Bernie Sullivan is a 73-year old retired seamstress who has never married. She w

Question

Bernie Sullivan is a 73-year old retired seamstress who has never married. She worked in the alterations department of a men's clothier for 48 years. Bernie is a chain smoker. On the job, she was never found without a cigarette hanging from her lips. When her employer announced that smoking was no longer allowed in the store, Bernie retired. Since her retirement three years ago, Bernie has not been feeling well. She fatigues easily, even with light exertion. She has shortness of breath and recently has begun to sleep on two pillows. However, despite these problems, she has refused to stop smoking. Ms. Sullivan made an appointment with her physician, who noted a prolonged expiratory phase in her breathing, expiratory wheezes, and increased anteroposterior (AP) chest diameter. Her nail beds were cyanotic, and she had moderate pitting edema at her ankles. Based on these observations and results of laboratory and pulmonary tests, the physician concluded that Ms. Sullivan has a combination of emphysema and bronchitis, called COPD, which resulted from her long history of smoking. The results of pulmonary function and laboratory tests are given below. Vital Capacit Residual Volume Functional Residual Capacit FEVi; Expiratory Flow RateDe Decreased Increased Increased Decreased 14.5 g/dL (normal is 12-15 85% 45 mm H 70 mm H 34 mEq/L (normal is 24 mEa/L g/dL Hemoglobin O2 saturation Arterial Po2 Arterial Pco bicarbonate

Explanation / Answer

Ans:Edema is a normal response of the body to inflammation or injury. Increased fluid from the blood vessels allows more infection fighting white blood cells to enter the affected area.

The Starling equation explains the role of hydrostatic and oncotic forces in the movement of fluid across capillary membranes. Capillary fluid movement is due to diffusion, filtration and pinocytosis.

The reason for Ms.Sullivan developed ankel edema: Since, there is a long distance in between heart and feets thus when body is fit even than the feets do not receive proper blood supply compared to the other parts of the body. Upon smoking the peripheral arteries are affected and result in peripheral arterial disease and thus smoking in turn also affects the feet too. Due to smoking and peripheral arterial disease plaque starts building in the arteries which also affect the the arteries of legs and feet. Due to plaque build up the arteries become narrow and stiff resulting in a poor blood supply and also cause pain while walking. This condition can be overcome either by bypassing the blocked arteries of leg so as to improve the blood circulation in the feet.

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