Week 3 Case Study Template
Pathophysiology & Clinical Findings of the Disease
1. Are the spirometry results consistent with obstructive or restrictive pulmonary disease?
What is the most likely pulmonary diagnosis for this patient?
The spirometry results are consistent with an obstructive pulmonary disease due to the decreased
FEV1/FVC % < 70%. This case study has a 56% FEV1/FVC % indicating obstructive disease
and a poor response to bronchodilator therapy, which provides consistent findings with a non-
reversible obstructive disease known as COPD. (McCance & Huether, 2019).
2. Explain the pathophysiology associated with the chosen pulmonary disease.
COPD is an airway limitation obstructive disease that consists of chronic bronchitis and
emphysema. Chronic bronchitis is the hypersecretion of mucus and chronic productive cough
that continues at least 3 months of the year for at least two consecutive years. Emphysema is the
permanent enlargement of gas exchange airways with destruction of alveolar walls without
obvious fibrosis. These both initiate an inflammatory response (releasing mediators of histamine,
prostaglandins, leukotrienes, and interleukins) and long-term exposure to environmental irritants
(cigarette smoke as seen in the case study) causes a detrimental response. Smooth muscle
constriction, bronchial wall inflammation, and mucus plug formation leads to air trapping in the
alveoli causing alveolar hyperinflation, which compromises exhalation. This leads to poor gas
exchange in the alveoli causing hypercapnia and can result in respiratory acidosis. As the disease
progresses, hypoxemia and hypercapnia can worsen causing a ventilation perfusion mismatch
due to the poor exchange of gas transfer. This leads to right to left shunting. The kidneys
response to chronic low oxygen levels is to stimulate erythropoietin, which is responsible for
stimulating RBC production, which further strains the pulmonary and cardiovascular systems
from increased blood volume leading to pulmonary hypertension. Overtime, this results in right
sided heart failure and cardiac hypertrophy. (McCance & Huether, 2019).
3. Identify at least three subjective findings from the case which support the chosen
diagnosis.
Patient reporting symptoms of fatigue, increasing dyspnea for 3 months, and worsening
breathlessness.
4. Identify at least three objective findings from the case which support the chosen
diagnosis
Hyperinflation of lungs with flattened diaphragm, dry nonproductive cough, bilateral wheezes
noted with forced exhalation along with a prolonged expiratory phase, spirometry findings
(FEV1/FVC 56%) with a poor response to bronchodilator response <12% (not reversible).
This study source was downloaded by 100000830246019 from CourseHero.com on 06-14-2022 07:58:54 GMT -05:00
https://www.coursehero.com/file/153971148/Case-Study-3-NR507docx/
Pathophysiology & Clinical Findings of the Disease
1. Are the spirometry results consistent with obstructive or restrictive pulmonary disease?
What is the most likely pulmonary diagnosis for this patient?
The spirometry results are consistent with an obstructive pulmonary disease due to the decreased
FEV1/FVC % < 70%. This case study has a 56% FEV1/FVC % indicating obstructive disease
and a poor response to bronchodilator therapy, which provides consistent findings with a non-
reversible obstructive disease known as COPD. (McCance & Huether, 2019).
2. Explain the pathophysiology associated with the chosen pulmonary disease.
COPD is an airway limitation obstructive disease that consists of chronic bronchitis and
emphysema. Chronic bronchitis is the hypersecretion of mucus and chronic productive cough
that continues at least 3 months of the year for at least two consecutive years. Emphysema is the
permanent enlargement of gas exchange airways with destruction of alveolar walls without
obvious fibrosis. These both initiate an inflammatory response (releasing mediators of histamine,
prostaglandins, leukotrienes, and interleukins) and long-term exposure to environmental irritants
(cigarette smoke as seen in the case study) causes a detrimental response. Smooth muscle
constriction, bronchial wall inflammation, and mucus plug formation leads to air trapping in the
alveoli causing alveolar hyperinflation, which compromises exhalation. This leads to poor gas
exchange in the alveoli causing hypercapnia and can result in respiratory acidosis. As the disease
progresses, hypoxemia and hypercapnia can worsen causing a ventilation perfusion mismatch
due to the poor exchange of gas transfer. This leads to right to left shunting. The kidneys
response to chronic low oxygen levels is to stimulate erythropoietin, which is responsible for
stimulating RBC production, which further strains the pulmonary and cardiovascular systems
from increased blood volume leading to pulmonary hypertension. Overtime, this results in right
sided heart failure and cardiac hypertrophy. (McCance & Huether, 2019).
3. Identify at least three subjective findings from the case which support the chosen
diagnosis.
Patient reporting symptoms of fatigue, increasing dyspnea for 3 months, and worsening
breathlessness.
4. Identify at least three objective findings from the case which support the chosen
diagnosis
Hyperinflation of lungs with flattened diaphragm, dry nonproductive cough, bilateral wheezes
noted with forced exhalation along with a prolonged expiratory phase, spirometry findings
(FEV1/FVC 56%) with a poor response to bronchodilator response <12% (not reversible).
This study source was downloaded by 100000830246019 from CourseHero.com on 06-14-2022 07:58:54 GMT -05:00
https://www.coursehero.com/file/153971148/Case-Study-3-NR507docx/
