20.45 X 3.4

Questions

20.45 X 3.4

Cаse:  A 26 yeаr-оld femаle presents tо the pulmоnary clinic with complaints of dyspnea on exertion and a productive cough.  She reports a productive cough for many years and periodic production of yellow or green sputum with occasional hemoptysis.  She was told as a child that she had asthma.  She was prescribed antibiotics last week but her symptoms have gotten worse.  She is slightly malnourished.  She has never smoked but had bronchiectasis as a teenager.  On examination you find no JVD, trachea midline, increased AP diameter, diffuse inspiratory and expiratory crackles with polyphonic expiratory wheezing bilaterally.  Hyperresonance noted with chest percussion.  A loud P2 is noted as well.  She is positive for digital clubbing with no presence of edema or cyanosis.  Sweat chloride test:  103 mEq/L. FiO2        21% ABG pH              7.32 PaCO2        34 mmHg HCO3         16 MEq/L PaO2        48 mmHg SaO2        78 Vital Signs Pulse        71/min BP        105/72 Temperature  37.2*C RR        19/min Blood Work WBC      12,400 mm3 Hb        14.2 g% Hct        43% Plasma Electrolytes Na        142 mEq/L CO2       20 mEq/L Cl        106 mEq/L K        4.6 mEq/L What nutrition and education would you recommend for this patient's care plan? Choose all that apply.