Question

Need help with the following case study:

Ralph is a 50-year-old diesel engine mechanic who presented to her physician a chief complaint of dyspnea and productive cough for the last 3 consecutive months. Ralph said that he had another one of these episodes last year and that he would feel some relieve by pursing his lips during exhalation. He complains of fatigue and wheezing. Ralph also stated that the cough is worse in the mornings and that is sometimes accompanied blood streaked sputum. He said has not traveled outside the country and there is no family history of respiratory diseases.

Habits: Coffee, 4 cups a day. Quit smoking 5 years ago.

Physical Exam: Average weight male appears anxious with obvious dyspnea and foul-smelling sputum.

Temperature: 100.5 F Pulse: 110 Respirations: 20 Blood Pressure: 140/90

Thorax: Symmetric, no palpable masses. Use of accessory respiratory muscles that present with indrawing of lower intercostal muscles. Difficulty breathing on supine position (orthopnea) with wheezing and crackles.

Skin: Cyanotic

Nails: Cyanotic

Feet: Swollen

Laboratory Data:

Hematocrit: 47%

WBC count: 11,500 Leukocytosis (normal 5,000 to 10,000)

pH: 7.25

Arterial Blood Gases: PaO2 55mm Hg   PcO2 75mm Hg

Pulmonary Function Test: decreased forced expiratory volume (FEV), increased total lung capacity (TLC)

Reid Index: > 50% (ratio of thickness of the mucous producing gland layer to total bronchial wall)

X-Ray: bronchial wall thickening with increased blood vessels markings and cardiomegaly.

Based on the chief complaint, explain the importance of knowing that Ralph had not traveled outside the country or that there is no family history of respiratory diseases.

What is the normal pH of blood and what Ralph’s lab results tell us.

What is the normal oxygen (PaO2) and carbon dioxide (PaCO2) content in blood? Based on the results, would you say Ralph presents hypoxemia or hypercapnia?

Based on the blood test results is it possible that Ralph also presents an infection?

Would you say lifestyle choices or occupation are to blame for Ralph’s disease?

What is the name of the disease affecting Ralph’s lungs? Provide evidence to support your conclusion.

Answer 1

Ralph has not traveled outside the country and had no family history of respiratory disease. It signifies that patient has not acquired respiratory disease from any pandemic associated flu. Nor anybrisk of hereditary illness

ph of blood is 7 .35-7.45. Ph is 7.25 that sems patient may be having acidosis.
Partial pressure of oxygen (PaO2): 75 to 100 millimeters of mercury (mm Hg), or 10.5 to 13.5 kilopascal (kPa) Partial pressure of carbon dioxide (PaCO2): 38 to 42 mm Hg (5.1 to 5.6 kPa). Patient is having hypoxia and hyper apnea as evident from lab balues.

yes, patient may have infection as wbcs is more than normal limits

yes as patient is working as diesel engine mechanic and has history of smoking that may predispose him for respiratory infection

Disease may be chronic bronchitis with pulmonary edema as patient has developed breathing difficulty associated with chest retractions , wheezing with crackles, leuckocytosis