Patient Profile
C.L. is a 55-year-old male who presents to his healthcare provider with complaints of difficulty breathing,
which has progressively worsened over the past couple of weeks. He has a history of hypertension. He is
currently taking furosemide and Lisinopril.
Subjective Data
Has had some shortness of breath for the past couple of weeks. At first, it was just with activity,
but it has gotten worse and is present at rest.
Started smoking at age 18 and has smoked one pack per day for the past 37 years
Adds he has cut down on his smoking the past week and is only smoking one-half pack of
cigarettes per day
Objective Data
Physical Examination
Blood pressure 140/88, pulse 90, temperature98.7° F, respirations 22
O2 saturation 90% on room air
Respirations labored, frequent productive cough with yellow sputum
Breath sounds reveal distant breath sounds in right lower lobe, clear in all other lobes
Dullness to percussion of right lower lung lobe
Diagnostic Studies
Chest x-ray reveals a 2.5 cm lesion and pleural effusion in the right lower lung
Discussion Questions
1. What is a pleural effusion? What type of effusion do you suspect C.L. has and why?
2. The health care provider performs a thoracentesis to alleviate C.L.’s dyspnea and to have the
fluid analyzed for diagnostic purposes. What is the procedure for a thoracentesis? What tests
and monitoring are done after the procedure?
Case Study Progress
The results of the thoracentesis revealed malignant cells in the pleural fluid. C.L. then has CT scans of the
chest, brain, and bone to evaluate the exact location and size of the lung mass and check for any
mediastinal or lymph node involvement and metastatic disease. The results of the CT scan show only the
2.5 cm lesion in the lower lobe of the right lung with no evidence of mediastinal or lymph node
involvement and metastasis. C.L. undergoes a thoracotomy with a right lower lobectomy. After this
surgery, he is admitted to the surgical step-down unit with a chest tube.
