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Posted: July 12th, 2023

D.R. is a 27-year-old man, who presents to the nurse practitioner

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 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 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.
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 within the last 5 years. Pulmonary & Fluid/Electrolyte/Acid-Base Homeostasis Case Study

Pulmonary Function Case Study:

Classification of the severity of D.R.’s asthma attack:
Based on the case study information, D.R.’s asthma attack can be classified as a moderate exacerbation. The symptoms he presents with, such as shortness of breath (SOB), wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage, indicate an acute worsening of his asthma. The fact that his peak flow rates have ranged from 65-70% of his regular baseline and he experienced nighttime symptoms for three nights suggests a moderate exacerbation. Additionally, the need for frequent albuterol nebulizer therapy, with his usual albuterol inhaler not providing sufficient relief, indicates an escalation of treatment beyond his baseline management.

Common triggers for asthma and their relevance to D.R.:
Common triggers for asthma can vary among individuals, but some common ones include:

Allergens: Pollen, dust mites, pet dander, mold spores.
Respiratory infections: Viral or bacterial infections affecting the respiratory system.
Irritants: Tobacco smoke, air pollution, strong odors, chemical fumes.
Exercise: Intense physical activity leading to bronchoconstriction.
Weather changes: Cold air, dry air, or changes in humidity.
Stress and emotions: Emotional distress or anxiety.
In D.R.’s case, the triggers that seem applicable include respiratory infection (due to symptoms of cough and postnasal drainage), allergens (as indicated by stuffy nose and watery eyes), and potentially exercise (if he experiences symptoms during physical activity). It is important to assess and identify specific triggers for individual patients to develop effective management strategies.

Factors contributing to D.R.’s asthma:
The etiology of D.R. being an asthmatic patient can involve several factors, including genetic predisposition, environmental factors, and immune system dysregulation. Asthma is a complex disease with both genetic and environmental components. Some potential factors contributing to D.R.’s asthma include:
a) Genetic factors: Certain genes associated with asthma have been identified, and individuals with a family history of asthma are more likely to develop the condition. Genetic factors may influence the development of airway hyperresponsiveness and susceptibility to specific triggers.

b) Environmental factors: Exposure to allergens (e.g., pollen, dust mites), respiratory infections (e.g., common cold, flu), air pollution, and occupational exposures (e.g., chemicals, dust) can trigger or exacerbate asthma symptoms. In D.R.’s case, the presence of symptoms like postnasal drainage, watery eyes, and stuffy nose suggests an allergic component, possibly due to exposure to allergens.

c) Immune system dysregulation: Asthma is characterized by chronic inflammation of the airways, involving immune system cells and mediators. In individuals with asthma, the immune response to certain triggers leads to increased inflammation, bronchoconstriction, and airway remodeling. This immune dysregulation contributes to the symptoms and underlying pathology of asthma.

It is important to note that the specific etiology of asthma can vary among individuals, and a comprehensive evaluation of each patient’s history, symptoms, and triggers is essential for appropriate management.

Fluid, Electrolyte, and Acid-Base Homeostasis Case Study:

Water and electrolyte imbalance in Ms. Brown:
Based on the laboratory values provided, Ms. Brown is experiencing hyperglycemia (elevated blood glucose) and hypernatremia (elevated serum sodium). These imbalances can be indicative of hyperosmolar hyperglycemic state (HHS) or diabetic ketoacidosis (DKA). However, since Ms. Brown’s pH

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