SCENARIO
Patient with initial D.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 DATA
1) Patient smoked one pack of cigarettes daily for more than 30 years
2) Patient has difficulty breathing when he walks.
3) Patient has been sleeping in a recliner to make it easier to breath.
4) Patient shoes are tight at the end of the day.
OBJECTIVE DATA
PHYSICAL EXAMINATION
1) Blood pressure 125/90, Pulse 90, Temperature 98.4 F, Respiration 32.
2) Increased anterior posterior diameter
3) Breath sound diminished with prolonged expiration.
4) 2+ peripheral edema bilateral lower extremities
5) Thin with muscle wasting
6) Respiration labored
DIAGNOSTIC STUDIES
1) Arterial blood gases: PH 7.32, SaO2 86%, PaCO2 55mm hg, PaO2 70mm Hg
2) Chest x-ray shows hyperinflation in lungs
3) FEV1 65%
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