[Answered]: Chronic Bronchitis ADMITTING HISTORY A…

Chronic Bronchitis ADMITTING HISTORY A 68-year-old retired geologist arrived in the emergency room with his daughter. Well known to the respiratory care consult team, he has a 40-year history of smoking a pack of cigarettes a day, is widowed, lives alone, and has difficulty managing his daily activities. For the past week the man has experienced increased dyspnea and cough and has been unable to care for himself. On observation his personal hygiene appeared to have deteriorated. The man stated that he has been unable to get his breath or inhale deep enough to cough up secretions. He complained of mild nausea without abdominal pain or vomiting. His physician had given him an unknown oral antibiotic 3 days before this admission. The man was diagnosed with severe chronic bronchitis approximately 6 years ago and had an acute myocardial infarction 2 years ago. His pulmonary function studies 1 year before this admission showed severe airway obstruction and air trapping. He has a history of high blood pressure, congestive heart failure, chronic dyspnea on exertion, and chronic cough, and he experienced two episodes of pneumonia within the last year. In recent months, according to a neighbor, he has become increasingly depressed. According to his daughter, his physical activity is minimal. He generally spends most of his days watching television, smoking, and napping. All his children, none of whom live in the immediate area, have tried to coax him to move to a boardinghouse environment, but he has adamantly refused. During his last admission the advantages of pulmonary rehabilitation were discussed with him. The patient said that he had no need for pulmonary education, nor for the services of other agencies or organizations to check up on him in his home. PHYSICAL EXAMINATION (TIME: I730) Inspection revealed a barrel chest, clubbing of his fingers and toes, cyanotic skin, and pitting edema