Case Scenario of an Older Patient.

Running head: Case scenario of an older patient
Case scenario of an older patient
Name of the Student
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Case scenario of an older patient
Patient scenario
A 60-year-old woman was admitted to the emergency room with extreme shortness of
breath, with acute exacerbation of chronic obstructive pulmonary disease (COPD). The patient
was found to breathe heavily and was using accessory muscles of respiration. Symptoms started
about two days ago and slowly progressed without related, aggravating or alleviating causes.
However, she reports no chills, fever, cough, wheezing, sputum, palpitations, stresses, stomach
pain, and distensions of the intestinal muscle, nausea, vomiting and diarrhoea. She experiences
trouble breathing, exhaustion, moderate weakness, a cold sensation in need of blankets or warm
clothes, increased urinary frequency, incapacity and swelling in her lower bilateral limbs that are
beginning to develop again and deteriorating. She did not leave her bed for many days except in
the toilet because she felt weak, exhausted and breathless. Her medical background encompasses
her father's severe heart disorder and prostate malignancy. She was an active smoker and smoked
about 10 cigarettes a day. She reduced her smoking rates due to shortness of breath two years
ago, however, could not quit it completely. She denies any use of drugs and alcohol and no food
or frug allergies have been reported so far. Past medical history has been significant for Chronic
Obstructive Pulmonary Disorder (COPD), coronary artery disease, myocardial infarction,
elevated blood pressure, hyperlipidemia, peripheral vascular disorder, hypothyroidism, diabetes
mellitus, heavy smoking and obesity. The previous experience of surgery was critical for
appendectomy, heart catheterization with stent placement, hysterectomy and nephrectomy.
Reason for admission: Acute shortness of breath.

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Case scenario of an older patient
Symptoms experienced by the patient: Shortness of breath, fatigue, a cold sensation, persistent
wheezing, chest tightness, nausea, vomiting, exhaustion, weakness, restlessness, swelling lower
bilateral limbs and increased frequency for urinating.
Social history: The patient is Catholic. She lives alone in an apartment. Her husband died 5
years back due to heart attack and her daughter lives in another city. She comes often to visit her,
especially during the weekends. She is not engaged in any physical activity or exercise, instead
she spends her day lying on bed and working very less. She does not socialize much in her
community and do not take part n any social activities.
Medical history: Her medical history reveals that she is a patient of Chronic Obstructive
Pulmonary Disorder (COPD), cardiovascular disorders, hypothyroidism, hypertension, diabetes
mellitus and obesity. Besides that, she suffered from severe depression and anxiety after her
husband’s death, which needed medical attention.
Vital signs:
 Body temperature= 97.3 F
 BMI= 38.5
 Respiratory rate= 24
 BP= 160/90
 Heart rate= 89 bpm
 O2 Saturation= 90% on room air.
Current medication:
 Breo Ellipta 100-25 mcg inhaled to control her breathlessness.
 Hydralazine 50 mg by mouth for treating her high blood pressure.

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Case scenario of an older patient
 Hydrochlorothiazide 25 mg, used for managing hypertension and other cardiac
conditions.
 Aspirin 81 mg.
 An antiplatelet drug, Clopidogrel 75 mg taken orally.
Discussion
The patient reports severe shortness of breath and found to breathe heavily using her
asessory muscle for respiration. Assessory muscles are the muscles that lead to inhalation and
exhalation, allowing the thoracic cavity to extend and contract. The diaphragm and intercostal
muscles, to a lesser degree, induce respiration in silent respiration. Further Assessory extension
muscles are usually utilized only in elevated aerobic (e.g. exercise) or respiratory impairment
circumstances. However, the width of the rib cage may be reduced in situations when these
attachment muscles are rigid and stiff. Maintenance of the elasticity of the muscles is important
for the protection and operation of the respiratory system.
History: The patient’s past medical history include Chronic Obstructive Pulmonary Disorder
(COPD) coronary artery disease, myocardial infarction, elevated blood pressure, hyperlipidemia,
peripheral vascular disorder, hypothyroidism, diabetes mellitus, heavy smoking and obesity. The
previous experience of surgery was critical for appendectomy, heart catheterization with stent
placement, hysterectomy and nephrectomy. It is important to understand patient’s history in
order to identify her risks. Also, family history is indeed a documentation of an individual and
their close relatives 'health records. A complete history provides records on kids, brothers and
sisters, siblings, aunts and uncles, nephews and nieces, relatives, and cousins over three
generations of family members. Families share several factors, such as genes, their culture and
their lifestyle. Such factors can together provide clues to a family's medical conditions. Through