Case 1

75 y/o M, jeepney driver, chronic smoker complaining of intermittent difficult

breathing for 1 year. He has chronic cough for 10 years now. Admitted
because of severe dyspnea, easy fatigability and persistent cough. Initial ABG:
pH 7.30 pCO2 58 pO2 79 Hco3 30

PE: Conscious, coherent, wheel chair borne, speak in phrases

BP 150/90, CR 112, RR 32, T 37.8
(+) Nasal flaring and intercostal retractions
(+) Lagging on the L hemithorax, Dec tactile fremitus on the L Lower lung field
Dullness on percussion and decrease breath sounds L
Clubbing on nail beds

1. what is the likely problem in this case?

2. Create a pathophysiologic flow chart/diagram that is applicable to this
case.
3. Enumerate 3 NCPs according to priority.