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Posted: May 25th, 2023
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:
Include both case studies in your post.
Your initial post should be at least 250 words per case study, a total of 500 words for both, formatted and cited in current APA style with support from at least 2 academic sources per case study. Your initial post is worth 8 points.
You should respond to at least two of your peers, by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response before 11:59 PM ET Thursday, and comment on the posts of two classmates before 11:59 PM ET Sunday. NB: Responses to peers can be done on the same day, but not on the day the initial post is made.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.
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Pulmonary Function
Case Study Questions
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 severe. His peak flow rates have ranged from 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, which is not providing him with relief.
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
Smoke
Viral infections
Stress
In D.R.’s case, it is likely that his asthma attack was triggered by a combination of factors, including allergies, exercise, and cold air.
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 or pollutants
Personal factors, such as obesity or a history of allergies
In D.R.’s case, it is possible that his asthma is due to a combination of genetic and environmental factors.
Fluid, Electrolyte and Acid-Base Homeostasis
Case Study Questions
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 sodium level is too high and the blood osmolarity is too high. The high blood sodium level is causing the water to move out of the cells and into the extracellular fluid, which is causing the cells to shrink.
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:
Headache
Fatigue
Dizziness
Confusion
Seizures
Coma
The clinical manifestations of hypernatremia can include:
Dry skin
Sunken eyes
Decreased sweating
Increased thirst
Nausea and vomiting
Confusion
Seizures
Coma
The clinical manifestations of hypokalemia can include:
Muscle weakness
Muscle cramps
Paralysis
Arrhythmias
Heart failure
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 replace the fluids and electrolytes that she has lost. This can be done by giving her intravenous fluids and electrolytes. It is also important to treat the underlying cause of her dehydration, which in this case is her cough.
What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
The ABGs from Ms. Brown 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. The respiratory alkalosis is caused by her hyperventilation, which is a compensatory mechanism for her hypernatremia.
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. The anion gap is calculated by subtracting the sum of the chloride and bicarbonate ions from the total serum osmolarity. A normal anion gap is 8-12 mEq/L.
A high anion gap can be caused by a number of conditions, including:
Diabetic ketoacidosis
Lactic acidosis
Uremia
Poisoning with certain drugs, such as methanol or ethylene glycol
A low anion gap can be caused by a number of conditions, including:
Hypoalbuminemia
Hyperlipidemia
Hyponatremia
The anion gap is a useful tool for diagnosing and monitoring a number of medical conditions.
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