COPD and Asthma: how are they different - Term Paper Example

?COPD and Asthma: How they are different? With the similarity of presenting signs and symptoms, COPD and asthma are to be misdiagnosed (Cranston et al., 2008). In this paper, two cases will be discussed separately including the full medical history, laboratory and diagnostic procedure, treatment and care plan in each case. Although these patients showed similar signs and symptoms, the results of diagnostic work- up, especially that related directly to the respiratory status such as Spirometry, bronchodilator test, and chest x- ray revealed that they have different diseases. Case No. 1: Patient with Asthma Chief Complaint Shortness of breath History of Present Illness J.G., 46, male, comes to the health clinic having shortness of breath after doing his normal routine of workout at a fitness gym. He admits having these episodes of SOB after four weeks of having chest cold, but refused to seek medical care. He is also having a non- productive cough. Lately, he had been into “so much stress from work”. Rest and relaxation technique usually alleviates his symptom. Past Medical History Patient claims to and healthy person, although he admits that he had mild asthmatic attacks until he was a teenager. He was never admitted of any disease and has never been surgically operated Family History His mother died from status asthmaticus at 65, while his father died of complications from diabetes at 62. He is the only child in the family. He had not known much about his relatives. Genogram Personal Social History Patient claims to be a very active person. He is athletic and loves to join camps, and other sports events as a form of relaxation and relief from stress. He attends a fitness gym and usually runs at 3 miles per session. He does not smoke, but drinks alcoholic drinks at least once a week. He works as an accountant in a local firm. He claims to be in “so much stress” lately. He divorced his wife this year and has no child. Review of Systems. Patient does not have history of pathology involving the cardiovascular, gastrointestinal, neurologic, and musculoskeletal systems, although he admits having asthmatic attacks back in his childhood that rarely required hospital admission. While he had a wife for 10 years, he has no child and denies having a medical check-up pertaining to his reproductive capacity. No allergies reported. He denies any pain felt, but says “uncomfortable” with persistent cough and SOB. No changes were noted in his usual bowel and bladder habits. General. Patient is physically fit and has an athletic body. He is anxious for both of his work and health. Vital Signs. T- 36.5 C, RR- 34 cpm (labored breathing), PR- 113 bpm (weak and fast), BP- 126/ 87 mmHg Height/Weight . 5’7”, 72 kg, BMI= 25 Neurologic. Patient is conscious, coherent, oriented to time, person, and place. He has not experienced any changes in his level of consciousness, orientation, and level of functioning, thinking, cognition, and intellect. Eyes, ears, nose, throat. Patient wears his eyeglasses. His conjunctiva appears moist and pink, unicteric. Ears are clean, with minimal amount of cerumen noted upon direct inspection. No mastoid inflammation noted. No hearing difficulties reported. Nose is central and symmetrical. No discharges noted. Nasal flaring was observed in each breathing cycle. Throat is moist even if the patient breaths through his mouth to assist in breathing difficulty. Throat is not deviated to either side. Cardiovascular. No murmurs, rubs, and splits heard upon auscultation of the heart. Upon auscultation of the lower left sternal border, the first heart sound (S1) heard was soft, long, and low pitched. The second heart sound (S2) was shorter and high- pitched. No pulse deficit noted between the heart rate and radial pulse rate. No cyanosis noted. Respiratory. Breathing pattern is notably longer, irregular, and labored. He is unable to complete a sentence with just a few words between breaths. Use of accessory muscles of breathing is noted. Muscular retractions in the sternum, suprasternal notch, and in between ribs are noted. The AP diameter of the chest is twice its lateral diameter. Wheezes are heard louder in each exhalation, with the breathing cycle notably longer and with much effort. Fine crackles are heard on the tracheal, bronchial, bronchovesicular, and vesicular lung fields. No cyanosis and clubbing of fingers noted. Gastrointestinal. The abdomen is flat, not distended, and has prominent abdominal muscles. Borborygmi were actively heard upon auscultation of the four quadrants of the abdomen. No bruits heard upon auscultation of the area over the aorta. Upon percussion, dull sounds are heard on the area directly over the liver (right upper quadrant), while tympanic sounds over the stomach area (epigastric and left upper quadrant). No pain and tenderness felt upon deep palpation of the liver and spleen. Integumentary. Thin film of sweat is noted on the forehead, axillary, and neck areas. Skin color is appropriate for race, no cyanosis noted on his nail beds and palm. Hair is evenly distributed in the body, as it occurs in a normal pattern for adult males. Genitourinary. No discoloration noted at the costovertebral angle. No obvious swelling, lumps, and enlargement noted on the flank area. No bruit heard upon auscultation. No bladder distention noted upon palpation. The kidneys cannot be palpated directly from the back. No tenderness and pain felt by the patient. Patient refused assessment of the genital area. Laboratory Assessment ARTERIAL BLOOD GASES NORMAL RANGE* RESULT AND MEANING Arterial Oxygen Level (PaO2) 80- 100 mmHg Initially, 77 mmHg (due to decreased inflow of oxygen through narrowed airways prior to clinical intervention). Then, 87 mmHg after oxygen therapy and administration of bronchodilators. This means that the patient responded well to the medications (Smeltzer et al., 2010). Arterial Carbon Dioxide Level (PaCO2) 35- 45 mmHg Initially, 52 mmHg (due to entrapment of carbon dioxide in the lungs). Then, 43 mmHg after oxygen therapy and administration of bronchodilators. This indicates recovery of oxygenation status and a good response to interventions (Smeltzer et al., 2010). Oxygen Saturation 95%- 100% 92%. Slightly below the normal range for adults. This is due to the acute asthmatic attack that caused a sudden but partial airflow limitation. Although the oxygen saturation value does not confirm the presence of asthma, comparing the results before and after giving bronchodilators provide spectacular significance whether the wheezing and SOB are due to asthma or COPD. Oxygen saturation returns to normal as the asthmatic attack is managed, unlike COPD when the airway and oxygenation management may take a longer time and the patient may have to adapt to the decreased supply of oxygen (Ignatavicius & Workman, 2010). BLOOD TESTS Serum Eosinophil 1-2% 2% implies that the asthmatic attack is not caused by an allergy (Ignatavicius & Workman, 2010). Immunoglobulin E 39 IU/ml (usually Read More