Case study: Mary (COPD) Flashcards
Who is Mary?
A 74 year old retired government office worker with severe COPD.
In the past month her COPD has worsened to the point in which she became breathless when getting out of bed, dressing or showering.
She has also experienced a decreased appetite and has lost 2 kg in the past month.
This has significantly impacted on her ability to engage in everyday activities, prompting admission to hospital.
What caused mary’s recent hospital admission?
Breathlessness.
She’s fine sitting but as soon as she tries to walk has issues.
Has to “feel” like going out. Struggles with groceries; has to hold onto trolley.
What are the effects of Mary’s condition on her family?
Husband: Where they shop depends on whether Mary can enter the store or not. (If you have to go upstairs or if they cannot find a park closer means he will do it by himself).
Hubby gets worried- Watches her, and is alert. If she takes too long on the toilet. thinks “why is she taking so long”. “Big drain on the family”. “Still love her”.
What are mary’s previous hospital admissions?
Mary has been admitted to hospital three times in the past two years for exacerbations of her COPD.
“Been in hospital a few times. They have managed to get me stable enough to go back home”
Hospital admission october last year “Was really ill. Didn’t think I was going to come out”. Was bring up a lot of “muck”. “Lots of congestion in the lungs”. Septum was all colours- green, yellow… no blood.
Dr said to breath out fully, then cough. This technique helped mary get the mucous out.
What are the general risk factors for COPD?
Main risk factor is smoking.
Other risk factors include
- Environmental irritants/ pollution
- Asthma
- Family hx/ Genetics
- Frequent resp infections as a child
- Age
What COPD risk factors did Mary specifically have?
- Smoking 10 cigarettes per day for 40 years.
- Family hx. 3 people have passed away in her family due to COPD.
- Social welfare work: Being exposed to environmental irritants. “Dropping muck”.
What is the genetic risk factor for COPD?
Alpha-1 anti-trypsin (AAT) deficiency
How does smoking contribute to the development of COPD?
Long term exposure to irritants associated with smoking leads to an inflammatory response in the resp tract.
What does smoking do to the alveoli?
Smoking causes an increase in oxidants and a protease-antiprotease imbalance. This causes tissue/protein breakdown, which leads to enlarged air spaces and decreased surface area for gas exchange.
Protease- Enzymes that break down protein.
Antiproteases- Inhibit protease/ protein breakdown and modulate immune responses in the lung.
COPD protease outweighs antiproteases.
Smoking leaves carbon deposits in the air spaces
What does smoking do to the bronchioles?
Inflammation from smoking causes bronchial edema, impaired cilia function, and increase mucus production.
Therefore causing narrowed airways and a greater airway resistance.
What are general signs of COPD?
- Barrel chest
- Blue tinged lips
- Chronic cough
- Pursing lips with breathing
- SOB on exertion
- Use of accessory muscles
- Laboured breathing
- Finger clubbing
What signs of COPD did mary have?
- Breathlessness
- SOB
- Dyspnea/laboured breathing
- Pursed lips breathing
- Barrel shaped chest
- Increased expiratory effort
- Use of accessory muscles
- Slightly blueish tinged lips
- Wheezing
What are the two main kinds of COPD?
Emphysema & bronchitis
What is emphysema?
Inflammation that causes destruction in the alveoli and capillaries.
Causes a decrease in alveolar surface area for gas exchange.
The destruction of alveoli tissue also includes the breakdown of elastin; Which decreases expiratory airflow leading to trapping and a further reduction in the volume of exchangeable air.
What is chronic bronchitis?
Inflammation of the bronchioles leading to bronchial edema, increasec mucous production and decreased ciliary action.
Causing an increase of airway resistance, therefore decreasing the volume of of air flowing in/out of the lungs for gas exchange.
What kind of COPD does mary have?
Emphysema and chronic bronchitis
What are the conclsuions of Marys COPD?
Principle symptom and complaint is SOB on effort. Progressive over the period of 8 to 10 years.
Shes thin.
Grosley increased WOB.
When she gets a winter chest infection- She decompensates and tips into respiratory failure. At risk of losing her life due to hypoxia, or retention of carbon dioxide (Hypercapnia).
Once in a while will get ankle swelling. Secondary to R) sided heart problems; complication of her COPD.
Lifestyle severely impacted by SOB.
What does alveolar tissue damage result in?
As a consequence of alveolar tissue damage, air spaces enlarge and air is trapped in the lungs at the end of expiration. Gradually the residual volume (RV) increases, causing hyperinflation.
This causes a further reduction in the volume of exchangeable air.
What are consequences of hyperinflation?
Hyperinflation of the lungs flattens the diaphragm, causing it to become less effective at regulating the pleural pressures necessary for efficient breathing.
Therefore, the chest and neck muscles must work harder to assist with breathing.
This increases the work of breathing significantly, and thus patients suffer from dyspnoea.
Patients often breathe faster in an effort to ventilate their lungs normally.
During pulmonary function tests, what does hyperinflation show up as?
Hyperinflation of the lungs is also demonstrated by an increase in functional residual capacity (FRC).
Characteristically, expiration becomes prolonged relative to inspiration.
What do you see in Marys chest xray that is different to a normal persons chest xray
- Marys lungs take up more space in the chest cavity.
- Marys heart is pushed out of position by her over-inflated lungs
- Marys clavicles are pulled up superiorly (Due to increased action of accessory muscles to breathe)
