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
- Limited Relief from Albuterol: His usual inhaler is no longer providing adequate relief, suggesting a worsening condition.
Possible Triggers:
Common asthma triggers include:
- Allergens: Dust mites, pet dander, pollen, mold
- Irritants: Smoke, air pollution, strong cleaning chemicals
- Respiratory infections: Colds, flu
- Exercise (Exercise-induced asthma)
- Medications: Aspirin, ibuprofen (for some people)
- Weather changes: Cold, dry air
Possible Triggers in D.R.'s Case:
It's difficult to pinpoint the exact trigger without more information. However, considering the time of year (unspecified), the possibility of allergens like pollen or mold exposure is less likely.
Here are some possibilities based on the information provided:
- Respiratory infection: The recent onset of cough, congestion, and overall illness could indicate a respiratory infection, which is a common asthma trigger.
- Irritants: Exposure to smoke, air pollution, or other irritants at work or home could be a possibility.
Etiology of Asthma:
The exact cause of asthma is unknown, but several factors are believed to contribute:
- Genetics: A family history of asthma increases the risk.
- Atopy: A tendency to develop allergic reactions.
- Environmental factors: Exposure to allergens and irritants can trigger asthma development.
- Airway hyperresponsiveness: Hypersensitive airways that constrict easily in response to triggers.
Ms. Brown's Case Study:
Water and Electrolyte Imbalance:
Based on Ms. Brown's lab values, she has the following imbalances:
- Hyperglycemia: Elevated blood sugar (412 mg/dL) due to her diabetes.
- Hypernatremia: Elevated sodium (Na+) level (156 mEq/L). This could be due to dehydration.
- Hyperkalemia: Elevated potassium (K+) level (5.6 mEq/L). This can be dangerous and requires immediate attention.
Signs and Symptoms of Water Imbalance:
- Dehydration: Thirst, fatigue, dizziness, dry mouth, decreased urine output.
- Overhydration: Headache, nausea, vomiting, confusion, edema (swelling).
Clinical Manifestations of Hyperkalemia:
- Muscle weakness, cramping, and paralysis (especially heart muscles).
- Arrhythmias (irregular heartbeats).
- Tingling or numbness.
- Slow heart rate.
Treatment for Ms. Brown:
Ms. Brown requires immediate medical attention due to her hyperkalemia and potential complications. Treatment will likely involve:
- Intravenous (IV) fluids: To correct dehydration and electrolyte imbalances.
- Insulin: To lower blood sugar levels.
- Medications to lower potassium: This might involve diuretics or other medications depending on the cause of the hyperkalemia.
- Monitoring of vital signs and electrolytes: Close monitoring is crucial to ensure her safety.
Acid-Base Imbalance:
Ms. Brown's ABGs show:
- Respiratory acidosis: Low pH (7.30) and high PaCO2 (32 mmHg) indicate her body is retaining CO2, a sign of respiratory problems.
- Partial compensation: Her HCO3- level (20 mEq/L) is slightly elevated, suggesting the body is attempting to compensate for the acidosis.
Anion Gap:
The anion gap is a calculated value used to assess the body's acid-base balance. It's not provided in this case, but here's some background information:
- Definition: The difference between measured cations (positively charged ions) and measured anions (negatively charged ions) in the blood.
- Clinical Significance: An abnormal anion gap can indicate various conditions, including metabolic acidosis from accumulation of unmeasured anions (e.g., ketones, lactate).