Don is experiencing symptoms of coughing, shortness of breath, and fatigue due to chronic bronchitis and a respiratory infection likely caused by influenza. Examination finds his blood pressure, pulse, and respiration are elevated, indicating severe respiratory distress. Chest X-rays reveal Don has emphysema, a destructive lung disease where the air sacs have been destroyed, reducing oxygen transfer and lung elasticity and causing shortness of breath.

1. Pharm-T 402
Body System II
Case Study the Respiratory system
Halla Eltahir
I. Chronic bronchitis is causing these symptoms of coughing and shortness of breath.
II. Don’s feeling tired is a result of theinfection (flu) and sleeping poorly due to coughing.
III. Coughing makes Don wake up all night and that will make him feel tired.
IV. Patients with influenza typically experience a dry cough that cause chest pain and interferers with
sleep. Influenza causes diffuse muscle soreness, particularly in the back and lower extremities
that’s why many patients complain of feeling weak and easily fatigue.
V. Sputum is mucus and other matter brought up from the lungs, bronchi and trachea that one
may cough up and spit out or swallow.
VI. Clear sputum (colorless) that is slightly sticky and a bit viscous (thicker than water) is accepted
as normal sputum. It is produced and secreted in moderate amounts to moisten the respiratory
tract and trap dust and microorganisms (mucus) and lubricate the mouth and aid with chewing,
swallowing and digestion (saliva). While any expectorated sputum is considered to be abnormal,
small amounts of sputum can be coughed up or spat out with effort even in the absence of any
respiratory pathology.
VII. Sputum can be clear, white, gray, yellow, green, brown or black and red.
VIII. Sputum color and amount may indicate different lung diseases and infection. The color can
provide hints as to effective treatment in Chronic Bronchitis Patients. Ex. Bloody sputum (lung
cancer), massive blood sputum( tuberculosis of lung), purulent sputum( infection),Frothy pink
sputum pulmonary edema
IX. Smoking causes lung diseases (e.g., emphysema, bronchitis, chronic airway obstruction) by
damaging the airways and alveoli of the lungs. Smokers are more likely than nonsmokers to
have upper and lower respiratory tract infections. Smokers have a higher risk of developing lung
cancer.
X. Because of the secondhand smoke .Exposure to environmental cigarette smoke is known to
damage the lung and it may contribute to emphysema.
XI. Don doesn’t like to walk the golf course because COPD slowly destroys the lung and makes it
increasingly difficult for a patient to breathe and to perform exercise and minim activity such as
walking.
XII. He might appear to be thin and malnourished. In part, this cachexia results from the high energy
cost of breathing with COPD. In addition, the chronic inflammatory state underlying COPD tends
to put the body’s metabolism into a catabolic state.
XIII. Hypertension (HTN) or high blood pressure, sometimes arterial hypertension, is a chronic
medical condition in which the blood pressure in the arteries is elevated. This requires the heart
to work harder than normal to circulate blood through the blood vessels.

2. XIV. Vasodilator medication works to relax and open your blood vessels. This allows your blood to
flow more easily, which lowers blood pressure.
XV. HTN is risk factor for heart disease which causes shortness of breath, cough and difficulty
breathing.
XVI. Forced expiration is a simple but extremely useful pulmonary function test. A spirometry tracing
is obtained by having a person inhale to total lung capacity and then exhaling as hard and as
completely as possible. These tracings are a very effective way of separating normal ventilatory
states from obstructive and restrictive states.
XVII. Tell you the severity of the lung damage and whether you have obstructive or restrictive??
XVIII. Muscles used during forced expiration :
The diaphragm, internal oblique, external oblique, scaleus anterior, the trapezius,
Inspiratory muscles: Diaphragm, ext oblique, scalene, trapezius, SKM.
Expiratory muscles: Abdominal, internal oblique.
XIX. Don’s BP, pulse, and respiration are higher than the normal.
XX. That he is in severe respiratory distress
XXI. His EKG indicates no heart problem.
XXII. The ABG indicate that his oxygenation is normal.
XXIII. The X-ray reveals that Don’s has emphysema (COPD).
XXIV. The air sacs (alveoli) are destroyed in his lung, so they are able to transfer less and less oxygen
to the bloodstream, causing shortness of breath. The lungs also lost their elasticity, which is
important to keep airways open.
XXV. Depressed diaphragm cause shallow rapid breathing so the patient usesthe accessory muscle to
assist the breathing.
XXVI. When the lungs become enlarged and overinflated with air, the diaphragm is displaced
downward (flattened) and is unable to contract efficiently. Furthermore, the chest wall is
enlarged, making accessory breathing muscles less efficient causing the barrel chest.
XXVII. Emphysema is a destructive disease of the lung in which the alveoli (small sacs) that promote
oxygen exchange between the air and the bloodstream are destroyed
XXVIII. The other factors are shortness of breath, chronic dry cough, physical exam (barrel chest),
history of smoking, X-ray image all of that support a diagnosis of emphysema.
XXIX. The damaged alveoli and the reduced number of capillaries mean that the heart has to pump
hard to move blood through the lungs. Over time, this can place considerable strain on the
heart.
XXX. X-ray of the lung will not look normal because the damage to the lungdue to emphysema is
irreversible.