Clinical Case Study, Respiratory System
Prepared by Myrna C Colom RN, MD Keiser University
Ralph is a 50-year-old diesel engine mechanic who presented to her physician a chief complaint of dyspnea and productive cough for the last 3 consecutive months. Ralph said that he had another one of these episodes last year and that he would feel some relieve by pursing his lips during exhalation. He complains of fatigue and wheezing. Ralph also stated that the cough is worse in the mornings and that is sometimes accompanied blood streaked sputum. He said has not traveled outside the country and there is no family history of respiratory diseases.
Habits: Coffee, 4 cups a day. Quit smoking 5 years ago.
Physical Exam: Average weight male appears anxious with obvious dyspnea and foul-smelling sputum.
Temperature: 100.5 F Pulse: 110 Respirations: 20 Blood Pressure: 140/90
Thorax: Symmetric, no palpable masses. Use of accessory respiratory muscles that present with indrawing of lower intercostal muscles. Difficulty breathing on supine position (orthopnea) with wheezing and crackles.
WBC count: 11,500 Leukocytosis (normal 5,000 to 10,000)
Arterial Blood Gases: PaO2 55mm Hg PcO2 75mm Hg
Lung Function Test
Spirometry: decreased forced expiratory (FEV), increased total lung capacity (TLC)
Reid Index: > 50% (ratio of thickness of the mucous producing gland layer to total bronchial wall)
X-Ray: bronchial wall thickening with increased blood vessels markings and cardiomegaly.
Based on the chief complaint, explain the importance of knowing that Ralph had not traveled outside the country or that there is no family history of respiratory diseases.
What is the normal pH of blood and what Ralph’s lab results tell us.
What is the normal oxygen (PaO2) and carbon dioxide (PaCO2) content in blood? Based on the results, would you say Ralph presents hypoxemia or hypercapnia?
Based on the blood test results is it possible that Ralph also presents an infection?
Would you say lifestyle choices or occupation are to blame for Ralph’s disease?
What is the name of the disease affecting Ralph’s lungs? Provide evidence to support your conclusion.