Posted: February 28th, 2022

D.R. is a 27-year-old man

Pulmonary Function:
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
Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources.

______________________-
Pulmonary Function

Case Study Questions

1. According to the case study information, how would you classify the severity of D.R. asthma attack?

Based on the information provided, D.R.’s asthma attack is classified as moderate to severe. His peak flow rates have decreased to 65-70% of his regular baseline, and he has been experiencing nighttime symptoms for the past week. He has also been self-treating with frequent albuterol nebulizer therapy, but his symptoms have not improved.

2. 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.

The most common triggers for asthma include:

Allergens, such as dust mites, pollen, and pet dander
Exercise
Cold air
Viral infections
Smoke
Strong odors
Based on the information provided, it is likely that D.R.’s asthma attack was triggered by a viral infection. He has been experiencing nighttime symptoms for the past week, which is a common symptom of a viral infection. Additionally, he has been self-treating with frequent albuterol nebulizer therapy, which is an effective treatment for asthma symptoms caused by a viral infection.

3. Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.

There are a number of factors that can contribute to the development of asthma, including:

Genetics
Environmental factors, such as exposure to allergens
Air pollution
Occupational exposures
Personal habits, such as smoking
It is likely that D.R. has a genetic predisposition to asthma. Additionally, he has been exposed to a number of environmental factors that could have triggered the development of his asthma, such as dust mites, pollen, and pet dander.

Fluid, Electrolyte and Acid-Base Homeostasis

Case Study Questions

1. Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?

Based on Ms. Brown’s admission laboratory values, she is experiencing a hyperosmolar hypernatremia. This is a condition in which the blood is too concentrated, and the sodium level is too high.

2. 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.

The signs and symptoms of water imbalance can vary depending on the type of imbalance. However, some common signs and symptoms include:

Changes in weight
Changes in thirst
Changes in urination
Headache
Fatigue
Confusion
Seizures
The clinical manifestations of hyperkalemia can vary depending on the severity of the imbalance. However, some common manifestations include:

Muscle weakness
Fatigue
Numbness or tingling in the hands and feet
Slow heart rate
Irregular heart beat
Arrhythmia
3. In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?

The most appropriate treatment for Ms. Brown would be to rehydrate her with intravenous fluids. This will help to dilute the blood and lower the sodium level. Additionally, she may need to be given potassium-binding medications to help lower the potassium level.

4. What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?

Ms. Brown’s ABGs indicate that she is experiencing a respiratory alkalosis. This is a condition in which the blood pH is too high, and the carbon dioxide level is too low.

5. Based on your readings and your research define and describe Anion Gaps and its clinical significance.

The anion gap is a measure of the concentration of unmeasured anions in the blood. It is calculated by subtracting the sum of the chloride and bicarbonate levels from the sodium level. A normal anion gap is 8-12 mEq/L.

An increased anion gap can be a sign of a number of conditions, including:

Diabetic ketoacidosis
Lactic acidosis
Renal failure
Poisoning
A decreased anion gap can be a sign of a number of conditions, including:

Hypoalbuminemia
Multiple myeloma
Sepsis
The anion gap is a valuable tool for diagnosing and managing a number of medical conditions.

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