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 drainageall 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 admissions 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 manifestations 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.