Case Study: COPD Exacerbation
Due Date: January 16, 2012
Wayland Baptist University
Adult Health II
The purpose of this paper is to discuss an exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and its effect on my patient, Mr. HS, a 78 year old male. In this paper we will look at the various facets in the disease process including its incidence, pathophysiology, presenting complaints, analysis of his clinical presentation, and discuss treatment. We will analyze the effect the disease process has on Mr. HS and will examine his clinical manifestations and laboratory work, as well as provide an outcome analysis. Understanding these various facets will enable one to understand various long term effects of this chronic disease process. Incidence
COPD is defined as the persistent obstruction of the airways and occurs with emphysema, chronic bronchitis, or both. Cigarette smoking most commonly causes the disease process. Typically patients will develop a cough and become short of breath. In the United States, an estimated 15.5 million people now suffer from this disease. Statistics show that 13.5 million people suffer chronic bronchitis and 2 million from emphysema (Workman, 2010). COPD is now considered the fourth leading cause of death in the United States and is projected to be the third leading cause of death for both males and females by the year 2020 (COPD Intl, 2004). COPD is second only to heart disease as a cause of disability that forces people to stop working (Wise, 2007). This disease process affects men more commonly then women and 95% of all COPD related deaths occur in people over the age of 55 (Wise, 2007). Statistically, Men are 7 times more likely to be diagnosed with emphysema although the prevalence of in women is on a steady increase (COPD Intl, 2004). In a recent study, the median length of each hospital stay in patients with COPD was 4 days while mean hospital costs equaled $5,357 (Shore, et. al). Unfortunately, COPD has become a major cause of morbidity, mortality and disability in the United States (Manino, et al., 2002) With increasing severity of COPD, the risk of respiratory tract infection also increases. The impairment of the immune system is most likely responsible for both the colonization of respiratory tract with bacteria and for an increased risk for infection with new strains of bacteria causing acute exacerbations. Also lung infections like pneumonia, lung abscesses, and empyema are more often seen in patients with COPD than in healthy subjects (Lange, 2009). According to Griffen, et al, secondary viral lung infection in patients with COPD accounted for a 9% increase in mortality in patients over 65 years old. Worldwide statistics are staggering. According to the World Health Organization, in 2005, COPD accounted for 5% of all deaths globally and that number is expected to rise. The World Health Organization projects an increase of total deaths worldwide form COPD by than 30% in the next ten years (WHO, 2011). Pathophysiology
Chronic obstructive pulmonary disease (COPD) is a mixture of 3 separate disease processes that together form the complete clinical and pathophysiological picture. It is characterized by progressive inflammation in the small airways and lung parenchyma, is mediated by the increased expression of multiple inflammatory genes (Barnes, 2009). The processes that are responsible for this disease are chronic bronchitis, emphysema, and, to a lesser extent, asthma. The specific pathophysiology of COPD is not well understood (Hunter & King, 2001). However, the progression of COPD is characterized by accumulation of inflammatory mucous exudates in the lumens of the small airways in the lungs, which are known as bronchioles. Chronic inflammation causes a thickening of their walls resulting in infiltration by adaptive and innate inflammatory immune cells. According to Barnes, activity of the...
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