Mrs X is a 56 year old lady who presents with dyspnea on exertion that has slowly and progressively gotten worse over the last year. She has had a minor non-productive cough. She denies fever, nausea, vomiting or night sweats. Her past medical history is positive for hypertension and hyperlipidemia. Her current medications include simvastatin and lisinopril. She has smoked 1-2 packs of cigarettes daily for 25 years. Her vital are remarkable for respiratory rate of 24 and O2 Sat 89%. Exam reveals a thin female using pursed lip breathing and tripod positioning, the chest is barrel shaped, lung sounds are markedly diminished but there are faint exp wheezes bilaterally. Fingernail clubbing is present bilaterally. Her chest X-ray shows hyperinflation.
a. What is the pathological difference between restrictive and obstructive lung disease? Is the diagnosis in question 1 a restrictive of obstructive process?
b. How is the normal ventilatory cycle affected by the primary diagnosis identified in question 1?
c. Define total lung volume (total lung capacity), vital capacity, and forced expiratory volume (FEV1).
d. How does this diagnosis identified in question 1 affect total lung volume, vital capacity, and forced expiratory volume.
e. How and why is diffusion capacity altered by the diagnosis identified in question 1?
f. If you were to draw an ABG on this person, what would you expect his CO2 level to be high or low and why?
g. Why does this patient have a Barrel Chest?
5. For what actual or potential complications related to the diagnosis in question 1 does she need to be monitored? You may simply list your answer(s) below using a bullet point format. This does not have to be in a complete sentence.