module 6 case study Flashcards
From what general chronic respiratory condition is Mr. Tims likely suffering? What are the risk factor(s) in his case? (3)
chronic pulmonary disease with risk factors being his age and smoking history
What is the respiratory issue that is associated with this condition? (1
Problem with breathing out (prolonged expiration time)
Does he have both aspects of this chronic condition? Support your conclusion with facts from the case
Both aspects COPD -> emphysema – pink, breathing in tripod position, breathing through peruse lips chronic (keeps airways open while breathing out), accessory muscles chronic bronchitis – yellow sputum, fever, heavy coughing over last few years
Explain his vital signs.
With a temperature of 39°C results in a fever that could be due to inflammation or infection
- A pulse hypoxemia
- With high blood pressure compensating for pulse
- His respiration rate of 36bpm shows as high which could indicate respiratory obstruction and/or lung condition
Is he more of a “pink puffer” or a “blue bloater”? Explain your choice by describing the basis behind each description.
Pink puffer able to maintain amount of oxygen by increasing breathing rate (increased respiration rate) (breathing through peruse lips) blue – cyanosis bloater because experiencing right heart failure
- Mr. Tim is more of a pink puffer because he is experiencing shortness of breath and is needing help to take breaths in by leaning over while displaying pursed lips. His color and complexion are still good whereas a blue bloater would be experiencing edema along with blue discoloration of the skin due to hypoxemia.
Describe the pathophysiological development of both aspects of Mr. Tims’ chronic condition.
emphysema: 1) inflammation occurs, inflammatory cells release proteases that cause destruction of alveolar septae. this eliminates part of the capillary bed & increases volume in acini 2) this produces large air spaces within the lungs and on the surface of the lungs, next to the pleura. these air spaces cannot function in gas exchange, which increases hypoxemia 3) damage from inflammation includes a loss in the elastic lung tissue, which helps to keep air passages open. this results in expiration becoming difficult, thus trapping air in lungs 4) this hyperexpands the thorax, making it difficult to breathe, causing hypoventilation and hypercapnia
bronchitis: 1) the airway becomes inflamed with inspiration of irritants. edema occurs, along with the production of thick, tenacious mucous 2) continual inflammation leads to increases in size & number of mucous glands & goblet cells in airway epithelium 3)continual inflammation brings in macrophages & neutrophils that release proteases, which harm ciliated epithelial cells 4) due to impairment of the ciliary function, the mucous cannot be cleared 5) the airways are constricted by thickened bronchial wall and the mucous. expiration becomes more difficult as airways are narrowed 6) obstruction eventually leads to hypoxemia 7) eventually the airways collapse early in expiration, causing air trapping. this expands the thorax making expiration more difficult = decreased tidal volume, hypoventilation and hypercapnia
What are “blebs” and “bullae” and where do they fit in?
Bullae is a large blister appearing inside the lungs. Blebs are protrusions of the cell membrane. During inflammation, there are proteases released that cause destruction of the alveolar septae, which eliminates part of the capillary bed and increase the volume of acini. Then, large air spaces are produced in the lungs and are being filled with bullae and blebs because of the destruction of the lung.
What would be a likely cardiovascular explanation should Mr. Tims develop signs including neck vein extension, swelling of the lower extremities and hepatomegaly over subsequent years? Support your conclusion by explaining the appearance of these signs
Right heart failure (cor pulmonale) veins in neck under high pressure
Mr. Tims encounters a fellow patient who suffers only from emphysema. “How many years did you smoke?” he asks. The other patient declares: “I never touched a cigarette in my life!” Explain how this may be possible
Emphysema can also be inherited. They could have an insufficiency of alpha 1-antitrypsin that combats proteases released by normal amounts of inflammatory cells.
Based on her recent history and the signs and symptoms that arose in the hospital waiting room, what condition was Julie likely initially experiencing in the hospital waiting room? On what signs/symptoms do you base this choice? (Use proper medical terms for the sign/symptom).
Pulmonary embolism – feeling faint, coughing up blood, shortness of breath, blue around mouth
One of the listed signs (skin colour, pulse, BP, RR) suggest that another condition was subsequently developing in Julie. Name and describe this condition - be as specific as possible
Shock (blood pressure decrease not enough blood delivery to tissues)
Give an explanation for each of the listed signs
The skin around the patient’s mouth and her tongue were a tinge of blue because of the increased amounts of deoxygenated hemoglobin in her blood (cyanosis)
Heart pulse was 120 per minute because of the reduced amount of blood flow reaching the lungs because of the embolism, causing shortness of breath and a racing heart rate.
Her blood presure increased to compensate for pulse
Her respiratory rate was 30 per minute, indicating that her breathing rate is very high compared to a normal rate (12-25). This is called hyperventilation.
Would her blood pH likely be above or below normal level? Explain your choice
Respiratory alkalosis
Her blood pH would likely be above the normal level because her respiratory rate was much higher than the normal rate indicating that she was suffering from hyperventilation which causes a decrease in the amount of gas in the blood.
What type of heart failure is Julie in danger of developing? Explain your choice.
It could lead to Right heart failure because of the obstruction of blood flow causing the pulmonary vessels to constrict, there can be an impairment in gas exchange and cause hypoxemia. If the clot that was formed does not dissolve quickly enough, it can cause hypertension and lead to right heart failure.
Would a V/Q mismatch be present? If present, would it be high or low? Explain your choice
Yes, a V/Q mismatch would be present. It would be high. Because as there is an impairment in gas exchange, this means there is inadequate perfusion of a well-ventilated area which produces alveolar dead air space. So due to the ventilation without perfusion, it would be a high V/Q mismatch.
