Case Study on Copd
A Case Study on
Chronic Obstructive Pulmonary Disease
Elmer P. Samoy, RN
Case Summary
History
A case of a 68 y/o White male, who sought consult primarily for evaluation and management of severe dyspnea. The patient was apparently well until about 6 months prior to consult, when he began to experience dyspnea when walking more than 20 ft., associated with chronic productive cough. No consult was done, no medications taken, and no weight loss reported. Three days prior to consult, the patient’s condition further declined – having experienced dyspnea on moderate exertion, associated with worsening cough and increased sputum production from 1-2 tablespoons to approximately 1-2 cups daily. OTC cough medication was taken, offering temporary relief of cough. Three hours prior to consult, the patient complained of severe dyspnea associated with cyanosis, hence sought medical advice. Patient had no medical history of Cancer, Asthma, Hypertensive Heart Disease, CHF, CAD, or DVT. Patient had no known allergies. Surgical or trauma history was unremarkable. Personal history revealed that he lived alone but received 4 hours of paid caregiver assistance for his ADL/IADLs daily, history of 60 pack-year smoking and still smoked up to this time. Family history was unremarkable. Review of systems was pertinent for worsening dyspnea, chronic cough productive of copious sputum, and generalized weakness. No chest pain, edema, fever, or cachexia reported.
Physical Examination
On physical examination, vital signs revealed: BP= 120/70 mmHg; HR=90/min; RR=32/min; Temp=37.1oF; O2 sat = 85% in room air. Inspection showed a well-groomed, medium-built man, looked appropriate for his age, in cardiorespiratory distress as manifested by pursed-lip breathing and use of some accessory respiratory muscles for breathing, with barrel chest, cyanotic finger nails, and had weak cough productive of copious, thick, yellowish sputum. Pulmonary findings revealed presence of tactile fremitus
Chronic Obstructive Pulmonary Disease
Elmer P. Samoy, RN
Case Summary
History
A case of a 68 y/o White male, who sought consult primarily for evaluation and management of severe dyspnea. The patient was apparently well until about 6 months prior to consult, when he began to experience dyspnea when walking more than 20 ft., associated with chronic productive cough. No consult was done, no medications taken, and no weight loss reported. Three days prior to consult, the patient’s condition further declined – having experienced dyspnea on moderate exertion, associated with worsening cough and increased sputum production from 1-2 tablespoons to approximately 1-2 cups daily. OTC cough medication was taken, offering temporary relief of cough. Three hours prior to consult, the patient complained of severe dyspnea associated with cyanosis, hence sought medical advice. Patient had no medical history of Cancer, Asthma, Hypertensive Heart Disease, CHF, CAD, or DVT. Patient had no known allergies. Surgical or trauma history was unremarkable. Personal history revealed that he lived alone but received 4 hours of paid caregiver assistance for his ADL/IADLs daily, history of 60 pack-year smoking and still smoked up to this time. Family history was unremarkable. Review of systems was pertinent for worsening dyspnea, chronic cough productive of copious sputum, and generalized weakness. No chest pain, edema, fever, or cachexia reported.
Physical Examination
On physical examination, vital signs revealed: BP= 120/70 mmHg; HR=90/min; RR=32/min; Temp=37.1oF; O2 sat = 85% in room air. Inspection showed a well-groomed, medium-built man, looked appropriate for his age, in cardiorespiratory distress as manifested by pursed-lip breathing and use of some accessory respiratory muscles for breathing, with barrel chest, cyanotic finger nails, and had weak cough productive of copious, thick, yellowish sputum. Pulmonary findings revealed presence of tactile fremitus
References: 1 Global Strategy for the Diagnosis, Management and Prevention of COPD. (2013, February). Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013. Retrieved from: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdf 2 Hoyert, D., & Xu, J. (2012). Deaths: Preliminary Data for 2011. Natl Vital Stat Rep, 61(6), 1-65. 3 Centers for Disease Control and Prevention. (2011). Chronic obstructive pulmonary disease among adults—United States, 2011. MMWR, 61(46), 938-943. 4 Kohansal R, Martinez-Camblor P, Agusti A, Buist AS, Mannino DM, Soriano JB. (2009). The Natural History of Chronic Airflow Obstruction Revisited: An Analysis of the Framingham Offspring Cohort. Am J Respir Crit Care Med, 180, 3-10. 5 Stoller JK, Aboussouan LS. (2005). Alpha1-antitrypsin Deficiency. Lancet, 365, 2225-36. 6 Hunninghake GM, Cho MH, Tesfaigzi Y, et al. (2009). MMP12, Lung function, and COPD in High-risk Populations. N Engl J Med, 361, 2599-608. 7 Barnes PJ, Shapiro SD, Pauwels RA. (2003). Chronic Obstructive Pulmonary Disease: Molecular and Cellular Mechanisms. Eur Respir J, 22, 672-88. 8 Hogg JC. (2004). Pathophysiology of Airflow Limitation in Chronic Obstructive Pulmonary Disease. Lancet, 364, 709-21. 9 Cosio MG, Saetta M, Agusti A. (2009). Immunologic Aspects of Chronic Obstructive Pulmonary Disease. N Engl J Med, 360, 2445-54. 10 Rahman I. (2005). Oxidative Stress in Pathogenesis of Chronic Obstructive Pulmonary Disease: Cellular and Molecular Mechanisms. Cell Biochem Biophys, 43, 167-88.