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Posted: September 6th, 2023

Case Study 1: Pulmonary Function

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.

Case Study 1: Pulmonary Function

According to the case study information, the severity of D.R.’s asthma attack can be classified as moderate persistent asthma. The symptoms he presents with, including increasing shortness of breath (SOB), wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage, indicate an exacerbation of his asthma. The fact that his peak flow rates have ranged from 65-70% of his regular baseline suggests moderate airflow limitation. The nighttime symptoms and the need for frequent albuterol nebulizer therapy further indicate the worsening of his asthma.

The most common triggers for asthma in any given patient include:

Allergens: Such as pollen, dust mites, pet dander, and mold spores.
Irritants: Including cigarette smoke, air pollution, strong odors, and chemicals.
Respiratory infections: Viral infections, such as common cold or flu, can trigger asthma symptoms.
Exercise: Physical exertion or exercise-induced asthma can be a trigger.
Weather changes: Cold air, humidity, or changes in temperature can provoke asthma.
Stress and emotions: Emotional stress can trigger asthma symptoms.
In the case of D.R., it is likely that allergens, such as pollen or dust mites, could be contributing to his symptoms as he presents with stuffy nose, watery eyes, and postnasal drainage. It is also possible that a respiratory infection could have triggered his current asthma exacerbation.

The etiology of D.R. being an asthmatic patient can be attributed to various factors, including:
Genetic predisposition: Asthma tends to run in families, suggesting a genetic component.
Environmental factors: Exposure to allergens, pollutants, and respiratory infections can contribute to the development of asthma.
Immunological factors: Abnormal immune responses, including inflammation and hypersensitivity reactions, play a role in asthma.
Airway hyperresponsiveness: Asthma involves increased sensitivity of the airways to various triggers, leading to bronchoconstriction and inflammation.
Allergic reactions: Many individuals with asthma have allergies, and allergic reactions can trigger asthma symptoms.
It is important to note that asthma is a complex disease with multiple potential causes, and individual cases may have varying etiologies. Further evaluation and assessment of D.R.’s medical history, family history, and environmental exposures would provide a more comprehensive understanding of his specific asthma triggers and etiological factors.

Case Study 2: Fluid, Electrolyte, and Acid-Base Homeostasis

Based on Ms. Brown’s admission laboratory values, she has hyperglycemia (high blood glucose) indicating uncontrolled diabetes mellitus. Additionally, her serum sodium (Na+) level is elevated (hypernatremia), her serum potassium (K+) level is elevated (hyperkalemia), and her serum chloride (Cl–) level is elevated (hyperchloremia). These electrolyte imbalances suggest a state of dehydration and fluid loss.

Signs and symptoms of water and electrolyte imbalances:

Hypernatremia: Thirst, dry mouth, decreased urine output, restlessness, confusion, seizures, and coma.
Hyperkalemia: Weakness, fatigue, palpitations, arrhythmias, muscle cramps, and potentially life-threatening cardiac dysrhythmias.
Hyperchloremia: Deep, rapid breathing (Kussmaul respirations), weakness, lethargy, hypertension, and metabolic acidosis.
With Ms. Brown’s elevated potassium level (hyperkalemia), she may exhibit muscle weakness, fatigue, palpitations, and potentially cardiac arrhythmias. These symptoms can be attributed to the effect of elevated potassium

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