Patient Diagnosis & Suggested Treatment
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Qu.1 This patient is in respiratory acidosis because of his emphysema. The patient needs oxygen therapy to counteract his low pO2 level, and IV bicarbonate to restore the buffering capacity of the blood and raise the blood pH (Applegate, 2000, 390). The patient should be placed on a sound, nutritious diet, with vitamin supplements, particularly vitamin A, and antioxidants. Pulmozyme may be prescribed to help break up the mucus in the lungs. If possible, he should get regular exercise. The patient should be assessed to see if he is a candidate for the National Heart, Lung, and Blood Institute FORTE (Feasibility of Retinoid Therapy for Emphysema) study, which employs an experimental drug, ATRA (13 cis-retinoic acid) (Emphysema, 2004). This is a vitamin A derivative which has proven useful against emphysema in animals and is now being tested in humans. He may also be a candidate for lung reduction surgery if he has extensive lung damage, and this would be carried out under the National Emphysema Treatment Trial. The patient should definitely not smoke, and should avoid all sources of second-hand smoke (Emphysema, 2004). He should also try to avoid air pollutants, aerosol sprays, herbicides, pesticides, exhaust fumes and fumes from fuel, and household dust. Qu.2 Four symptoms that indicate that a patient has a partial airway obstruction if choking on food occurs while being fed by a nurse are: 1) wheezing, crowing, whistling or other unusual breathing noises indic
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teria. People working near bird droppings (e.g. poultry workers) get pneumonia from Chlamydia psittaci, and a sudden large outbreak at a convention in 1976 was caused by an organism later named Legionella pneumophila, or ôLegionnaireÆs disease.ö
Tuberculosis is spread by airborne droplet nuclei, which are small particles (1-5 um)containing hundreds of bacilli (Tomford and Ioachimescu, 2004). They are expelled into the air by coughing, sneezing, singing, laughing, talking, etc. and remain suspended in the air for many hours. They can be inhaled and trapped in the alveoli and distal airways. There, they are ingested by local macrophages, multiply within the cells, and within two weeks are transported through the lymphatics to establish secondary sites. The development of a delayed-type hypersensitivity reaction over the next four weeks leads to granuloma formation, with a subsequent decrease in numbers of bacilli. Some of these may lie dormant for many years, and this stage is asymptomatic and radiologically undetected in humans.
Sometimes a primary complex (a Ghon) can be seen radiologically, and later these primary lesions become calcified and can be seen radiologically (Tomford and Ioachimescu, 2004). At this stage,
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Approximate Word count = 1483
Approximate Pages = 6 (250 words per page)
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