Case Study (95 points possible) Daniel McClure is a 49 year old bartender with e
ID: 54238 • Letter: C
Question
Case Study (95 points possible)
Daniel McClure is a 49 year old bartender with emphysema being seen in the Respiratory Clinic due to
increased dyspnea and fatigue.
Selected Data Obtained From Nursing Assessment
• Bartender for 25 years. Married. Two children.
• Quit smoking three years ago when he was diagnosed with emphysema. Previously smoked two
packs a day for 25 years.
• States he has had increased shortness of breath for the past two days and his sputum is so thick
he has trouble coughing it out.
• Skin warm and dry. Slight clubbing of finger noted.
• Lung sounds diminished with inspiratory crackles and expiratory wheezes. Barrel chest present.
• Vital signs: temperature, 101.8°F; pulse, 110; respirations, 32; Blood pressure 150/82
• Lab values: Blood gases show decreased oxygen and increased carbon dioxide. Other blood
work shows an increase in red blood cells and twice normal white blood cells.
Case Study Questions: Emphysema (45 points)
1. What are Mr. McClure’s risk factors for emphysema? (5 points)
2. Describe the pathological changes in emphysema. (15 points)
3. What is the difference between emphysema and chronic bronchitis? (5 points)
4. What is primary emphysema? (10 points)
5. Why do patients with COPD develop wheezes, a barrel chest, clubbed fingers and
elevated carbon dioxide levels? (10 points)
Mr. McClure is admitted to the hospital for exacerbation of his COPD. The next day he
complained of chill and pleural pain. His assessment included:
• Temperature104°F; blood pressure 90/60.
• Rapid shallow breathing, respiratory alkalosis and decreased blood oxygen levels even with
supplemental oxygen.
• Laboratory results indicated his sputum and blood cultures are positive for S. pneumonia .
He was transferred to the intensive care unit and placed on a ventilator.
Case Study Questions: Pneumonia (50 points)
1. Describe the pathological changes in pneumonia. Why are most healthy individuals less
likely to get pneumonia? (15 points)
2. Why is Mr. McClure especially susceptible to pneumonia? (5 points)
3. What are the common bacterial causes of infection in both the community and the
hospital? (10 points)
4. What are the common causes of acute respiratory distress syndrome (ARDS)? (5 points)
5. What is the pathogenesis of ARDS? (15 points)
Explanation / Answer
1. The main risk factor for Emphysema is Smoking . Since he has a history of smoking two packets a day the tobacco levels are really high .
2. The main pathological changes are
(a) Destruction of alveolar wall (b) Inflation of lungs and blisters in the lung tissues (c) Loss of alveoli and reduced surface for gas exchange.
3. Emphysema includes destruction of alveolar walls and loss of alveoli which is mainly caused due to smoking whereas Chronic Bronchitis causes inflammation of bronchioles in the lungs which casues irritation in breathing.
4. Primary Emphysema is caused due to deficiency of Alpha-1-Antitrypsin enzyme which allows white blood cells to damage the lungs . It is hereditary.
5. Wheezing occurs because the air tries to pass from the chest which has become narrow due to COPD and thus makes such noise. Barrel chest occurs because the lungs are filled with air due to which chest remains inflated and breathing becmes difficult.Clubbing fingers occurs due to low levels of Oxygen and in people whi possess High blood pressure.Since the functions of lungs are inappropriate in COPD patients the level of Carbon dioxide increases in such patients.
1. Pathological changes are (a) Decrease in oropharyngeal secretions (b) Destruction of oropharynx and nasopharynx
Because healthy individuals possess a line of defense which can control the entry of pathogens . If some pathogen passes that then it is defended by airway epithelial cell
2. Because he is unhealthy in terms of presence of Wheezing , Barrel chest , and Clubbing of fingers . The presence of white blood cells is low so pathogens can pass easily through his self defense mechanism.
3. In community Streptococcus pneumonia is the main cause . In hospitals Pseudomonas aeruginosa and Staphylococcus aureus are the main cause.
4. ARDS is mainly caused by Smoking , Aspiration , Drowning( somehow saved) , Pneumonia , Severe Acute Respiratory Syndrome , Bacterial infection , Lung infections , Traumatic injury.
5. Pathogenesis of ARDS is that pulmonary inflammation occurs which causes an injury to the alveolocapillary membrane and produces pulmonary edema