Case Study- Barbara Questions and
Answers
Barbara is 61 years old and has been smoking since she was 22 years old. Despite
numerous attempts, she has been unable to break her pack-a-day habit.
During her annual examination at her physician's office, Barbara reports being
"constantly out of breath" and tired. She is wheezing slightly and states this is because
she has recently been fighting a cold.
On assessment, her physician notes several symptoms, including clubbing of the
fingers. Barbara has a barrel-shaped chest, uses pursed-lip breathing, and is using
accessory muscles to breathe. She has difficulty catching her breath while speaking.
Inspection reveals peripheral edema.
Vital signs include a heart rate of 82 beats per minute and respiratory rate of 12 breaths
per minute. Oxygen saturation is 82%. Spirometry results show reduced vital lung
capacity and reduced forced vital capacity. - answer
Is Barbara's oxygen saturation value normal? - answerNo, "normal" is 95-100%. Even in
cases where O2 sat is as low as 88% can be "normal" for a person with COPD.
Anywhere below that and the person needs more oxygen.
What may explain the clubbing of Barbara's fingers? - answerChronic hypoxia causes
clubbing of the fingers
Why has Barbara developed a barrel-shaped appearance to her chest? - answerDue to
the air trapping or caused by emphysema
Why is barbara using pursed lip breathing? - answerPursed lip breathing helps those
with breathing by keeping airway open longer, controlling the breathing and focusing on
the breathing as it is difficult for these people
What is the significance of the spirometry test results? - answerAirflow limitation of
COPD is identified by a FEV1/FVC ratio of lower than 70%. FEV1 significantly
diminishes in COPD because the patient's exhalation phase is slow and prolonged.
Given Barbara's pulmonary issues, why may she have developed peripheral edema? -
answerChronic hypoxia leads to pulmonary hypertension which leads to right sided
heart failure. The effects of right sided heart failure include JVD, peripheral edema,
splenomegaly, hepatomegaly. Cor pulmonale is right sided heard failure caused by
pulmonary dysfunction.
Answers
Barbara is 61 years old and has been smoking since she was 22 years old. Despite
numerous attempts, she has been unable to break her pack-a-day habit.
During her annual examination at her physician's office, Barbara reports being
"constantly out of breath" and tired. She is wheezing slightly and states this is because
she has recently been fighting a cold.
On assessment, her physician notes several symptoms, including clubbing of the
fingers. Barbara has a barrel-shaped chest, uses pursed-lip breathing, and is using
accessory muscles to breathe. She has difficulty catching her breath while speaking.
Inspection reveals peripheral edema.
Vital signs include a heart rate of 82 beats per minute and respiratory rate of 12 breaths
per minute. Oxygen saturation is 82%. Spirometry results show reduced vital lung
capacity and reduced forced vital capacity. - answer
Is Barbara's oxygen saturation value normal? - answerNo, "normal" is 95-100%. Even in
cases where O2 sat is as low as 88% can be "normal" for a person with COPD.
Anywhere below that and the person needs more oxygen.
What may explain the clubbing of Barbara's fingers? - answerChronic hypoxia causes
clubbing of the fingers
Why has Barbara developed a barrel-shaped appearance to her chest? - answerDue to
the air trapping or caused by emphysema
Why is barbara using pursed lip breathing? - answerPursed lip breathing helps those
with breathing by keeping airway open longer, controlling the breathing and focusing on
the breathing as it is difficult for these people
What is the significance of the spirometry test results? - answerAirflow limitation of
COPD is identified by a FEV1/FVC ratio of lower than 70%. FEV1 significantly
diminishes in COPD because the patient's exhalation phase is slow and prolonged.
Given Barbara's pulmonary issues, why may she have developed peripheral edema? -
answerChronic hypoxia leads to pulmonary hypertension which leads to right sided
heart failure. The effects of right sided heart failure include JVD, peripheral edema,
splenomegaly, hepatomegaly. Cor pulmonale is right sided heard failure caused by
pulmonary dysfunction.
