Medicine
Patient ProfileD.B. is a 63-year-old electrician who came to the emergency department with shortness of breath, morning cough, and swelling in his lower extremities.Subjective DataHas smoked one pack of cigarettes daily for more than 30 yearsHas difficulty breathing when he walksHas been sleeping in a recliner to make it easier to breatheHis shoes are tight at the end of the dayObjective DataPhysical ExaminationBlood pressure 125/90, pulse 90, temperature 98.4F, respirations 32Increased anterior-posterior diameterBreath sounds diminished with prolonged expiration2+ peripheral edema bilateral lower extremitiesThin with muscle wastingRespirations laboredDiagnostic StudiesArterial blood gases: pH 7.32, SaO 86%, PaCO 55 mm Hg, PaO 70 mm HgChest x-ray shows hyperinflation of lungsFEV 65%Question 1What in D.B.s history is commonly associated with pulmonary problems?What is a likely medical diagnosis for D.B.?Question 2What are some common signs and symptoms of this disease?Question 3The patient asks you about how this happened to him. What kind of education would you provide to the patient?Question 4As part of patient teaching, is it "too late" to encourage D.B. to stop smoking? Why?Question 5The patient is prescribed oxygen 2 liters per minute PRN SOB, Albuterol MDI Q4 hours PRN SOB, prednisone 60 mg PO QD.-Which medication should be administered first?Question 6The patient is being discharged. Please give 5 educational tips about the medications that he is prescribed.