[SOLUTION] 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

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 – Homework Solution

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.

Pulmonary Function
Pulmonary Function

Case Study Questions

  1. According to the case study information, how would you classify the severity of D.R. asthma attack?
  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.
  3. 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

  1. Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?
  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.
  3. In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
  4. What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
  5. Based on your readings and your research define and describe Anion Gaps and its clinical significance.

Sample Answer

Pulmonary Function:

Severity Classification of D.R.’s Asthma Attack:

Based on the provided information, D.R.’s asthma attack can be classified as moderate persistent asthma. This classification is determined by the presence of symptoms more than twice a week but not daily, peak flow rates ranging from 60-80% of baseline, and nighttime symptoms occurring more than once a week.

Common Triggers for Asthma and Application to D.R.:

Common triggers for asthma include allergens (e.g., pollen, dust mites), respiratory infections, exercise, cold air, smoke, and stress. In D.R.’s case, his symptoms started after exposure to triggers such as respiratory infections (manifested by stuffy nose, watery eyes, and cough) and possibly allergens, considering the season or his environment. Additionally, his symptoms worsened despite using his usual albuterol inhaler, indicating a worsening of his asthma.

Etiology of D.R.’s Asthma:

Asthma is a complex disease influenced by both genetic and environmental factors. In D.R.’s case, the etiology of his asthma could involve a combination of genetic predisposition (family history) and environmental triggers (allergens, respiratory infections). Other factors such as air pollution, tobacco smoke exposure, and occupational hazards may also contribute to the development and exacerbation of his asthma symptoms.

Fluid, Electrolyte and Acid-Base Homeostasis:

Water and Electrolyte Imbalance in Ms. Brown:

Ms. Brown exhibits hypernatremia, hyperchloremia, and hyperglycemia, indicating a hyperosmolar hyperglycemic state (HHS). This condition is characterized by severe dehydration, hyperglycemia, and elevated serum osmolality.

Signs and Symptoms of Water Imbalance and Clinical Manifestations of High Potassium:

Signs and symptoms of hypernatremia and hyperchloremia include thirst, dry mucous membranes, confusion, and weakness. With a potassium level of 5.6 mEq/L, Ms. Brown may exhibit symptoms such as muscle weakness, fatigue, and cardiac arrhythmias.

Pulmonary Function
Pulmonary Function

Appropriate Treatment for Ms. Brown:

The most appropriate treatment for Ms. Brown would involve rehydration with intravenous fluids, correction of hyperglycemia with insulin therapy, and monitoring and correction of electrolyte imbalances, including hypernatremia and hyperkalemia.

ABGs and Acid-Base Imbalance:

Ms. Brown’s ABGs indicate a metabolic acidosis, as evidenced by a pH of 7.30 and a decreased bicarbonate level (HCO3–) of 20 mEq/L. This acid-base imbalance is likely due to the accumulation of acidic ketones in the bloodstream resulting from uncontrolled diabetes mellitus and dehydration.

Anion Gap and Clinical Significance:

Anion gap refers to the difference between the measured cations (sodium and potassium) and the measured anions (chloride and bicarbonate) in the serum. A high anion gap (>12 mEq/L) indicates the presence of unmeasured anions, which can be due to metabolic acidosis from conditions such as diabetic ketoacidosis (DKA). Monitoring the anion gap is essential in diagnosing and managing metabolic acid-base disorders and guiding appropriate treatment interventions.

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