 25.73, which is a little high for a woman of her age (Brasher, 2012).
Question 8
Based on the expected FEV1/FVC ratio as compared to what it was (a little more than half), the patient is a state III COPD-sufferer and is on the cusp of being stage 4 (Brasher, 2012).
Question 9
The absence of acute infiltrates is a good sign but the rest of the results are all bad news. The patient is not at the most advanced stage of COPD yet but she is getting close (Brasher, 2012).
Question 10
If the patient is still smoking, she needs to stop immediately. She should attend a COPD support group as well as any therapies such as hypnosis or something similar that help her condition. She should be vaccinated for the flu and pneumonia as contracting those diseases could very likely be fatal. The patient should regulate her diet and be educated on how to treat symptoms when they arise. She should be informed on the very specific symptoms to watch out for (Brasher, 2012).
Question 11
She seems to be regressing even more. She's still not quite stage IV but her overall levels are not good. She should be given long-acting inhaled B-agonists or anticholinergic and should get pulmonary rehabilitation (Brasher, 2012).
References
Asthma - PubMed Health. (n.d.). National Center for Biotechnology Information.
Retrieved August 25, 2012, from http://www.ncbi.nlm.nih.gov/pubmed health/PMH0001196/
Chronic obstructive pulmonary disease - PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved August 25, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001153/
McCance, K.L., & Huether, S.E. (2010). Pathophysiology: the biologic basis for disease in adults and children (6th ed.). Maryland Heights, Mo.: Mosby Elsevier.
