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.
Full Answer Section
Common Asthma Triggers:
Many factors can trigger asthma attacks. Here are some common ones, with potential applicability to D.R.:
- Viral infections (common cold, flu): D.R.'s symptoms began four days ago, potentially coinciding with a viral illness that could be a trigger.
- Allergens: Dust mites, pet dander, pollen, or mold exposure are not mentioned but could be contributing factors.
- Irritants: Smoke, pollution, or strong cleaning chemicals are not mentioned but could be possibilities.
- Exercise-induced asthma: Not mentioned, but it's a possibility to explore.
Factors Contributing to D.R.'s Asthma:
Several factors might contribute to D.R.'s asthma:
- Genetics: Asthma has a genetic component, so a family history could be a risk factor.
- Environmental Exposures: Regular exposure to triggers like allergens or irritants could worsen asthma.
- Obesity: Not mentioned, but obesity can worsen asthma symptoms.
Ms. Brown's Case Study:
Water and Electrolyte Imbalance:
Based on Ms. Brown's lab values, she has a combination of:
- Hyperglycemia: High blood sugar (412 mg/dL).
- Hypernatremia: Elevated sodium (156 mEq/L).
- Hyperkalemia: High potassium (5.6 mEq/L).
Water Imbalance and Potassium Signs/Symptoms:
- Dehydration: Her inability to eat or drink for two days likely led to dehydration, contributing to her hypernatremia. Symptoms can include fatigue, dizziness, and confusion.
- Hyperkalemia: This can cause muscle weakness, nausea, and irregular heartbeat.
Treatment for Ms. Brown:
- Intravenous (IV) Fluids: Rehydration with normal saline solution is crucial to address hypernatremia and improve her overall condition.
- Monitoring Potassium: Close monitoring of her potassium level is needed to prevent further complications. Medications or treatments to lower potassium might be necessary if levels become critically high.
Acid-Base Imbalance:
Ms. Brown's ABGs show a mild respiratory acidosis. Here's the breakdown:
- pH: Slightly acidic (7.30, normal range 7.35-7.45).
- PaCO2: Elevated carbon dioxide (32 mmHg, normal range 35-45 mmHg).
- HCO3-: Low bicarbonate (20 mEq/L), indicating the body's attempt to compensate for the acidosis.
Anion Gap:
The anion gap is a calculation used to assess the body's acid-base balance. It's not provided in the case, but understanding it's helpful:
- Definition: The difference between measured cations (positively charged ions) and anions (negatively charged ions) in the blood.
- Clinical Significance: An abnormal anion gap can indicate various conditions, including metabolic acidosis from toxins or kidney problems.
Important Note:
This information is for educational purposes only and is not a substitute for professional medical advice. If you are concerned about your health, please consult a licensed physician.