CASE STUDIES:
The case studies will become more complex as they move throughout the semester. Below are
some highlighted responses for your reference but are not all inclusive. The students should
include broad coverage of the topic, fully answering the case presented.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Mr. Appel has severe chronic obstructive pulmonary disease (COPD). He was recently
discharged from the hospital with a COPD exacerbation and is coming to the office today for
follow up. He tells you he is feeling better but continues to feel short of breath. He is frustrated
at his inability to do the things he used to do like mowing the lawn. He was previously on Lasix
but during his hospital stay they stopped the medication and told him to talk with his doctor
about restarting. Below is his initial blood work on admission to the hospital.
Medical History
COPD/emphysema
Hypertension
Current smoker
Medications
Lisinopril 5 mg daily
MVT daily
Albuterol nebulizer PRN
Current Information
BP 154/88
HR 80
SaO2 94%
Afebrile
Lab values(on admission)
Sodium (Na+) 140 mEq/L
Potassium (K+) 2.0 mEq/L
Chloride (Cl–) 105 mEq/L
Arterial blood gases (ABGs) pH- 7.25; PCO2, 78 mmHg; PO2, 60 mmHg; HCO3−, 30
mEq/L
This study source was downloaded by 100000890490578 from CourseHero.com on 09-06-2024 17:09:48 GMT -05:00
https://www.coursehero.com/file/239238951/Complex-Case-Studies-COPD-CAD-GI-Complaints-Explore-diverse/
, 1. What kind of electrolyte imbalance did Mr. Appel have? What might have contributed to
this? What clinical symptoms might he have been experiencing resulting from this
imbalance?
2. Interpret the ABG and explain why this might happen to this patient.
3. Would you restart the Lasix in light of his current blood pressure? Any precautions?
4. Explain the pathophysiology of emphysema and what improvement/outlook clinically
should he expect with this disease?
5. What would you educate the patient about at this visit?
CORONARY ARTERY DISEASE
Mrs. Blake age 63 comes to your office today for her annual physical exam. On your review of
systems, she reports that she has been having indigestion off and on over the last month, which
is a new symptom for her. She has tried antacids but it hasn’t seemed to help. The only thing
that really seems to help is for her to sit down and rest. She describes it as pressure and burning
in the center of the chest usually preceded by activity and resolves with rest. Associated
symptoms include fatigue and nausea. Usually last a few minutes and rated 7/10 pain. Currently
asymptomatic.
Medical History
Hyperlipidemia
Hypertension
Current smoker
Medications
Lisinopril 10 mg daily
Simvastatin 40 mg daily
Calcium 1200 mg daily
Vitamin D 400 iu daily
Current Information
BP 138/78
HR 74
BMI 36.4
Normal clinical exam today
EKG:
This study source was downloaded by 100000890490578 from CourseHero.com on 09-06-2024 17:09:48 GMT -05:00
https://www.coursehero.com/file/239238951/Complex-Case-Studies-COPD-CAD-GI-Complaints-Explore-diverse/
The case studies will become more complex as they move throughout the semester. Below are
some highlighted responses for your reference but are not all inclusive. The students should
include broad coverage of the topic, fully answering the case presented.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Mr. Appel has severe chronic obstructive pulmonary disease (COPD). He was recently
discharged from the hospital with a COPD exacerbation and is coming to the office today for
follow up. He tells you he is feeling better but continues to feel short of breath. He is frustrated
at his inability to do the things he used to do like mowing the lawn. He was previously on Lasix
but during his hospital stay they stopped the medication and told him to talk with his doctor
about restarting. Below is his initial blood work on admission to the hospital.
Medical History
COPD/emphysema
Hypertension
Current smoker
Medications
Lisinopril 5 mg daily
MVT daily
Albuterol nebulizer PRN
Current Information
BP 154/88
HR 80
SaO2 94%
Afebrile
Lab values(on admission)
Sodium (Na+) 140 mEq/L
Potassium (K+) 2.0 mEq/L
Chloride (Cl–) 105 mEq/L
Arterial blood gases (ABGs) pH- 7.25; PCO2, 78 mmHg; PO2, 60 mmHg; HCO3−, 30
mEq/L
This study source was downloaded by 100000890490578 from CourseHero.com on 09-06-2024 17:09:48 GMT -05:00
https://www.coursehero.com/file/239238951/Complex-Case-Studies-COPD-CAD-GI-Complaints-Explore-diverse/
, 1. What kind of electrolyte imbalance did Mr. Appel have? What might have contributed to
this? What clinical symptoms might he have been experiencing resulting from this
imbalance?
2. Interpret the ABG and explain why this might happen to this patient.
3. Would you restart the Lasix in light of his current blood pressure? Any precautions?
4. Explain the pathophysiology of emphysema and what improvement/outlook clinically
should he expect with this disease?
5. What would you educate the patient about at this visit?
CORONARY ARTERY DISEASE
Mrs. Blake age 63 comes to your office today for her annual physical exam. On your review of
systems, she reports that she has been having indigestion off and on over the last month, which
is a new symptom for her. She has tried antacids but it hasn’t seemed to help. The only thing
that really seems to help is for her to sit down and rest. She describes it as pressure and burning
in the center of the chest usually preceded by activity and resolves with rest. Associated
symptoms include fatigue and nausea. Usually last a few minutes and rated 7/10 pain. Currently
asymptomatic.
Medical History
Hyperlipidemia
Hypertension
Current smoker
Medications
Lisinopril 10 mg daily
Simvastatin 40 mg daily
Calcium 1200 mg daily
Vitamin D 400 iu daily
Current Information
BP 138/78
HR 74
BMI 36.4
Normal clinical exam today
EKG:
This study source was downloaded by 100000890490578 from CourseHero.com on 09-06-2024 17:09:48 GMT -05:00
https://www.coursehero.com/file/239238951/Complex-Case-Studies-COPD-CAD-GI-Complaints-Explore-diverse/
