NR 507 Week 3 Case Study; Pulmonary

Case Study Scenario Chief Complaint A.C., is a 61-year old male with complaints of shortness of breath. History of Present Illness A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain. The event was preceded with complaints of fatigue and increasing dyspnea for 3 months, for which he did not seek care. He was evaluated by cardiology and underwent a successful and uneventful angioplasty prior to discharge. Despite the intervention, the shortness of breath has not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The cardiologist has requested that you, his primary care provider, evaluate him for further work-up. Prior to today, his last visit with your practice was 3 years ago when he was seen for acute bronchitis and smoking cessation counseling. Past Medical History • Hypertension • Hyperlipidemia • Atherosclerotic coronary arterydisease • Smoker Family History • Father deceased of acute coronary syndrome at age65 • Mother deceased of breast cancer at age58. • One sister, alive, who is a 5 year breast cancersurvivor. • One son and one daughter with no significant medical history. Social History • 35 pack-year smoking history; he has cut down to one cigarette at bedtime following his cardiacintervention. • Denies alcohol or recreational druguse • Real estateagent Allergies • No Known DrugAllergies Medications • Rosuvastatin20 mgonce daily by mouth • Carvedilol 25 mg twice daily bymouth • Hydrochlorothiazide 12.5 mg once daily bymouth • Aspirin 81mg daily bymouth Review of Systems • Constitutional: Denies fever, chills or weight loss. +Fatigue. • HEENT: Denies nasal congestion, rhinorrhea or sorethroat. • Chest: + dyspnea with exertion. Denies productive cough or wheezing. + Dry, nonproductive cough in theAM. • Heart: Denies chest pain, chest pressure orpalpitations. • Lymph: Denies lymph node swelling. General Physical Exam • Constitutional: Alert and oriented male in no apparentdistress. • Vital Signs: BP-120/84, T-97.9 F, P-62, RR-22, SaO2: 93% •Wt. 180 lbs., Ht. 5'9" HEENT • Eyes: Pupils equal, round and reactive to light and accommodation, normalconjunctiva. • Ears: Tympanic membranesintact. • Nose: Bilateral nasal turbinates without redness or swelling. Narespatent. • Mouth: Oropharynx clear. No mouth lesions. Dentures well-fitting. Oral mucous membranesdry. Neck/Lymph Nodes • Neck supple withoutJVD. • No lymphadenopathy, masses or carotid bruits. Lungs • Bilateral breath sounds clear throughout lung fields. + Bilaterally wheezes noted with forced exhalation along with a prolonged expiratory phase. No intercostalretractions. Heart • S1 and S2 regular rate and rhythm, no rubs ormurmurs. Integumentary System • Skin cool, pale and dry. Nail beds pink withoutclubbing. Chest X-Ray • Lungsarehyper-inflatedbilaterally witha flatteneddiaphragm.No effusionsorinfiltrates. Spirometry Case Study Questions Pathophysiology & Clinical Findings of the Disease 1. Arethespirometryresultsconsistentwithobstructiveorrestrictivepulmonarydisease?Whatisthemostlikelypulmonary diagnosis for thispatient? 2. Explain the pathophysiology associated with the chosen pulmonary disease. 3. Identify at least three subjective findings from the case which support the chosendiagnosis. 4. Identify at least three objective findings from the case which support the chosendiagnosis. Management of the Disease *Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations. 1. Classify the patient's disease severity. Is this considered stable or unstable? 2. Identifytwo(2)"EvidenceA"recommendedmedicationclassesforthetreatmentofthisconditionandprovideanexample (drug name) foreach. 3. Describe the mechanism of action for each of the medication classes identifiedabove. 4. Identify two (2) "Evidence A" recommended non-pharmacological treatment options for thispatient.