Answer Happy

Case Study 33. Bronchiectasis ADMITTING HISTORY A 56-year-old black wanansacquined with the medical staff because of frequest episodes of upper respiratory infections. The woman works 40 or more hours per week as a file clerk at a local health department and is known as a hard worker Despite what she describes as her "chronic cold, she rarely miss a day of work, whough she frequently needs to request permission to leave work surly because of doctor appointments Fortunately, hermediate supervisor is a compassionate person and understands the woman's health problem and frequent requests to leave early The woman's hospital chart shows that her respiratory problems began when she was in her early ters. During that period frequent upper respiratory tract infections and an annoying caugh were her only symptoms. The chart also states that she was a smoker of about one pack of cigaretes per day during her teen years. Over the years she has unit and restarted making many times. For the past several years she has treated herself wih aerosolized tronchodilators and kept a humidifier running in her room most of the time. She frequently has been given antibiotics in alternating cycles Her husband often acoministers chest percussion and postural drainage at home, and she finds this treatment helpful for come flare-ups (cough and increased sputum production) The woman stated that she had not smoked for 3 months. Over the last 6 months however, she stated that she had lost bath weight and her merally "good spirits. She further stated that her cough was almost continuous with production of copious amounts of foul smiling, purulent put. She denied hemoptysis She ako indicated that her cowarkers had become concemed() about her condition and recommended that she seekinmedinte medical attention PHYSICAL EXAMINATION (TIME: 0930) The patient appeared well-nourished and complained of severe, nearly constant shortness of breathe a frequent, strong cough, and punken sputum production. She appeared cymous, and her fingers and does showed mid clubbing She was pursed-lip breathing and using her accessory muscles of inspiration. Couching episodes produced large amounts of foul-smelling yelow.green sputure Her vital signs were as follows blood pressure 185/90, heart rate 110 bpm, respiratory rate 30/min, and oral temperature 379°C(1002), Palpation of the chest and percussion of the hangs revealed to remarkable abnormalities. On ausculation, bila wal shonchi and persistent crackles over the hung bases were heard. Examination other chart revealed mikl to moderate airway obstruction on pulmonary function tests PET perfumed 2 years ago. Her history abo showed the following baseline arterial blood values (ABG) on 2 min xvien pH 7.38 PCO2 55 mmHg. HCO3 33 mmol/L and P0268 THE. On this day her bedside peak expiatory flow (PEER) W325 L/min and her ABC on 3 Luni 02, by nasal cannula were as follows.ph 2, Pa CO2 5 monte HCO3 27