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Module 3 Discussion

Lakeesha McCloud

St. Thomas University

NUR-502-AP7: Advanced Pathophysiology

Dr. Sabine D. Saintable

August 29th, 2024

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Case Study 1: Pulmonary Function (D.R.)

Classifying the Severity of D.R.'s Asthma Attack

Considering the information provided, D.R.'s asthma attack falls within a classification of

moderate to severe. In the National Asthma Education and Prevention Program (NAEPP)

guideline, asthma exacerbations are classified based on symptoms, peak flow rates, and response

to treatments (Murphy & Solis, 2021). D.R. has had symptoms for four days already, and his

peak flow rates are between 65-70% of his baseline, which indicates moderate to severe

obstruction. The need for frequent albuterol treatments and persistence of symptoms in spite of

treatment would also suggest that it is more than a mild episode. This classification of severity

helps in deciding the next steps in management, including systemic corticosteroids or

hospitalization if necessary.

Common Triggers for Asthma and Specific Triggers for D.R.

Whereas the specific triggers for asthma may well be varied from one individual to

another, generally the common triggers have been known to include allergens like dust mites,

pollen, mold, pet dander; irritants such as tobacco smoke, pollution, strong odors; respiratory

infections; exercise; cold air; and emotional stress (Ramsahai et al., 2019). In D.R., symptom

development such as SOB with wheezing and postnasal drainage would indicate that the most

likely trigger would be a respiratory infection. This is further supported by the stuffy nose,

watery eyes, and timing of symptom onset. The bottom line is that respiratory infections are very

common triggers of asthma exacerbation and highly affect asthma control in affected patients.

Factors Contributing to the Etiology of Asthma in D.R.

The etiology of asthma can be attributed to the interplay of genetic and environmental

factors. A genetic influence is an important one since asthma can run in families. Other important
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environmental contributing risk factors include allergen exposure, tobacco smoke, air pollution,

and respiratory infections (Ramsahai et al., 2019). In the case of D.R., chronic symptoms and a

history of effective albuterol inhaler use for symptom control would most likely suggest a

chronic asthmatic condition that was exacerbated by an environmental trigger, probably allergens

or a recent respiratory infection. Research has indicated that viral infections, especially those

caused by the common cold or rhinovirus, can precipitate asthma exacerbations in predisposed

individuals.

Case Study 2: Fluid, Electrolyte, and Acid-Base Homeostasis (Ms. Brown)

Determining Ms. Brown's Water and Electrolyte Imbalance

According to Ms. Brown's laboratory values, she is presenting with hypernatremia (Na+

156 mEq/L), hyperkalemia (K+ 5.6 mEq/L), and hyperglycemia (glucose 412 mg/dL).

Hypernatremia, an elevation in sodium levels in the blood, results in a deficit in the amount of

free water, which is commonly seen in older adults when their fluid intake is minimal (Rateau,

2019). The kidneys must be functioning inadequately, or there has been a shift in potassium out

of the cells into the bloodstream; this may have resulted from her current diabetic state or from a

related acidosis state. These are life-threatening imbalances that need immediate attention in

order to prevent further complications such as arrhythmias or altered mental status.

Signs and Symptoms of Water Imbalance and Hyperkalemia

Symptoms of a water imbalance range from mild to severe and include confusion,

irritability, muscle twitching, seizures, and coma. Neurological symptoms for Ms. Brown may

include confusion or lethargy in the case of hypernatremia. Symptoms of hyperkalemia range

clinically also from muscle weakness, fatigue, and paresthesia to severe manifestations such as
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cardiac arrhythmias (Tinawi, 2020). This may present with increased potassium levels, peaked T

waves, lengthened PR interval, or even ventricular fibrillation on ECG if not corrected in time.

Appropriate Treatment for Ms. Brown

The most appropriated treatment for Ms. Brown would include intravenous fluids to

correct her hypernatremia and insulin administration with glucose since it will lower her blood

glucose as well as drive potassium back into the cells (Whitmore & Gunnerson, 2020).

Monitoring her fluid balance, electrolytes, and cardiac status is important in ensuring that

cerebral edema or a rapid shift in potassium levels does not occur. In addition, a sodium-

restricted and potassium-restricted diet may be recommended as part of her long-term

management plan.

Interpretation of Ms. Brown's ABGs

ABGs taken on Ms. Brown show metabolic acidosis, pH 7.30, HCO3- 20 mEq/L, with a

partial compensation due to respiratory alkalosis, as evidenced by the PaCO2 of 32 mmHg. The

low pH and low level of bicarbonate mean poor compensation for the acidotic state (Whitmore &

Gunnerson, 2020). This can be seen with poorly controlled diabetes mellitus in the form of

diabetic ketoacidosis or in cases of severe dehydration, both of which may be contributing to her

presentation.

Understanding Anion Gaps and Clinical Significance

An elevated anion gap (>12 mEq/L) would indicate the presence of unmeasured anions,

as in diabetic ketoacidosis, lactic acidosis, or renal failure (Rateau, 2019). That would be

clinically important because it would narrow the causes of metabolic acidosis and help realize

proper treatment plans.

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References

Murphy, K. R., & Solis, J. (2021). National asthma education and prevention program 2020

guidelines: what's important for primary care. J Fam Pract, 70(6S), S19-S28.

https://doi.org/10.12788/jfp.0219

Ramsahai, J. M., Hansbro, P. M., & Wark, P. A. (2019). Mechanisms and management of asthma

exacerbations. American Journal of Respiratory and Critical Care Medicine, 199(4),

423-432. https://doi.org/10.1164/rccm.201810-1931ci

Rateau, M. R. (2019). Fluid, Electrolyte, and Acid-Base Imbalances. Lewis's Medical-Surgical

Nursing E-Book: Lewis's Medical-Surgical Nursing E-Book, 268.

Tinawi, M. (2020). Diagnosis and management of hyperkalemia. Archives of Clinical and

Biomedical Research, 4(3), 153-168. http://dx.doi.org/10.26502/acbr.50170095

Whitmore, S. P., & Gunnerson, K. J. (2020). Acid-Base and Electrolyte. Emergency Department

Critical Care, 301. http://dx.doi.org/10.1007/978-3-030-28794-8_18