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    Pathophysiology

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    Karla Karina Dela Cruz
    Mrs. Siwit, a 60-year-old female with COPD and a history of smoking, presented to the emergency department with acute shortness of breath that had progressively worsened over 5 days. On examination, she was tachypneic with wheezing, rhonchi, and decreased breath sounds, as well as barrel chest, cyanosis, tachycardia, and confusion. Initial blood gas analysis showed hypoxemia with low oxygen saturation.

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    Pathophysiology

    Uploaded by

    Karla Karina Dela Cruz
    121 views2 pages
    Mrs. Siwit, a 60-year-old female with COPD and a history of smoking, presented to the emergency department with acute shortness of breath that had progressively worsened over 5 days. On examination, she was tachypneic with wheezing, rhonchi, and decreased breath sounds, as well as barrel chest, cyanosis, tachycardia, and confusion. Initial blood gas analysis showed hypoxemia with low oxygen saturation.

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    COPD

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    Mrs. Siwit, a 60-year-old female with COPD and a history of smoking, presented to the emergency department with acute shortness of breath that had progressively worsened over 5 days. On examination, she was tachypneic with wheezing, rhonchi, and decreased breath sounds, as well as barrel chest, cyanosis, tachycardia, and confusion. Initial blood gas analysis showed hypoxemia with low oxygen saturation.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    121 views2 pages

    Pathophysiology

    Uploaded by

    Karla Karina Dela Cruz
    Mrs. Siwit, a 60-year-old female with COPD and a history of smoking, presented to the emergency department with acute shortness of breath that had progressively worsened over 5 days. On examination, she was tachypneic with wheezing, rhonchi, and decreased breath sounds, as well as barrel chest, cyanosis, tachycardia, and confusion. Initial blood gas analysis showed hypoxemia with low oxygen saturation.

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    Smokin

    Continual airway
    irritation and
    inflammation

    Ciliary Bacterial infection


    Hypertrophy & Dysfunction
    hyperplasia of mucous
    & goblet cells Yellow-green
    phlegm
    Mucus Obstruction and
    hypersecretion narrowing of
    airway Wheezing
    Cough
    reflex
    Rhonch
    Persistent Air i
    productive trapping Difficulty of
    cough breathing

    Weakened Alveolar hypoxia Pulmonary


    pelvic hyperinflation
    muscles
    Tonically
    ↑ urinary Pulmonary Tachycard contracted
    constriction ia Ventilation diaphragm
    frequency &
    perfusion mismatch
    incontinence Barrel chest
    ↓ LV RH Tachypne
    output F a
    Hypercapni Hypoxemi
    ↓ circulating Cor a a
    volume pulmonale
    Respiratory Dyspne Cyanos
    acidosis a is

    Activation of ↓ SpO2
    RAAS ↓ Perfusion of
    body tissues

    Fluid Periphera
    retention l edema Fatigue
    Confusio &
    n weakness
    The patient, Mrs. Siwit, is a 60-year-old female presenting to the emergency department with
    acute onset shortness of breath.  Symptoms began approximately 5 days prior to consult and
    had progressively worsened with no associated, aggravating, or relieving factors noted. She had
    similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary
    disease (COPD) exacerbation requiring hospitalization. She uses nasal cannula O2 support at
    night when sleeping and has requested to use this in the emergency department due to
    shortness of breath and wanting to sleep.
    She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure,
    abdominal pain, abdominal distension, nausea, vomiting, and diarrhea.
    She reported difficulty of breathing at rest, mild fatigue, feeling chilled requiring blankets,
    increased urinary frequency, incontinence, and swelling in her bilateral lower extremities that is
    new onset and worsening. Subsequently, she has not ambulated from bed for several days
    except to use the restroom due to feeling weak, fatigued, and short of breath. Patient barely
    able to finish a full sentence due to shortness of breath. She reported having persistent
    productive cough with yellow, thick secretions in moderate amounts.
    There are no known ill contacts at home. Her family history includes significant heart disease
    and colorectal malignancy in her father’s side. Social history is positive for smoking tobacco use
    at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She
    denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental
    allergies.
    Past medical history is significant for COPD, hypertension, tobacco usage, and obesity.  Past
    surgical history is significant for appendectomy.

    Her current medications include Salbutamol and Amlodipine.

    At the ER, the following assessments were noted: (+) shortness of breath, tachypnea present,
    (+) wheezing noted, bilateral rhonchi, decreased air movement bilaterally. Noted barrel chest
    configuration and (+) cyanosis on lips. The patient was unable to remember where she was and
    why she was at the hospital. Upon assessment of the cardiovascular system, tachycardia was
    noted. Her initial ABG showed a PaO2=58 mmHg and SpO2 readings were 88%.

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