Analysis Of Pulmonology Case Study And Plan Of Care

HPI (History of Present Illness): The patient is a 65-year-old Caucasian female with symptoms of dry cough for the past two weeks, low grade fever for two days, and decreased appetite that have been deteriorating with time. She also experiences shortness of breath (SOB) with activity. She was treated for similar symptoms three months ago with antibiotics and an inhaler and some improvement was noted in her condition. At the moment she is seeking medical attention as she is concerned about her fever and prolonged illness.

Another Consultation Report dated 12/06/2016, indicated that the claimant presented with exacerbation of COPD, acute bronchitis, and pseudomonas aeruginosa. The CT scan of the chest revealed bilateral lower lobe atelectatic changes, fibrosis, and a small 1 cm left lower lobe nodular density. A pulmonary consultation was recommended. His blood pressure was 142/79 mmHg. The physical examination revealed bilateral decreased breath sounds and scattered wheezes. His glucose was 189. DuoNeb, IV Solu-Medrol, and IV antibiotics were prescribed.

Patient “DD” is a 56-year-old woman who was admitted to a nearby hospital for respiratory failure. With the only previous medical history being chronic bronchitis, she was diagnosed upon admission with COPD, anemia, hypoxia, moderate anxiety, and dyspnea.

HPI: Margaret Elliot is a 52-year-old Caucasian female that is presenting with shortness of breath that has recently worsen. Mrs. Elliot states that her problems began 20 years ago when she had bronchitis, which she consistently has 2-3 times a year. She said that her symptoms have been getting worse the last 2.5 month, but have severely worsen over the past three days. She states that it has been restricting her daily activities and has been troubling her while sleeping lying down. She states that her symptoms improve alittle when she takes her medications. She also states that her symptoms worsen when she tries to walk across the room

Admitted through the Emergency Room at 4 PM to a semi-private room is Maggie P., a 78-year-old retired Registered Nurse with end-stage Chronic Obstructive Pulmonary Disease (COPD). Her temperature is 98.7, B/P 130/92, heart rate 124 and respirations are labored and irregular at 37 per minute. She appears frail and weighs 89 pounds. She is pale with a bluish hue to her lips and nail beds. Oxygen at 3 liters per minute is applied via nasal cannula. She is alert and oriented to time, place, and person. She coughs intermittently, expectorating copious amount of thick gray, blood-tinged sputum. She complains of back and rib pain and 5mg of Morphine Sulfate in administered intramuscularly. On assessment the nurse lists, between

Lungs: Mild end-expiratory wheezing. Pursed-lip breathing noted and has a prolonged expiratory phase. Chest x-ray shows pulmonary hyperinflation, flattening of the diaphragm; Pulmonary function test (after bronchodilation with 2 puffs albuterol—FEV1/FVC ratio 0.60 FEV1 60% of predicted value)

He was formerly a lawyer who resided in Miami, Florida and recently moved to Lexington, Kentucky. He denies any alcohol, drug, or tobacco use. The client has two-primary nursing diagnoses. The first was, ineffective airway clearance related to dyspnea, rhonchi bilaterally, older age, and decreased energy. The second was, impaired gas exchange related to dyspnea and peripheral capillary oxygen saturation (SPO2) of 94% with use of a nasal cannula (NC). The client was admitted to the hospital for healthcare-acquired pneumonia. HAP is an acute infection, caused by several different organisms, that infects the alveoli of the lungs (Driver, 2012). Once the alveoli become infected, an inflammatory response is activated causing fibrin-rich exudate that fills the alveolar space, and if not properly treated, it can cause life-long lung damage (Driver,

As she has now returned back to baseline, she has no cough, no shortness of breath and no wheeze. She has recently seen David Marty who does not believe there are chronic sinus issues that are contributing here and that it is acute sinus issues with post-nasal drip causing tracheal irritation as a cause of her prolonged episodes of cough. A laryngotracheal cause for her cough is certainly consistent with other past ENT opinions and her clinical presentation. What we have not ruled out is a chest cause. He did a bronchoprovocation test in February last year which showed a borderline response, but there was no benefit from Alvesco at the time and this was during an acute episode. Her chest x-ray was clear.

During my clinical rotation in the ER, I had a patient who came in complaining with shortness of breath and cough for the past few days. He had a history of CHF and COPD and was on 2L of oxygen at night. While I assessed him with the nurse by my side, I heard audible wheezes and crackles in his lung bases. He also had a persistent cough. I knew that he was having a COPD exacerbation and needed appropriate medications to ease his discomfort. I discussed my findings with the nurse and after examining the patient the nurse agreed with me. We relayed the information to the physician who concurred with us after examination and gave us orders to treat the patient’s COPD exacerbation.

Patient C.P.’s medical history is essentially unremarkable until approximately two months prior to admission. Details regarding the patient’s decline will be discussed later. Socially, patient C.P. is the younger of her parent’s two daughters. She is a high school student who is active in ballet and cheerleading. Patient denies any tobacco or illegal

With regards to her chest, she ha never had any significant chest issues and does not recall any chest infection, even in her childhood. She has never had asthma and never smoked. She has had no significant occupational exposures of concern and of note, emigrated from Lebanon in

Should she become more symptomatic in the near future, it would be reasonable to perform bronchoscopy for AFB cultures and should those results be positive, I believe further consideration for Mycobacterium avium complex infection therapy would then be warranted. She does have some plural thickening as noted on her CT scan in May and I have ordered a six-month repeat CT scan for follow up. It is interesting to note that she does have some nodular disease that are both tree and bud as well as in a bronchovascular distribution, which calls to question the possibility of sarcoidosis as well. However, she does not have any significant mediastinal or hilar

The ambulance brought in the patient from her home. Medics had been called by her family to the residence earlier in the day for this same patient that refused transport to a hospital. Upon their initial response to a complaint of difficulty breathing, they found a 59 year old female in moderate to extreme respiratory distress that refused to leave her home for further care. Despite her distress and being on oxygen at 4 liters nasal cannula, she continued to smoke. It was reported she had approximately 3-4 word dyspnea at that time, coughing up thick yellow brown mucus and may have had a fever that she made excuses about and tried to deny. Despite her refusal, she was desperate for air, and accepted a nebulizer treatment administered by

Two weeks ago, she had what sounds to be viral upper respiratory tract infection which has caused a profound worsening of her cough. She also believes with the normal laryngeal cough which she is describing has changed in nature and she is describing a bronchitic type cough, though it is not productive. Thank you for organising a chest x-ray which did not reveal any significant abnormalities. I

R: Cough excessive amount of yellow sputum with no odor, difficulty breathing, lack of energy, malaise, fatigue, poor appetite and lost “a little weight” over the past few weeks.