Case Study: Pulmonary

Patient: R.T. is a 68 year old male with complaints of worsening shortness of breath on exertion and chronic cough. Symptoms have been present for several years but have worsened over the past few months. Aggravating factors include cold air, respiratory infections, and physical activity. He experiences partial relief of symptoms with bronchodilator inhalers and resting. Denies fever, chest pain, significant weight loss or hemoptysis.

Medical History: History of smoking (40 pack-years), diagnosed with COPD

Current Medications: Inhalers (bronchodilators and corticosteroids), oxygen therapy as needed

Vital Signs: Blood pressure 140/80 mmHg, heart rate 80 bpm, respiratory rate 20 breaths/min, temperature 98.4F.

Oxygen Saturation: 92% on room air, improves to 95% with supplemental oxygen.

Respiratory Examination:

Prolonged expiratory phase with wheezing and diminished breath sounds bilaterally.

Accessory muscle use and increased work of breathing noted.

Discussion Questions:

• Propose your differential diagnosis and rationale
• What would be the diagnostic workup?
• Pharmacological and non-pharmacological management plan

Peer Response:

• R.T.s oxygen saturation improves with supplemental oxygen. What are the benefits and potential risks of oxygen therapy in patients with COPD?
• Considering the chronic and progressive nature of COPD, what long-term care considerations or advanced planning discussions might be appropriate?

Submission Instructions

• Your initial post should be at least 200 words, formatted and cited in current APA style with support from at least 2 academic sources.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.