Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago

NURS-6501
Week 4 case study 
– Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago

Week 4 case study

Case Study: Occupational Pulmonary Fibrosis

Case Presentation:

Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago. Oxygen dependent at 5L/min (non-compliant). Bilateral inspiratory crackles (“Velcro crackles”) at lung bases noted; no wheezing but has significantly reduced breath sounds. He has digital clubbing, and noted even walking to the kitchen or bathroom he has to use his walker as fear of “running out of air” and falling. He states he wakes up at night gasping for air at times and has to sleep in his chair in the living room and “I can’t even go to bed”. He states all throughout the day he does nothing but cough but states no sputum.

His history notes he had asthma as a child and COPD diagnosed at the age of thirty from what was diagnosed at that time as “chronic bronchitis” [bronchial inflammation]. “I hate walking around with that cord like a dog-leash all day just to breath” “I don’t think I need it” and “I have been around smoke and smoked my whole life” [unfiltered – cigarettes]; “I just use an inhaler as I have for years when they diagnosed me with COPD”. He worked for over 30 years as a concrete mixer driver, frequently exposed to silica dust from cement. Over the last two years, his symptoms worsened, requiring continuous emergency room visits and treatment. Despite treatment with steroids and agents, his pulmonary function continued to decline, leading to his recent placement on organ list for bilateral lung transplant.

Pulmonary Function Tests (PFTs) FVC: 48% predicted (severely reduced); DLCO: 35% predicted (severely impaired gas exchange); FEV1/FVC Ratio: Normal (>80%).

Vitals: BP 128/76 mmHg, HR 92 bpm, RR 24/min, SpO₂ 89% on room air 91% on 5-liters O2; Weight: 240 pounds x 1 year ago now with unintentional weight loss at 170 pounds.

BY RUBRIC:

Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following: Explain pathophysiologic mechanisms responsible for the patient symptoms and why patient is susceptible to more frequent infections.

Explain the pulmonary pathophysiologic processes of how smoking can lead to the changes seen in the lungs.

Explain any racial/ethnic variables that may impact physiological functioning. — Explain factors in the patient’s history and lifestyle that could have contributed to the development of COPD.

(SOLVED) NURS-6501
Week 4 case study 
– Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago

Case Study Analysis – Occupational Pulmonary Fibrosis

The Case Study

The patient is a 58-year-old disabled construction worker presenting with progressive exertional dyspnea and a persistent dry cough in the last 5 years. He was diagnosed with COPD and his symptoms have worsened over the past 2 years requiring frequent emergency room visits and treatment.

The pulmonary pathophysiologic processes of how smoking can lead to the changes seen in the lungs

The pathophysiologic processes causing the symptoms of COPD involve lung damage, which compromises airflow. In this case, the various offending mechanisms in COPD like cigarette smoke or other airway pollutants cause inflammation and obstruction of the airways and damage to the lung tissues (Haddad & Sharma, 2023). This leads to difficulty in breathing, coughing, and dyspnea. The airway inflammation causes air sac destruction and shrinkage, making them unable to expand thus limiting airflow. The inflammation also triggers mucus production, which blocks the airway and limits air exchange. These factors together create a ventilation-perfusion mismatch, leading to poor oxygenation as seen in the patient’s low SPO2, low FVC, and reduced DLCO (Rodrigues et al., 2021).

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Explain any racial/ethnic variables that may impact physiological functioning.
Many racial/ethnic factors influence the pathophysiological functioning in COPD including genetic factors, socioeconomic factors, environmental factors, and lifestyle factors. These factors impact the pathophysiology of COPD either by increasing the risks of COPD, the recovery process, and influencing their response to treatment and outcomes. For instance, genetics play an important role in the development and maturation of lungs as well as in inflammatory responses to triggers like asthma. As a result, certain genetic variances predispose an individual to diseases like COPD more than other people (Cho et al., 2024). An example is the gene coding for alpha-1 antitrypsin. Alpha-1 antitrypsin is an enzyme inhibitor, which serves to protect the lung parenchyma from injury and damage by injurious agents that lead to COPD. Certain individuals have a deficiency of alpha-1 antitrypsin, which makes their lungs more prone to damage from inhalation pollutants such as cigarette smoke and other harmful environmental contaminants like dust. It is more common in white individuals compared to other races. This increases their risk of developing COPD together with increased morbidity and mortality from the disease (Hernandez-Pacheco et al., 2024).Another variable that impacts the pathophysiology of COPD is socioeconomic factors in which individuals of lower socioeconomic status are at a greater risk of developing COPD due to several factors like poor access to healthcare, higher exposure to environmental pollutants like smoke, and higher smoking habits. In this instance, the patient was exposed to environmental contaminants at work, which predisposed him to COPD (Assari et al., 2020). Other variables impacting COPD include environmental exposures like dust and fumes, cigarette smoking habits that vary among different ethnicities, and environmental pollutants, which vary according to ethnicity because certain ethnicities are more predisposed to poorer living conditions and pollution.
Explain factors in the patient’s history and lifestyle that could have contributed to the development of COPD.
One important factor in his history that could have contributed to the COPD is his occupational history as a construction worker where he was a concrete mixer driver for 30 years, exposing him to silica dust from the cement. He also reports a long history of smoke exposure and a history of asthma, which also predisposes him to COPD (B. Ozoh et al., 2023). Other factors predisposing the patient to COPD include his obesity, male sex, and respiratory infections due to asthma
NURS-6501
Week 4 case study 
– Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago.

References

Assari, S., Chalian, H., & Bazargan, M. (2020). Race, ethnicity, socioeconomic status, and chronic lung disease in the U.S. 
Research in Health Science
, 
5
(1), p48. 
https://doi.org/10.22158/rhs.v5n1p48

Ozoh, O., K. Dede, S., A. Ekete, O., O. Ojo, O., & G. Dania, M. (2023). Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria. 
Ghana Medical Journal
, 
57
(3), 175-182. 
https://doi.org/10.4314/gmj.v57i3.3

Cho, M. H., Hobbs, B. D., & Silverman, E. K. (2024). 
The genetics of COPD
. PMC Home. 
https://pmc.ncbi.nlm.nih.gov/articles/PMC11197974/

Haddad, M., & Sharma, S. (2023, July 20). 
Physiology, lung – StatPearls – NCBI bookshelf
. National Center for Biotechnology Information. 
https://www.ncbi.nlm.nih.gov/books/NBK545177/

Hernandez-Pacheco, N., Kilanowski, A., Kumar, A., Curtin, J. A., Olvera, N., Kress, S., Bertels, X., Lahousse, L., Bhatta, L., Granell, R., Marí, S., Bilbao, J. R., Sun, Y., Tingskov Pedersen, C., Karramass, T., Thiering, E., Dardani, C., Kebede Merid, S., Wang, G., … Melén, E. (2024). Exploring the genetics of airflow limitation in lung function across the lifespan – a polygenic risk score study. 
eClinicalMedicine
, 
75
, 102731. 
https://doi.org/10.1016/j.eclinm.2024.102731

Rodrigues, S. D., Cunha, C. M., Soares, G. M., Silva, P. L., Silva, A. R., & Gonçalves-de-Albuquerque, C. F. (2021). Mechanisms, pathophysiology, and currently proposed treatments of chronic obstructive pulmonary disease.
Pharmaceuticals
, 
14
(10), 979. 
https://doi.org/10.3390/ph14100979
  
NURS-6501
Week 4 case study 
– Occupational Pulmonary Fibrosis – Michael, a 58-year-old disabled construction worker, presents with progressive exertional dyspnea and a persistent dry cough which started 5 years ago