Hesi Case Study Angelo Raimundo

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Thank you for referring Angelo Raimundo, a 70-year-old gentleman who immigrated from Portugal around 30 years ago. Angelo is a retired toolmaker and reports lead dust exposure. He is an ex-smoker, having ceased this over 35 years ago, and prior to that accumulated a 20 pack-year history. He currently keeps no pets. Regular medications are amlodipine??? and vitamin D.

Angelo recalls having a chest illness as a 10-year-old, although believes this was short lived. At the age of 22, this illness apparently recurred, although Angelo cannot recall any specific symptoms. He underwent lung biopsy of some sort and whilst he was reassured that there was no evidence of cancer or tuberculosis and he was treated for six months with medication.
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Associated with this, he does notice some chest tightness and mild dyspnoea. The mucus production tends to occur in the evening and overnight and Angelo does notice transient dysphonia. There have been no fevers or sweats. There has been no overt wheeze, but he does note some whistling noises when the mucus builds up.

Over the last few years, he has experienced allergic rhinitis that is particularly prominent during pollen season and one thing that has helped is changing his bedroom flooring from carpet to floorboards which raises suspicion of dust mite sensitisation. Over the last couple of months, Angelo has not been aware of any significant allergic rhinitis symptoms, although on reflection believes there may be some intermittent nasal congestion with post-nasal drip. He reports very infrequent reflux symptoms.

Thank you for forwarding copies of recent investigation including a chest x-ray that reveals hyper-inflated lung fields with some flattening of the hemidiaphragm. Pathology including FBE, U&Es, CRP and LFTs are essentially normal and specifically there is no eosinophilia. A sputum sample has not cultured any

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