Medical Dilemma of David Burns Essay Example

Medical Dilemma of David Burns Essay Example Medical Dilemma of David Burns Paper Medical Dilemma of David Burns Paper Essay Topic: Emma Medical The case of David Burns presents a clinical picture of a patient suffering from a respiratory disorder. Using a cephalocaudal approach of physical assessment, the client demonstrated some signs and symptoms that provide a clearer picture of the medical condition he is enduring. The client has yellow teeth that signify tar build-up due to chronic smoking. Evidence of mild jugular vein distention is also evident refers to an increase in blood volume, or prresence of any abnormalities and obstructions to the normal pathway of blood. Manifestations like shortness of breath, mild dyspnea while talking, use of accessory muscles at rest, and pursed lip breathing may indicate inadequate oxygen intake. The subsistence of yellow sputum denotes infection. Barrel chest or an increase in the anterior posterior (AP) diameter of the chest may mean air trapping. Percussion over the lung fields conjointly revealed ubiquity of hyperresonant sounds that indicate air trapping. Decreased breath sounds may signify overinflation of lungs, presence of air or fluid around the lungs, reduced air flow to a part of the lung, or increased in chest wall thickness. Tactile fremitus is increased whhich denotes lung tissue consolidation. In addition, a +2 pitting edema on the legs may mean venous obstruction or blood pooling. Diverse respiratory diseases can be concluded if presented with these signs and symptoms. Shortness of breath is usually associated with respiratory, circulatory or cardiac problems. If consorted with body malaise, low-grade fever, and expectorating yellow sputum, it may imply chronic bronchitis. Difficulty of breathing, productive coughing as well as a profound increase in the anterior posterior diameter of the chest wall are symptoms related with emphysema and chronic bronchitis. Moreover, hyperresonant percussion, decreased breath sounds, and increased tactile fremitus suggest the same cconditions. David Burns also underwent some neccessary laboratory examinations to aid in diagnosing the disease. The clients blood test showed a decrease in the levels of hemoglobin and hematocrit. An increase in lung compliance makes it unable for the lungs to expel carbon dioxide resulting in a build-up, which subsequently lowers the oxygen level in the blood. Low oxygenation level prevents the hemoglobin in getting enough oxygen, thereby resulting in pale microcytic red blood cells and low hemoglobin. This correspondingly lowers the hematocrit because a low hematocrit reflects a low number of circulating red blood cells and is an indicator of a decrease in the oxygen-carrying capacity (Wennecke, 2004). Arterial Blood Gas (ABG) is also examined and interpreted as respiratory acidosis. In his condition, the production of carbon dioxide occurs rapidly, and failure of ventilation promptly increases the partial arterial pressure of carbon dioxide (PaCO2). Alveolar hypoventilation leads to an increased PaCO2 which, in turn, decreases the bicarbonate (HCO3 -)/PaCO2, decreasing the pH (Minaoui, 2009). Taking into consideration the case of David Burns, chronic smoking is the main factor why he manifested these signs and symptoms. The habit of smoking causes an introduction of irritants to the airways which causes an inflammation. The inflammatory process results to fever and release of chemical mediators such as bradykinin, histamine and prostaglandin, which then increases the capillary permeability. The mechanism resulted in fluid or cellular exudation which in turn causes edema of the mucous membrane. Hypersecretion of mucus follows which accounts for the clients productive cough. Smoking also causes the build-up of nicotine, which is a strong vasoconstrictor. It makes arteries all over the body become smaller making it harder for the heart to pump through the constricted arteries (Spitzer, 2001) to the sytemic circulation, and then back to the heart. Therefore, blood has a tendency to pool down on the lower extremities causing hydrostatic pressure to rise which later results to edema. Since blood vessels are constricted, it would be very difficult for some parts of the human body to have enough oxygen. The condition is further aggravated by the fact that smoking lowers the hemoglobin level in the blood, therefore lowering the oxygen-carrying capacity of the blood. The brain will sense the low oxygen saturation, which then signals the lungs to work faster. This event is responsible for the clients increase in respiratory rate. However, air is trapped considering that there are constricted airways due to the inflammatory process in the lungs. The AP diameter protracts due to an increase in lung compliance, which in turn increases the thoracic pressure. Consequently, the chest expands anteriorly making the it look like a barrel. The disease process, which can lead to unexpected complications, needs medications for treatment and relief of symptoms. With David Burns case, he needs to deal with several classes of medications. Steriods may be prescribed to halt down the inflammatory process. Inhaled corticosteroids have been found to improve symptoms and decrease the frequency of COPD exacerbations, with less systemic effects than oral corticosteroids (Donohue, 2006). Antibiotics may be prescribed to counteract infection. Bronchodilators are also used to help open the bronchial tubes (airways) of the lungs, allowing more air to flow through them. Bronchodilators work by relaxing the smooth muscles that line the airways. This makes the airways open wider and allows air to leave the lungs (Ross-Flannigan, 2002), thus, lowering and preventing build up of intrathoracic pressure.