Overview :
You are required to complete a pathophysiological template for chronic obstructive pulmonary disease (COPD) in relation to a case study and answer three questions.
To complete the template you must summarize the relevant information for each component. This summary may consist of a combination of sentences, flow diagrams and dot points where relevant. The information in the template must be accurately referenced using the APA referencing style.
The questions are to be answered using correct sentence structure, paragraphs, grammar and spelling. Your answers must be accurately referenced using the APA referencing style. Details Length: Pathophysiology template 400 words Answers to questions 850 words .
CASE STUDY
Mrs Ellen White, a 68 year old woman, is brought to the emergency department by her husband. She presents with worsening dyspnoea, cough and increasing sputum production over the past three days.
On examination Mrs White is severely dyspnoeic, centrally cyanosed and exhibits pursed-lip breathing. She is alert and oriented but very anxious.
Mrs White is using accessory muscles and on auscultation has decreased breath sounds, prolonged expiration and an expiratory wheeze. Observations on admission
Temperature: 38.2° C Pulse: 96 beats/minute Respiration rate: 28 breaths/minute BP: 140/90mmHg Oxygen saturation: 91%
Patient history Mrs White, a retired nurse, began smoking when she was 17 and smoked between 20 and 25 cigarettes a day until 10 years ago when she was diagnosed with pulmonary emphysema.
Mrs White lives with her husband and is experiencing more difficulty with her usual activities due to increasing breathlessness.
The medications that she has been taking are tiotropium bromide (Spiriva®) inhaler once daily and salbutamol inhaler every 4-6 hours when required.
Results of tests and investigations Pulmonary function tests FVC 1.8L (75% of predicted) FEV1 1.0L (55.5% of predicted) FEV1/FVC 55% (Normal >70%) TLC 4.5L (109% of predicted) Chest X-ray The chest X-ray shows a flattened diaphragm and lung hyperinflation with a translucent appearance f the lungs and no cardiac enlargement. The AP (anterior-posterior) diameter of the chest is increased. These changes are suggestive of COPD.
Blood gases pH: 7.30 (7.35-7.45) PaO2: 45 mmHg (80-100 mmHg) PaCO2: 51 mmHg (35-45 mmHg) Bicarbonate: 36 mmHg (21-28 mmHg) Sputum culture and sensitivity Awaiting results.
Mrs White was diagnosed with an acute exacerbation of chronic obstructive pulmonary disease resulting from a respiratory infection. Management Oxygen 2L/minute via nasal prongs. Salbutamol 400 micrograms and ipratropium 80 micrograms via metered dose inhaler and spacer 4th hourly prn.
Prednisolone 40 mg orally daily for one week. Doxycycline 100mg orally daily.
Mrs White is transferred to a medical ward. PART 1: – Pathophysiology template Complete a pathophysiology template related to the case study (400 words).
PART 2- Questions related to the case study Question 1 (400 words) Explain the pathogenesis that leads to the structural and functional changes resulting from Mrs White’s chronic obstructive pulmonary disease.
Question 2: (225 words) Explain how three of Mrs White’s clinical manifestations are related to the structural and functional changes of her chronic obstructive pulmonary disease .
Question 3: (225 words) Select two drugs that have been used to treat Mrs White’s chronic obstructive pulmonary disease. Discuss the rationales for the administration of these drugs. Relate your discussion to the pathophysiological process.
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