MEA2203 MODULE 05 CASE STUDIES

Patient Name: Janice Navarro

Date of Birth: 12/3/1971

Clinical Notes: The patient presents with chronic shortness of breath and dyspnea upon exertion.
Symptoms started several years ago and have progressively gotten worse. She reports that she is no
longer able to walk around her block without severe breathlessness. She has a history of heavy smoking,
does not take any regular medications, and has no personal or family history of heart disease. Physical
exam reveals cyanosis in bilateral fingernail beds.

Current vital signs: BP 140/92, HR 88 bpm, Temperature 98.4°F

After a physical examination, imaging, and laboratory testing, the physician confirms the diagnosis of
emphysema.

Question #1: What might Ms. Navarro’s spirometry results look like?

Spirometry-Pulmonary function testing (PET) is used to test pulmonary volumes. It measures volume
and air flow times. The breakdown of the alveolar wall effects lung function and expiration and loss of
surface area for gas exchange. Ms. Navarro’s spirometry results would indicate presence of increased
residual volume and a decrease in total lung capacity as well as decreased forced expiatory volume and
vital capacity.

Question #2: What are other possible signs and symptoms of emphysema that are not mentioned in this
case?

Other possible signs and symptoms of emphysema not mentioned would be hyperventilation,
hyperinflation leading to development of barrel chest, tripod position to facilitate breathing, anorexia,
fatigue (contributes to weight loss), clubbed fingers, secondary polycythemia (possible compensation
development), and manifested signs of heart failure.

Question #3: What types of imaging tests may be used to confirm emphysema? Describe the
abnormalities that would be present in the imaging test.

Imaging tests to confirm emphysema would be a chest x-ray as it could show a pneumothorax as the
tissue and pleural membrane surrounding the large blebs near the surface of the lung have ruptured.
Lungs appear to have many large holes where infection and old air inhabit, so the x-ray would show
structural problems of the lungs (Bullae).

Question #4: How is the cyanosis in Ms. Navarro’s nailbeds related to her diagnosis?
 MEA2203 MODULE 05 CASE STUDIES

The Cyanosis is related to the diagnosis as it is the result of large amounts of unoxygenated hemoglobin
in the blood which is caused by the emphysema. Having cyanosis is showing lung transfer of oxygen to
the blood stream and removal of carbon dioxide is impaired.

Question #5: How is Ms. Navarro’s condition different from other forms of COPD?

Everyone who has emphysema has COPD but not everyone who has COPD has emphysema. COPD is
characterize by the increase of breathlessness associated with having a group of lung conditions.
Emphysema is a progressive lung disease where old air gets trapped into holes in the alveoli making it
difficult for the person to inhale fresh air.
 MEA2203 MODULE 05 CASE STUDIES

Patient Name: Jeffrey Buddell

Date of Birth: 1/18/1985

Clinical Notes: Male patient presents with fatigue, jaundice, dark urine, unintended weight loss, and
poor appetite. He reports that the symptoms have been getting worse over several weeks. He states
that he “thought I was just dehydrated and everything would get better, but it’s getting much worse.”
Yesterday, he noticed several bruises on his hips and legs but does not remember any injury that would
have caused the bleeding.

Mr. Buddell admits to heavy alcohol intake in the past and three instances of intravenous drug use, but
he has been sober for more than five months.

Current vital signs: BP 122/78, HR 88 bpm, Temperature 100.2°F

The physician suspects hepatitis and orders laboratory tests to confirm his diagnosis.

Question #1: Given Mr. Buddell’s symptoms and history, which type of hepatitis is most likely?

Given the patients symptoms and history, Hepatitis B is the type that is most likely.

Question #2: Describe the etiology and route of infection for the type of hepatitis you believe Mr.
Buddell is exhibiting.

Transmitted primarily by infected blood, hepatitis is a result from an infection by a group of viruses that
specifically target hepatocytes. Route of infection was through a syringe during intravenous drug use.
Hepatitis B starts as an acute infection. The severity ranges from mild to serious and requiring
hospitalization.

Question #3: What are potential complications of hepatitis that Mr. Buddell should be aware of?

potential complications Mr. Buddell should be aware of are fibrosis, cirrhosis, hepatocellular carcinoma,
and liver failure.

Question #4: If the physician orders a complete blood count (CBC), which abnormal results would you
expect?

Abnormal results on a CBC would be a decrease in WBC’s, elevated level of liver enzymes (released
when liver cells become inflamed or damaged). Infected liver cells produce large amounts of the surface
antigen HBsAg when this antigen persists into the serum, continued active infections and damage to the
liver from chronic disease are a large risk factor.
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Question #5: Should Mr. Buddell worry about passing this disease to other people? If so, what
protective measures can he take?

Yes Mr. Buddell should worry about passing the disease to other people. Hepatitis B is a disease of the
liver spread by body fluids or blood of an infected person entering the body of another who is not
infected. Protective measures he can take would be having partners get vaccinated if not yet infected,
and refrain from all intravenous drug use in the future.
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Patient Name: Rajani Jefferson

Date of Birth: 11/17/1984

Clinical Notes: Female patient presents with extreme, acute right-sided lower back pain. She reports
that the pain began as a dull ache last evening, but escalated to an intense sharp pain quickly since this
morning. The pain radiates in the lower right abdomen. She denies any history of trauma. The patient
reports experiencing hematuria a few hours ago.

Medical history reveals multiple urinary tract infections, dehydration, Cushing syndrome, and a family
history of multiple cancers (breast, prostate, colon).

Current vital signs: BP 126/78, HR 76 bpm, Temperature 98.6°F

The physician ordered an ultrasound of the right kidney, which identified renal calculi. A CT scan of the
kidneys, ureters, and bladder was ordered as a follow-up.

Laboratory tests ordered: Complete blood count, urinalysis

Diagnosis: Nephrolithiasis

Question #1: Which risk factors did Ms. Jefferson exhibit for the diagnosis of urolithiasis?

Ms. Jefferson exhibited personal history of cushing syndrome which is a factor as body weight and some
other medical conditions are among the many causes of kidney stones. Urinary tract infections are a
factor as concentrated urine can allow crystallization of minerals. Hematuria is also a factor as blood in
the urinary tract indicates trauma in that area. Flank pain and dehydration as low liquid volumes in the
urine can cause crystallization as well.

Question #2: If her CT scan revealed renal calculi larger than 6mm in size, what type of treatment(s)
would likely be recommended?

Surgery would most likely be recommended as stones that are any larger than 6mm can cause
obstruction to the ureter or bladder.

Question #3: Lab results determine that Ms. Jefferson has the most common type of kidney stones,
calcium oxalate and calcium phosphate. Does this mean her renal calculi are caused by a high dietary
intake of calcium?

No it does not mean renal calculi are caused by a high dietary intake of calcium. Calcium oxalate is
caused by too much oxalate in the urine. Oxalate is one substance that if the levels are high in urine, can
form crystals as a result of too much waste and not enough liquid. Calcium phosphate are caused by the
urinary functions having abnormalities. They often occur in conjunction with calcium oxalate stones.
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Question #4: What type of complications may occur if Ms. Jefferson does not go through with the
recommended treatment?

Complications that may arise if Ms. Jefferson does not go through with the recommend treatment
would be the functioning kidney could have destruction issues and can also lead to infections and
sometimes lead to cancer.

Question #5: What preventative measures should Ms. Jefferson take to avoid recurrence?

Preventative measures Ms. Jefferson should take to avoid recurrence would be staying hydrated, eating
less salt in her diet, decrease intake of oxalate-rich foods, and less intake of foods high in animal protein.