Pulmonary Function

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Lou is a 35-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no
significant medical history. She takes no medications and does not smoke. She reports that she was in her usual
state of good health until approximately three weeks ago when she developed a “really bad cold.” The cold is

characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary
problem is a cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of
green sputum. She hasn’t had any fever but does have a scratchy throat. Lou has tried over-the-counter cough
medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she
gags and dry heaves.
Instructions:
1. Identify the most likely condition that best explains the patient’s cough. Provide a description of the disorder
and underlying respiratory alteration associated with the type of cough selected in the scenario.
2. Describe and explain the pathophysiologic process of the disease and underlying respiratory alteration
associated with the cough.
3. Describe common clinical manifestations associated with the disorder.
Identify the causes and risk factors for the condition depicted in the chosen case.
4. Consider the following patient factors genetics, gender, ethnicity, age, or behavior. Select two patient factors
and discuss the influence of the factors chosen on the disorder.

 

Sample Solution

Spirometry assesses the integrated mechanical function of the lung, chest wall, respiratory muscles, and airways by measuring the total volume of air exhaled from a full lung (total lung capacity [TLC]) to maximal expiration (residual volume [RV]). This volume, the forced vital capacity (FVC) and the forced expiratory volume in the first second of the forceful exhalation (FEV1), should be repeatable to within 0.15 L upon repeat efforts in the same measurement unless the largest value for either parameter is less than 1 L. In this case, the expected repeatability is to within 0.1 L of the largest value. The patient is instructed to inhale as much as possible and then exhale rapidly and forcefully for as long as flow can be maintained.

ization that immo-rality is a universal blight. Ethan, feeling “a darkness [fall] on the world and on him” (19), pulls down the shades, allowing it “to fall on the store” (19) as well. This advent of darkness represents the worldwide spread of corruption, and the normally honest Ethan, recognizing his inability to escape, feels he must become a part of it. His scrupulous per-sonal ethics set him apart from the world’s immoral majority, but when he strays from these principles and allows the darkness to assimilate him, he conforms to society’s not-so-scrupulous standards. Seated in his seaside sanctuary, the Place, Ethan watches the tide “creep in, black from the dark sky” (44). As time passes, this black sea of immorality and corruption rises, extending its area of influence over the masses. It gradually flows towards Ethan, who, in time, it will consume. Near the end, when Ethan leaves his home, the “night closes thick and damp about him” (263), and “streetlights…sprout…halos of moisture” (263). In leaving his home, he turns away from his family-the past Hawleys that begin the moral tradition and the present that must continue it-and gives himself over entirely to the darkness of depravity. From his new perspective, however, he can rec-ognize the honest and scrupulous few that still exist. The streetlights, with their “halos of moisture”, represent these people whose resistance to corruption makes them seem an-gelic.

One such beacon of virtue is Ethan’s daughter, Ellen. When Ethan stumbles upon her as she sleepwalks, he notices “a glow [coming] from [her]” (127) as she holds his ta-lisman, a translucent pink stone, and he can “see her face…in the darkened room” (127). Though Ethan himself cannot penetrate the darkness that surrounds him, his daughter ex-udes an aura of virtue that defends against its onslaught; the talisman, a physical reminder of the Hawley tradition of morality, makes this defense possible. At this point in the sto-ry, Ethan does not entirely understand the significance of the light, as he has not yet suc-cumbed to corruption, but he does realize that the talisman is necessary to maintain it. And by the time he discovers its meaning, it is almost too late to preserve it.

Ethan only recognizes the true implications of this light after losing himself entirely to corruption. Marullo, his Italian employer, is blind to his clerk’s moral degrada-tion and therefore, by giving him the store, makes Ethan his “down payment…so the light won’t go out” (226). In doing so, Marullo entrusts that Ethan, the epitome of honesty, will fend off the immorality that has overcome society, but instead, the Italian unkno-wingly hastens the demise of Ethan’s virtue. He forces Ethan to take care of his own life, the store, but Ethan, unable to escape corruption on his own, only falls deeper into his pit of immorality, now filled with regret and remorse for his many betrayals. When Ethan finally realizes that his “light is out” (275) and that there is “nothing blacker than a wick” (275), he goes to the Place, which will soon be “under dark water” (202), to commit sui-cide. He can find no glimmer of morality within himself, no ray of virtue, no gleam of honesty; he is as black and corrupt as the society in which he lives. Sitting in the Place, the “dark water” of the ocean surrounds Ethan, signifying that corruption has finally con-sumed him. Trapped in this void of darkness and despair, he realizes he has lost his most important possession: his virtue. But as he lies in the water, the talisman in his pocket remind

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