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a 59 year old african american male presents to ambulatory clinic with increased shortness of breath...

a 59 year old african american male presents to ambulatory clinic with increased shortness of breath in the last week. He needs two pillows to sleep, swollen legs, malaise, weakness, and weight gain. his furosemide dose was decreased 2 weeks ago due to hypokalemia. shortness of breath is increasing with paroxsymal nocturnal dyspnea and ankle edema seems to be progressing

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Expert Solution

DYSPNEA REFERS TO THE SENSATION OF DIFFICULT OR UNCOMFORTABLE BREATHIMG.

PAROXYSMAL NOCTURNAL DYSONEA IS A SENSATION OF SHORTNESS OF BREATH THAT AWAKENS THE PATIENT,OFTEN AFTER 1 TO 2 HOURS OF SLEEP,AND IS USUALLY RELIEVED IN THE UPRIGHT POSITION.

IN OUR PATIENT USAGE OF PILLOWS FOR SLEEP IS TWO,SHORTNESS OF BREATH,SWOLLEN LEGS,MALAISE,WEAKNESS AND WEIGHT GAINARE PRESENTING.AND MORE OVER FUROSEMIDE DOSE WAS DECREASED.CHARACTERISTCALLY THE PATIENT WITH LEFT VENTRICULAR FAILURE SITS UP AT BEDSIDE,DANGLES HIS FEET ,AND REFRAINS FROM AMBULATION OR OTHER ACTIVTY THAT IS LIKELY TO WORSEN HIS SYMPTOMS.

PAROXYSMAL NOCTURNAL DYSPNEA MAY BE CAUSED BY MECHANISMS SIMILAR TO THOSE FOR ORTHOPNEA.THE FAILING LEFT VENTRICLE IS SUDDENLY UNABLE TO MATCH THE OUTPUT OF A MORE NORMALLY FUNCTIONING RIGHT VENTRICLE ;THIS RESULTS IN PULMONARY CONGESTION.ADDITIONAL MECHANISM MAY BE RESPONSIBLE IN PATIENTS WHO EXPERIANCE PAROXYSMAL NOCTURNAL DYSPNEA ONLY DURING SLEEP.THEORIES INCLUDE DECREASED RESPONSIVENESS OF THE RESPIRATORY CENTRE IN THE BRAIN AND DECREASED ADRENERGIC ACTIVITY IN MYOCARDIUM DURING SLEEP.

WE NEED TO PUT BACK INTO THE PREVIOUS TREATMENT ;PATIENT GOING TO LEFT VENTRICULAR FAILURE,SO GIVE BACK FUROSEMIDE DOSE AS BEFORE.AND SIGNIFICANT CARDIAC CARE

Nightingale answered 2 years ago
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