Question

In: Nursing

A 25-year-old previously well woman presents to doctor’s office with complaints of episodic shortness of breath...

A 25-year-old previously well woman presents to doctor’s office with complaints of episodic shortness of breath and chest tightness. She has had the symptoms on and off for about 2 years but states that the have worsened lately, occurring two to three times a month. She notes that the symptoms are worse during the spring months. She has no exercise-induced or nocturnal symptoms. The family history is notable for a father with asthma. She is single and works as an administrative assistant in a high-tech firm. She lives with a roommate, who moved approximately two months ago. The roommate has a cat. The patient smokes occasionally when out with friends and drinks socially, but has not history of illicit drug use. Examination is notable for mild end-expiratory wheezing. The history and physical examination are consistent with a diagnosis of asthma. Pulmonary function tests are ordered to confirm the diagnosis.

1. What are three categories of provocative agents that can trigger asthma? What are some possible triggers in this patient?

2. Describe the early events responsible for the pathogenesis of asthma. How does this result in chronic airway inflammation and airway hyperresponsiveness.

3. Define wheezing. What pathogenetic mechanisms are responsible for this patient’s symptoms of wheezing, shortness of breath, and chest tightness?

4. What might you expect the results of her pulmonary function tests to be? Why?

Solutions

Expert Solution

1) Provocative agents for Asthma :

- Physiological mediators like histamine which cause contraction of respiratory smooth muscles.

- Physical agents like cold exposure or exercise.

- Allergy inducing mediators like pollen or pests.

The possible triggers in this patient are:

- Exposure to pets like cat.

- Smoking habit.

2) Pathogenesis of Asthma :

After inhalation triggers of Asthma cause mast cell degranulation and release of histamine which will induce production of leukotrienes and other inflammatory mediators. Cytokines released by mast cells enhance infiltration by other inflammatory cells.

Early events responsible for Asthma are : airway inflammation, increased permeability of vascular endothelium, enhanced secretion of mucus. These processes leads to bronchospasm and leads to wheezing.

These changes when untreated leads to hypertrophy of airway smooth muscle, hyperplasia of airway epithelium and connective tissue deposition and leads to chronic airway inflammation and airway hyperresponsiveness.

3) Wheezing : is defined as a high pitched whistling like sound produced while breathing due to the constriction of the airways.

Mechanism of :

a) Wheezing : Constriction of air ways.

b ) Shortness of breath : due to Constriction of air ways as well as impaired gas exchange.

c) Chest tightness : is due to blocking of airways resulting in failure to expire after inspiration.

4) Pulmonary function test in Asthma Patients :

- Low FEV1/ FVC ratio because of obstruction to airflow. Lung volumes and gas exchange are obstruction to airflow is due to Bronchoconstriction.


Related Solutions

A 67-year-old man presents to the doctor’s office with worsening cough, sputum production, and shortness of...
A 67-year-old man presents to the doctor’s office with worsening cough, sputum production, and shortness of breath. He has been a cigarette smoker for the past 50 years, smoking approximately 1 pack a day. He has a chronic AM cough productive of some yellow sputum but generally feels ok during the day. He was in his usual state of health until two weeks ago when he developed a cold. Since then, he has had a hacking cough and increased thick...
Kevin, a 65-year-old male, presents to the office with chest pain complaints on inspiration and shortness...
Kevin, a 65-year-old male, presents to the office with chest pain complaints on inspiration and shortness of breath(SOB). He states that the chest pain began about 12 hours ago and feels like a sharp pain in the center of his chest. When the pain began, he immediately took aspirin and then went to bed. When he woke up this morning, the pain was still there. Although not as intense. The patient’s medical history includes nephrolithiasis and gastroesophageal reflux disease. Social...
A 45-year-old woman presents with a chief complaint of 3-day duration of shortness of breath, cough...
A 45-year-old woman presents with a chief complaint of 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. Patient has history of COPD with chronic cough but states the cough has gotten much worse and is interfering with her sleep. Sputum is thicker and harder for her to expectorate. CXR reveals flattened diaphragm and increased AP diameter. Auscultation demonstrates hyper resonance and coarse rales and rhonchi throughout all lung fields. In your Case Study Analysis...
A 67-year-old man presents to your office with worsening cough, sputum production, and shortness of breath....
A 67-year-old man presents to your office with worsening cough, sputum production, and shortness of breath. He is a smoker for the past 50 years. He is known to have Chronic Obstructive Pulmonary Diseases (COPD). He was in his usual state of health until one week ago until he got a common cold and since then he has a hacking cough and increased sputum production. this is all information I have 1. What are the two major clinical disorders/diseases are...
A 67-year-old man presents to your office with worsening cough, sputum production, and shortness of breath....
A 67-year-old man presents to your office with worsening cough, sputum production, and shortness of breath. He is a smoker for the past 50 years. He is known to have Chronic Obstructive Pulmonary Diseases (COPD). He was in his usual state of health until one week ago until he got a common cold and since then he has a hacking cough and increased sputum production. this is all information I have 1. What are the two major clinical disorders/diseases are...
An elderly client presents to the clinic with complaints of shortness of breath, inability to lay...
An elderly client presents to the clinic with complaints of shortness of breath, inability to lay flat in bed, and swollen feet bilaterally. He has a history of congestive heart failure and poor eating habits. He weighs 325 pounds and is 66 inches tall. (20 points each) Describe the cardiac assessment that the nurse would perform on this client, including key sounds and landmarks. Identify the assessment findings the nurse will expect to find. Discuss the respiratory questions should the...
A 72 year old woman went into a walk-in clinic with complaints of coughing and shortness...
A 72 year old woman went into a walk-in clinic with complaints of coughing and shortness of breath. She was diagnosed with acute bronchitis and was given a prescription for antibiotics. She was told to return to the clinic if her symptoms did not respond to the antibiotics. The patient returned, the following week. She had similar complaints and was given a chest x-ray, which was normal. The patient was diagnosed with respiratory illness and was referred to a pulmonologist....
Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman...
Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In...
Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman...
Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In...
Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman...
Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In...
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT