COPD CASE STUDY

COPD CASE STUDY ASSIGNMENT DETAILS The ability to communicate your knowledge in" rel="nofollow">in oral and written formats is a core academic skill set you should acquire whilst at University. Learnin" rel="nofollow">ing Outcomes Successful completion of this assignment should allow you to: -    demonstrate an understandin" rel="nofollow">ing of the pathophysiology, diagnosis and prehospital management of patients with respiratory-related conditions, -    apply an in" rel="nofollow">integrated understandin" rel="nofollow">ing of the anatomy and physiology of body systems to paramedic practice, -    defin" rel="nofollow">ine and effectively convey clin" rel="nofollow">inically relevant in" rel="nofollow">information in" rel="nofollow">in an organised and logical fashion, -    support your viewpoin" rel="nofollow">ints with sound reference sources and where possible provide a balanced critical assessment of the evidence base used to in" rel="nofollow">inform accepted clin" rel="nofollow">inical practices, -    broaden your understandin" rel="nofollow">ing of the relationships between body systems and the development of pathology/pathophysiology Assignment Requirements A 1500 word, structured response answerin" rel="nofollow">ing the specific questions presented in" rel="nofollow">in the followin" rel="nofollow">ing case study. •    Information provided in" rel="nofollow">in your answers must be referenced followin" rel="nofollow">ing academic conventions. A bibliography should be in" rel="nofollow">included at the end of your document conformin" rel="nofollow">ing to Harvard (author/date) format. References and in" rel="nofollow">in text citations are not in" rel="nofollow">included in" rel="nofollow">in the word count. •    Diagrams can be in" rel="nofollow">included to help support your answers – they are not in" rel="nofollow">included in" rel="nofollow">in the word count. •    Use the answer template provided by pastin" rel="nofollow">ing it in" rel="nofollow">into a new document Integrated Clin" rel="nofollow">inical Case Patient Background You have been tasked Priority 2 to a 75 year old man with chest tightness and shortness of breath.  On your arrival you fin" rel="nofollow">ind a very thin" rel="nofollow">in, elderly man sittin" rel="nofollow">ing on a chair with his arms braced on his knees.  He looks very dyspnoeic.  His in" rel="nofollow">initial observations are: Table 1 Respiratory rate    45 breaths/min" rel="nofollow">inute Heart rate    120 beats/min" rel="nofollow">inute Blood Pressure    95/50 mmHg Oxygen saturation    82% Glasgow Coma Score    13 (E=3,V=4, M=6) The man’s name is Mr Wenham, and he is only able to speak sin" rel="nofollow">ingle words.  His wife tells you that his breathin" rel="nofollow">ing is never very good, because he smoked far too much.  She says he sometimes struggles to walk around the house. Table 2 Symptoms    Shortness of breath, chest tightness, cough Onset    “His breathin" rel="nofollow">ing has been particularly bad for the last two days and much worse for the last hour or so” Chest examin" rel="nofollow">ination    Barrel chested, little chest wall movement Breathin" rel="nofollow">ing sounds    Very quiet breath sounds, occasional wheeze Jugular vein" rel="nofollow">ins    Elevated 5cm You form the view that Mr Wenham is sufferin" rel="nofollow">ing from an exacerbation of Chronic Obstructive Pulmonary Disease (COPD).  You admin" rel="nofollow">inister supplemental oxygen, atrovent and salbutamol (followin" rel="nofollow">ing local guidelin" rel="nofollow">ines), and prepare for the 60 min" rel="nofollow">inute journey to hospital. 1.    Describe the pathophysiological changes that occur in" rel="nofollow">in COPD and lead to the signs and symptoms listed in" rel="nofollow">in Table 2. With reference to the relevant pathophysiological changes, explain" rel="nofollow">in the reason/s for the patient observations listed in" rel="nofollow">in Table 1.(20 marks) 2.    Discuss why you would admin" rel="nofollow">inister salbutamol and describe how it works at the cellular level.(10 marks) Mr Wenham’s oxygen saturation improves with supplemental oxygen but he remain" rel="nofollow">ins tachypnoeic, tachycardic and hypotensive.  On arrival at the Emergency Department you go straight to the resuscitation room and an arterial blood gas sample is taken and analysed immediately with the followin" rel="nofollow">ing results: Table 3 pH    7.12 PaO2    100 mmHg. PaCO2    110 mmHg HCO3    38 3.    Discusswhy they would take an arterial blood gas and explain" rel="nofollow">in what the results mean and how they relate to the pathophysiology you described.(10 marks) The emergency department staffsuggest you may have given Mr Wenham too much oxygen. They say they are goin" rel="nofollow">ing to remove the oxygen. 4.    Overview the normal physiological control of breathin" rel="nofollow">ing (not the mechanics of ventilation). Then, explain" rel="nofollow">in how carbon dioxide retention might occur when COPD patients are receivin" rel="nofollow">ing supplemental oxygen. How would you recognise this if it was happenin" rel="nofollow">ing to Mr Wenham? (20 marks) 5.    When considerin" rel="nofollow">ing his blood gas analysis, do you thin" rel="nofollow">ink it is a good idea to remove Mr Wenham’s oxygen and have him just breathin" rel="nofollow">ing air? Provide an argument supportin" rel="nofollow">ing why it is OR why it is not.(10 marks) The emergency department consultant returns from his lunch break to in" rel="nofollow">interrupt the oxygen debate.  He suggests that Mr Wenham needs BiPAP. 6.     What is BiPAP?  How might BiPAP help to improve Mr Wenham’s clin" rel="nofollow">inical condition? (10 marks) Three days later, after 18 hours of BiPAP, corticosteroids and physiotherapy, Mr Wenham is much improved.  The respiratory physician responsible for his care orders spirometry.  This shows: Table 4 FEV1    0.75 litres FVC    1.5 litres FEV1/FVC    50% 7.    What is spirometry?  (5 marks) 8.    Discuss the significance of the results by examin" rel="nofollow">inin" rel="nofollow">ing the differences between Mr Wenham’s spirometry and that of a normal in" rel="nofollow">individual? (10 marks) 9.     How does the pathology of COPD explain" rel="nofollow">in these differences? (5 marks) PARA2001: Integrated Clin" rel="nofollow">inical Case Answer Template (cut and paste in" rel="nofollow">into a new document). 1.    Describe the pathophysiological changes that occur in" rel="nofollow">in COPD and lead to the signs and symptoms listed in" rel="nofollow">in Table 2. With reference to the relevant pathophysiological changes, explain" rel="nofollow">in the reason/s for the patient observations listed in" rel="nofollow">in Table 1.(20 marks) 2.    Discuss why you would admin" rel="nofollow">inister salbutamol and describe how it works at the cellular level. (10 marks) 3.    Discuss why they would take an arterial blood gas and explain" rel="nofollow">in what the results mean and how they relate to the pathophysiology you described. (10 marks) 4.    Overview the normal physiological control of breathin" rel="nofollow">ing (not the mechanics of ventilation). Then, explain" rel="nofollow">in how carbon dioxide retention might occur when COPD patients are receivin" rel="nofollow">ing supplemental oxygen. How would you recognise this if it was happenin" rel="nofollow">ing to Mr Wenham? (20 marks) 5.    When considerin" rel="nofollow">ing his blood gas analysis, do you thin" rel="nofollow">ink it is a good idea to remove Mr Wenham’s oxygen and have him just breathin" rel="nofollow">ing air? Provide an argument supportin" rel="nofollow">ing why it is OR why it is not.(10 marks) 6.    What is BiPAP?  How might BiPAP help to improve Mr Wenham’s clin" rel="nofollow">inical condition? (10 marks) 7.    What is spirometry?  (5 marks) 8.    Discuss the significance of the results by examin" rel="nofollow">inin" rel="nofollow">ing the differences between Mr Wenham’s spirometry and that of a normal in" rel="nofollow">individual. (10 marks) 9.     How does the pathology of COPD explain" rel="nofollow">in these differences? (5 marks) REFERENCES