Thank you for referring Gentian Balashi, a 37-year-old gentleman of Albanian origin who immigrated to Australia 18 year ago. Gentian is a current smoker of 10-15 cigarettes per day and in total has smoked for five years. He works as a farmer and keeps pet dogs. His only regular medication is Nexium.
Gentian reports a history of childhood asthma and frequent upper respiratory tract infections. Over the last couple of years, he has been aware of intermittent wheeze, a cough productive of small amounts of thick discoloured phlegm and intermittent dyspnoea. There has also been sino-nasal congestion with post-nasal drip. Gentian does not report typical allergic rhinitis symptoms. He also experiences frequent reflux symptoms.
A couple
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of months ago, he went to Albania and whilst there developed a respiratory tract infection and was commenced on a course of antibiotics after seeing a doctor in Italy. He arrived back a month ago and had another course of antibiotics that was completed a month ago. On review today, he does feel better, but reports many of the previous symptoms.
As you are aware, Gentian has had a couple of CT chest scans, the most recent of which has commented on a 6mm right lower lobe superior segment nodule and a 4mm nodule in the lateral basal segment of the left lower lobe. There are no other obvious parenchymal abnormalities.
On review today, Genian is comfortable at rest with an oxygen saturation of 97%. Oropharyngeal inspection revealed some crowding, but no oropharyngeal secretions. Chest auscultation was clear and two heart sounds were audible with nil else.
Assessment:
Concerning the pulmonary nodules, pleasingly these have not changed over a two-year period and I have reassured Gentian that these will be benign and post-inflammatory in nature. No further imaging is required.
Concerning his ongoing symptoms, it is likely that he has some mild asthma in association with low-grade rhinosinusitis and intermittent reflux. I have advised him to continue with Nexium, but he will commence Alvesco 160mvg daily and intranasal saline and steroid sprays.
I will see him again in a few weeks, at which point we will perform lung function tests to get an objective measure of his asthma control.
Thank you again for your
referral.
Examination revealed an oxygen saturation of 98% and blood pressure of 145/90. Oropharyngeal inspection revealed significant crowding (Mallampati class 3) with macroglossia. Chest auscultation was clear and two heart sounds were audible with nil else.
R.S.’s clinical findings as a consequence of his chronic bronchitis are likely to include: being overweight, experiencing shortness of breath on exertion, producing excessive amount of sputum, having a chronic productive cough, as well as edema and hypervolemia just to name a few. (Copstead & Banasik, 548) Some of these signs and symptoms would be different if R.S. had emphysematous COPD. In emphysema (or “pink puffers”), there is weight loss, the cough is absent or negligible, and edema is not present. While central cyanosis and jugular vein distention are present in late chronic bronchitis, these pathologic manifestations are absent in emphysema. . (Copstead & Banasik, 549)
R.S. has chronic bronchitis. According to the UC San Francisco Medical Center “Chronic bronchitis is a common type of chronic obstructive pulmonary disease (COPD) in which the air passages in the lungs — the bronchi — are repeatedly inflamed, leading to scarring of the bronchi walls. As a result, excessive amounts of sticky mucus are produced and fill the bronchial tubes, which become thickened, impeding normal airflow through the lungs.” (Chronic Bronchitis 2015) There are many things that can be observed as clinical findings. R.S. will have a chronic cough that has lasted from 3 months to two years or more, and a lot of sputum. The sputum is due to
My PICOT question was developed after reading the case study about a patient named Vincent Brody who had for the last 50 years of his life consumed 40 cigarettes a day and despite his diagnosis of Chronic obstructive pulmonary disease (COPD) and a recent episode of exacerbation of his condition that required him to be admitted to hospital he was continuing to smoke.
Growing up with a best friend who has been smoking since middle school, I have seen many of the negative effects it has on a person. Football was a passion and way of life for Andy; however, smoking caused him to struggle with breathing while running up and down the field. He would cut down on his daily amount of cigarettes before and during the season, but cutting down was little help for him. Not only was his breathing affected by smoking, but he also had yellow teeth, smoker’s cough, and would get “the shakes” when in need of a smoke.
Husain, A., (2010), The Lung, Robbins and Cotran Pathologic Basis of Disease, pp. 677-737, Philadelphia: Saunders Elsevier
The clinical manifestation one may see in patients with chronic bronchitis are chronic cough, weight loss, excessive sputum, and dyspnea. Chronic cough is from the body trying to expel the excessive mucus build up to return breathing back to normal. Dyspnea is from the thickening of the bronchial walls causing constriction, thereby altering the breathing pattern. This causes the body to use other surrounding muscles to help with breathing which can be exhausting. These patients ca...
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
ENT: His TM's are _____ with _____. He has no palpable masses or nodes in his neck.
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
Neck: AROM, no carotid bruit bilaterally,the trachea is midline, no nodules, lymph or thyroid enlargement or JVD.
Smoking cigarettes is a detrimental practice not only to the smoker, but also to everyone around the smoker. According to an article from the American Lung Association, “Health Effects” (n.d.), “Smoking is the leading cause of preventable death in the U.S., causing over 438,000 deaths per year”. The umbrella term for tobacco use includes the use of cigarettes, cigars, e-cigs and chewing tobacco. While tobacco causes adverse health consequences, it also has been a unifying factor for change in public health. While the tobacco industries targets specific populations, public health specifically targets smokers, possible smokers, and the public to influence cessation, policies and education.
I also noticed that he a past medical history of End Stage Renal Disease. I was able to assess his fistula on his left arm. I was able to hear the bruit and feel the thrill. He got a Chest XRAY and they found that there was a small pleural effusion in his left lung. There are no known causes for it because they performed cultures. The plan was to monitor I/O using a foley catheter. They did not get anything back. He had a fistula in his left arm because he goes on dialysis Monday, Wednesday, and
“Dangers of Smoking Cigarettes for Smokers” healthliteracy.worlded.org. Copyright 1995 by Marjorie Jacobs revised 1997, n.d web 14 April 2011
...inhalers whenever he has difficulty breathing but other than that he has no other medical problems.