Al Waysmoking: A Case Study
Al Waysmoking was a 72 year-old retired factory worker who was a chain smoker. He is experiencing fatigue, shortness of breath, but continues to smoke. Upon exam his Nurse Practitioner notes that he has a prolonged expiratory phase, expiratory wheezes, and an increased anteroposterior chest diameter. His nail beds were cyanotic and he had moderate pitting edema. Pulmonary Function Testing (PFT) revealed that Al had a decreased VC and an increased RV and FRC. Although HB was normal, PaO2 was decreased (48 mmHg) and O2 saturation was decreased at 78%. PaCO2 was increased at 69 mmHg and bicarb was elevated at 34 mEq/L. His NP concluded that Al had a combination of emphysema and bronchitis, called chronic obstructive pulmonary disorder (COPD) which resulted from his long history of smoking. 1. Define COPD and explain how …show more content…
Therefore, peak expiratory flow rate would refer to the maximum speed of expiration. Expiratory flow is decreased in Al because loss of elastic fibers in the lungs impairs the expiratory flow rate. Narrowing of the airways inside the lungs, in addition to damage to the lungs, causes the exhaled air to come out more slowly than normal (NIH, 2016). In people with COPD, the air sacs can no longer revert back to their original shape. The airways become swollen or thicker than normal. Mucus production might also increase (Porth, 2014, p. 973). The airways are ultimately obstructed, making expiratory flow difficult. 4. Why is Al’s AP chest diameter increased and how does this correspond to the PFTs? Al 's AP chest diameter is increased ("barrel chest") from the chronic air trapping. Excess air is trapped in the lungs, which is shown in his PFTs results (NIH, 2016). The lungs are hyperinflated, which is why the RV and FRC are increased. COPD pathophysiologically prevents the trapped air from being breathed out, which is indicated by the decreased VC. 5. Why are PaO2 and O2 sats
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