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
- Albuterol Use: While his usual albuterol inhaler isn't providing enough relief, he's not experiencing life-threatening symptoms requiring immediate emergency care.
Common Asthma Triggers:
Many triggers can cause asthma attacks. Here are some common ones, with some potentially applicable to D.R.:
- Allergens: Dust mites, pollen, pet dander (not mentioned in the case study but a possibility).
- Irritants: Smoke, air pollution, strong cleaning chemicals (not mentioned but possible).
- Respiratory infections: The common cold or flu (not mentioned but could explain the recent onset of symptoms).
- Exercise-induced asthma (EIA): Not mentioned, but D.R.'s age suggests EIA is less likely.
- Medications: Certain medications like aspirin can trigger asthma in some individuals (not mentioned).
Potential Etiology of D.R.'s Asthma:
While the exact cause of asthma is unknown, several factors can contribute:
- Genetics: A family history of asthma increases the risk.
- Atopy: A tendency to develop allergies, which can be linked to asthma.
- Environmental Exposures: Early exposure to allergens, irritants, or air pollution can increase risk.
- Viral respiratory infections: Early childhood respiratory infections might play a role.
Ms. Brown's Case Study
Water and Electrolyte Imbalance:
Based on Ms. Brown's lab values, she has several imbalances:
- Hyperglycemia: Elevated blood sugar (412 mg/dL) is a sign of uncontrolled type 2 diabetes.
- Hypernatremia: Elevated sodium (156 mEq/L) indicates dehydration.
- Hyperkalemia: Elevated potassium (5.6 mEq/L) can be dangerous.
Water Imbalance and Potassium Signs & Symptoms:
- Dehydration: Symptoms include thirst, fatigue, dry mouth, decreased urination, and dizziness. Ms. Brown's inability to eat or drink for two days strongly suggests dehydration.
- Hyperkalemia: Symptoms can include muscle weakness, cramps, nausea, and irregular heartbeat. Ms. Brown might be experiencing some of these due to her elevated potassium.
Treatment for Ms. Brown:
Ms. Brown needs immediate medical attention due to her hyperglycemia, hypernatremia, and hyperkalemia. Treatment might involve:
- Intravenous fluids: To address dehydration and electrolyte imbalances.
- Insulin: To lower blood sugar levels.
- Medications or interventions: To address her high potassium if necessary (diuretics, dialysis).
Acid-Base Imbalance:
Ms. Brown's ABGs show a mild respiratory acidosis:
- 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 and Significance:
The anion gap is a calculation used to assess the body's acid-base balance. A normal anion gap is 9-14 mEq/L.
In Ms. Brown's case, the anion gap cannot be accurately calculated due to her hyperglycemia. However, the anion gap is clinically significant because it can help identify potential causes of acid-base imbalances.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult a qualified healthcare professional for diagnosis and treatment.