Mrs. H, a 65-year-old woman with a history of hypertension, presents to the clinician with a continued complaint of a cough. She has been to the office 3 times over the last 6 months with the over the past few week the hospital.
Mrs. H, a 65-year-old woman with a history of hypertension
Case Study #1 – Respiratory
Mrs. H, a 65-year-old woman with a history of hypertension, presents to the clinician with a continued complaint of a cough. She has been to the office 3 times over the last 6 months with the over the past few week the hospital. She reports that she has been feeling increasingly fatigued and breathless on exertion same troublesome cough. Also, she has had 2 chest infections, 1 of which resulted in an admission.
She had a hysterectomy 20 years ago and an appendectomy when she has 4 children, 2 living nearby and 2 in the UK. She has an occasional social drink, does n was a child. Lives on her own in a rural area. Her husband died when she was in her 40s. Currently She smokes, but has a smoking history of 15–20 cigarettes per day for 45 years. She stopped pension. She is very involved with her family and attends Catholic smoking 4 years ago.
Her income comes primarily from social security and a small widow’s services weekly.
Recently she prescriptions and, when needed, follow and she finds these to be increasing struggles. She visits her clinician every month for repeat she finds it very difficult to climb stairs. She is having some problems with bathing and dressing, finds housework almost impossible; and she has just moved her bedroom to the ground floor as feels that her health is declining, and she finds that she is able to do less and less. In particular, she -up of her hypertension. Her children are healthy. Both of tasks.
Her coughing. She is also experiencing fatigue and is worried about her capacity to manage her home dyspnoea on exertion (DOE), difficulty in undertaking household tasks, and disturbed sleep due to cancer at 66. On review it is evident that she is experiencing increasing shortness of breath (SOB), her parents are deceased. Her father died in his sixties of chronic bronchitis. Her mother died of medications include Spiriva, 500 mcg once daily; Seretide, 200 mcg twice daily;
Ventolin, 200 mcg as needed; and Exforge, 100 mg once daily. She has no known allergies (NKA).
OBJECTIVE: Mrs. H is awake, alert, and oriented. She appears breathless on exertion.
Her oxygen saturation levels are 93%, dropping to 90% following exertion. She appears clean and well kept. Hyperinflation of the chest, some use of accessory P: 110; respirations: 25 per minute. She is afebrile with a temperature of 97.8. There is her clothes are appropriate. She is 5 ft 2 inches and weighs 180 lb. Her vital signs are BP: 164/92; y muscles of respiration, crackles, and and she has a small scar as sounds. Her abdomen is soft and nontender, and her bowel sounds are present in all 4 quadrants.
Occasional audible wheeze. Cardiac exam reveals a regular heart rate, S1, S2, and no abnormal a result of an appendectomy as a child. Her skin is dry and intact, and there clear normal sclerae with PERRLA. Her ears reveal heavy wax buildup and normal is some dehydration evident. She has slight pedal edema and positive pedal pulses. Her eyes reveal
Tympanic normal, and she has full range of motion of all extremitie Neurological exam reveals 2+ deep tendon reflexes bilaterally and equal strength. Her gait is membranes bilaterally. Her mouth is dry; oral mucosa is spotted with possible thrush presents.
DIAGNOSTICS: Spirometry performed and a post-bronchodilator measurement using spirometry. The test results reveal pre-bronchodilator: FVC 1.64, FEV1 .98, FEV1% predicted
47%, FEV1/FVC ratio 60%. Post-bronchodilator: FEV1 .96, FEV1% predicted 55%, FVC 1.62,