Question

Case study background information – Mr Jim Fletcher

Jim Fletcher is a 75-year-old man living with COPD. He is a retired geologist who was exposed to asbestos early in his career. He lives by himself in the local township since the death of his wife Joan from Acute Myeloid Leukemia 12 months ago. Jim has 3 married sons all of whom are very supportive and either ring or visit regularly. Jim was diagnosed with cataracts 6 months and currently wears bifocals glasses. His GP, Dr North has discussed with him the benefits of cataract surgery which Jim is considering in the near future due to his deteriorating vision which contributed to a fall 1 week ago.

PMH: COPD, HT (undiagnosed for many years), Bilateral Cataracts, Osteoarthritis (Bilateral Hips and Knees and lumbar spine), Depression diagnosed 12 months ago.

PSH: Bilateral Cataract removal and IOL implant

PFH: Brother died from Bowel Ca, Father died from Heart Failure.

Current medications include:

PO Captopril 50mg TDS

PO Tramadol 50-100mg 6/24 hrly PRN

PO Panadol Osteo 650mg 6/24hrly prn

PO Fluoxetine 20mg mane

Symbicort 100/6 1-2 Inhalations BD

Spiriva (Tiotropium bromide) 2.5mcg Inhalation daily

You meet Jim in the local hospital’s emergency department. Jim has reported he has had increasing episodes of shortness of breath, a productive cough, fatigue and increasing difficulties in managing at home particularly over the past week.

In your own words, explain the pathophysiology of COPD and how it affects Jim. This is a good definition but we need pathophysiology of whats happening to the alveoli ? why does it make breathing difficult?

i need reference with this question aswell plz

Answer 1

To understand pathophysiology first we should understand normal physilogy.

The air we breath in which carries oxygen moves through trachea to bronchus then to bronchioles and reaches elastic sac like structure called Alveoli surrounded by cappilary. The oxygen in air exchanged to carbon dioxide through terminal Alveoli and the carbon dioxide is expelled when we breath out.

COPD mainly a combination of two disease conditions chronic bronchitis and Emphysema.

Pathophysiology

• Mr.Jim was a geologist and had a chronic exposure to asbestos. Asbestos is a chemical irritant to lungs which causes inflammation of bronchioles.
• Inflammation leads to production of mucus and narrowing of airway lead to Chronic bronchitis.
• The mucus obstructs the airway and air is partially expelled from Alveoli.
• The trapped air and mucus decreases the elasticity of Alveoli and the walls of Alveoli breaks..
• The broken Alveoli traps air in lungs and small Alveoli turns to large in size.
• This cause Emphysema.
• Mr.jim have productive cough which indicates mucus in bronchus as a result of chronic bronchitis. The oxygen exchange is impaired and air to be forcefully inhaled inorder to reach Alveoli. Which result in breathing difficulty and fatique.
• The decreased oxygen in blood cause increasing difficulty and fatique.