Case Study:
Clinical scenario 1: Chronic Obstructive Pulmonary Disease
Answer 1.
Patient is having Acute Exacerbation of COPD which most likely developed
due to current smoking status despite of COPD. The patient is having the
saturation level upto 88% on room air in long standing. The COPD patient is
considered normal. Also there respiratory drive become dependent on Hypoxia.
Thus the supplemental oxygen is targeted for a saturation between 88- 92% only
so that not to suppress hypoxia. Thus the supplemental oxygen is targeted for a
Saturation between 88-92% only so that not to supress hypoxia dependent
respiratory drive.
Answer 2.
This Acute Exacerbation is most likely a result of persistent smoking despite
emphysema.
Smoking leads to loss of elasticity of alveoli causing air to be trapped in alveoli
during expiration. The condition is already irreversible. It is defined that if the
cough produces a lot of mucus, then is known as smoker’s cough. The patient
may have the following condition of SOB while doing physical activity. The
patient may also suffer with chest tightness. If an individual is having COPD,
then he will have the condition of colds and other respiratory infections like flu
and influenza. The severity of the symptoms depend on how much the lungs are
damaged. The other condition associated with COPD can be swelling in ankles,
feet and legs, weight loss and lower muscle endurance.
Answer 3.
The patient presents with the complaint of COPD, hence following
interventions should be done:
Diaphragmatic breathing.
Diaphragmatic breathing helps in increasing the strength of diaphragm. It
helps in reduction of respiratory rate, it increases the alveolar ventilation
and sometimes helps expel as much as possible during expiration. It is
also known as belly breathing or abdominal breathing. This exercise leads
to number of benefits that affect the entire body. It is base for meditation
and relaxation. It helps in lowering the blood pressure and stress levels
(by lowering harmful effects of stress hormone cortisol) and regulate
other important bodily processes. It helps in the improvement of the core
muscle stability and the body’s ability to tolerate intense exercise. It
reduces the injuring or wearing out of the muscles.
Pursed lip breathing.
The technique of pursed lip breathing helps in slow expiration, which
prevents the collapse of small airways, it controls the rate and depth of
respiration. It is a breathing technique which is designed to make the
breaths more effective. This technique is done after the inhalation is done
by puckering lips and exhaling through slowly. It improves lung
mechanics and breathing. This technique is beneficial for the people who
have lung conditions and breathing problems like obstructive lung
disease, such as asthma, and restrictive lung disease, such as pulmonary
fibrosis (PF), which is a type of interstitial lung disease (ILD). It is also a
part of treatment for COPD (leads to severely declining lung function and
breathing ability). This disease can make breathing difficult that it
impacts the quality of the person’s life. In one of the study it was revealed
that pursed lip breathing caused the reduction in dynamic hyperinflation
in COPD patient and significantly improved the exercise tolerance,
breathing patterns, and arterial oxygen.
Answer 4.
Depending on the condition of the given patient. The patient will be discharged
home with oxygen (SpO2 less than 88%), smoking cessation (Pharmacotherapy
if needed like Bipropion, Varenicline), antibiotic and Short Course Oral steroid
(5 days recommended now only).
