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Assignment Questions

Chronic obstructive pulmonary disease (COPD)

Mr. Jack Little is a 59-year-old panel beater with a past medical history of smoking two packs of cigarettes per day for approximately 40 years (80 pack years), chronic bronchitis and cor pulmonale.
Jack was on holidays with his wife in the high, mountainous area when became extremely short of breath. His wife took him to the Emergency Department (ED). On
presentation to the ED, Jack was agitated and dyspnoeic at rest and had a Glasgow Coma Scale (GCS) of 15. His physical examination revealed the presence of loud wheeze in the mid-lung fields, a temperature of 38.5 ? C, SpO2 88% on room air and a respiratory rate of 28 breaths/min. Jack?s lips were bluish color, and he complained of new-onset ankle swelling. During the past three days, Jack has had a productive
cough and was expectorating thick, tenacious, green sputum in the morning on waking up. Dr Santorini ordered a preliminary blood test, chest X-ray and ECG that revealed:
? Blood test – moderate elevation of total white blood cell count (13.0 x 109 /L)
? Chest X-ray ? hyperinflation with flattened diaphragm, increased anteroposterior diameter, no infiltrates or effusions
? ECG ? normal
Based on the preliminary test results Dr Santorini suspects an infective exacerbation of Jack?s chronic bronchitis. Jack was admitted to the medical ward in the Blue Mountains Medical Centre and prescribed pharmacological therapy consisting of intravenous amoxycillin with clavulanic acid, inhaled salmeterol and inhaled ipratropium. Furthermore, Dr Santorini orders two additional tests, arterial blood gas analyses and
spirometry. Arterial blood gas analyses revealed pH of 7.32, PaCO2 of 56 and PaO2 of 62. Spirometry results showed decreased tidal volume and decreased forced expiratory volume in 1 second (FEV1).
Assessment Outline: Case study presentation
? The body of work needs to be divided into three (3) main parts:
a) Patients with chronic obstructive pulmonary disease (COPD) present with a number of characteristic signs and symptoms. In relation to the case study, identify the signs and symptoms and link them to the pathophysiological changes underpinning the potential disease process supported by preliminary diagnoses and test results.
b) Discuss the rationale for the additional tests (Arterial blood gas analysis and Spirometry) that have been ordered. Analyse and describe the findings of the additional tests in relation to your patient.
c) Discuss the rationale for medications that have been prescribed to Mr. Little. Describe their mechanism of action, adverse effect profile and outline any potential for drug-drug and/or patient-drug interaction.

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