Breathlessness Case study
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages
Vicky Jeffrey is a 78-year-old woman who was first diagnosed with asthma when she was
15. She has recently complained of continuous breathlessness to her GP, despite taking her inhalers. She is normally on Clenil® 100mcg 2 puffs BD via a metered dose inhaler (MDI) and salbutamol as needed, both via a spacer device. (Clenil® is a formulation of beclometasone dipropionate, an inhaled corticosteroid.) Mrs Jeffrey has been referred by her GP to a specialist respiratory service for assessment and management of her continuous breathlessness. The patient referral also states that she has never smoked but previously worked in a pub and lived with a husband who was a heavy smoker and died of lung cancer. Mrs Jeffrey finds it increasingly difficult to do her daily domestic chores and can only manage 60 metres walking outdoors on a flat surface.
A careful history of the patients symptoms is required to understand whether or not she has a diurnal variation of her symptoms and if she has been taught to step up and step down her inhaler during an acute asthma attack. It is also necessary to establish whether the patient carries out a regular peak flow, which will help to determine step up and step down of therapy.
Mrs Jeffrey has no diurnal variation in symptoms and no allergies. A history of allergies is important, as an allergic reaction can trigger an exacerbation of asthma in the majority of asthma patients. We know from the patients history that she never smoked but lived with her husband who was a heavy smoker and used to work in a pub when smoking was not banned in public places in the UK. From the literature, we know that COPD can occur as a result of passive smoking in non-smokers the risk is highest with environmental tobacco exposure in multiple settings such as home and work (Hagstad et al. 2014).
Past medical history revealed none of the following: heart failure, hypertension, atrial fibrillation, DVT, pulmonary embolus and no previous cardiac surgery. This information will help to rule out other causes of breathlessness.
Drug history: Clenil 100mcg MDI 2 puffs BD, salbutamol 100mcg MDI as required, simvastatin 20mg at night, and paracetamol 500mg when needed.
The following investigations were carried out:
Chest X-ray showed bilateral hyperinflation
Arterial blood gases PH 7.37, PCO2 4.8 kpa, PaO2 11kpa, SaO2 99%, HCO3 23, BE -2
Blood test CRP 3mg/l, Na+ 138mmol/l, K+ 4.2mmol/l, Hb 12.5g/dL, BNP 30pg/ml, WCC 7 x 109/l, INR 0.9, Troponin 10
No chest pain
Pulse oximetry SpO2 96% HR 85b/min
Spirometry result showed FEV1 40% predicted, FEV1/FVC ratio 45%, with the usual concave shape of the flow volume curve
Frequency of exacerbation: 34 in 12 months
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