NUR 502 Week 3 Pulmonary Function DR and Ms Brown Case Study St Thomas University

Adv Pathology Discussion 3

Pulmonary Function

  1. According to the case study information, how would you classify the severity of D.R. asthma attack?

The patient has moderate persistent asthma. This is characterized by: Daily symptoms of wheezing, cough, chest tightness, or difficulty breathing; Flare-ups that affect activity level; Nighttime symptoms five or more times a month; Lung function test FEV 1 above 60% but below 80% of normal values; Peak flow with more than 30% variability (Bush, 2019). The patient has had dyspnea, wheezing, and cough for the past four days. His FEV 1 ranges from 65-70%, and she has had nighttime symptoms for three days in the past week.          

  • 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.

Common asthma triggers include environmental allergens like dust mites, tobacco smoke, mold, pollen, and animal fur. Irritants like household sprays and paint fumes also trigger asthma attacks. Other common risk factors for asthma include Viral respiratory infections, Exercise and hyperventilation, Weather changes, sulfur dioxide exposure, food additives, and stress or emotional upset (Chau-Etchepare et al., 2019). D.R. has symptoms of a viral respiratory infection, like stuffy nose, watery eyes, and postnasal drainage. Thus, the asthma attack can be attributed to a viral respiratory infection.  

  • Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.

D.R. may be living in a neighborhood or house with environmental allergens like house dust mites, animal allergens like cat and dog, cockroach allergens, and mold. Constant exposure to these allergens may have contributed to the patient’s asthma. The patient might also be having work-related asthma caused by exposure to occupational hazards that irritate the airways (Chau-Etchepare et al., 2019). Jobs at high risk for asthma include painting, farming, janitorial work, and plastics manufacturing. In addition, D.R. may have developed asthma due to genetics. Genome-wide association studies (GWAS) show that more than 50 gene variations are linked with asthma from inflammation or hyperresponsive airways (Chau-Etchepare et al., 2019). Asthma is a multifactorial condition with genetic and environmental input needed for expression. D.R. may have a parent with asthma who passed the gene associated with asthma.

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Fluid, Electrolyte, and Acid-Base Homeostasis

Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?

            Ms. Brown has hypernatremia with an elevated sodium level of 156 mEq/L. She also has hyperkalemia with a potassium level of 5.6 mEq/L and hyperchloremia with chloride levels of 115 mEq/L.            

Describe the signs and symptoms of the different types of water imbalance and described clinical manifestation she might exhibit with the potassium level she has.

The signs and symptoms of hypernatremia include generalized body weakness, cognitive dysfunction, short attention span, agitation, confusion, and muscle weakness. Besides, hypernatremia presents with features of dehydration like dry mucous membranes and skin, poor skin turgor, tachycardia, and reduced urine output (Qian, 2019). The signs and symptoms of hyperchloremia include irregular heart rate, high blood pressure, muscle weakness, edema, tingling sensations, confusion, and seizures.

The patient has an elevated potassium level. She might exhibit clinical manifestations in the cardiovascular system, such as hypotension, bradycardia, and ECG changes of tall, peaked T waves, flat or absent P waves, prolonged PR intervals, and wide QRS complexes (Wu et al., 2022). Other manifestations include paresthesia, muscle twitching, hyperactive bowel sounds, and diarrhea.

In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?

Treatment interventions should focus on rapidly correcting hyperkalemia. The patient should be administered IV glucose and insulin (100 mL of 10% -20% glucose with 10 to 20 units of regular insulin) to promote potassium uptake by cells (Wu et al., 2022). IV calcium should be administered to alleviate cardiac toxicity. Sodium bicarbonate is administered to correct metabolic acidosis.

            What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?

The ABGs results indicate Metabolic Acidosis with partial compensation. The patient has metabolic acidosis due to a Bicarbonate deficit below 22 mEq/L. A pH of 7.30 below the normal range indicates acidosis (Quade et al., 2021). The patient has partial compensation since the pH range is still outside the normal range.

            Based on your readings and your research define and describe Anion Gaps and its clinical significance.

The Anion Gap (AG) is a derivative variable mainly used to evaluate metabolic acidosis to establish the presence of unmeasured anions. It is calculated by subtracting the sum of chloride and bicarbonate concentration from the sodium concentration (Quade et al., 2021). A normal anion gap is 7-9 mEq/L. An anion gap of more than 10-12 mEq/L indicates metabolic acidosis.

References

Bush, A. (2019). Pathophysiological Mechanisms of Asthma. Frontiers in pediatricspp. 7, 68. https://doi.org/10.3389/fped.2019.00068

Chau-Etchepare, F., Hoerger, J. L., Kuhn, B. T., Zeki, A. A., Haczku, A., Louie, S., Kenyon, N. J., Davis, C. E., & Schivo, M. (2019). Viruses and non-allergen environmental triggers in asthma. Journal of investigative medicine: the official publication of the American Federation for Clinical Research67(7), 1029–1041. https://doi.org/10.1136/jim-2019-001000

Qian, Q. (2019). Hypernatremia. Clinical journal of the American Society of Nephrology: CJASN14(3), 432–434. https://doi.org/10.2215/CJN.12141018

Quade, B. N., Parker, M. D., & Occhipinti, R. (2021). The therapeutic importance of acid-base balance. Biochemical Pharmacology183, 114278. https://doi.org/10.1016/j.bcp.2020.114278

Wu, Y., Fu, Y. Y., Zhu, H. D., Xu, J., & Walline, J. H. (2022). Treatment of hyperkalemic emergencies. World journal of emergency medicine13(3), 232–236. https://doi.org/10.5847/wjem.j.1920-8642.2022.054

Description

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

  1. According to the case study information, how would you classify the severity of D.R. asthma attack?
  2. 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.
  3. 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

  1. Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?
  2. 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.
  3. In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
  4. What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
  5. Based on your readings and your research define and describe Anion Gaps and its clinical significance.

Submission Instructions:

  • You must complete both case studies
  • Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
  • All replies must be constructive and use literature where possible.
  • Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

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