solved include all information is related to the patient E. R.

include all information is related to the patient E. R. has come to the health center with reports of a productive cough with bloody sputum and shortness of breath especially on exertion. A unilateral wheeze is heard on auscultation. Health record indicates that he is a one-pack-a-day cigarette smoker. Previous medical history (PMH): hypertension (HTN), diabetes mellitus (DM). There is an increased anteroposterior diameter and barrel chest. He is using his accessory muscles to breath and is sitting in a tripod position. He appears anxious. A lag in expansion is noted when performing chest expansion. Vital signs: T 38.2°C, P 72, R 32, BP 160/84 Lungs: Decreased chest expansion, dull sound over lower lobes and diminished breath sound throughout. Expiration is prolonged. Decrease in tactile fremitus. Nailbeds cyanotic.