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3. Discuss the role of inhaled and/or oral corticosteroids in the management of COPD.  4. What is spirometry? Discuss the process of interpreting FEV1/FVC results. 5. Describe the relationship between α1-antitrypsin deficiency and the development of emphysema

3. Discuss the role of inhaled and/or oral corticosteroids in the management of COPD.  4. What is spirometry? Discuss the process of interpreting FEV1/FVC results. 5. Describe the relationship between α1-antitrypsin deficiency and the development of emphysema

Phlebotomy Essentials
Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
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3. Discuss the role of inhaled and/or oral corticosteroids in the management of COPD. 

4. What is spirometry? Discuss the process of interpreting FEV1/FVC results.

5. Describe the relationship between α1-antitrypsin deficiency and the development of emphysema

 

FH: Mother died from emphysema 4 years ago at the age of 82. Father has a history of coronary artery disease. SH: He lives with his daughter and her family. His wife died 10 years ago from breast cancer. He has a 35-pack-year history of smoking. He quit smoking approximately 3 months ago but has had occasional relapses. He states he has not smoked for approximately a week. He drinks one to two beers every evening. Meds: Metoprolol tartrate 50 mg PO BID, Salmeterol (Serevent Diskus) 1 inhalation (50 mcg) BID, Tiotropium (Spiriva) 1 capsule (18 mcg) inhaled once daily, Lisinopril 20 mg PO once daily, Esomeprazole (Nexium) 20 mg PO once daily, Albuterol MDI 1-2 puffs Q 6 h PRN, Aspirin 81 mg PO once daily ROS: (+) Shortness of breath with chronic nonproductive cough; (+) fatigue; (+) exercise intolerance Objective PHYSICAL EXAMINATION Gen: WDWN man appearing in mild respiratory distress after walking to the end of the hall to reach the exam room VS: BP 138/88, P 85, RR 26, T 37.5°C; Wt 95 kg, Ht 5'11" Skin: Warm, dry; no rashes HEENT: Normocephalic; PERRLA, EOMI; normal sclerae; mucous membranes are moist; TMs intact; oropharynx clear Neck/Lymph Nodes: Supple without lymphadenopathy . . . Lungs: Tachypnea with prolonged expiration; decreased breath sounds; no rales, rhonchi, or crackles CV: RRR without murmur; normal S1 and S2 Abd: Soft, NT/ND; (+) bowel sounds; no organomegaly Genit/Rect: No back or flank tenderness; normal male genitalia MS/Ext: No clubbing, cyanosis, or edema; pulses 2+ throughout Neuro: A & O x 3; CN II-XII intact; DTR 2+; normal mood and affect LABORATORY EXAMINATION Na 135 mEq/L K 4.2 mEq/L Cl 108 mEq/L CO₂ 26 mEq/L BUN 19 mg/dL SCr 1.1 mg/dL Glu 109 mg/dL Hgb 12.1 g/dL Hct 38.5% Plt 195 x 10³/mm³ WBC 6.4 x 10³/mm³ AST 40 IU/L ALT 19 IU/L T. bili 1.1 mg/dL Alb 3.1 g/dL Pulse Ox 93% (RA) Pulmonary Function Tests (during Hospital Admission 1 Month Ago): Prebronchodilator FEV1 = 1.1 L (predicted is 3.1 L) Prebronchodilator FVC = 3.2 L Postbronchodilator FEV1 = 1.6 L Pulmonary Function Tests (during Clinic Visit Today): Prebronchodilator FEV1 = 1.3 L (predicted is 3.1 L) Prebronchodilator FVC = 3.2 L Postbronchodilator FEV1 = 1.47 L Ca 8.9 mg/L Mg 3.6 mg/L Phos 2.9 mg/dL
Transcribed Image Text:FH: Mother died from emphysema 4 years ago at the age of 82. Father has a history of coronary artery disease. SH: He lives with his daughter and her family. His wife died 10 years ago from breast cancer. He has a 35-pack-year history of smoking. He quit smoking approximately 3 months ago but has had occasional relapses. He states he has not smoked for approximately a week. He drinks one to two beers every evening. Meds: Metoprolol tartrate 50 mg PO BID, Salmeterol (Serevent Diskus) 1 inhalation (50 mcg) BID, Tiotropium (Spiriva) 1 capsule (18 mcg) inhaled once daily, Lisinopril 20 mg PO once daily, Esomeprazole (Nexium) 20 mg PO once daily, Albuterol MDI 1-2 puffs Q 6 h PRN, Aspirin 81 mg PO once daily ROS: (+) Shortness of breath with chronic nonproductive cough; (+) fatigue; (+) exercise intolerance Objective PHYSICAL EXAMINATION Gen: WDWN man appearing in mild respiratory distress after walking to the end of the hall to reach the exam room VS: BP 138/88, P 85, RR 26, T 37.5°C; Wt 95 kg, Ht 5'11" Skin: Warm, dry; no rashes HEENT: Normocephalic; PERRLA, EOMI; normal sclerae; mucous membranes are moist; TMs intact; oropharynx clear Neck/Lymph Nodes: Supple without lymphadenopathy . . . Lungs: Tachypnea with prolonged expiration; decreased breath sounds; no rales, rhonchi, or crackles CV: RRR without murmur; normal S1 and S2 Abd: Soft, NT/ND; (+) bowel sounds; no organomegaly Genit/Rect: No back or flank tenderness; normal male genitalia MS/Ext: No clubbing, cyanosis, or edema; pulses 2+ throughout Neuro: A & O x 3; CN II-XII intact; DTR 2+; normal mood and affect LABORATORY EXAMINATION Na 135 mEq/L K 4.2 mEq/L Cl 108 mEq/L CO₂ 26 mEq/L BUN 19 mg/dL SCr 1.1 mg/dL Glu 109 mg/dL Hgb 12.1 g/dL Hct 38.5% Plt 195 x 10³/mm³ WBC 6.4 x 10³/mm³ AST 40 IU/L ALT 19 IU/L T. bili 1.1 mg/dL Alb 3.1 g/dL Pulse Ox 93% (RA) Pulmonary Function Tests (during Hospital Admission 1 Month Ago): Prebronchodilator FEV1 = 1.1 L (predicted is 3.1 L) Prebronchodilator FVC = 3.2 L Postbronchodilator FEV1 = 1.6 L Pulmonary Function Tests (during Clinic Visit Today): Prebronchodilator FEV1 = 1.3 L (predicted is 3.1 L) Prebronchodilator FVC = 3.2 L Postbronchodilator FEV1 = 1.47 L Ca 8.9 mg/L Mg 3.6 mg/L Phos 2.9 mg/dL
Subjective Chief Complaint: "Why can't I just take prednisone every day? It always works when I get admitted to the hospital." HPI: Thomas Jones is a 66-year-old man with COPD presenting to the family medicine clinic today for a 1-month follow- up appointment from his last hospital admission for an acute exacerbation of COPD. This last COPD exacerbation is the second hospital admission in the last 6 months related to TJ's COPD instability. After TJ's hospitalization, his discharge COPD regimen was changed to include tiotropium, 1 inhalation daily in addition to salmeterol 50 mcg, 1 inhalation Q 12 h, and an albuterol MDI as needed. TJ had pulmonary function tests (PFTs) while he was in the hospital 1 month ago but has yet to have them reassessed after the change in his COPD regimen. He wants to start taking prednisone every day because he believes this would prevent him from being readmitted to the hospital. The patient states that his respiratory symptoms are better than when he was admitted 1 month ago, but he still has shortness of breath every day and a decreased exercise capacity (e.g., he becomes very short of breath after walking a couple of blocks). He states that he is adherent to the new medication regimen that was changed on discharge from the hospital. No other medications were changed at that time that he can recall. His daughter, who is at the appointment today, states that she makes sure he uses his inhalers but often wonders if he is using them correctly because he still has daily symptoms. PMH: COPD × 12 years, GERD × 5 years, HTN × 20 years, CAD (MI 5 years ago)
Transcribed Image Text:Subjective Chief Complaint: "Why can't I just take prednisone every day? It always works when I get admitted to the hospital." HPI: Thomas Jones is a 66-year-old man with COPD presenting to the family medicine clinic today for a 1-month follow- up appointment from his last hospital admission for an acute exacerbation of COPD. This last COPD exacerbation is the second hospital admission in the last 6 months related to TJ's COPD instability. After TJ's hospitalization, his discharge COPD regimen was changed to include tiotropium, 1 inhalation daily in addition to salmeterol 50 mcg, 1 inhalation Q 12 h, and an albuterol MDI as needed. TJ had pulmonary function tests (PFTs) while he was in the hospital 1 month ago but has yet to have them reassessed after the change in his COPD regimen. He wants to start taking prednisone every day because he believes this would prevent him from being readmitted to the hospital. The patient states that his respiratory symptoms are better than when he was admitted 1 month ago, but he still has shortness of breath every day and a decreased exercise capacity (e.g., he becomes very short of breath after walking a couple of blocks). He states that he is adherent to the new medication regimen that was changed on discharge from the hospital. No other medications were changed at that time that he can recall. His daughter, who is at the appointment today, states that she makes sure he uses his inhalers but often wonders if he is using them correctly because he still has daily symptoms. PMH: COPD × 12 years, GERD × 5 years, HTN × 20 years, CAD (MI 5 years ago)
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