Question

Patient's Chief Complaints "I'm falling apart. I've been having more trouble breathing, my cough has gotten worse in the past three days, and now my ankles are beginning to swell up." History of Present IIlness J.T. is a 61 yo man with COPD who presents to the emergency room with a three-day history of progressive dyspnea, cough, and increased production of clear sputum. He usually coughs up only a scant amount of clear sputum daily, and coughing is generally worse after rising in the morning. The patient denies fever, chills, night sweats, weakness, muscle aches, joint aches, and blood in the sputum. He treated himself with albuterol MDI, but respiratory dis- tress increased despite multiple inhalations Upon arrival at the emergency room, there were few breath sounds heard with auscul- tation, and the patient was so short of breath that he had difficulty climbing up onto the examiner's table and completing a sentence without a long pause. He was placed on 4 L oxy- gen via nasal cannulae and given nebulized ipratropium and albuterol treatments. Past Medical History History of mental illness as a young adult; one suicide attempt at age 20 HTN X 10 years COPD diagnosed 6 years ago Left lateral malleolus and first metatarsal fracture repair 17 months ago Occasional episodes of acute bronchitis treated as outpatient with antibiotics Mild CVA 4 months ago, appears to have no residual neurologic deficits (-) history of TB, asbestos exposure, occupational exposure, heart disease, or asthma Family History Father died from lung cancer Mother is alive, age 80, also has COPD and is being treated with oxygen One sister, developed heart disease in her 50s One daughter and three grandchildren, alive and well
Please answer all Case Question 1-15. this case study is from "100 case studies in pathophysiology. case #14

Answer 1

Answer1 : Patient is taking almodipine as it is a calcium channel blocker which dialted the blood vessels to increase the blood flow to the heart. It is given as in his medical history, it was found that he was having CVA, 4 months ago.

Answer2: As patient is suffering from hypertension, the HCTZ is a diuretic which will increases the urination and treat the hypertension.

Answer3: The patient weight is normal but requires to gain weight because there is excess weight loss in the COPD.

Answer 4: The factors are:

• Chain smoker
• COPD
• Hypertension
• The hypertension is one of the most serious reason for the cardiovascular disease.