Case Study #4 A 65-year-old female who was a lifelong smoker visited her doctor because she was having difficulty breathing. This was nothing new but seemed to be getting worse. It was most difficult to exhale, but it helped if she pursed her lips. After her examination, her doctor prescribed an oxygen tank for her use at home and ordered the following tests: Test Normal Range Patient's Results FVC (Forced Vital Capacity) 2.07 L 1.8 L FEV1.0 (Forced Expiratory Volume in 1 sec) 1.7 L 0.9 L FEV% FEV1.0/FVC 77% 50% MVV (Maximum Voluntary Ventilation) 80-120 L/min 75 L/min FRC (Functional Residual Capacity) 2.4 L 3.0 L ERV (Expiratory Reserve Volume) 1.2 L 0.8 L RV (Residual Volume) 0.5 L 2.2 L Arterial Blood Gas PO2 = 95 mmHg PCO2 = 40 mmHg pH = 7.38-7.42 PO2 = 85 mmHg PCO2 = 46 mmHg pH = 7.39 ECG Mean Electrical Axis Between +110 to -20° +130° 1. What would be the specific diagnosis for this patient? 2. Which of the following test results above would support this diagnosis? List all that apply. 3. Explain why the RV in this patient has increased. 4. Why is this patient's Arterial Blood Gas measurement abnormal? Is it the increase in PCO2 or the decrease in PO2 that caused the change in her blood pH? Explain. 5. Does her heart have a normal Mean Electrical Axis? If it is abnormal, explain what led to this.
Added by Santiago H.
Close
Step 1
The specific diagnosis is that the patient has emphysema. Show more…
Show all steps
Your feedback will help us improve your experience
Madhur L and 100 other Biology educators are ready to help you.
Ask a new question
Labs
Want to see this concept in action?
Explore this concept interactively to see how it behaves as you change inputs.
Key Concepts
Recommended Videos
Meera is a 24-year-old woman who has been studying at a local university. She recently returned from a 14-hour flight to Delhi, where she had been visiting family. She came to your emergency room worried that she is having a heart attack; she describes 2 hours of sharp pain in her chest and back, which is worse when she takes a deep breath. She states she is having a hard time breathing. Her vital signs are as follows: Blood pressure is normal at 120/72, pulse elevated at 112, normal body temperature of 98.1℉, and an increased respiratory rate of 40. Meera’s past medical history is unremarkable. She has never been pregnant and is currently taking an oral contraceptive to prevent pregnancy. In addition to her oral contraceptive, she takes a multivitamin daily and sometimes uses ibuprofen for menstrual cramps. She occasionally drinks alcohol, is a ½ pack per day smoker, and denies any illicit drug use. Treatment (part 2) You have ordered a set of arterial blood gases (ABGs), a D-dimer, an EKG, and chest imaging for Meera. Her EKG did not show evidence of cardiac ischemia or myocardial infarction, and her Chest CT revealed a large pulmonary embolism. Her D-dimer was elevated. Her ABGs are as follows: PaO2: 75 mmHg Normal range: 80–100 mmHg pH: 7.5 Normal range: 7.35–7.45 pCO2: 30 mmHg Normal range: 35–45 mmHg HCO3: 22 mmol/L Normal range 22–26 mmol/L Thinking back to Chapter nine, does Meera’s lab work reveal an acidotic or alkalotic state? Which buffer system(s) will work to restore her pH to a normal value? Briefly (2-3 sentences) describe how that buffer system works to restore normal pH. Meera’s PaO2 and CO2 are low. What is the definition of low PaO2? What is the definition of low pCO2? What type of alteration in normal physiology is driving Meera’s low PaO2? Explain the alteration in her normal physiology. What general treatment(s) do you anticipate will be ordered for Meera? Explain briefly how those treatments will restore normal respiratory function.
Adi S.
History: A 68-year-old man with chronic renal failure was in the hospital in serious condition recovering from a heart attack. He had just undergone "balloon angioplasty" to redilate his left coronary artery and was thus on an "NPO" diet (i.e., he was not allowed to have food or drink by mouth). He received fluid through an intravenous (IV) line. Late one night, a weary nurse who was on the 11th hour of a 12-hour shift came into the patient's room to replace the man's empty IV bag with a new one. Misreading the physician's orders, he hooked up a fresh bag of IV fluid that was "twice-normal" saline rather than "half-normal" saline (in other words, the patient started receiving a fluid that was four times saltier than it should have been). This mistake was not noticed until the following morning. At that time, the man had marked pitting edema around the sacral region and had inspiratory rales ("wet-sounding crackles") at the bases of the lungs on each side. He complained that it was difficult to breathe as well. Blood was drawn, revealing the following: Na+ 157 mEq/liter (Normal = 136-145 mEq/liter) K+ 4.7 mEq/liter (Normal = 3.5-5.0 mEq/liter) Cl- 101 mEq/liter (Normal = 96-106 mEq/liter) A chest x-ray revealed interstitial edema in the lungs. Questions: 1. Most dissolved substances in the blood plasma can easily move out of the bloodstream and into the interstitial fluid surrounding the cells. A. Will the nurse's mistake increase or decrease the "saltiness" of the interstitial fluid? B. Given your knowledge of osmosis, will this cause the cells in the body to increase or decrease in size? 2. Why does this patient have pitting edema and inspiratory rales? 3. How would this increase in salt load affect the patient's blood-aldosterone level? In your answer, explain the function of the hormone aldosterone. 4. Can you think of any other normal mechanisms that the body has to control salt and water balance? How might they react in this situation? 5. What symptoms might result from hypernatremia ("high blood-sodium" level)? 6. How is this patient's interstitial edema in the lungs affected by his already-weakened heart?
Patricia C.
A 72 year old male came to emergency with a complaint of difficulty in breathing and dyspnea (feeling short of breath).You learn he has smoked since he was 18. In the past he had smoked a pack a day but due to finances has a limit of 4 cigarettes a day. He has tried to stop smoking but has been unsuccessful. During your conversation you note he has a persistent and productive (mucus producing) cough – he reports he has had this cough for years. His blood pressure is 102 (normal is 60-100), and you note crackling and wheezing when auscultating (listening to sounds produced with a stethoscope) both lungs. No abnormal sounds were noted when auscultating the heart. Distention of neck veins and mild edema at the wrist and ankle were noted.Radiographic analysis demonstrates right ventricular hypertrophy (enlargement). Radiographic analysis of the lungs revealed several dark fields. EKG was unremarkable (normal). 1) Based on the intake interview and diagnostic evidence what organ system is diseased? 2) Why would the patient exhibit slightly elevated blood pressure? 3) Why would the patient exhibit distention of the neck veins? 4) Why would the patient exhibit right ventricular hypertrophy? 5) Is the productive cough significant – and why?
Bryan V.
Recommended Textbooks
Biology for AP Courses
Objective Biology for NEET
Introduction to General, Organic and Biochemistry
Transcript
18,000,000+
Students on Numerade
Trusted by students at 8,000+ universities
Watch the video solution with this free unlock.
EMAIL
PASSWORD