Reference no: EM133979890

Assignment:

A 70- year old male was brought to the Emergency Room of a government hospital with fever and difficulty of breathing.

Patient is apparently homeless and was brought by companions who said that he has had fever and productive cough the past 4 days and he has not been eating well. Also, one week prior to admission, patient was hit by a runaway motorcycle. He sustained bruises and complained of pain in the right foot but did not seek medical consultation.

Personal and social history: Patient is a neglected elderly, with no known family relations. He subsisted on begging for alms; apparent reliance on other homeless mendicants within the same area

Physical Findings:

General: elderly male, conscious, incoherent, cachectic, in respiratory distress,

nonambulant

Vital signs: BP 140/80 T 38.9 C per axilla

HR 108bpm RR 36/min Weight: 48kg

Skin: warm with poor turgor, dry, rough

(+) multiple abrasions

HEENT: Pale conjunctiva, dry cornea; pupils reactive to light

(+) alar flare; (+) dry lips and mucosa

Chest Findings: symmetrical chest movement, rapid, shallow breathing

(+) intercostal retractions; (+) harsh breath sounds over midlung fields

(+) course rales, midlungs to bases; absent breath sounds in the left lower lung

Cardiovascular: (+) dynamic precordium; (+) tachycardia

Abdomen: Scaphoid, with poor skin turgor

Laboratory:

CBC: Decreased hemoglobin and elevated WBC count with predominance of neutrophils

Hb 8.2 g/dL; RBC 3 M/cmm; WBC 20 K/cmm

Arterial Blood Gas: pH 7.42; PaO2 55 mmHg; PaCO2 30 mmHg

Chest X-ray, PA view:

There is homogenous opacification of the left lower lung with pleural effusion;

Impression: Pneumonia, bilateral with consolidation of left lower lobes.

Pleural effusion, left lung.

Clinical Impression: Pneumonia, community- acquired

Malnutrition

QUESTIONS:

1. Identify the changes that occur in the in pneumonia.

2. Describe the effect of the above changes on respiratory function, as follows:

a. Tidal Volume

b. Inspiratory Reserve Volume

c. Expiratory Reserve Volume

d. Residual Volume

3. What is the effect on ventilation:perfusion ratio in the lungs of this patient?

4. What causes the hyperventilation in the patient?

5. Explain the effect of the PO2 and PCO2 on the respiratory center.

6. Create a concept map for the case