Whistling-wheezing(narrowing of the airways)

Sinusitis-Inflammation of sinus cavities

Atopic disease-tendency to get the particular disease due to genetics

began during the daytime, which aggravated by modest dust

inhalation-Farmer exposed to pesticides/dust

-obstruction of the airway

-Dust act as allergen cause bronchospam/hypersensitivity

2)tightness in his chest and shortness

of breath were so severe that he had to eventually seek medical help-Significant pressure in the chest/inflammation causing reduced lung function

3) patient is now very uncomfortable, even at rest-Significant resp problems since it is caused by

4) he has had a productive cough with greenish yellow

sputum, mild fever, malaise, and fatigue-(green/yellow)-due to content of mucus that has immune cells/bacterial infection.White sputum(healthy).

(green/yellow appearance)-presence of myeloperoxidase

-mild fever which is the inflammatory response of the patient.

-malaise is non specific and caused by various disease.Can be caused by metabolic disorder.

6)He denies previous lung problems except for mild “whistling” in his chest, which has occurred off and on during the past several years

• whistling-asthma,bronchiolitis

• mild,intermittent

• exposure to allergens causing on and off symptoms

7) denies the use of any prescription medications and any

previous episodes of dyspnoea, sinusitis, or allergies

• not diagnosed by any problems and did not take any medication to treat the problem

• did not take any ACEi

• can exclude drug induced asthma such as aspirin

  8)non-smoker and his family history is negative for lung

  disease and atopic diseases-probably does not have COPD

• no atopic-occur later

  
  

• bp,resp rate,temp,heart rate,oxygen saturation

2)Physical examination

• tripod position,cyanosis,increased resp rate

• chest examination(anterior/posterior) diameter-increase indicates asthma

  3)Lung auscultation

4)FBC-increase in WBC we can conclude that he has infection

5)Urine analysis

• detect the presence of strp pneumonia

6)Chest X- ray-detect the change in lungs

• check for lung collapse

7)Sputum/blood culture test

8)Mantoux test-tb

9)Spirometry-detect the severity of shortness of breath

10)ECG-to rule out cardiac involvement(if normal)

-paradoxical pulse - abnormal drop - drop more than 25mm hg -

- resonance - low pitch hollow sound in lung tissue

-SCM - assist in forced inhalation

- mild abdominal paradox - chest wall goes opposite of the normal

- polyphonic - diff pitch

-

-mild diaphoretic - due to fever - as a compensatory mechanism

- sitting up on the edge of the bed - facilitate the breathing - tripod

- vital signs -temperature -slight increase - indicate infection

• High HR, increase respiratory rate - compensatory mechanism - due to inadequate of O2 supply

• BP - normal

- paradoxical pulse - sudden drop -small airway - more negative pressure inside - reduce venous return - reduce CO -systolic pressure drop

-nasal wing flare - more inhalation by widening

- SCM tensed - more workload

-Chest examination revealed increased anteroposterior diameter with decreased expansion during breathing - reflects hyper-inflated lung - deformity which lung in expanded size

-resonance to percussion moderately increased bilaterally-occur due to air trapping and hyperinflation - incerase of resonance

- mild abdominal paradox with respiratory efforts - main reason is due to hyperinflation - when we exhale the lung does not go inward - diaphragm doesnt function properly - accessory muscle lift up the rib cage when inhaling

- Respiratory rate was rapid with prolonged

expiratory phase - mucus obstruct the airways, hard for expiration- prolonged expiratory phase - increase breathing

- polyphonic wheezing heard over entire chest

during inhalation and exhalation - polyphonic obstruct small airways - bronchiole - asthma or copd

-focus on respi only

- spirometry

- sputum test - pneumonia

- ABG - arterial blood gas

- FBC

infiltrates - occur inn air traping or over inflation lung, no abnormal substance like pus, fluid accumulate within lung parenchyma- no infection lung tissue(not pneumonia)

2. PaO2 - hypoxemia, low O2 in blood, H+ ion normal (pH not altered much then )(due to PaCO2 normal)-insufficient oxygen supply- mucus deposition cause difficulties gas exchange

3. FEV and FVC low- obstructive type lung disease

4. Peak expiratory flow 140 liters/minute- exhale low air(obstruction)(air trap)

5. Full blood count - within normal range( not infection related)

6. diagnosed with asthma

   exacerbated by acute bronchitis and started on oxygen via nasal

   cannula, which improved oxygen saturation from 87% to 97%.-(preexisting condition of asthma, worsen by acute bronchitis)(show improvement o2 saturation)

7. salbutamol by nebulizer-saba receptor antagonist- relaxing the airways smc-

8. patient was discharged on oral antibiotics and fluticasone- ab to trea infection, fluticasone-corticosteroid to reduce the airways inflammation, (salmetarol is LABA ( long bronchodilator effect)