Chronic Bronchitis
S: A 68-year-old man stated that he could not catch his breath or breathe deeply enough to cough up secretions. He complained of mild nausea, abdominal pain, or vomiting.
O: Vital signs: HR 125, RR 30, Temp 37° C (98.6° F), BP 190/115
Overview: The man was diagnosed with severe chronic bronchitis approximately 6 years ago and suffered an acute myocardial infarction 2 years ago. Last week, he felt excessive fatigue (depressive state), and physical activity was minimized.
A: Primary diagnosis: pulmonary hypertension
Among the causes of pulmonary hypertension, an important place is occupied by chronic obstructive pulmonary disease and its most common variant, chronic bronchitis, which occurs in 90% of smokers. It is based on symptoms such as cough (mainly in the morning), chest discomfort, mucus secretion, swelling of the ankles and legs; bluish color of the lips and skin (cyanosis); rapid pulse, and palpitations. The patient has a history of heart and lung disease, which requires close attention to the symptoms presented and suggests this diagnosis.
P: Inhaled nitric oxide (NO) is the only available selective pulmonary vasodilator. Examples of vasodilators (vasodilators) for pulmonary hypertension include calcium channel blockers, treprostinil, iloprost, and treprostinil sodium.
Chronic Bronchitis (2)
S: The man complained of a severe cough, shortness of breath, and difficulty breathing.
O: Vital signs: HR 130, RR 28, Temp 37° C (98.6° F), BP 185/135
General overview: A man complains of a difficult period and worsening symptoms, which causes concern.
A: Main diagnosis: purulent bronchitis
The patient has an active purulent process with fibrous tissue changes; due to the accumulation of secretion, the disease becomes obstructive. In this case, shortness of breath becomes more pronounced, cough – hacking and less productive, breathing – wheezing.
P: In the acute period, it is necessary to observe bed rest and exclude smoking and other factors irritating the bronchi. In order to increase the hydration of sputum and improve its evacuation from the bronchial tree, mucolytics and expectorants (acetylcysteine, ambroxol) are prescribed. The primary method of therapy is empirical antibiotic therapy with drugs of the aminopenicillin group (ampicillin, amoxicillin).
Emphysema
S: The patient was admitted with a complaint of severe, worsening dyspnea — a 62-year-old male who was a smoker for 35 years (he quit smoking 2 years ago). The man worked in a steel factory for 35 years. Two years ago, he was forced to retire due to a deteriorating state of health and a diagnosis of chronic emphysema.
O: Vital signs: HR 95, RR 25, Temp 38.3° C (101° F), BP 155/110
General overview: The patient actively seeks to cope with the disease and carefully performs the drugs and activities prescribed by the doctor.
A: Main diagnosis: chronic emphysema
Prolonged work in a highly dusty place and a long period of smoking are the leading causes of emphysema development. In addition, judging by the words of relatives, the patient often suffers from lung diseases such as influenza, which is also a stimulus for developing the disease.
P: Of the drugs, bronchodilators are used; these include β2-agonists and anticholinergics. Preference is given to long-acting drugs (formoterol, salmeterol). Their use can reduce the severity of shortness of breath and improve the quality of life.
Emphysema (2)
S: The patient complains of heaviness in the chest and increased shortness of breath.
O: Vital signs: HR 97, RR 15, Temp 37.8° C (100° F), BP 160/115
General review: the patient began to expectorate thick, yellow, tenacious sputum; he is also worried that it has become difficult for him to breathe, and his shortness of breath has only worsened.
A: General diagnosis: bronchial obstruction due to progression of emphysema
Clinical manifestations of biofeedback include lengthening of the exhalation, expiratory noise (wheezing, noisy breathing), using accessory muscles in breathing, and an unproductive cough often develops.
P: Salbutamol is used to relieve an attack of bronchial obstruction. Short-acting β2-agonists (salbutamol, terbutaline, fenoterol) are the drugs of choice for reducing the acute bronchial obstruction. When inhaled, they give a quick (after 5-10 minutes) broncho-dilating effect. They should be prescribed 3-4 times a day.