Cardiopulmonary Diagnosis

Your patient is a 76 year-old female who has been admitted after experiencing a right embolic CVA. She presents with dysphagia and left sided hemiparesis. Physical therapy has been consulted to evaluate and treat this patient. On reading the chart you note the patient to have a temperature or 101.6 F, a consolidated left lower lobe on the chest x-ray, and a WBC count of 14,000.

1. What would you consider is a major medical complication for this patient other than the newly diagnosed stroke? Please consider the appropriate classification and type of condition for this patient's pulmonary diagnosis. Provide rationale for your answer.
2. Name and provide rationale for 3 appropriate examination procedures you would perform for this patient during the initial evaluation.

Your patient is referred to your pulmonary rehabilitation clinic with diagnosis of severe COPD. The patient has a 50 pack year smoking history and presents to your clinic with dyspnea, a barreled chest, digital clubbing, and poor functional capacity.

1. Based on your knowledge of this patient's condition what single important test would be appropriate in helping you evaluate the extent of the disease process? Please provide rationale for your choice of test.
2. Based on the information provided for this patient, would you be interested in evaluating this patient's SpO2? Please provide 2 reasons why this measure may or may not be important in examining?

You are consulted to treat a 55 year old male with oxygen and steroid dependent COPD. On entering the room, you notice the patient to be experiencing shortness or breath, RR 26, and using his accessory muscles. The patient is lying in bed with HOB 45 degrees and being provided 4L of oxygen by nasal cannula.

1. What could be a possible reason for this patient's symptoms of respiratory distress while lying in bed at rest? What medical test can best confirm your reasoning for this patient's symptoms?
2. Name 2 examination procedures that would be necessary for you to perform to help this patient recover form his symptoms of shortness of breath?

Your patient is a 40 year old male who has been diagnosed with a bronchogenic carcinoma obstructing a bronchus as observed on the CT scan. The hospital resident (physician) contacts you to evaluate and treat this patient due to the presence of an infiltrate seen on the chest x-ray and the patient's increasing symptoms of dyspnea and productive cough.

1. What would be important considerations to examine prior to treating the pneumonia? What 2 important laboratory values would you want to assess prior to treating this patient. Why?
2. Name and state rationale for any three examination tests you would include in the initial evaluation of this patient.