Discussion 3

Pulmonary Function

Case Study Questions

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

asthma attack?

Based on the case study information, D.R.'s asthma attack can be classified as moderate

in severity. This is because his peak flow rates range from 65-70% of his regular baseline, and he

has been self-treating with albuterol nebulizer therapy for three days. Additionally, he has been

experiencing nighttime symptoms for the past three nights (Katz et al., 2018). These factors

indicate that his asthma attack is of moderate severity.

2. 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.

The most common asthma triggers include environmental triggers such as pollen, mold,

dust mites, pet dander, smoke, air pollution, exercise, exposure to cold air, stress, certain

medications, and some foods. In the case of D.R., environmental triggers such as pollen, dust

mites, and pet dander are the most likely triggers since they are the most common. Cold air

exposure and stress could also have contributed to the asthmatic episode. Other less common

triggers that could have played a role in D.R.'s asthmatic episode include exercise, exposure to

smoke, and air pollution (Katz et al., 2018).

The potential asthma triggers that should be considered in D.R.'s case include

environmental allergens, air pollution, smoke, extreme temperatures, upper respiratory

aspirin, may also trigger an asthma attack in some people. Other triggers include irritants such as

perfumes, dust, and pollen (Sylvester et al., 2020). Identifying and avoiding potential triggers is

important to help manage D.R.'s asthma symptoms. If you have any questions about asthma

triggers, please consult with a healthcare professional.

In this case, the nurse practitioner should consider assessing D.R.'s environmental

allergies and air pollution levels to see if they contribute to his symptoms. Additionally, it may

be helpful to prescribe beta-blockers or aspirin as potential treatments for his asthma. If D.R.

experiences an asthma attack triggered by a particular medication or irritant, he may need to

adjust his dosage or stop taking the trigger to manage his symptoms (Sylvester et al., 2020). In

this case, the nurse practitioner should be able to guide managing asthma triggers and symptoms

in D.R. as needed.

3. Based on your knowledge and your research, please explain the factors that might

be the etiology of D.R. being an asthmatic patient.

The etiology of asthma is not completely understood, but environmental and genetic

factors likely cause it. Environmental triggers can include allergens, pollutants, smoke, and

certain medications. Genetics may also play a role, as individuals with a family history of asthma

are more likely to develop asthma. Other factors that may contribute to asthma development

include exposure to secondhand smoke, being overweight, and having a weakened immune

system (Sylvester et al., 2020). Additionally, certain illnesses such as respiratory tract infections,

cystic fibrosis, and asthma can also lead to the development of asthma. Finally, lifestyle choices

such as smoking, eating a high-fat diet, and not exercising may also contribute to the

development of asthma.
 D.R.'s peak flow rates suggest that he is experiencing an asthmatic episode. His asthmatic

episode may be caused by environmental or genetic factors or an illness such as a respiratory

tract infection. It is also possible that D.R.'s s asthma is related to his lifestyle choices, such as

smoking and not exercising. Overall, it is still unclear why D.R. is experiencing an asthmatic

episode. However, with continued treatment, including medications and lifestyle changes, if

necessary, he may be able to manage his symptoms more effectively.

Case Study Questions

1. Based on Ms. Brown admission’s laboratory values, could you determine what type

of water and electrolyte imbalance does she has?

Based on Ms. Brown's laboratory values, she appears to have a fluid and electrolyte

imbalance with high serum glucose, low serum sodium, low serum potassium, low serum

chloride, and an acid-base imbalance with a decreased pH, increased PaCO2, and low HCO3-.

This indicates that she likely suffers from hyperglycemia and dehydration, which can lead to

hypovolemia and electrolyte imbalances. Her acid-base imbalance suggests that she may also

have a respiratory infection (Menni et al., 2019). Treatment for Ms. Brown's conditions would

involve correcting her fluid and electrolyte imbalance, providing antibiotics if necessary, and

providing supportive care to address her hypovolemia and acid-base imbalance.

2. 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.

Ms. Brown may exhibit dehydration due to her inability to eat or drink for two days.

Dehydration can cause electrolyte imbalances, such as a low potassium level. Signs of

dehydration include dry skin, dizziness, fatigue, and dark-colored urine. Low potassium levels

can cause muscular weakness, cramps, irregular heart rate, and constipation (Menni et al., 2019).

She may also exhibit acid-base imbalance due to her low pH and high HCO3- levels. This can
include chest pain, shortness of breath, and confusion. Ms. Brown should be monitored for signs

of dehydration and acid-base imbalances and treated as needed.

3. In the specific case presented which would be the most appropriate treatment for

Ms. Brown and why?

The most appropriate treatment for Ms. Brown would be to treat both her diabetes and

her dehydration. Since she has not been able to eat or drink for two days, she is likely

dehydrated, which can cause electrolyte imbalances (Noda & Matsuda, 2022). Her laboratory

values show elevated serum glucose and low serum sodium, potassium, and chloride levels,

indicating that her dehydration has affected her electrolyte balance. Her ABGs show that she is

mildly acidotic and hypovolemic, likely due to her diabetes and dehydration. Treatment for Ms.

Brown would include rehydrating her with intravenous fluids and correcting her electrolyte

balance. She should also be monitored closely for signs of complications from her diabetes and

dehydration.

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

The ABGs from Ms. Brown indicates that she has acidosis. This is evidenced by her pH

of 7.30, below the normal range (pH 7.35-7.45), and her lower-than-normal HCO3- of 20

mEq/L. The other ABG values also support this acidosis diagnosis, as her PaCO2 is lower than

normal, and her PaO2 is higher than normal. This acidosis is likely due to her diabetes and the

accompanying high levels of blood sugar (Noda & Matsuda, 2022). Her kidneys cannot quickly

rid her body of excess sugar, leading to acidosis. Treatment for Ms. Brown's acidosis will

include aggressive diabetes management and possibly medication to lower her blood sugar
levels. If left untreated, her condition could develop into diabetic ketoacidosis (DKA), a life-

threatening complication of diabetes that can lead to coma and death (Menni et al., 2019).

5. Based on your readings and research, define and describe Anion Gaps and their

clinical significance.

The anion gap is the difference between the blood's measured cations (sodium and

potassium) and the measured anions (chloride and bicarbonate). It is calculated as (Na+) - (Cl- +

HCO3-). It is an indicator of metabolic acidosis and is typically elevated in cases of metabolic

acidosis. High anion gaps can indicate the presence of an underlying metabolic process, such as

acidosis, ketoacidosis, or diabetic ketoacidosis (Noda & Matsuda, 2022). Anion gap can also be

an early sign of kidney failure.

Katz, S., Arish, N., Rokach, A., Zaltzman, Y., & Marcus, E.-L. (2018). The effect of body

position on pulmonary function: a systematic review. BMC Pulmonary Medicine, 18(1).

https://doi.org/10.1186/s12890-018-0723-4

Menni, C., McCallum, L., Pietzner, M., Zierer, J., Aman, A., Suhre, K., Mohney, R. P.,

Mangino, M., Friedrich, N., Spector, T. D., & Padmanabhan, S. (2019). Metabolomic

profiling identifies novel associations with Electrolyte and Acid-Base Homeostatic

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Noda, M., & Matsuda, T. (2022). Central regulation of body fluid homeostasis. Proceedings of

the Japan Academy. Series B, Physical and Biological Sciences, 98(7), 283–324.

https://doi.org/10.2183/pjab.98.016

Sylvester, K. P., Clayton, N., Cliff, I., Hepple, M., Kendrick, A., Kirkby, J., Miller, M., Moore,

A., Rafferty, G. F., O’Reilly, L., Shakespeare, J., Smith, L., Watts, T., Bucknall, M., &

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