R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial 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 using an inhaled ß2 agonist and Theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia.
1. What clinical findings are likely in R.S. as a consequence of his COPD? Chronic obstructive pulmonary disease (COPD) is composed of two related diseases, chronic bronchitis and emphysema. He is likely to have a chronic or recurrent productive cough that is over three months to two successive years. He will experience shortness of breath on exertion, sputum production and frequently develop hypoxemia, which could lead to cyanosis.
2. How would the consequences of the COPD of R.S. (identified in question 1) differ from those of emphysematous COPD? Those of emphysematous COPD have α1-Antitrypsin deficiency. There is a result in decrease in size of smaller bronchioles. R.S. would have progressive dyspnea, an increased shortness of breath for past 3-4 years, pursed-lip breathing, leaning forward to breath, barrel chest, digital clubbing, and cough.
3. Interpret R.S.’s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia? R.S. is in a partially compensated respiratory acidosis with moderate hypoxemia and mild polycythemia. The pH is acidic which means if there is any compensation present then it is not complete. Polycythemia is a consequence of chronic hypoxemia. It is the body’s attempt to adjust to decreased amounts of blood oxygen by increasing the...
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