case study

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.
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 of the lungs and no cardiac enlargement. The AP (anterior-posterior) diameter of the chest is increased. These changes are suggestive of COPD.
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M O B I L I T Y
S P R I N G 2 0 1 2 | SECTION TWO
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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 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.
Criteria A: Analyses information from a discerning selection of sources and synthesises in own words an accurate and clear explanation of the pathogenesis of chronic obstructive pulmonary disease. The discussion is relevant to the case study.

b) Within the discussion the relationships between the pathogenesis of chronic obstructive pulmonary disease and all structural and functional changes are clearly and logically explained.
answers includes:just an idea.
structural
The COPD pathophysiology thus includes –
•Narrowing of the airways
•Damage to the lungs and other supportive tissues
•Hyperactivity of the lungs
•Dysfunction of the cilia in the airways
•Constant damage of the alveolar walls
metaplasia, loss of epithelial cilia, goblet-cell hyperplasia, mucus gland enlargement, smooth-muscle hypertrophy, and inflammatory cell infiltration.

functional Reduced FEV1
Hyperinflation of the lungs
Hypoxemia and hypercapnia
Pulmonary hypertension-

Question 2
Explain how two of Mrs White’s clinical manifestations (dyspnoea and coughing)are related to the structural and functional changes of her chronic obstructive pulmonary disease .

criteria
Demonstrates comprehensive and detailed knowledge of the reasons for three clinical manifestations presented by the patient in the case study with clear links to the structural and functional changes identified.

Analyses information from the case study and a discerning selection of sources and synthesises a response in own words explaining the reasons, with clear links to the structural and functional changes, for three clinical manifestations presented by the patient in the case study.

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