Smoking Case Studies

3. Something is missing from the scenario. Based on his history, L.J. should have been taking an important medication. What is it, and why should he be taking it?

D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is an acute

History of Present Illness: Mr. Olson is a very pleasant 57-year-old gentleman with multiple medical problems to include severe COPD, who is here today for an initial consultation for his shortness of breath. He is followed by a pulmonologist Dr. William Goodman, at the Veteran Affairs Administration. His last evaluation there was in February 2015. Mr. Olson states he has had ongoing dyspnea on exertion over the last two years. He complains of minimal cough. He does note some sinus problems for which he is on Flovent. In the past, he has had pulmonary function testing that did demonstrate reversible airflow obstruction, therefore he likely has some component of asthma overlay. He states that occasionally has chest tightness and chest heaviness. He has gained about 25 pounds over the last year. He is currently using Spiriva, albuterol as needed as well as Symbicort. He is also using supplemental oxygen at 2.5L per minute at night as well as on an as needed basis during the day. Mr. Olson admits to continued tobacco use with about a half pack to a pack a day. He states that when he is feeling depressed, he will smoke more.

D.Z.is a 65-year-old man admitted to medical ward with an exacerbation of chronic obstructive pulmonary disease (COPD; emphysema). Past medical history (PMH) indicates hypertension (HTN), well managed with enalapril (Vasotec) past six years, diagnosis (Dx) of pneumonia yearly for the past three years. D.Z. appears cachectic with difficulty breathing at rest. Patient reports productive cough with thick yellow-green sputum. He seems anxious and irritable during subjective data collection. He states, he has been a 2-pack-a-day smoker for 38 years. He complains of (c/o) insomnia and

R.W. appears with progressive difficulty getting his breath while doing simple tasks, and also having difficulty doing any manual work, complains of a cough, fatigue, and weight loss, and has been treated for three respiratory infections a year for the past 3 years. On physical examination, CNP notice clubbing of his fingers, use accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs, and also pulmonary function studies show an FEV1 of 58%. These all symptoms and history represented here most strongly indicate the probability of chronic obstructive pulmonary disease (COPD). COPD is a respiratory disease categorized by chronic airway inflammation, a decrease in lung function over time, and gradual damage in quality of life (Booker, 2014).

This essay is aimed to explore, analyse and discuss smoking in adults. Smoking is a public health issue as such is one of the major contributors to high mortality and ill-health in the adults which is preventable (Health and Excellence Care (NICE) (2012). The United Kingdom (UK) is known to have the highest number of people with a history of smoking among people with low socio-economic status (Scriven and Garman, 2006; Goddard and Green, 2005). Smoking is considered a serious epidemic in the UK and the National institute for Health and Excellence Care (NICE, 2012) stated that 28% of adults with low economic status are tobacco smokers compared with 13% of those with economic status or having professional

A chest X-ray and CT scan result demonstrated a cavitation of the right lower pulmonary lobe. This result alone along with Bob’s history of smoking is a big red flag related to lung cancer. Bob’s history reveals that he has been smoking a ½ pack or more per day for 37 years. According to a study done on the diagnosis, staging, and treatment of lung cancer, habitual smokers have the highest risk of developing cancer of the lung than any other cancer (Herth, Eberhardt, Ernst, 2006). The study also concludes that a related association with lung cancer is swelling of the tissue, lung tumors and/cavitation, lymph in the bronchioles, and paratracheal areas. The swelling can lead to an obstructed airway, which matches Bob’s symptoms as well. Chest pain, stridor, and chest pain are all indications of complications in the respiratory system.

Scenario: Matthew Joseph is a Freshman in college and he smokes two packs of cigarettes a week. Matthew’s great-grandfather, who was a solider in WW2 died from lung cancer and his farther as well as his uncle smoke habitually and have trouble breathing from time to time. Matthew says that he is aware of the deadly effects of cigarettes but he cannot stop because it keeps him from smoking marijuana. Matthew works at the local Bucee’s gas station to help pay for is car and phone bills. Matthew’s job does monthly drug testing for marijuana, cocaine, and other types of paraphernalia. Matthew states that “If smoking cigarettes allows me to keep my job and pay my bills then I want stop no matter how dangerous they are.”

Rationale: L.J. exhibits symptoms of COPD that include shortness of breath and productive cough. He has a smoking history of 65-pack-year and smoking has been identified as the primary cause/trigger of the disease (Nagelmann et al., 2011).

Lungs: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored. Diminished breath sounds in all lung fields. Resonant to percussion.

The information collected in the history was highly suggestive of COPD. One of the best predictors of airflow obstruction was the patient’s smoking history (Qaseem, et al., 2011, pp. 181). According to Qaseem, et al. (2011), the presence of the patient’s smoking history and wheezing on physical examination is indicative of airflow obstruction (pp. 181). Additionally, the patient’s presenting complaint was dyspnea on exertion, which is one of the most commonly presenting complaints in patients with COPD (Boardman, 2013, pp. 446). The chronic nature of the patient’s cough and slow progression of symptoms are consistent with a diagnosis of COPD rather than asthma. Finally, the diminished breath sounds on auscultation is indicative of airflow obstruction and considered to be a reliable finding in the diagnosis of COPD (Boardman, 2013, pp. 447). In addition to the new diagnosis of COPD, the patient also had current diagnoses of hypertension, hyperlipidemia, and osteoarthritis.

Chronic Obstructive Pulmonary Disease, also known as COPD, is the third leading cause of death in the United States. COPD includes extensive lungs diseases such as emphysema, non-reversible asthma, specific forms of bronchiectasis, and chronic bronchitis. This disease restricts the flow of air in and out of the lungs. Ways in which these limitations may occur include the loss of elasticity in the air sacs and throughout the airways, the destruction of the walls between air sacs, the inflammation or thickening of airway walls, or the overproduction of mucus in airways which can lead to blockage. Throughout this paper I am going to explain the main causes, symptoms, diagnosis, and ways to reduce COPD.

Ineffective breathing pattern related to decreased oxygen saturation, poor tissue perfusion, obesity, decreased air entry to bases of both lungs, gout and arthritic pain, decreased cardiac output, disease process of COPD, and stress as evidenced by shortness of breath, BMI > 30 abnormal breathing patterns (rapid, shallow breathing), abnormal skin colour (slightly purplish), excessive diaphoresis, nasal flaring and use of accessory muscles, statement of joint pain, oxygen saturations of 85-95% 2L NP, immobility 95% of the day, and adventitious sounds throughout lungs (crackles) secondary to CHF, hypertension, pain caused by gout and arthritis, and obesity

Cohen, E. L., Shumate, M. D., & Gold, A. (2007). Original: anti-smoking media campaign messages: theory and practice. Health Communication, 22(2), 91-102.

-The client made aware that it is not necessary to cease smoking before starting treatment