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A member of your family has smoked cigarettes for years and is now having difficulties breathing. They were diagnosed with emphysema. Describe the specific kinds of structural changes you would expect to observe in their respiratory system. How is air flow and gas exchange affected by these structural changes

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Nestor RutherfordLv2

8 Mar 2018

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Case Study 1: Case Presentation

John, a healthy twenty-eight year old electrical engineer, was driving home from work one evening when he experienced sudden stabbing pain in his right pectoral and right lateral axillary regions. He began to feel out of breath and both his respiratory rate and heart rate increased dramatically. As luck would have it, John passed a hospital each day on his way home and was able to get himself to the hospitalâs emergency room. The emergency room physician listened to Johnâs breathing with a stethoscope and requested blood gas analysis and a chest x-ray. John answered a few of the doctorâs questions. The doctor noted that John had no history of respiratory problems but was a heavy smoker.

After viewing the chest radiograph, the doctor informed John that he had experienced a spontaneous pneumothorax, or what is commonly called a collapsed lung. The doctor explained that a hole had opened in Johnâs right lung and that this hole had allowed air to leak into the cavity surrounding the lung. Then, as a result of the lungâs own elastic nature, the lung had collapsed. The doctor said he could not be certain of the cause of the pneumothorax, but smoking cigarettes had certainly increased the likelihood of it happening. He told John he was fortunate the pneumothorax was small, which meant that relatively little air had escaped from the lung into the surrounding cavity, and it should heal on its own. He instructed John to quit smoking, avoid high altitudes, flying in nonpressurized aircraft, and scuba diving. He also had John make an appointment for a re-check and another chest x-ray.

Case Background

Spontaneous pneumothorax occurs when a blister on the surface of the lung opens, allowing air from the lung to move into the pleural cavity. This occurs because alveolar pressure is normally greater than the pressure in the pleural cavity. As air escapes from the lung, the lung tissues will recoil, and the lung will begin to collapse. The lung will continue to collapse until the difference between the alveolar pressure and pleural pressure disappears or until the collapsing of the lung causes the opening to seal.

The pneumothorax decreases the efficiency of the respiratory system, which in turn results in decreased blood oxygen concentration, increased respiratory rate, and increased heart rate. If the pneumothorax is small, the air that escapes into the pleural cavity can be reabsorbed into the lung once the opening has sealed shut. If the pneumothorax is large, a needle or chest tube may have to be inserted into the pleural cavity to draw the air out and allow for the reexpansion of the lung.

Questions

Define the following terms and explain how they may have been affected by Johnâs spontaneous pneumothorax.

Visceral pleura

Parietal pleura

Pleural cavity

As a result of a pneumothorax, the lung tissues recoil, and the lung collapses. Explain how recoil and collapse are prevented in a healthy lung?

How does elastic recoil function in breathing?

Why was John instructed to avoid high altitudes and flying in nonpressurized aircraft?

Case Study 2: The Case of the Coughing Housewife

Jessica, a fifty-nine year old mother of four, moved from a ranch in Colorado to Los Angeles, after the death of her husband, to be closer to her oldest son and his family. She has been in Los Angeles for 18 months and has noticed that she is experiencing shortness of breath which has worsened over the last six months. For the last week, she has been coughing and bringing up yellow mucus. She also noticed swelling in her ankles so she decided to visit a physician about her condition.

Jessica's family and medical history include a negative history of asthma or allergies, lack of occupational or home exposure to asbestos, a previous smoking history (one package of cigarettes per day between the ages of 16 and 52), episodes of bronchitis, treated with antibiotics on an outpatient basis, and a positive history of heart disease (father at 52 and brother at 56). Jessica has no history of serious illness, including heart disease, and her weight is within five pounds of her "desired" weight. She usually coughs in the morning to "clear her throat", but there is usually only a small amount of white mucus.

Her nurse practitioner conducts a general physical examination with the following results. Jessica's skin is normal (no rashes or cyanosis) and her nervous system is functioning normally. Her body temperature was 98.4oF while her pulse was regular at 95 beats per minute with an occasional premature beat. Jessica's blood pressure was within normal limits, however her jugular veins were slightly distended. Her respiratory rate was 28 breaths per minute; she breathed with pursed lips and used her accessory respiratory muscles more than would be expected. Jessica presented with a barrel chest and mild dyspnea when climbing onto the examination table. When listening to her breathing, the nurse practitioner noticed that Jessica had prolonged expiration accompanied by expiratory wheezes. Evaluation of her abdomen indicated no masses or tenderness, but she presented with both hepatomegaly and splenomegaly. All of her extremities were normal with the exception of bilaterally pedal edema.

Based on these results, the nurse practitioner suspected a pulmonary disorder and, after consultation with a physician, ordered laboratory tests (blood and sputum), spirometry and chest x-rays. The results of the laboratory tests were as follows: plasma bicarbonate = 38 mEq/L, hematocrit = 49%, white blood cell count = 9000, pH = 7.38; PaCO2 = 56, and PaO2 = 54. Analysis of the sputum sample indicated the presence of epithelial cells, polymorphonucleocytes and gram positive diplococci. Jessica's 1 second forced expiratory volume (FEV1) was 1.5 L/sec and her forced vital capacity (FVC) was 4 L. These values were 40% and 83% of normal, respectively. Results of the chest x-ray indicated scarring and hyperinflation of the lungs.

The results of these tests coupled with the physical examination and history lead to a diagnosis of emphysema. Jessica was prescribed antibiotics for the infection and oxygen by nose as well as a b2-agonist nebulizer as an acute treatment and requested to stay for observation and stabilization. After Jessica's condition was stabilized she was discharged and given a prescription for an inhaler containing a b2-agonist to be used as needed. She was also encouraged to exercise regularly and follow the nutritional guidelines she was given. Jessica was also informed that if the symptoms either worsened or did not lessen within the next week, to return and her treatment would be reevaluated and would possibly include nocturnal oxygen and an inhaler containing corticosteroids.

Answer the following questions about this case

Define the bold terms in the text. (8 points)

What risk factors and symptoms did Jessica present with prior to the physical examination that suggested a pulmonary disorder?

How did the physical examination, chest X-ray and spirometry confirm this hypothesis?

Identify muscles involved in respiration and how these muscles are responsible for the process of ventilation.

How will the b2-agonist in the inhaler help with the respiratory problems Jessica presents with?

Why is it important that a b2-agonist and not simply an b-agonist is used in the inhaler?

If her condition does not progress, why would corticosteroids be used in the inhaler?

Amy is cooking dinner for her family. She moves to pull a pot off the stove and accidently touches the burner. She reflexively pulls her finger away from the stove and immediately feels the pain. Which receptor neuron is responsible for sending information from her finger to her peripheral nervous system? Is this receptor neuron, an afferent or efferent neuron? Explain where the information from the receptor neuron is sent and how does it result in Amy moving her finger away from the stove. How many neurons are typically involved in this response? What are the names of these neurons? Evolutionarily, why do you think the human body has this system in place? What might happen if we did not have this response?

Glen, who is 45 years old, begins to notice that his hands shake (tremors) when he is performing everyday tasks such as signing his signature. His family members have noticed that he also has muffled speech and tends to shuffle when he walks. He is diagnosed with Early Onset Parkinsonâs disease. What is Early Onset Parkinsonâs disease? What specific cell type is affected in Parkinsonâs disease? What is dopamine? What effects does dopamine have on the body? Explain the structure of a synapse and why Glenâs neurologist would prescribe him a dopamine agonist? Glen has genetic testing performed and it is determined that he does carry an autosomal dominant mutation in the SNCA gene associated with Early Onset Parkinsonâs disease. Glen has three children. Would you advise his children to have genetic testing performed to determine if they also carry the disease mutation? Why or why not?

Patricia, who is 37 years old, discusses with her physician recent symptoms that she has experienced including blurred vision, numbness in her fingers and face, dizziness, fatigue and weakness. The physician performs multiple neurological tests and she is diagnosed with multiple sclerosis (MS). What is MS? Is MS a disease of the central or peripheral nervous system? What is the main cell structure affected in MS? How is the action potential of a neuron affected in MS? The origins of MS are not clear. What do scientists hypothesize to be the causes of MS?

Overview

How do you study pathophysiology? You have observed a case, and you have read many articles on topics related to how our body adapts to environmental toxins on a cellular level. Now you are going to go deeper in your observations to build your report.

Instructions

In at least 375 words, or 1.5 double-spaced pages, prepare a case report that addresses the following:

Based on the case study provided, respond to the following questions:

Identify and differentiate the symptoms from the signs in this patient.

What is the personal and social history of our patient?

What is the family history?

What results do you expect to find in the tests ordered?

What are some complications the patient is suffering now?

In regard to the patient's mother's breast cancer:

What are the four mechanisms of cellular adaptation? Explain.

What is the general classification of neoplasms according to their tissue of origin?

How would sickle cell anemia induce ischemia? What are the differences between ischemia and necrosis?

What are the differences between sickle cell anemia and leukemia? Compare their pathophysiology, symptoms, signs, and lab results.

All references must be cited using APA Style format.

Case Study:

Personal Information

Name: Mr. Peter Smith

Age: 45 years old

Gender: Male

Description

Mr. Peter Smith came to the medical office complaining of fatigue, asthenia, headaches, and generalized abdominal pain. Our patient tells us that he has had a high fever, but he did not take his temperature. The patient has had previous episodes of abdominal pain and arthralgia. Also, he was diagnosed with sickle cell anemia when he was a child. His father suffers from sickle cell anemia, diabetes mellitus, and essential hypertension. Our patientâs mother had a right radical mastectomy due to breast cancer a few years ago, and she suffers from sickle cell anemia, like Mr. Smith and his father. There is no other remarkable pathologic family history.

Mr. Smith drinks alcohol at least once per month and smoke cigarettes. He has no history of drug addiction. He is allergic to penicillin and iodine.

On physical we found:

Remarkable Signs on Physical Regions

Abdomen: Distended and painful on palpation, mostly on the left upper quadrant. Splenomegaly.

SOMA: Joint pain

Remarkable Signs on Physical by Systems

Integumentary system: Yellowish skin and pale nail beds. Superficial crater-like skin lesion on the right medial ankle area. An erythematous area accompanied by edema, purulent secretion, and heat surrounds the lesion.

Respiratory system: Tachypnea

Cardiovascular system: Tachycardia

Lab Tests

Complete blood count (CBC)

Hemoglobin electrophoresis

Abdominal ultrasound

EKG

Supporting Material

In order to understand Mr. Smith's case, we need to investigate the primary concepts of homeostasis at a cellular level and explore specific conditions when homeostasis is not present. How does our body adapt to environmental toxins? We will explore this question by looking at specific outcomes when there are deviations from homeostasis in three specific areas:

Cellular adaption and neoplasia

Infection, immunity, and inflammation

Hematological disorders