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PATHOPHYSIOLOGY

Predisposing Factors Old age (72 yrs old) Socioeconomic status


Budesonide neb Ciprobay 250mg 1 tab productive cough with thick and mucupurulent sputum Decreased tactile fremitus X-ray (07-19-10): Hazy densities are seen in the left lower lung field

Precipitating Factors Exposure to chemical irritants such cigarette smoke

Hematology (July 17, 2010) Segmenters: 94 WBC: 11,000 (NV: 5000-10,000) Lymphocytes: 43% (NV: 20-40%)

Mucosal Inflammation

Mucosal Edema Hypertrophy of bronchial mucus glands

Muscle Contraction Bronchial smooth muscle cell hyperactivity

Mucus Secretion Goblet cell hyperplasia

Narrowing of bronchial lumen

bronchospasm

Squamous cell metaplasia

RR= 36 cpm Nasal flaring and use of accessory muscle Dyspnea

Obstruction of airflow

Accumulation of secretions

Combivent 1neb + budesonide neb

Decrease ventilation

impaired gas exchange

Air trapping

ABG (07-17-10) PO2: 69mmHg (NV: 80-100mmHg) O2 sat-93% (NV: 95-100%)

Hypoxemia

Hypercapnia

ABG (07-17-10) PCO2: 80.5mmHg (NV: 35-45mmHg)

Low flow oxygen therapy (2L/min) via nasal cannula

Vasoconstriction of blood vessels

Respiratory acidosis BP: 150/90mmHg (NV: <120/80)

Pulmonary hypertension

HR: 112bpm (NV: 60-100bmp)

Increase workload in the right side of the heart

Valsartan 8mg tab Digoxin 0.25mg 1 tab

Right sided heart failure

Bipedal edema Jugular vein distention

Spironolactone 50mg 1 tab Legend: Precipitating & predisposing factors Disease process Complications Signs and Symptoms Management

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