Thank you for referring Sevda Gurkovski, a 56-year-old lady who has previously worked in a warehouse. Sevda is a current smoker of 10-12 cigarettes per day and in total has accumulated a 30 pack-year history. She is of Macedonian origin, having immigrated to Australia 40 years ago. She reports no history of tuberculosis. She keeps a pet cat and has had cat exposure for a number of years. She is generally in good health and does not take any regular medication. Around two months ago, Sevda became aware of exertional dyspnoea and a mild cough productive of clear phlegm. She has also experienced intermittent wheeze and a stabbing sensation in the chest. There have been no fevers or sweats. She recalls no sinus of reflux symptoms. In …show more content…
She is marginally better today, but not significantly so. Examination revealed an oxygen saturation of 96% and chest auscultation was notable for basal crackles. Two heart sounds were audible with nil else and JVP was not elevated. Assessment: Given Sevda’s smoking history, it is quite possible that she will have underlying COPD and in the last few weeks has experienced a low-grade infective exacerbation. Given the absence of any current overt infective symptoms, I have not prescribed any antibiotics, but instead will collect a sputum sample for culture and she will have some baseline pathology. I have also requested an HRCT chest scan to assess for the presence of any emphysema or bronchiectasis. Sevda will commence a trial of Spiriva and we have had a lengthy discussion regarding smoking cessation. She does seem keen to cease smoking and I have given her a script for nicotine patches. She will give me a call in a week or so once the investigation are completed and provided she is settling, I will arrange lung function tests in a few weeks that will obviously be useful in quantifying any respiratory impairment. Thank you again for your referral. Kind regards,
What risk factors and symptoms did Jessica present with prior to the physical examination that suggested a pulmonary disorder?
Examination revealed an oxygen saturation of 98% and blood pressure of 145/90. Oropharyngeal inspection revealed significant crowding (Mallampati class 3) with macroglossia. Chest auscultation was clear and two heart sounds were audible with nil else.
The presented case is of a patient named R.S. who has a smoking history of many years, which can be directly tied to his development of chronic bronchitis, a chronic obstructive pulmonary disease (COPD) specified as Type B. It is estimated that in 90% of chronic bronchitis or “blue bloaters”, cigarette smoking is the major cause. Chronic bronchitis involves persistent and irreversible airway obstruction, due to the constant inflammation of the bronchial mucosa, leading to hypertrophy and hyperplasia of bronchial glands. The latter exposes the individual to higher risks of bacterial infections; often colonization of organisms such as Streptococcus or Staphyloccocus pneumoniae can be exhibited. This is due to the lost or impaired function of mucociliary clearance action which results from the replacement of certain sections of ciliated columnar epithelium by squamous cells in the bronchi. (Copstead &Banasik, 546-547)
R.S. has chronic bronchitis. According to the UC San Francisco Medical Center “Chronic bronchitis is a common type of chronic obstructive pulmonary disease (COPD) in which the air passages in the lungs — the bronchi — are repeatedly inflamed, leading to scarring of the bronchi walls. As a result, excessive amounts of sticky mucus are produced and fill the bronchial tubes, which become thickened, impeding normal airflow through the lungs.” (Chronic Bronchitis 2015) There are many things that can be observed as clinical findings. R.S. will have a chronic cough that has lasted from 3 months to two years or more, and a lot of sputum. The sputum is due to
Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.
Thank you for referring Gentian Balashi, a 37-year-old gentleman of Albanian origin who immigrated to Australia 18 year ago. Gentian is a current smoker of 10-15 cigarettes per day and in total has smoked for five years. He works as a farmer and keeps pet dogs. His only regular medication is Nexium.
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
[Name] returns. The last time we saw her she was admitted for chest pain, and T-wave inversions. The T-wave inversions were old, but they did evaluate her for pulmonary embolism, and also cardiac causes. She did have a CTPA protocol, and a nuclear stress test; which were satisfactory. She did have a slight heart murmur, and I asked her to follow up with me again.
The prevalence of COPD is heavily associated with elderly persons that are predisposed to various risk factors (Viegi et al., 2001). The prevalence of these risk factors is often a major aspect in the diagnosis of the disease, the most detrimental of these being cig...
Vijayan, V. K. (2013). Chronic obstructive pulmonary disease. Indian Journal Of Medical Research, 137(2), 251-269.
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.
Yanbaeva, Dilyara G., et al. "Systemic effects of smoking." Chest Journal 131.5 (2007): 1557-1566. Web. 10 Apr. 2014.
“Dangers of Smoking Cigarettes for Smokers” healthliteracy.worlded.org. Copyright 1995 by Marjorie Jacobs revised 1997, n.d web 14 April 2011