Question

Mr. Brennan, age 63, has smoked cigarettes since he was 14. He has a long history of gradually increasing dyspnea. Currently, he has a chronic morning cough productive of only scant white sputum. Mr. Brennan has been losing weight and now feels fatigued and weak at all times. Upon examination, he has a barrel chest. His diagnosis is emphysema.

a. What assessment questions should you ask Mr. Brennan?

b. Why should you assess Mr. Brennan for swollen ankles and distended neck veins when he is upright?

c. How did Mr. Brennan’s smoking contribute to development of emphysema?

d. Mr. Brennan says, “Why is my chest so round?” How should you respond?

Answer 1

a. Assessment Questions

Are you a smoker? if yes how many cigerate per day and how long you are smoking?

Are you living or working in a highly polluted area, occupatiomal exposure to fumes or dust?

Any family history of pulmonary disorder?

Are you suffering from anorexia, fatigue and weight loss, breatlessness, long term cough,sputum production, difficulty in breathing?

b. Assessment of swollen ankles and distended neck veins

Distended neck veins provides informaton about pulmonary hypertension which can lead to right side heart failure . This means that the right side of the heart is no longer able to pump enough blood into the lungs.  In this case, the heart is not able to pump the amount of blood through the body that is needed for organs like the liver and kidneys to function well. This causes too much fluid to collect and build up in areas like the ankles, legs, and feet.

c. How did Mr. Brennan’s smoking contribute to development of emphysema?

Tobacco smoking contain nicotineleads to activation of reactiveoxygen species, leads to inactivation of antiprotease leads to functional alpha tripsin deficiency leads to increase number of netrophil and elastase leads to leads to tissue damage leads to emphysema.

d. Mr. Brennan says, “Why is my chest so round?” How should you respond?

Due to emphysema, developed a  barrel chest .  Your lungs are chronically overinflated with air, so the rib cage stays partially expanded leads to barrel chest.