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academic conventions This is a case study assignment, the requirements are below, please follow step by step answering each question and writing the answers below each question. Use Australian sources (journal articles, diagrams, statistics… ect). Harvard referencing is required. Please provide text references in each paragraph. Assignment Requirements A 1500 word, structured response answering the specific questions presented in the following case study. • Information provided in your answers must be referenced following academic conventions. A bibliography should be included at the end of your document conforming to Harvard (author/date) format. References and in text citations are not included in the word count. • Diagrams can be included to help support your answers – they are not included in the word count. Integrated Clinical Case Patient Background You have been tasked Priority 2 to a 75 year old man with chest tightness and shortness of breath. On your arrival you find a very thin, elderly man sitting on a chair with his arms braced on his knees. He looks very dyspnoeic. His initial observations are: Respiratory rate 45 breaths/minute Heart rate 120 beats/minute Blood Pressure 95/50 mmHg Oxygen saturation 82% Glasgow Coma Score 13 (E=3, V=4, M=6) The man’s name is Mr Wenham, and he is only able to speak single words. His wife tells you that his breathing is never very good, because he smoked far too much. She says he sometimes struggles to walk around the house. Symptoms Shortness of breath, chest tightness, cough Onset “His breathing has been particularly bad for the last two days and much worse for the last hour or so” Chest examination Barrel chested, little chest wall movement Breathing sounds Very quiet breath sounds, occasional wheeze Jugular veins Elevated 5cm You form the view that Mr Wenham is suffering from an exacerbation of Chronic Obstructive Pulmonary Disease (COPD). You administer supplemental oxygen, atrovent and salbutamol (following local guidelines), and prepare for the 60 minute journey to hospital. Questions: 1. Describe the underlying pathology of COPD. What impacts do these pathological changes have on normal physiology? In particular, describe alveolar ventilation in a normal individual and discuss how this might be different in Mr Wenham. 2. Discuss why you would administer salbutamol and describe how it works at the cellular level. Mr Wenham’s oxygen saturation improves with supplemental oxygen but he remains tachypnoeic, tachycardic and hypotensive. On arrival at the Emergency Department you go straight to the resuscitation room and an arterial blood gas sample is taken and analysed immediately with the following results: pH 7.12 PaO2 100 mmHg. PaCO2 110 mmHg HCO3 38 3. Discuss why they would take an arterial blood gas and explain how the results relate to the pathophysiology you described. The emergency department staff suggest you may have given Mr Wenham too much oxygen. They say they are going to remove the oxygen. 4. Discuss the issues surrounding the use of supplemental oxygen therapy in patients with severe exacerbations of COPD. What problems can it cause and why? 5. Do you think it is a good idea to remove Mr Wenham’s oxygen? Provide an argument supporting why it is OR why it is not. The emergency department consultant returns from his lunch break to interrupt the oxygen debate. He suggests that Mr Wenham needs BiPAP. 6. What is BiPAP? How might BiPAP help to improve Mr Wenham’s clinical condition? Three days later, after 18 hours of BiPAP, corticosteroids and physiotherapy, Mr Wenham is much improved. The respiratory physician responsible for his care orders spirometry. This shows: FEV1 0.75 litres FVC 1.5 litres FEV1/FVC 50% 7. What is spirometry? 8. Discuss the significance of the results by examining the differences between Mr Wenham’s spirometry and that of a normal individual? 9. How does the pathology of COPD explain these differences? Answer the question in this structure below. Integrated Clinical Case 1. Describe the underlying pathology of COPD. What impacts do these pathological changes have on normal physiology? In particular, describe alveolar ventilation in a normal individual and discuss how this might be different in Mr Wenham. 2. Discuss why you would administer salbutamol and describe how it works at the cellular level. 3. Discuss why they would take an arterial blood gas and explain how the results relate to the pathophysiology you described. 4. Discuss the issues surrounding the use of supplemental oxygen therapy in patients with severe exacerbations of COPD. What problems can it cause and why? 5. Do you think it is a good idea to remove Mr Wenham’s oxygen? Provide an argument supporting why it is OR why it is not. 6. What is BiPAP? How might BiPAP help to improve Mr Wenham’s clinical condition? 7. What is spirometry? 8. Discuss the significance of the results by examining the differences between Mr Wenham’s spirometry and that of a normal individual. (10 marks) 9. How does the pathology of COPD explain these differences?

academic conventions

This is a case study assignment, the requirements are below, please follow step by step answering each question and writing the answers below each question. Use

Australian sources (journal articles, diagrams, statistics… ect). Harvard referencing is required. Please provide text references in each paragraph.
Assignment Requirements

A 1500 word, structured response answering the specific questions presented in the following case study.

•    Information provided in your answers must be referenced following academic conventions. A bibliography should be included at the end of your document

conforming to Harvard (author/date) format. References and in text citations are not included in the word count.
•    Diagrams can be included to help support your answers – they are not included in the word count.

Integrated Clinical Case

Patient Background
You have been tasked Priority 2 to a 75 year old man with chest tightness and shortness of breath.  On your arrival you find a very thin, elderly man sitting on a

chair with his arms braced on his knees.  He looks very dyspnoeic.  His initial observations are:

Respiratory rate    45 breaths/minute
Heart rate    120 beats/minute
Blood Pressure    95/50 mmHg
Oxygen saturation    82%
Glasgow Coma Score    13 (E=3, V=4, M=6)

The man’s name is Mr Wenham, and he is only able to speak single words.  His wife tells you that his breathing is never very good, because he smoked far too much.  She

says he sometimes struggles to walk around the house.

Symptoms    Shortness of breath, chest tightness, cough
Onset    “His breathing has been particularly bad for the last two days and much worse for the last hour or so”
Chest examination    Barrel chested, little chest wall movement
Breathing sounds    Very quiet breath sounds, occasional wheeze
Jugular veins    Elevated 5cm

You form the view that Mr Wenham is suffering from an exacerbation of Chronic Obstructive Pulmonary Disease (COPD).  You administer supplemental oxygen, atrovent and

salbutamol (following local guidelines), and prepare for the 60 minute journey to hospital.

Questions:
1.      Describe the underlying pathology of COPD.  What impacts do these pathological changes have on normal physiology?  In particular, describe alveolar

ventilation in a normal individual and discuss how this might be different in Mr Wenham.

2.    Discuss why you would administer salbutamol and describe how it works at the cellular level.

Mr Wenham’s oxygen saturation improves with supplemental oxygen but he remains tachypnoeic, tachycardic and hypotensive.  On arrival at the Emergency Department you go

straight to the resuscitation room and an arterial blood gas sample is taken and analysed immediately with the following results:

pH    7.12
PaO2    100 mmHg.
PaCO2    110 mmHg
HCO3    38

3.    Discuss why they would take an arterial blood gas and explain how the results relate to the pathophysiology you described.

The emergency department staff suggest you may have given Mr Wenham too much oxygen. They say they are going to remove the oxygen.

4.     Discuss the issues surrounding the use of supplemental oxygen therapy in patients with severe exacerbations of COPD. What problems can it cause and why?

5.    Do you think it is a good idea to remove Mr Wenham’s oxygen? Provide an argument supporting why it is OR why it is not.

The emergency department consultant returns from his lunch break to interrupt the oxygen debate.  He suggests that Mr Wenham needs BiPAP.

6.     What is BiPAP?  How might BiPAP help to improve Mr Wenham’s clinical condition?
Three days later, after 18 hours of BiPAP, corticosteroids and physiotherapy, Mr Wenham is much improved.  The respiratory physician responsible for his care orders

spirometry.  This shows:

FEV1    0.75 litres
FVC    1.5 litres
FEV1/FVC    50%

7.    What is spirometry?
8.    Discuss the significance of the results by examining the differences between Mr Wenham’s spirometry and that of a normal individual?

9.     How does the pathology of COPD explain these differences?

Answer the question in this structure below.
Integrated Clinical Case

1.      Describe the underlying pathology of COPD.  What impacts do these pathological changes have on normal physiology?  In particular, describe alveolar

ventilation in a normal individual and discuss how this might be different in Mr Wenham.

2.    Discuss why you would administer salbutamol and describe how it works at the cellular level.

3.    Discuss why they would take an arterial blood gas and explain how the results relate to the pathophysiology you described.

4.     Discuss the issues surrounding the use of supplemental oxygen therapy in patients with severe exacerbations of COPD. What problems can it cause and why?

5.    Do you think it is a good idea to remove Mr Wenham’s oxygen? Provide an argument supporting why it is OR why it is not.

6.    What is BiPAP?  How might BiPAP help to improve Mr Wenham’s clinical condition?

7.    What is spirometry?

8.    Discuss the significance of the results by examining the differences between Mr Wenham’s spirometry and that of a normal individual. (10 marks)

9.     How does the pathology of COPD explain these differences?

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