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 Capacity Residual Volume Functional Residual Capacity FEV: Expiratory Flow Rate Decreased Decreased Increased Increased O2 saturation Arterial Po2 Arterial Pco2 bicarbonate 14.5 g/dL (normal is 12-15 g/dL) 85% 45 mm H 70 mm H 34 mEq/L (normal is 24 mEgL)

Explanation / Answer

Ms. Sullivan is suffering from chronic obstructive pulmonary disease. COPD will lead to pulmonary hypertension which in turn causes right heart failure. Right heart failure in long term will cause decrease in venous return and congestion of liver. All these will cause fluid retention in veins of lower extremities and ankle edema.

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