Pulmonary Function
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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 in 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 1 Questions:
According to the case study information, how would you classify the severity of D.R.’s asthma attack?
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.
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 2 Questions:
Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance she has? Name all of them based on the lab results and clinical presentation.
Describe the signs and symptoms of the different types of water imbalance and describe the 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? Include both pharmacologic and non-pharmacologic approaches.
What do the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
Based on your readings and your research define and describe Anion Gaps and their clinical significance.
Sample Solution
Based on Ms. Brown’s admission laboratory values and clinical presentation, it is possible to determine that she has several water and electrolyte imbalances. Firstly, her serum glucose level of 412 mg/dL indicates hyperglycemia which is a sign of uncontrolled diabetes mellitus (Kapoor et al., 2018). Secondly, her sodium levels are elevated at 156 mEq/L which indicates hypernatremia. This can be caused by dehydration due to her lack of fluids intake during the past two days or increased sodium excretion in urine as a result of diabetes insipidus (Kapoor et al., 2018). Thirdly, her potassium level is low at 5.6 mEq/L which suggests hypokalemia which can be caused by an increase in urinary losses due to diuretics or metabolic acidosis from dehydration (Kapoor et al., 2018). Finally, her chloride level is below normal at 115 mEq/L indicating an imbalance known as hypochloremia. This can be caused by vomiting or diarrhoea resulting from viral gastroenteritis combined with dehydration leading to loss of fluids containing chloride ions (Kapoor et al., 2018).
In addition to these electrolyte imbalances, Ms. Brown’s ABG results reveal additional information about her condition. Her pH result of 7.30 indicates metabolic acidosis which can arise from high levels of glucose in the blood leading to reduced buffering capacity in the body and decreased bicarbonate concentration (Berman & Snyder, 2017). Her PaCO2 and PaO2 values are both lower than normal range indicating respiratory alkalosis; this occurs when there is inadequate oxygen supply or excessive breathing due to underlying illnesses such as coughs as seen in this case study (Berman & Snyder, 2017). Lastly, HCO3– value is below normal suggesting metabolic acidosis since bicarbonate molecules help neutralize acids within the body hence their deficiency will lead to a decrease in pH levels over time (Berman & Snyder, 2017).
Overall, Ms Brown’s laboratory values indicate she has several water and electrolyte imbalances including hyperglycemia; hypernatremia; hypokalemia; hypochloremia; metabolic acidosis; respiratory alkalosis all contributing towards worsening health conditions within her body, requiring immediate medical attention for proper management.
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