Ms S is a 76yearold female client who is admitted to the hos

Ms. S is a 76-year-old female client who is admitted to the hospital with a diagnosis of pneumonia. Upon examination, you notice a barrel chest and diminished breath sounds in the bases. Her arterial CO₂ is 55 mm Hg, and further questioning reveals that she has a history of chronic obstructive pulmonary disease (COPD). She has smoked two packs of cigarettes per day for the past 50 years.

1) How does her history of smoking increase her risk for pneumonia?

2) What findings make you suspect COPD? Why?

3) Ms. S has thick tenacious secretions that are blocking the airways. How will this impact her ventilation and perfusion? Why is this important?

4) Further lab testing reveals a low hematocrit and hemoglobin. How will this impact her respiratory status?

Solution

1. Smoking, that is inhaling the complex mixture of chemicals contained in the tobacco smoke can damage DNA and causes inflammation and oxidative stress. Smoking weakens the immune system, and hardens the slimy layer of the respiratory tract, which reduces the normal microflora that protects the tract. So, the history of smoking increases the risk for pneumonia.