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McClure Case Study
Patient Overview -- Patient, Mr. M., is 49 years old and has smoked for 25 years, quit three years ago when diagnosed with emphysema. He indicates he as shortness of breath for the past 48 hours, with sputum so thick he has difficulty coughing it out. Skin is warm and dry with slight clubbing of fingers noted. Lung sounds diminished with crackles and expiratory wheezes and barrel chest. Vitals are 101.8 Temp, pule 110, respiratory 32, BP 150/82. Blood gases show decreased O2 and increased C02 with an increase in red blood cells and twice the normal white cells.
M's risk factors for emphysema are high. Smoking for so long contributed to decrease of long function and is an abnormal dilation and destruction of the alveolar ducts and air spaces in the lungs. It usually occurs in people over 50, so Mr. M is at the lower end of the scale, but the symptoms of shortness of breath,...
Emphysema is a COPD (Chronic Obstructive Pulmonary Disease) that also includes chronic bronchitis and asthma. Ironically, chronic bronchitis and emphysema often occur together, but chronic bronchitis typically clears with coughing and irritation of the bronchioles of the lungs. The thick sputum in CB also harbors bacteria, making it more difficult for the patient to recover. The wheezing, coughing and inability to take in enough oxygen also cause barrel chest as the lungs try to take in more aid, and the crackles and other sounds are mucus being trapped inside lung tissue (Cash and Glass, 2011, pp. 126-7).
Part 2 -- The next day Mr. M was admitted to the hospital due to the worsening of his condition. His temperature rose to 104 and the sputum and blood cultures are positive…
REFERENCES
Cash, J. And Glass, C. (2011). Family Practice Guidelines. New York: Springer.
Dains, J., et al. (2012). Advanced Health Assessment & Clinical Diagnosis in Primary Care.
St. Louis, MO: Mosby/Elsevier.
Mortelli, M., et al. (2002). Acute respirator distress syndrome. American Family Physician. 65 (9): 1823-30.
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