ST Thomas University Pulmonary Function Case Study

# 1 andrea

Pulmonary Function Case Study

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.

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

Asthma has a classification system according to the severity of the attack using the colors of a traffic light. The green zone is when the patient is asymptomatic, and the peak flow measurement is at least at the 80% level. The yellow zone is when the peak flow measurement is in the 50% -80% range and is indicative of asthma getting worse and being poorly controlled (Leik, 2021). Mr. D.R. did exactly what the asthma zones protocol requires when he began his Albuterol Inhaler after 24 hours of being in the yellow zone and also when he began measuring his peak flow regularly. In the ‘red zone’ the person’s asthma symptoms are more extreme, and they have a lot of trouble breathing. Their symptoms are not relieved from quick relief meds, they are not able to perform regular tasks normally. Usually in the red zone, the peak flow is less than 50% of the person’s best. Although Mr. D.R.’s peak flow rates are not as low as less than 50%, I would say he has entered into the Red Zone based on his other findings. A person is considered as having entered the red zone after 24 hours of being in the yellow zone, without improvement. This is congruent with Mr. J.D.’s case.

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.

The most common triggers for asthma exacerbation are exposure to allergens, irritants, weather changes, and common upper respiratory viral infections (Rogers & Brashers, 2023). Exercise can induce some asthma attacks. Women have reported pre-menstrual exacerbations (Duglasch &Story, 2024). Some common indoor allergens that can trigger asthma are dust mites, mold, and pet dander or fur, while the usual outdoor allergies that can trigger asthma are pollens and molds. Another cause for asthma attacks can be extreme emotional stress, like intense anger, crying, and laughter (Duglasch & Story, p. 269). I think that Mr. D.R.’s asthma exacerbation might’ve been caused by an upper respiratory virus like the common cold, according to his symptoms of cough, fatigue, stuffy nose, and nasal drainage.

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

Asthma’s general etiological factors include having a parent with asthma, a severe respiratory illness in childhood, allergic condition, or exposure to industrial dusts or chemical irritants. Allergen exposure, living in an urban area, exposure to pollution, tobacco smoke, obesity, recurrent respiratory tract infections, GERD, and the use of acetaminophen all impact gene expression that can increase the risk of developing asthma (Rogers & Brashers, 2023). However, I didn’t see anything in the case study that would indicate the specific etiology of Mr. D. R.’s asthma.

Fluid, Electrolyte and Acid-Base Homeostasis Case Study

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.

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

I think that Ms. Brown might have hypovolemia / dehydration from the water loss from the polyuria that accompanies hyperglycemia and decreased fluid and food intake. Her serum sodium, potassium, and chloride are showing as higher than normal because of the decrease in fluid volume. Her Ph indicates acidosis. Another cause of high k+ is that Potassium shifts from the intracellular fluid to the extracellular in metabolic acidosis (Rogers & Brashers, 2023). Her Ph and the fact that she is hyperglycemic also points to metabolic acidosis.

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.

Serum potassium (K+) cannot shift up or down much without serious implications. 3.5-5.0 being the normal range, Ms. Brown has a reading of 5.6, which is high (hyperkalemia). Since K+ is a key element of electrical conduction in the body, the nervous, skeletal, cardiac, respiratory, and GI systems can be affected by imbalances (Dlugasch & Story, 2024). Neuromuscular symptoms can include paresthesia, muscle cramps, weakness/fatigue, hyperreflexia, flaccid paralysis, and anxiety. Cardiovascular symptoms can include EKG changes and dysrhythmias from delayed conduction, bradyarrhythmia, asystole, ventricular tachycardia & fibrillation, and even cardiac arrest. There is diaphragm weakness that can lead to respiratory depression and arrest. The GI symptoms can be nausea, vomiting, diarrhea, and cramping (Dlugasch & Story, 2024).

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

Ms. Brown could benefit from Lactated Ringer’s intravenous fluids since polyuria occurs with hyperglycemia and this can deplete fluid volume. Administration of isotonic IV fluids replace fluids when there has been a loss, such as in dehydration (Dlugasch & Story, 2024). Also, the lactate is converted to bicarbonate ions in the liver and will act to increase the PH to a normal value, also aiding the correction of the acidosis. A rapid- acting Insulin to correct her hyperglycemia would be appropriate. Insulin also promotes K+ to reenter the cell, so insulin deficits (which happen in Diabetic Keto-acidosis) is often accompanied by hyperkalemia (Rogers & Brashers, 2023). The cause of metabolic acidosis can be the keto-acidosis that occurs from hyperglycemia (Leik, 2014).

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

Her Ph indicates acidemia. When the pH and paCO2 change in the same direction (which normally should not), the primary problem is metabolic (Sood et al., 2014). Considering her hyperglycemia, Diabetic Keto-acidosis is most likely which is a type of metabolic acidosis. Her O2 level is below normal, and this might likely be due to whatever the respiratory illness is that is causing her to cough severely.

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

Anion Gaps refer to a method of diagnosis for metabolic acidosis that indicates the underlying cause. This test measures for albumin, sulfates, and phosphates, anions which are not usually measured. Normally, the sum of the cations is about the same as the sum of anions in the extracellular fluid. The sum of the bicarbonate and chloride are subtracted from the sum of sodium and potassium. A normal anion gap range is 3-10 mEq/L. Conditions of metabolic acidosis (as in Ms. Brown) like keto-acidosis, will result in an increased anion gap (Dlugasch & Story, 2024).

#2 MelissaPulmonary Function

Assessment of D.R.’s Asthma Attack Severity

The data presented in the case study supports the diagnosis of mild chronic asthma attack in the patient. His primary symptoms have been present for four days and include shortness of breath (SOB), wheezing, exhaustion, coughing, stuffy nose, watery eyes, and postnasal discharge. Moreover, he has had nocturnal symptoms for three nights in the last week, and his peak flow rates have fluctuated between 65% and 70% of his normal baseline. It is suggestive of mild chronic asthma that he has been using the lowest possible peak flow rate range in the morning. The fact that his albuterol inhaler is no longer as effective as it once was and that he must use the nebulizer so often implies that his symptoms have worsened beyond the control of his current medication.

Common Triggers for Asthma

While everyone’s asthma is different, some of the most common triggers include weather conditions, respiratory infections, occupational exposures, allergens, environmental factors, and exercise. Asthmatics are more vulnerable to the effects of meteorological extremes, such as cold air or excessive humidity. This information should be considered in a thorough evaluation, even if it is not included in the case study. Asthma symptoms may be worsened by viral respiratory illnesses like the flu or the common cold. According to Rudd (2019), D.R.’s four-day history of symptoms may point to a viral infection as the cause of his asthma attacks. Workplace exposures to irritants or allergens might trigger asthma symptoms in certain people. The provider needs to ask if in D.R.’s job he is exposed to such things.

Allergens such as dust mites, pollen, mould, and pet dander are among the substances that might set off asthma attacks. It is possible that D.R. has been exposed to allergens since he has watery eyes, postnasal discharge, and a stuffy nose. Asthma symptoms may be exacerbated by being exposed to irritants such as cigarette smoke, air pollution, or strong odours. To determine if these elements have a role in D.R.’s health, it is crucial to gather information about his surroundings (Tanday, 2021). Particularly in cases when asthma is poorly managed, physical exertion might bring on symptoms. If D.R. is trying to control his exercise-induced asthma symptoms, he may be using albuterol nebulizer treatment.

Etiology of D.R.’s Asthma

In most cases, both hereditary and environmental variables interact to bring about the onset of asthma. Possible components that contribute to D.R.’s condition include inadequate asthma control, allergen sensitization, environmental exposures, genetic predisposition, and viral respiratory infections. A worsening of symptoms may occur if the patient does not comply to the treatment plan for asthma, which includes taking medicine as prescribed and avoiding triggers. It is possible that D.R.’s lack of control is due to his dependency on regular albuterol nebulizer treatment.

Sensitization and the onset of asthma symptoms may be caused by prolonged exposure to allergens. The presence of postnasal discharge and watery eyes in D.R.’s symptoms indicates that there may be an allergy component. It is crucial to investigate D.R.’s living and working environment to see whether his symptoms are being exacerbated by allergies or irritants at work or at home. Onother possible factor that might increase D.R.’s risk of developing asthma is a history of the disease in his family. This might be set off if D.R. recently had a respiratory illness. Inflammation of the airways and worsening of asthma symptoms are both caused by viruses (Chapman et al., 2020).

Ultimately, the case study indicates that D.R. may have a mild chronic asthma attack, with allergens, a viral respiratory illness, and environmental variables being possible triggers. Complex interactions between hereditary susceptibility, allergen sensitivity, and maybe insufficient asthma management contribute to the etiology. For optimal care and prevention of future exacerbations, it is necessary to conduct a comprehensive evaluation that considers environmental variables and the patient’s history.