Asthma and COPD Q 5

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A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders?

  

     A. ARDS

     B. Asthma

     C. Chronic obstructive bronchitis

     D. Emphysema

    

    

Correct Answer: D. Emphysema

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These are classic signs and symptoms of a client with emphysema. In the early stages of the disease, the physical examination may be normal. Patients with emphysema are typically referred to as “pink puffers,” meaning cachectic and non-cyanotic. Expiration through pursed lips increases airway pressure and prevents airway collapse during respiration, and the use of accessory muscles of respiration indicates advanced disease.

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Option A: Clients with ARDS are acutely short of breath and require emergency care. The physical examination will include findings associated with the respiratory system, such as tachypnea and increased effort to breathe. Systemic signs may also be evident depending on the severity of illness, such as central or peripheral cyanosis resulting from hypoxemia, tachycardia, and altered mental status. Despite 100% oxygen, patients have low oxygen saturation.

Option B: Those with asthma are also acutely short of breath during an attack and appear very frightened. Patients will usually give a history of a wheeze or a cough, exacerbated by allergies, exercise, and cold. There is often diurnal variation, with symptoms being worse at night. There may be some mild chest pain associated with acute exacerbations. Many asthmatics have nocturnal coughing spells but appear normal in the daytime.

Option C: Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance. The most common symptom of patients with chronic bronchitis is a cough. The history of a cough typical of chronic bronchitis is characterized to be present for most days in a month lasting for 3 months with at least 2 such episodes occurring for 2 years in a row. A productive cough with sputum is present in about 50% of patients.

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