Discussion 3 Response Diana

Case Study

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

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.

Case study

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.

 

Submission Instructions:

• Respond to Peer below by extending, refuting/correcting, or adding additional nuance to their posts. Your response should be at least 150 words.1 academic resource, within last 5 years
• All replies must be constructive and use literature where possible.

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Module 3 Discussion

Diana Cobos

 

Module 3 Discussion

Pulmonary Function

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

The asthma attack had by D.R. is categorized as a moderate persistent asthma attack. When symptoms of moderate persistent asthma recur on a daily basis, it is referred to as persistent asthma; this is because most days of the week, people with mild chronic asthma have symptoms. The symptoms of D. R’s moderate persistent asthma, such as wheezing, coughing, exhaustion, and postnasal, are indicators of this condition. His flow rates are between 65 and 70%, and he’s had three nights of overnight symptoms in the last week, all of which point to mild persistent asthma. His three-day self-treatment with regular albuterol nebulizer medicine had failed, indicating that his asthma had gotten worse.

2. Name the most common triggers for asthma in any given patient and specify in your answer which ones you consider applied to D.R. in the case study.

Asthma develops when the airways become inflamed, inflated, and constrict, resulting in the production of excessive mucus (Chau-Etchepare et al., 2019). Coughing, especially at night, shortness of breath, wheezing, and exhaustion are all signs of asthma, which can range from mild to fatal. Tobacco smoke, dust mites, outdoor air pollution, and pets are some of the asthma causes. Smoke causes the airways to enlarge, restrict, and fill with mucus, making it difficult to manage even with medicine. It is recommended that people with asthma avoid smoking, as well as secondhand smoking, which is just as harmful. Dust mites are small insects that live in our dwellings. Exposure to these mites on a regular basis can be harmful to an asthmatic’s health causing a range of asthma symptoms such as runny nose, sneezing, and coughing.

Because of many toxins in the air that come from diverse sources such as industries, cars, and smoke, outdoor air pollution is a likely trigger of asthma attacks. It is recommended that people with asthma avoid areas where there is a high risk of air pollution. Pets are another asthma trigger. Pets are known to have a protein in their saliva, urine, and fur that can trigger asthma attacks. The safest approach to keep from getting asthma episodes is to keep them outside as often as possible.

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

Because the case study does not provide much information about D.R.’s lifestyle, his etiology for asthma could be a family history. If one of D. R’s parents suffers from asthma, he is three to six times more likely to get asthma himself. D.R is more likely to develop persistent asthma if he had viral respiratory infections as a child. D.R is also more prone to acquire asthma if he has an allergic condition like atopic dermatitis because both eczema and asthma are caused by allergens in the environment. D.R. may be a smoker or a second-hand smoker Tobacco smoke is dangerous to everyone, particularly asthmatics (Korsbæk et al., 2021). Obesity is another possible reason for D. R’s asthma. Obesity raises D. R’s risk of developing asthma. Fat tissues create inflammatory molecules that can compromise lung function, resulting in asthma (Freitas et al., 2017).

Fluid, Electrolyte and Acid-Base Homeostasis:

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

According to her laboratory findings, Ms. Brown has a hypertonic imbalance with a high-solute extracellular fluid content (ECF). This means that the ECF water has been exhausted, and fluid from the intracellular space has now migrated to the extracellular space, this process is known as edema. A hypertonic imbalance occurs when the body’s water and salt levels are out of balance (Khan et al., 2019).

2. Describe the signs and symptoms of the different types of water imbalance and described the clinical manifestation she might exhibit with the potassium level she has.

Ms. Brown suffers from hypernatremia, which is a sort of water imbalance. The presence of sodium above 147 mEq/L provides evidence of this. ECF water losses created by decreased oral intake, rapid undetectable water loss from the pulmonary system, and the presence of glucose in the tubular fluid and urine as a result of the renal system’s ongoing loss of water could be the probable reasons for her hypernatremia. Restlessness, sleeplessness, and tachypnea are some of the symptoms associated with hypernatremia.

Ms. Brown also has Hyperchloremia, which is a water impairing condition. Excess chlorine in the body causes hyperchloremia. The typical range for chloride in the body is 98 to 107 mEq/L, but Ms. Brown’s serum chloride level is 115 mEq/L, indicating an excess of serum chloride. Fatigue, muscle weakness, increased thirst, and dry mucous membranes are all indications of hyperchloremia that could affect Ms. Brown. Mrs. Brown’s clinical manifestations of hyperchloremia include dehydration due to a lack of water intake, resulting in an electrolyte imbalance.

Potassium levels in the blood should be between 3.5 and 5.0 mmol/L in the normal range. Ms. Brown’s potassium levels, on the other hand, are exceptionally high at 5.6mmol/L, a condition known as Hyperkalemia. Hyperkalemia is a condition that arises when potassium levels in the blood are too high. Potassium is a nutrient that is contained in food and has the primary purpose of assisting neuron and muscle function. Too much potassium, however, can harm the heart and cause a heart attack. Ms. Brown may experience chest pain and stomach pain, diarrhea, muscular weakness due to the high potassium level.

4. In the specific case presented, which would be the most appropriate treatment for Ms. Brown and why?

Ms. Brown’s hypernatremia can best be treated by giving her a salt-free isotonic fluid-like D5W until her serum sodium level returns to normal, then treating the root cause of hypovolemia, as well as controlling hyperglycemia and acidosis. If patients are unable to tolerate oral water, they should be given intravenous 5 percent dextrose for acute hypernatremia or half-normal saline (0.45 percent sodium chloride) for chronic hypernatremia (Seay et al., 2020).

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

Ms. Brown’s ABGs demonstrate that she has metabolic acidosis because her PH level is below 7.35. As a result of compensatory hyperventilation, her PaCO2 is also lower than normal, and her HCO3 is below 24 mEq/L. She is hypoxemic since her PaO2 is less than 80mmHg.

6. Based on your readings and your research define and describe Anion Gaps and their clinical significance.

The disparity between measured citations like sodium and potassium and measured anions like chloride in blood is commonly referred to as the anion gap. The balance of electrolytes and acid in the blood can be determined with an anion gap test (Kum-Nji et al., 2017). In a patient with a normal serum albumin content of 4.0 g/dL, a normal anion gap is generally considered to be between 8 and 12. Acidosis is diagnosed by having a high anion gap. Dehydration or diarrhea can induce acidosis, which is characterized by high levels of acid in the blood. An individual with a low anion gap has a low albumin level. Low albumin levels are frequently associated with kidney or cardiac issues.

References

Chau-Etchepare, F., Hoerger, J. L., Kuhn, B. T., Zeki, A. A., Haczku, A., Louie, S., … & Schivo, M. (2019). Viruses and non-allergen environmental triggers in asthma. Journal of Investigative Medicine, 67(7), 1029-1041. http://dx.doi.org/10.1136/jim-2019-00100

Freitas, P. D., Ferreira, P. G., Silva, A. G., Stelmach, R., Carvalho-Pinto, R. M., Fernandes, F. L., … & Carvalho, C. R. (2017). The role of exercise in a weight-loss program on clinical control in obese adults with asthma. A randomized controlled trial. American Journal of Respiratory and Critical Care Medicine, 195(1), 32-42. https://doi.org/10.1164/rccm.201603-0446OC

Khan, R. N., Saba, F., Kausar, S. F., & Siddiqui, M. H. (2019). Pattern of electrolyte imbalance in Type 2 diabetes patients: Experience from a tertiary care hospital. Pakistan Journal of Medical Sciences, 35(3), 797. https://dx.doi.org/10.12669%2Fpjms.35.3.844

Korsbæk, N., Landt, E. M., & Dahl, M. (2021). Second-Hand Smoke Exposure Associated with Risk of Respiratory Symptoms, Asthma, and COPD in 20,421 Adults from the General Population. Journal of Asthma and Allergy, 14, 1277. https://dx.doi.org/10.2147%2FJAA.S328748

Kum-Nji, J. S., Gosmanov, A. R., Steinberg, H., & Dagogo-Jack, S. (2017). Hyperglycemic, high anion-gap metabolic acidosis in patients receiving SGLT-2 inhibitors for diabetes management. Journal of Diabetes and its Complications, 31(3), 611-614. https://doi.org/10.1016/j.jdiacomp.2016.11.004

Seay, N. W., Lehrich, R. W., & Greenberg, A. (2020). Diagnosis and management of disorders of body tonicity—Hyponatremia and hypernatremia: Core curriculum 2020. American Journal of Kidney Diseases, 75(2), 272-286. https://doi.org/10.1053/j.ajkd.2019.07.014

Discussion 3 Response Diana

Hypernatremia is a common electrolyte disorder in patients with poorly-controlled diabetes mellitus. Affected patients usually have variable concentrations of sodium in the blood. Fluid therapy is the recommended management action for hypernatremia in diabetic patients. For example, as you have indicated in your discussion, Mr. Brown’s hypernatremia can be resolved by administering a salt-free isotonic fluid-like D5W until her serum sodium level returns to normal (Seay et al., 2020). According to Nuwagaba et al. (2021), in order to manage hypernatremia in diabetic patients, the clinician should administer an infusion of isotonic or normal saline of 0.9% concentration. The recommended frequency for administration is 15 to 2o milliliters of fluid per kilogram weight per hour. The goal of this treatment is to improve plasma osmolarity. In order to achieve the best outcomes for Ms. Brown, the nurse should supplement the fluid therapy with potassium replacement. During treatment, the nurse should monitor urinary output, serum electrolyte levels, the status of hydration, and hemodynamics (Nuwagaba et al., 2021). From this case study, nurses learn the importance of monitoring serum electrolyte levels in patients with type 2 diabetes.

References

Nuwagaba, J., Srikant, S., & Darshit, D. (2021). Case series: Management of hypernatremia in DKA in a tertiary healthcare setting in a developing country. International Medical Case Reports Journal, 14, 567-571. https://doi.org/10.2147/IMCRJ.S326350

Seay, N. W., Lehrich, R. W., & Greenberg, A. (2020). Diagnosis and management of disorders of body tonicity—Hyponatremia and hypernatremia: Core curriculum 2020. American Journal of Kidney Diseases, 75(2), 272-286. https://doi.org/10.1053/j.ajkd.2019.07.014