Breathlessness Case study essay

Breathlessness Case study

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Vicky Jeffrey is a 78-year-old woman who was first diagnosed with asthma when she was
15. She has recently complained of continuous breathlessness to her GP, despite taking her inhalers. She is normally on Clenil® 100mcg 2 puffs BD via a metered dose inhaler (MDI) and salbutamol as needed, both via a spacer device. (Clenil® is a formulation of beclometasone dipropionate, an inhaled corticosteroid.) Mrs Jeffrey has been referred by her GP to a specialist respiratory service for assessment and management of her continuous breathlessness. The patient referral also states that she has never smoked but previously worked in a pub and lived with a husband who was a heavy smoker and died of lung cancer. Mrs Jeffrey finds it increasingly difficult to do her daily domestic chores and can only manage 60 metres walking outdoors on a flat surface.
A careful history of the patient’s symptoms is required to understand whether or not she has a diurnal variation of her symptoms and if she has been taught to step up and step down her inhaler during an acute asthma attack. It is also necessary to establish whether the patient carries out a regular peak flow, which will help to determine step up and step down of therapy.
Mrs Jeffrey has no diurnal variation in symptoms and no allergies. A history of allergies is important, as an allergic reaction can trigger an exacerbation of asthma in the majority of asthma patients. We know from the patient’s history that she never smoked but lived with her husband who was a heavy smoker and used to work in a pub when smoking was not banned in public places in the UK. From the literature, we know that COPD can occur as a result of passive smoking in non-smokers – the risk is highest with environmental tobacco exposure in multiple settings such as home and work (Hagstad et al. 2014).
Past medical history revealed none of the following: heart failure, hypertension, atrial fibrillation, DVT, pulmonary embolus and no previous cardiac surgery. This information will help to rule out other causes of breathlessness.
Drug history: Clenil 100mcg MDI 2 puffs BD, salbutamol 100mcg MDI as required, simvastatin 20mg at night, and paracetamol 500mg when needed.
The following investigations were carried out:
• Chest X-ray – showed bilateral hyperinflation
• Arterial blood gases – PH 7.37, PCO2 4.8 kpa, PaO2 11kpa, SaO2 99%, HCO3 23, BE -2
• Blood test – CRP 3mg/l, Na+ 138mmol/l, K+ 4.2mmol/l, Hb 12.5g/dL, BNP 30pg/ml, WCC 7 x 109/l, INR 0.9, Troponin 10
• No chest pain
• Pulse oximetry – SpO2 96% HR 85b/min
• Spirometry – result showed FEV1 40% predicted, FEV1/FVC ratio 45%, with the usual concave shape of the flow volume curve
• MRC 4
Frequency of exacerbation: 3–4 in 12 months

Breathlessness Case study

RUBRIC
Excellent Quality 95-100%	Introduction 45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.		Literature Support 91-84  points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.			Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score 50-85%	40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.		83-76  points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.			52-49  points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality 0-45%	37-1 points The background and/or significance are missing. No search history information is provided.		75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.			48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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