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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.

Sample Answer

Pulmonary Function Case Study:

1. Severity of D.R.’s Asthma Attack:

Based on the given information, D.R.’s asthma attack could be categorized as moderate. Here’s why:

Symptoms: D.R. experiences increasing shortness of breath, wheezing, fatigue, cough, nasal congestion, and postnasal drainage. These symptoms are indicative of moderate asthma.
Peak flow: His peak flow readings are 65-70% of his baseline, which falls within the moderate range (50-80% of predicted).
Nighttime symptoms: D.R. has had nighttime symptoms for 3 nights, suggesting persistent and disruptive asthma.
Albuterol response: Although his usual albuterol inhaler provides relief, it’s no longer sufficient, indicating a more severe episode requiring additional treatment.

Full Answer Section

Common Asthma Triggers and Potential Triggers for D.R.:

Several common triggers can provoke asthma attacks, including:

Allergens: Dust mites, pollen, mold, pet dander
Irritants: Smoke, air pollution, strong odors, cleaning chemicals
Respiratory infections: Colds, flu, bronchitis
Physical exercise
Emotional stress and anxiety

Based on the case study, potential triggers for D.R. could be:

Upper respiratory infection: His stuffy nose, watery eyes, and postnasal drainage suggest a possible infection triggering the asthma attack.
Stress: The case doesn’t mention stress, but it’s a common trigger worth considering.

3. Etiology of D.R.’s Asthma:

The exact cause of asthma is unknown, but several factors contribute to its development:

Genetics: Family history of asthma increases the risk.
Environmental factors: Exposure to allergens and irritants can trigger inflammation and airway narrowing.
Immune system dysfunction: Imbalances in the immune response can contribute to asthma.
Early life factors: Viral infections, childhood respiratory illnesses, and exposure to tobacco smoke can increase the risk.

Unfortunately, the case study doesn’t provide enough information to pinpoint the specific cause of D.R.’s asthma.

Fluid, Electrolyte and Acid-Base Homeostasis Case Study:

1. Ms. Brown’s Water and Electrolyte Imbalance:

Based on Ms. Brown’s lab values, she likely has:

Hyperglycemia: Her elevated blood glucose indicates uncontrolled diabetes mellitus.
Hypernatremia: Her serum sodium level of 156 mEq/L is above the normal range (135-145 mEq/L), suggesting dehydration.
Hyperkalemia: Her potassium level of 5.6 mEq/L is mildly elevated, although still within the normal range (3.5-5.3 mEq/L).

2. Signs and Symptoms of Water Imbalance and Clinical Manifestations of Ms. Brown’s Potassium Level:

Water imbalances:

Dehydration: Symptoms include thirst, dry mouth, fatigue, decreased urine output, and dizziness. Ms. Brown’s inability to eat or drink for 2 days likely contributed to her dehydration.
Overhydration: Less likely in this case, but symptoms can include nausea, vomiting, headache, and confusion.

Potassium level:

Hyperkalemia: At her current level, Ms. Brown might not experience significant symptoms. However, higher potassium levels can cause muscle weakness, irregular heartbeat, and even cardiac arrest.

3. Treatment for Ms. Brown:

The most appropriate treatment for Ms. Brown would likely involve:

Insulin therapy: To control her hyperglycemia and prevent further complications.
Fluid resuscitation: To correct her dehydration and normalize her electrolyte levels.
Monitoring: Closely monitoring her electrolytes and vital signs to ensure safe management of her condition.

4. Acid-Base Imbalance and Anion Gap:

Ms. Brown’s ABGs indicate a mild respiratory acidosis. This means her blood is slightly more acidic than normal due to elevated carbon dioxide levels (PaCO2 of 32 mmHg).

The anion gap is the difference between the strong cations (sodium and potassium) and the strong anions (chloride and bicarbonate) in the blood. A normal anion gap is 8-16 mEq/L. Ms. Brown’s anion gap likely remains within the normal range due to her elevated potassium level partially compensating for the metabolic acidosis caused by her hyperglycemia.

Clinical significance of anion gap:

An elevated anion gap can indicate various metabolic imbalances, including diabetic ketoacidosis, lactic acidosis, and alcohol intoxication. Monitoring the anion gap is crucial in diagnosing and managing these conditions.

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