William Sneeker is a 64 year old caucasian male brought to the ER by private vehicle complaining of SOB, and chest pain. Mr. Sneeker states that he has had these symptoms for 2 weeks and is progressively getting worse. Walking down to get the mail is becoming harder to do due to the increase in SOB. He states that he had a stress test a year ago that was normal. Patient also admits to a productive cough which has been getting worse in time. Cough is producing about a teaspoon of sputum a day, mostly in the morning. The patients wife states the she hears him wheeze at times and sometimes notices his left eye lid drooping. He denies smoking cigarettes but does state that he is the owner of a bar/restaurant in town for 40 years. He also states that he is 6 feet and 2 inches, he used to weight 250 but now is 203. This weight change has occurred over the last 6 months. He does admit to having trouble swallowing food at times.
Physical Exam
Patient is in moderate respiratory distress, seems to be very anxious and agitated. Patient has a harsh productive cough . HR is 115 regular, RR 24bpm, and BP of 160/92. Body temp. is normal, slight peripheral cyanosis. Auscultation discovers fine crackles in the bases on inspiration and slight expiratory wheezing in the right lung. Pulse ox showed a saturation of 89% on room air. CXR shows lung infiltrates in the bases with a mass in the lower tracheobronchial airways. His ABG’s are pH 7.37, PaCO2 46 mmHg, PaO2 58 mmHg and HCO3 23 mEq/L.
SOAP
S: Chest pain and dyspnea increasing in the past two weeks.
O: Vitals: 160/92, HR-115, RR-24, Temperature-97.8 degrees F (orally). Skin: slight peripheal cyanosis, clubbing of nailbeds present. Weight loss of 47 pounds in last 6 months. Sputum: tinge of blood present. BS: Bilaterally, fine crackles on end inspiration in the bases with slight I and E wheezing in the RML. Percussion: Dull over RML. Palpation: increased fremitis in RML. SpO2: 89% on room air. ABGs: on room air: pH 7.37, PaCO2 46, PaO2 58, HCO3 23. CXR: lung infiltates bilaterally in bases with mass present in the RML. A: - possible atelectasis in the bases (CXR, BS) - nodule present in RML possible (CXR, BS, Palpation, Percussion) - acute compensated respiratory acidosis with moderate hypoxemia (ABG) - possible blood in sputum (sputum color) P: Hyperinflation therapy for possible atelectasis. Supplemental oxygen to keep oxygen saturation above 90%. CT scan to show more percise view of mass size. Bronchoscopy to obtain sample of mass for tissue histology sampling. Sputum sample for presence of foreign pathogens and for blood.
Questions: #1 What symptoms in the history suggest possible Lung Cancer? #2 What is the importance of the ptosis? (drooping eye lid) #3 What is a possible cause of the patients hypoxemia? #4 What would be the first thing you would do for this patient?
Lung Cancer
Group Members:
- Amy Miller - use red text
- Rayann Osborne - use blue text
- Lance Shaffner- use green text
Lung Cancer
Admitting Diagnosis:
William Sneeker is a 64 year old caucasian male brought to the ER by private vehicle complaining of SOB, and chest pain. Mr. Sneeker states that he has had these symptoms for 2 weeks and is progressively getting worse. Walking down to get the mail is becoming harder to do due to the increase in SOB. He states that he had a stress test a year ago that was normal. Patient also admits to a productive cough which has been getting worse in time. Cough is producing about a teaspoon of sputum a day, mostly in the morning. The patients wife states the she hears him wheeze at times and sometimes notices his left eye lid drooping. He denies smoking cigarettes but does state that he is the owner of a bar/restaurant in town for 40 years. He also states that he is 6 feet and 2 inches, he used to weight 250 but now is 203. This weight change has occurred over the last 6 months. He does admit to having trouble swallowing food at times.
Physical Exam
Patient is in moderate respiratory distress, seems to be very anxious and agitated. Patient has a harsh productive cough . HR is 115 regular, RR 24bpm, and BP of 160/92. Body temp. is normal, slight peripheral cyanosis. Auscultation discovers fine crackles in the bases on inspiration and slight expiratory wheezing in the right lung. Pulse ox showed a saturation of 89% on room air. CXR shows lung infiltrates in the bases with a mass in the lower tracheobronchial airways. His ABG’s are pH 7.37, PaCO2 46 mmHg, PaO2 58 mmHg and HCO3 23 mEq/L.SOAP
S: Chest pain and dyspnea increasing in the past two weeks.
O: Vitals: 160/92, HR-115, RR-24, Temperature-97.8 degrees F (orally). Skin: slight peripheal cyanosis, clubbing of nailbeds present. Weight loss of 47 pounds in last 6 months. Sputum: tinge of blood present. BS: Bilaterally, fine crackles on end inspiration in the bases with slight I and E wheezing in the RML. Percussion: Dull over RML. Palpation: increased fremitis in RML. SpO2: 89% on room air. ABGs: on room air: pH 7.37, PaCO2 46, PaO2 58, HCO3 23. CXR: lung infiltates bilaterally in bases with mass present in the RML.A: - possible atelectasis in the bases (CXR, BS)
- nodule present in RML possible (CXR, BS, Palpation, Percussion)
- acute compensated respiratory acidosis with moderate hypoxemia (ABG)
- possible blood in sputum (sputum color)
P: Hyperinflation therapy for possible atelectasis. Supplemental oxygen to keep oxygen saturation above 90%. CT scan to show more percise view of mass size. Bronchoscopy to obtain sample of mass for tissue histology sampling. Sputum sample for presence of foreign pathogens and for blood.
Questions:
#1 What symptoms in the history suggest possible Lung Cancer?
#2 What is the importance of the ptosis? (drooping eye lid)
#3 What is a possible cause of the patients hypoxemia?
#4 What would be the first thing you would do for this patient?