Case Study – Chronic Bronchitis

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Case Study – Chronic Bronchitis

Admitting History

A 68 year old retired geologist arrived in the emergency room with his daughter.

Well known to the respiratory care consult team, he has a 40 year history of smoking 1.5

packs of cigarettes a day, is widowed, lives alone, and has difficulty managing his daily

activities. For the past week the man has experienced increased dyspnea and cough and

has been unable to care for himself. On observation, his personal hygiene appeared to

have deteriorated. The man stated that he has been unable to get his breath or inhale deep

enough to cough up secretions. He complained of mild nausea without abdominal pain or

vomiting. His physician had given him an unknown oral antibiotic 3 days before this

admission.

The man was diagnosed with severe chronic bronchitis approximately 6 years ago and

had an acute myocardial infarction 2 years ago. His pulmonary function studies 1 year

before this admission showed severe airway obstruction and air trapping. He has a

history of high blood pressure, congestive heart failure, chronic dyspnea on exertion, and

chronic cough and he experienced two episodes of pneumonia within the last year. In

recent months, according to a neighbor, he has become increasingly depressed.

According to his daughter, his physical activity is minimal. He generally spends

most of his days watching television, smoking, and napping. All his children, none of

whom live in the immediate area, have tried to coax him to move to a boarding house

environment, but he has adamantly refused. During his last admission, the advantages of

pulmonary rehabilitation were discussed with him. The patient said that he had no need

for pulmonary education, nor for the services of other agencies or organizations to check

up on him in his home.

Physical Examination (Time: 1730)

Inspection revealed a barrel chest, clubbing of his fingers and toes, cyanotic skin,

and pitting edema (2+) around his ankles. His breathing was labored; he was pursed-lip

breathing, using his accessory muscles of respiration, and he appeared weak. He had a

frequent, weak cough productive of large amounts of thick, yellow sputum.

Vital signs were as follows: blood pressure 190/115, heart rate 125 bpm,

respiratory rate 30/min, and oral temperature 37 C (98.6F). Tactile fremitus was present

over both lung fields, and hyperresonant perussion notes were produced both anteriorly

and posteriorly. Bilateral rhonchi were auscultated. His abdomen was soft and not

tender. Bowel sounds were active.

On room air his arterial blood gas values were as follows: pH 7.53, PaC02 56

mmHg, Pa02 64 mmHg, HC03 33 mmol/L. review of his chart showed that on his last

hospital discharge, his baseline ABG’s on 2 L/min 02 were as follows: pH 7.39, PaC02

85, mmHg, Pa02 64 mmHg, HC03 38 mmol/L. His carboxyhemoglobin level was 6%.

His chest x-ray on this admission showed severe hyperinflation with depressed

hemidiaphragms (refer to page 183 for reference). No acute infiltrates were apparent.

His heart size was normal. His CBC values were all normal except for hct of 58% and

hgb of 16.5. The attending physician ordered a respiratory care consult. The following

order was written in the patient’s chart: “All efforts should be made to keep the patient

off the ventilator.

Classify his baseline ABG stated in the previous information.

Classify his current ABG stated in the previous information.

Using the terms from chapter 4 of your Respiratory Disease textbook, which term would

be used to describe his current ABG?

SOAP chart based on the previous information:

What are the most common causes of chronic bronchitis?

Are the clinical manifestations of cough and sputum production characteristic of this

disorder? If so, why?

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Case Study – Chronic Bronchitis Admitting History A 68 year old retired geologist arrived in the emergency room with his daughter. Well known to the respiratory care consult team, he has a 40 year history of smoking 1.5 packs of cigarettes a day, is widowed, lives alone, and has difficulty managing his daily activities. For the past week the man has experienced increased dyspnea and cough and has been unable to care for himself. On observation, his personal hygiene appeared to have deteriorated. The man stated that he has been unable to get his breath or inhale deep enough to cough up secretions. He complained of mild nausea without abdominal pain or vomiting. His physician had given him an unknown oral antibiotic 3 days before this admission. The man was diagnosed with severe chronic bronchitis approximately 6 years ago and had an acute myocardial infarction 2 years ago. His pulmonary function studies 1 year before this admission showed severe airway obstruction and air trapping. He has a history of high blood pressure, congestive heart failure, chronic dyspnea on exertion, and chronic cough and he experienced two episodes of pneumonia within the last year. In recent months, according to a neighbor, he has become increasingly depressed. According to his daughter, his physical activity is minimal. He generally spends most of his days watching television, smoking, and napping. All his children, none of whom live in the immediate area, have tried to coax him t ...
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