|
|
He
denies any acute changes in his breathing, but he does
have a chronic cough that produces one to two
tablespoons of clear sputum daily. The cough and
sputum production have not recently changed. He
denies chest pains, hemoptysis, and wheezing.
He quit smoking three months ago because of his dyspnea.
Prior to that time, he smoked one pack of cigarettes
a day for 50 years. He denies alcohol use. He takes
no medications. He has not recently traveled beyond the
tri-state area. He has had no significant medical
illnesses or surgeries.
|
|
PE:
A thin, elderly man who appears older than his stated
age. P – 110 BP – 116/86 RR – 18 unlabored.
Afebrile
Neck:
Prominent SCM muscles, no thyromegaly, JVD 7cm
above the sternal angle.
Chest:
Increased AP diameter, hyperresonant with poor
diaphragmatic excursion, decreased breath sounds
throughout without sounds of wheezing or crackles
Cor:
Prominent PMI in the epigastrium, sinus rhythm
with occasional premature beats, normal S1, prominent S2
over the pulmonic area with paradoxical splitting in S2,
no S3, but prominent S4 in the left parasternal area,
5th intercostal space. 2+ pitting edema to
the knees in the lower extremities.
Abd:
Normal bowel sounds, nondistended, nontender, liver edge
palpable 2cm below the right costal margin, spleen tip
not felt, no other masses palpated.
What
exactly is an obstructive lung disease anyway?
-
During expiration, the flow of air through the airways
is decreased.
-
Diseases include:
-
COPD – chronic obstructive pulmonary disease
-
Emphysema
-
Chronic Bronchitis
-
Asthma is sometimes included, but more commonly
placed in its own category due to its unique
inflammatory response. If the obstruction in
asthma is incompletely reversible then it is
included as COPD.
-
Asthma – when it’s reversible it gets its own
category (and it most commonly is reversible)
-
Bronchiectasis
-
Cystic Fibrosis –Cystic Fibrosis is almost a
subclass of bronchiectasis. More on all of these
diseases will follow…
Back to the Respiratory System
Index
|
