D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic complaining of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage—all of which began four days ago. Three days ago, he began monitoring his peak flow rates several times a day. His peak flow rates have ranged from 65-70% of his regular baseline with nighttime symptoms for 3 nights on the last week and often have been at the lower limit of that range in the morning. Three days ago, he also began to self-treat with frequent albuterol nebulizer therapy. He reports that usually his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer enough treatment for this asthmatic episode.
Case Study Questions
According to the case study information, how would you classify the severity of D.R. asthma attack?
Name the most common triggers for asthma in any given patients and specify in your answer which ones you consider applied to D.R. on the case study.
Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.
Fluid, Electrolyte and Acid-Base Homeostasis:
Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:
Serum glucose 412 mg/dL
Serum sodium (Na+) 156 mEq/L
Serum potassium (K+) 5.6 mEq/L
Serum chloride (Cl–) 115 mEq/L
Arterial blood gases (ABGs): pH 7.30; PaCO2 32 mmHg; PaO2 70 mmHg; HCO3– 20 mEq/L
Case Study Questions
Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?
Describe the signs and symptoms to the different types of water imbalance and described clinical manifestation she might exhibit with the potassium level she has.
In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
Based on your readings and your research define and describe Anion Gaps and its clinical significance.
Submission Instructions:
You must complete both case studies if there are more than one.
Your initial post should be at least 500 words, formatted using the questions or a phrase that summarize the question as heading. This should be bold and centered and responses to each question under the heading. You must cite in current APA style with support from at least 2 academic sources within the last 5 years. Your initial post is worth 8 points.
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D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic
**Asthma Case Study**
**Severity of Asthma Attack Classification:**
D.R.’s asthma attack can be classified as moderate persistent asthma based on the symptoms and peak flow rates mentioned in the case study. Moderate persistent asthma is characterized by daily symptoms, nighttime symptoms more than once a week, peak flow rates ranging from 60-80% of baseline, and exacerbations affecting activity. D.R. exhibits symptoms of increasing shortness of breath (SOB), wheezing, cough, and nocturnal symptoms for three nights in the last week. His peak flow rates range from 65-70% of baseline, with morning symptoms also evident.
**Common Triggers for Asthma:**
Common triggers for asthma include allergens (such as pollen, dust mites, pet dander), respiratory infections (viral or bacterial), exercise, air pollutants (smoke, smog), weather changes, stress, and certain medications. In D.R.’s case, the triggers could be respiratory infections or allergens as he presents with symptoms of stuffy nose, watery eyes, and postnasal drainage, along with a recent onset of symptoms.
**Etiology of Asthma:**
The etiology of asthma involves a complex interplay of genetic predisposition and environmental factors. Genetic factors contribute to a person’s susceptibility to asthma, while environmental triggers such as allergens, pollutants, respiratory infections, and occupational exposures can exacerbate the condition. Inflammatory responses in the airways lead to bronchoconstriction, mucus production, and airway hyperresponsiveness, resulting in the characteristic symptoms of asthma. Additionally, factors like obesity, smoking, and early childhood respiratory infections can increase the risk of developing asthma.
**Fluid, Electrolyte, and Acid-Base Homeostasis Case Study**
**Type of Water and Electrolyte Imbalance:**
Based on Ms. Brown’s laboratory values, she is experiencing hypernatremia (elevated serum sodium) and hyperchloremia (elevated serum chloride), indicating dehydration and fluid volume deficit. Additionally, her hyperglycemia (elevated serum glucose) in the context of diabetes mellitus contributes to the osmotic diuresis, further exacerbating dehydration.
**Signs and Symptoms of Water Imbalance and Clinical Manifestations of Hyperkalemia:**
Signs and symptoms of dehydration include dry mucous membranes, decreased skin turgor, thirst, tachycardia, hypotension, and altered mental status. With hyperkalemia (elevated serum potassium), clinical manifestations may include muscle weakness, cardiac arrhythmias (such as bradycardia or heart block), and potentially life-threatening dysrhythmias.
**Appropriate Treatment for Ms. Brown:**
The most appropriate treatment for Ms. Brown would involve rehydration with intravenous fluids to correct her fluid and electrolyte imbalances. Additionally, insulin therapy should be initiated or adjusted to manage her hyperglycemia and prevent further osmotic diuresis. Monitoring of serum electrolytes and glucose levels, along with addressing the underlying cause of her illness (e.g., respiratory infection), is essential for comprehensive management.
**ABGs and Acid-Base Imbalance:**
Ms. Brown’s ABGs indicate a metabolic acidosis with respiratory compensation. The pH is slightly acidic (7.30), and the bicarbonate (HCO3–) level is decreased (20 mEq/L), indicating metabolic acidosis. The respiratory compensation is evidenced by the lower PaCO2 (32 mmHg), which attempts to normalize pH by decreasing respiratory acid excretion.
**Anion Gap and Clinical Significance:**
Anion gap is a calculated parameter used to assess for metabolic acid-base disorders. It represents the unmeasured anions in plasma and is calculated as (Na+ – [Cl– + HCO3–]). An elevated anion gap (>12 mEq/L) suggests the presence of unmeasured anions, which could indicate metabolic acidosis due to conditions such as lactic acidosis, ketoacidosis, or renal failure. Anion gap is clinically significant as it helps in diagnosing and managing acid-base disorders and guiding appropriate treatment interventions.
In conclusion, both cases highlight the importance of understanding respiratory conditions like asthma and electrolyte imbalances in clinical practice. Effective management requires a comprehensive approach considering both the underlying pathophysiology and individual patient factors.
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