Electrolyte imbalance

Case Study 1: Pulmonary Function

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

There are four types of asthma classifications outlined by the National Asthma Education and Prevention Program (NAEPP) (Lee et al., 2020). Asthma severity is determined based on the patient’s symptoms and lung functioning. Clinically, asthma includes asthma symptoms as well as sleep disturbances, decreased lung function, and trouble engaging in everyday activities. Asthma rescue medicines are commonly prescribed to treat these symptoms (Horak et al., 2016). D.R. suffers from a mild but persistent form of asthma. Among the symptoms of asthma include an increase in SOB, wheezing and exhaustion, as well as a runny nose, watery eyes and post-nasal discharge. For the past four days, D.R. has been experiencing these symptoms. There was also a drop in peak flow rate of 65-75 percent (65-75 percent) and overnight symptoms on more than one occasion (3 nights) in the recent week for D.R. In the beginning, albuterol nebulizer therapy was able to alleviate the symptoms of D.R. asthma, but it soon became ineffective.

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.

When a person is exposed to drugs or chemicals that cause an allergic reaction, they are more likely to develop asthma. The risk of an asthmatic attack can be reduced by avoiding asthmatic stimuli. Some of the most common allergy-inducing factors in asthma are substances such as mold, pet dander, dust mites, and pollen (Gautier, & Charpin, 2017). Asthma symptoms are exacerbated by exposure to tobacco smoke, strong perfumes, and air pollution. Asthma attacks are triggered by bronchoconstriction in asthmatic patients who engage in physical activity. Asthma can be triggered by stress, worry, and even cold, dry air. Asthma attacks can also be triggered by viruses and bacteria, such as the common cold and sinus infection. Respiratory infections, such as the common cold or sinusitis, are the most prevalent causes of D.R. asthma attacks.

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

Although the fundamental causes of asthma are still unknown, the two most important risk factors are a genetic predisposition and environmental exposures. For D.R., the following factors may play a role in his or her asthma: If D.R’s parent has asthma; his chances of having the condition are three to six times greater. Asthma runs in families, therefore this is why. D.R. asthma may be caused by a combination of genetic and environmental factors, including exposure to allergens. Due to the fact that males’ airways are narrower than girls’, wheezing is more common among children with asthma. However, the onset of asthma in both sexes begins around the age of 20. Adult females are more likely to suffer from asthma than males.

Infectious disease in children: Wheezing in children can be a precursor to asthma if it is brought on by viral infections in childhood. It has been found that Human Rhinovirus C is the principal cause of severe asthma in children. Asthma symptoms can be exacerbated by sinusitis, which is a common complication of the disease. Asthma patients are more likely to have a sinus infection than the general population. Asthma symptoms improve after 10 days of antibiotic treatment for sinusitis in an asthmatic patient.

Case Study 2: 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?

 In light of Ms. Brown’s laboratory results, one can deduce that she has a fluid alteration that is too high in sodium. When the osmolality of the extracellular fluid (ECF) is higher than normal, “hypertonic fluid changes” occur (McCance & Huether, 2019, p.111). Intracellular fluid (ICF) dehydration is caused by the ECF’s hypertonicity attracting water from the intracellular space (McCance & Huether, 2019). Clinical symptoms of hypertonicity include hypernatremia and hyperglycemia, according to Rondon-Berrios et al (2017). She had 156 mEq/L of salt in her blood and 412 mg/dL of glucose in her blood. Hypertonicity is caused by an increase in serum sodium levels (McCance & Huether, 2019). As a result of hypertonicity, fluid is transferred from inside the cells into the fluid compartment that surrounds them (Rondon-Berrios et al., 2017). Ms. Brown’s blood sugar level of 412 mg/dL indicates that she may not be properly managing her diabetes.Diabetic management education is essential prior to release from the hospital.

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.

One can deduce that Ms. Brown is dehydrated because she hasn’t had anything to eat or drink in the last two days. Headaches, thirst, disorientation, weakness, and lethargy are all signs of dehydration (McCance & Huether, 2019). These signs and symptoms are also typical of someone with hypernatremia, as was the situation with Ms. Brown. Other signs of hypertonicity, according to Rondon-Berrios et al. (2017), include muscle twitching, impatience, and probable seizures.

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

Hydration therapy is part of the proper course of action. Because Ms. Brown has been unable to eat or drink for two days, she is likely to require IV fluids to keep her hydrated. Dextrose water (D5W) is a good choice because it can reach all of her body’s compartments, including the intravascular and intracellular spaces (Asim et al., 2019). Giving D5W is the same as giving free water since glucose is rapidly digested, according to Asim et al. (2019). As long as the serum sodium level is within the normal range of roughly 135-145 mEq/L, D5W is to be administered (McCance & Huether, 2019). As a result, blood glucose monitoring will have to be carried out more regularly because D5W will boost her blood sugar to 412 mg/dL.

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

Using Ms. Brown’s blood gas values, a pH of 7.30 and a PaCO2 of 32 mmHg indicate metabolic acidosis. When the kidneys are unable to eliminate enough acid from the body, the result is metabolic acidosis (McCance & Huether, 2019). Dehydration is one of the many factors contributing to metabolic acidosis. She is also hypoxic, as evidenced by her PaO2 reading of 70 mmHg. Metabolic acidosis types can be distinguished using the anion gap. In 2019, (McCance & Huether, 2019). An anion gap of 10-12 mEq/L is considered normal. The anion gap for Ms. Brown is 26.6 mEq/L. Acidosis was correctly diagnosed by Ms. Brown.

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

I would propose that Ms. Brown be admitted to the hospital until her laboratory values are closer to normal. To avoid diabetic hyperosmolar syndrome, a diabetic patient will need frequent blood glucose testing when taking D5W. (HHS). A trickle of insulin may be necessary. She also had hyperkalemia, according to the early data. A careful monitoring of her potassium is necessary because of the inverse link between insulin and potassium (Li &Vijayan, 2014). To ensure a positive trend in results, it is important to do regular basic metabolic panels and ABGs.

References

Gautier, C., & Charpin, D. (2017). Environmental triggers and avoidance in the management of asthma. Journal Of Asthma And Allergy, 10, 47. http://www.dovepress.com/journal-ofasthma-and-allergy-journa

Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., … & Studnicka, M. (2016). Diagnosis and management of asthma–Statement on the 2015 GINA Guidelines. Wiener Klinische Wochenschrift, 128(15-16), 541-554.https://doi.org/10.1007/s00508-016-1019- 4

Lee, E., Song, D. J., Kim, W. K., Suh, D. I., Baek, H. S., Shin, M., … & Lim, D. H.(2020). Associated factors for asthma severity in Korean children: a Korean childhood Asthma Study. Allergy, Asthma & Immunology Research, 12(1), 86-98. https://doi.org/10.4168/aair.2020.12.1.86

Asim, M., Alkadi, M. M., Asim, H., & Ghaffar, A. (2019). Dehydration and volume depletion: How to handle the misconceptions. World Journal of Nephrology, 8(1) 23-32. doi: 10.5527/wjn.v8.i1.23

Li, T., & Vijayan, A. (2014). Insulin for the treatment of hyperkalemia: A double-edged sword. Clinical Kidney Journal, 7(3) 239-241. doi: 10.1093/ckj/sfu049

McCance, K. L., & Huether, S. E. (2019). Pathophysiology the biologic basic for disease in adults and children. (8th ed.). Elsevier.

Rondon-Berrios, H., Argyropoulos, C., Ing, T. S., Raj, D. S., Malholtra, D., Agaba, E. I., Rohrscheib, M., Khitan, Z. J., Murata, G. H., Shapiro, J. I., & Tzamaloukas, A. H. (2017). Hypertonicity: Clinical entities, manifestations and treatment. World Journal of Nephrology, 6(1), 1-13. doi: 10.5527/wjn.v6.i1.1

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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.

1. 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.
2. In the specific case presented which would be the most appropriate treatment for Ms. Brown and why? Include both pharmacologic and non-pharmacologic approaches.
3. What do the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
4. Based on your readings and your research define and describe Anion Gaps and their clinical significance

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