Case Scenario-A 61-year-old Male with Complaints of Shortness of Breath

We are utilizing the Week 3 Case Study TemplateLinks to an external site. Provide your responses to the case study questions listed below.
You must use at least one scholarly reference to provide pathophysiology statements. For this class, the use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal. Case Scenario-A 61-year-old Male with Complaints of Shortness of Breath

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You must use the current Clinical Practice Guideline (CPG) for managing and preventing COPD (GOLD Criteria) to answer the classification of severity and treatment recommendation questions. The most current guideline may be at the following web address: https://goldcopd.org/Links to an external site.. At the website, locate the current year’s CPG and download a personal copy for use. You may also use a medication administration reference such as Epocrates to provide medication names.
Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used. Case Scenario-A 61-year-old Male with Complaints of Shortness of Breath
Case Study Scenario
Chief Complaint
A.C. is a 61-year-old male with complaints of shortness of breath.

History of Present Illness
A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain. The event was preceded by complaints of fatigue and increasing dyspnea for three months, for which he did not seek care. Cardiology evaluated him, and underwent a successful and uneventful angioplasty before discharge. Despite the intervention, the shortness of breath has not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The cardiologist has requested that you, his primary care provider, evaluate him for further work-up. Before today, his last visit with your practice was three years ago when he was seen for acute bronchitis and smoking cessation counseling. Case Scenario-A 61-year-old Male with Complaints of Shortness of Breath

Past Medical History
Hypertension
Hyperlipidemia
Atherosclerotic coronary artery disease
Smoker
Family History
Father deceased of acute coronary syndrome at age 65
Mother deceased of breast cancer at age 58.
One sister, alive, is a 5-year breast cancer survivor.
One son and one daughter with no significant medical history.
Social History
35-pack-year smoking history; he has cut down to one cigarette at bedtime following his cardiac intervention. Case Scenario-A 61-year-old Male with Complaints of Shortness of Breath
Denies alcohol or recreational drug use
Real estate agent
Allergies
No Known Drug Allergies
Medications
Rosuvastatin 20 mg once daily by mouth
Carvedilol 25 mg twice daily by mouth
Hydrochlorothiazide 12.5 mg once daily by mouth
Aspirin 81mg daily by mouth
Review of Systems
Constitutional: Denies fever, chills, or weight loss. + Fatigue.
HEENT: Denies nasal congestion, rhinorrhea, or sore throat.
Chest: + dyspnea with exertion. Denies productive cough or wheezing. + Dry, nonproductive cough in the AM.
Heart: Denies chest pain, chest pressure, or palpitations.
Lymph: Denies lymph node swelling.
General Physical Exam
Constitutional: Alert and oriented male in no apparent distress.
Vital Signs: BP-120/84, T-97.9 F, P-62, RR-22, SaO2: 93%
Wt. 180 lbs., Ht. 5’9″
HEENT
Eyes: Pupils equal, round, and reactive to light and accommodation, normal conjunctiva.
Ears: Tympanic membranes intact.
Nose: Bilateral nasal turbinates without redness or swelling. Nares patent. Case Scenario-A 61-year-old Male with Complaints of Shortness of Breath

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Mouth: Oropharynx clear. No mouth lesions. Dentures well-fitting. Oral mucous membranes dry.
Neck/Lymph Nodes
Neck supple without JVD.
No lymphadenopathy, masses, or carotid bruits.
Lungs
Bilateral breath sounds clear throughout lung fields. + Bilaterally, wheezes were noted with forced exhalation along with a prolonged expiratory phase—no intercostal retractions.
Heart
S1 and S2 regular rate and rhythm, no rubs or murmurs.
Integumentary System
Skin cool, pale, and dry. Nail beds pink without clubbing.
Chest X-Ray
Lungs are hyper-inflated bilaterally with a flattened diaphragm. No effusions or infiltrates.
Spirometry
Predicted Pre-bronchodilator % Predicted Post-bronchodilator % Predicted Change
FVC (L)
5.64
5.23
93
5.77
102
9%
FEV1 (L)
4.57
2.92
64
3.01
66
2%
FEV1/FVC (%)
81
56
69
52
64
-5%
TLC
5.5
6.9
125
6.9
125
0%

Case Study Questions
Pathophysiology & Clinical Findings of the Disease

Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient?
Explain the pathophysiology associated with the chosen pulmonary disease.
Identify at least three subjective findings from the case that support the chosen diagnosis.
Identify at least three objective findings from the case that support the chosen diagnosis. Case Scenario-A 61-year-old Male with Complaints of Shortness of Breath
Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

Classify the patient’s severity. Is this considered stable or unstable?
Identify two (2) “Evidence A” “recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
Describe the mechanism of action for each of the medication classes identified above.
Identify two (2) “Evidence A” “recommended non-pharmacological treatment options for this patient. Case Scenario-A 61-year-old Male with Complaints of Shortness of Breath