MODULE 3: OXYGENATION ASSESSABLE QUESTIONS Question 1 Mr. Trevormly is a 60 year
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MODULE 3: OXYGENATION ASSESSABLE QUESTIONS Question 1 Mr. Trevormly is a 60 year old man with a history of significant emphysema and chronic obstructive pulmonary disease. He experiences difficulty breathing upon exertion and can no longer walk down his suburban driveway without needing a rest. His GP has noted ankle oedema and discolouration of his distal lower limbs. His alcohol intake is high and he continues to smoke 10-20 cigarettes per day with a 30 pack year history. a) Briefly outline the process of normal oxygenation in healthy lungs and circulation. (3) Name the physiological features of emphysema. (1) Describe whether a cardiology assessment should be considered for this patient and justify why (based on his symptoms) and how emphysema impacts upon heart function. (5) Describe and relate common potential cardiovascular disease(s) associated with emphysema. (3) Outline Mr Trevormly's prognosis? Describe the treatment or management options available to him. b) c) d) e)Explanation / Answer
A. Inhalation is the process of breathing in and exhalation is the process of breathing out. The vital muscle for inhalation is the diaphragm which is beneath the lungs and is dome shaped. Oxygen in the air is transferred into the blood and carbon dioxide from the blood is transferred into the lungs. This rhythm is controlled by the brainstem. The sensor in the brainstem provide information regarding the rate and depth of breathing. It monitors the levels of carbon dioxide in the blood. When the level is more it sends more electrical signals to the muscles of breathing making breathing faster and deeper and pushing out carbon dioxide. Thus making the level of carbon dioxide back to normal.
B. Emphysema is abnormal enlargement of air sacs in the lungs. It is a type of chronic obstructive pulmonary disease.
C. Yes a cardiology assessment should be done for this patient because the patient is complaining of shortness of breath upon exertion and while walking down his driveway. Due to emphysema it is difficult to exhale all the air out because of lung damage. Breathing becomes comfortable at rest but when active inhalation starts before exhalation. This causes shortness of breath. If the patient has heart failure, the heart doesn't pump blood effectively.
D. The common potential cardiovascular diseases associated with emphysema are left sided and right sided heart failure. In heart failure, the patient cannot breathe easily during activity because blood flow increases and the heart cannot pump hard and fast. Due to this the blood backs up in the lungs which causes fluid to build up in the body causing enema of legs and belly.
E. There is no cure but there are many treatment options to slow the progression of the disease. Quitting smoking is the best first step. The prognosis decreases if the patient continues to smoke. Treatment options are stop smoking, bronchodilators, steroids, antibiotics and oxygen therapy.
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