Asthma Case Study
Mr. Vargas, a 45-year-old male patient is rushed in to the emergency room by his wife. The patient is short of breath and gasping for air has dyspnea and audible wheezing on expiration. Mr. Vargas stated to the nurse that he noted his difficulty in breathing while going up a flight of stairs in his building. The patient complained of an “annoying and nagging cough” with persistent chest tightness. The patient also stated that everytime he coughed, a thick, white mucous came out. He described it as “white, gooey, stinky gunk”. Past Medical History: Patient was admitted through the ER of another hospital several years ago due to an episode of bronchitis. Patient states his symptoms back then were very similar to the ones he has presently, such as the wheezing, chest pain and diaphoresis. Allergies: Penicillin
Medications: Bayer aspirin 81mg once a day Glucosamine and Chondroitin 1500 mg once a day Family History: Father passed away from a community acquired pneumonia three years ago at the age of 70.Mother died at 68 of natural causes. Social History: The patient is married and lives with his three sons and wife in the suburbs. Patient has been an asbestos handler for almost twenty years. On his free time he enjoys bike riding with his sons. Patient has been a one pack a day smoker for the past twenty years, with limited alcohol use. Review of Systems: Intermittent chest pain, shortness of breath, wheezing and diaphoresis. Physical Examination: Patient was alert and oriented to time, date and place. His vitals were taken and recorded. His blood pressure 144/88mm Hg, pulse 102 beats per minute, had an oral temperature of 100.2 degrees Fahrenheit, respiratory rate of 26 and an oxygen saturation level of 90% on room air. Patient was noted sitting in upright position, with excessive use of his accessory muscles of respiration. It was noted that he had diminished breath sounds on inspiration and expiration. He was tachypneic and tachycardic with a continuous and productive cough with white sputum. Laboratory Evaluation: RBC 5.2 (normal ranges 4.7-6.1), WBC 7,000 (4,000-10,000 cells/mcl), platelets 250,000 (150,000-450,000), peak flow 540 (640).The ABG’s were Ph 7.55 (7.35-7.45), Pco2 28 (35-45), Po2 65 (70-100), HCO3 22 (22-26).Pulmonary Function tests were performed on Mr. Vargas, the forced vital capacity (FVC), forced expiratory volume (FEV) and total lung capacity (TLC).The results showed that the air exhaled after maximum inspiration and the air exhaled after maximum inspiration were less than the expected total value as well as his total lung capacity. Pathophysiology, Etiology and Risk Factors
Worldwide asthma is one of the most common childhood diseases, and its exact cause is idiopathic (Kaufman, 2012). Asthma is considered a chronic inflammatory disorder of the airways that is reversible. The number one trigger being household allergens (Casey, 2012). The lower respiratory tract consists of the trachea, bronchi and bronchioles that are affected by asthma. Asthma is commonly known for causing airway inflammation and narrowing of the airway leading to bronchoconstriction, edema, cough, wheezing and tightness of the chest (Kaufman, 2012). Airway inflammation in asthma is characterized by the release of chemical mediators. These mediators include histamine, bradykinin, prostaglandins and leukotrienes. These mediators initiate the inflammatory response causing dilation of the blood vessels increasing blood flow, vasoconstriction and leaky capillaries (Boulet, 2011). This is usually seen when the airway becomes irritated, the irritation is initiated by the release of immunoglobulin E (IgE) (Kaufman, 2012). IgE sits on the mast cells which are located all over the body, they cause them to degranulate which incites the inflammatory response (Casey, 2012). The major risk factors in the development of asthma are being genetically...