Investigation of One Case: Pulmonary Function
How would you rate the severity of D.R.’s asthma episode based on the case study data?
The National Asthma Education and Prevention Program (NAEPP) has identified four categories of asthma (Lee et al., 2020). Based on the patient’s symptoms and lung function, asthma severity is assessed. Clinical manifestations of asthma include sleep problems, a decline in lung function, and difficulty performing daily activities. To alleviate these symptoms, doctors frequently prescribe asthma rescue medications (Horak et al., 2016). D.R. has a mild form of asthma that persists. An increase in SOB, wheezing, and tiredness, together with a runny nose, watery eyes, and post-nasal discharge, are all signs of asthma. D.R. has been dealing with these symptoms for the past four days. In the most recent week, D.R. also experienced nighttime symptoms on more than one occasion (3 nights) and a decline in peak flow rate of 65-75 percent (65-75 percent). D.R.’s asthma symptoms were first managed by albuterol nebulizer therapy, but it quickly lost its effectiveness.
List the causes of asthma attacks that are most frequently experienced by patients and indicate in your response which ones you believe apply to D.R. in the case study.
Asthma is more prone to occur in those who are exposed to medications or substances that trigger an allergic reaction. By avoiding asthmatic stimuli, the chance of having an attack can be decreased. Mold, pet dander, dust mites, and pollen are some of the elements that cause asthma allergies most frequently (Gautier & Charpin, 2017). Exposure to tobacco smoke, potent scents, and air pollution all worsen asthma symptoms. Patients with asthma who exercise have bronchoconstriction, which sets off an asthma attack. Stress, anxiety, and even chilly, dry air can cause an asthma attack. Viruses and bacteria, such as the common cold and sinus infection, can also cause asthma attacks. The most common causes of D.R. asthma attacks are respiratory infections like the common cold or sinusitis.
Please describe the elements that might be the cause of D.R.’s asthma based on your expertise and research.
The two most significant risk factors for asthma are genetic predisposition and environmental exposures, despite the fact that its underlying causes are still unclear. The following elements might contribute to D.R.’s asthma: D.R. is three to six times more likely to develop asthma if one of his parents does. The reason for this is that asthma runs in families. D.R. asthma may result from a confluence of environmental and genetic elements, including exposure to allergens. Males have narrower airways than females. Therefore wheezing is more typical in children with asthma. However, asthma starts to develop in both sexes around the age of 20. Adult females are more likely than adult males to have asthma.
Children’s infectious disease: If childhood viral infections are the cause of a child’s wheezing, asthma may develop as a result. Human rhinovirus C has been identified as the main culprit behind severe childhood asthma. Sinusitis, a typical side effect of the condition, can make asthma symptoms worse. Those with asthma are more likely than the general population to get a sinus infection. An asthmatic patient’s sinusitis symptoms get better after 10 days of antibiotic treatment.
Case Study 2: Homeostasis of Fluid, Electrolytes, and Acid-Base
Could you identify the type of water and electrolyte imbalance that Ms. Brown has based on the test results from her admission?
Ms. Brown has a fluid alteration that is excessively high in sodium, according to the results of her lab tests. “Hypertonic fluid changes” take place when the extracellular fluid’s (ECF) osmolality is higher than usual (McCance & Huether, 2019, p.111). Dehydration of intracellular fluid (ICF) results from the ECF’s hypertonicity luring water out of the intracellular space (McCance & Huether, 2019). According to Rondon-Berrios et al., hypernatremia and hyperglycemia are two clinical signs of hypertonicity (2017). Her blood contained 412 mg/dL of glucose and 156 mEq/L of salt. An increase in serum sodium levels results in hypertonicity (McCance & Huether, 2019). Hypertonicity causes fluid to move from inside the cells into the fluid compartment around them (Rondon-Berrios et al., 2017). The blood sugar reading of 412 mg/dL in Ms. Brown suggests that her diabetes may not be well controlled. Prior to being discharged from the hospital, diabetes management education is crucial.
Explain the symptoms and indicators of the various sorts of water imbalances, as well as any clinical manifestations that her potassium level may cause.
Ms. Brown has not eaten or drunk anything for the past two days, so it is obvious that she is dehydrated. Dehydration symptoms include headaches, thirst, confusion, weakness, and lethargic behavior (McCance & Huether, 2019). These symptoms and indicators are also characteristic of someone who has hypernatremia, as Ms. Brown did. Rondon-Berrios et al. (2017) list muscle twitching, irritability, and even seizures as additional symptoms of hypertonicity.
Which kind of treatment would be best for Ms. Brown in the particular situation as it is given, and why?
As part of the recommended course of action, hydration therapy is used. Ms. Brown will probably need IV fluids to stay hydrated because she has not been able to eat or drink anything for the past two days. Because it can get to all of the body’s compartments, including the intracellular and vascular regions, dextrose water (D5W) is an excellent option (Asim et al., 2019). According to Asim et al., since glucose is quickly digested, administering D5W is equivalent to administering free water (2019). D5W should be taken as long as the serum sodium level is between the normal range of 135 and 145 mEq/L. (McCance & Huether, 2019). D5W will raise her blood sugar to 412 mg/dL; as a result, necessitating more frequent blood glucose testing.
What do Ms. Brown’s ABGs reveal about her acid-base imbalance?
According to Ms. Brown’s blood gas results, metabolic acidosis is indicated by a pH of 7.30 and a PaCO2 of 32 mmHg. Metabolic acidosis occurs when the kidneys are unable to remove enough acid from the body (McCance & Huether, 2019). One of the many elements causing metabolic acidosis is dehydration. In addition, she is hypoxic, as seen by her PaO2 value of 70 mmHg. The anion gap can be used to distinguish different kinds of metabolic acidosis. In 2019 (McCance & Huether, 2019). (McCance & Huether, 2019). An anion gap between 10 and 12 mEq/L is regarded as usual. Ms. Brown has an anion gap of 26.6 mEq/L. Ms. Brown properly identified acidosis.
Define and characterize anion gaps and their clinical importance based on your readings and research.
I would suggest Ms. Brown be kept in the hospital until her blood results are more in line with normal. When taking D5W, a diabetic patient will require frequent blood glucose tests in order to prevent diabetic hyperosmolar syndrome (HHS). A little insulin may be needed. According to the preliminary information, she also had hyperkalemia. She needs to have her potassium closely monitored due to the negative relationship between insulin and potassium (Li &Vijayan, 2014). Regular basic metabolic panels and ABGs are necessary to guarantee a positive trend in the results.
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.
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
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