Can you assist me with a case study re-write? Please see attached….. Pulmonary Function: D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic complaining of
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Ms. Brown's Fluid & Electrolyte Imbalance Case Study
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Question 1: Response to Ms. Brown's Health Assessment and Treatment
According to the case study information, how would you classify the severity of D.R.'s asthma attack?
Based on the information provided in the case study, D. R.'s asthma attack can be classified as a moderate persistent level. This can be justified when he experiences more than three consecutive nights in a week, his peak flow ranges from 65-70% of his regular baseline, and when he reports that his albuterol inhaler does not provide sufficient relief. The inability of the albuterol inhaler to relieve his asthma symptoms suggests that he is required to have a more aggressive treatment as he is approaching severe persistent levels, which is likely to have more impacts, such as constant symptoms.
What are the most common triggers for Asthma, considering D.R.'s case?
The most common triggers for Asthma include respiratory infections, allergens, and environmental factors. Allergens such as dust mites, pollen, and mold spores are likely to lead to Asthma. This is because the allergens release chemicals to the immune system, leading to allergy symptoms such as nasal congestion, running nose and itchy eyes. Allergen triggers can be justified in our case study, where D.R. is experiencing watery eyes, a stuffy nose, and post-nasal drainage. (Gans et al. 2020)
Respiratory infections result in Asthma by affecting the lungs, nose, sinuses and throat of a patient. Respiratory infections may be associated with a running nose, cough, fever or sore throat. In our scenario, D. R.'s respiratory infection symptoms began with shortness of breath and cough associated. There are several environmental factors that can lead to Asthma, which include tobacco, air pollution, and cold temperatures, which can result in asthma attacks. It is essential for our patient to identify his common triggers to address them to stop the severity of the incident.
Explain the factors that may be the etiology of D.R. being an asthmatic patient.
The main etiology that may have triggered Asthma in our patient is the allergens. This can be justified by some of the symptoms of our patient, such as stuffy nose and watery eyes. These symptoms illustrate that the allergens may have sensitized his airways, making his body associated with risks such as shortness of breath.
Secondly, Asthma may affect a person as a result of generic components. If D.R. comes from a family that has a long history of Asthma, he is likely to have inherited the generic predispositions, making him vulnerable to the healthcare condition. There are other etiological factors that may have contributed to the healthcare condition, which include airway inflammation and inadequate asthma management. Inflammation at the airway is likely to lead to bronchoconstriction, while inadequate asthma management is likely to lead to other medical complications if it is not readily available.
In Conclusion, our patient is likely to be facing moderate to severe persistent asthma levels. D.R. requires a comprehensive analysis of his health conditions to reduce the severity of his symptoms. Comprehensive analysis can allow medical practitioners to allow our patients' conditions better, which is essential for providing them with the most appropriate treatment, thus reducing the nighttime symptoms and also the peak rate, which is likely to increase if the health condition is not addressed on time.
Question 2: Response to Fluid, Electrolyte, and Acid-Base Imbalances
Based on the laboratory values, determine the type of water and electrolyte imbalance she might be experiencing.
Based on the laboratory values provided, Ms. Brown is likely to be experiencing hyperkalemia electrolyte imbalances. By breaking down the values, we are likely to find that serum glucose of 412 mg/dl exhibits hyperglycemia, serum sodium levels of 156 mEq/L exhibit hypernatremia, and serum potassium of 5.6 mEq/L exhibits hyperkalemia. The abnormalities possessed by our patients indicate that they are likely to be experiencing severe dehydration levels. (Shirai et al. 2022)
Describe signs and symptoms associated with different types of water imbalances.
There are two main types of signs and symptoms associated with different types of water imbalance for our patient, which include Hyperosmolarity and Hyperkalemia. Hyperosmolarity signs and symptoms are associated with lethargy, extreme thirst and dry mucus membranes. Severeness of this water imbalance is likely to result in confusion, weakness and even coma.
Signs and symptoms of hypokalemia may include palpitations, muscle weakness and arrhythmias, which might be life-threatening to the patient as the patient might be experiencing heart rates that are abnormally fast. Our patient is experiencing higher potassium levels, and the patient requires immediate attention from healthcare providers.
What would be the most appropriate treatment for our patient?
The most appropriate treatment for our patient would involve addressing both water and electrolyte imbalances. Some of the treatments that could be appropriate for our incident include rehydration, where healthcare practitioners can use intravenous fluid to address dehydration. The second treatment would involve hyperglycemia management, which would focus on reducing the elevated glucose levels of the patient and improving the healthcare condition of the patient.
The third treatment method would be hyperkalemia collection. Hyperkalemia collection allows doctors to make use of potassium-lowering interventions such as sodium bicarbonate, calcium gluconate and nebulized albuterol. Despite the potassium-lowering interventions being essential for collecting hyperkalemia, they should be used moderately to prevent severe cardiac consequences to the patient.
What are the ABGs from Ms. Brown regarding her acid imbalance?
Based on the laboratory tests, the arterial blood gases justify the patient is facing respiratory acidosis with partial compensation. The P.H. value of 7.30 suggests the patient is below the normal average, elevated PaCO2 32 mmHg, which suggests the patient is undergoing respiratory acidosis, and reduced levels of bicarbonate, which are represented using HCO3– 20 mEq/L. Based on the tests, there is a need for medical attention for our patients. (Bijapur et al. 2019)
Based on your research, define and describe Anion Gaps and its clinical significance.
Based on the readings, the anion gap is a calculated value that is used in assessing acid-base balance, and it is mainly used in identifying the main cause of specific metabolic balances. The anion gap can be calculated using (Na+ - (Cl– + HCO3–)). If the values of the onion gap are considerable, the patient is likely to be experiencing metabolic acidosis. Some of the metabolic acidosis the patient may suffer include diabetic ketoacidosis and lactic acidosis, and they are commonly considered as uncontrolled diabetes and comprehensive treatment is required to address the imbalances faced by the patient.
Reference
Bijapur, M. B., Kudligi, N. A., & Asma, S. (2019). Central venous blood gas analysis: an alternative to arterial blood gas analysis for pH, PCO2, bicarbonate, sodium, potassium and chloride in the intensive care unit patients. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 23(6), 258.
Gans, M. D., & Gavrilova, T. (2020). Understanding the immunology of Asthma: Pathophysiology, biomarkers, and treatments for asthma endotypes. Paediatric respiratory reviews, 36, 118-127.
Shirai, Y., Miura, K., Nakamura-Utsunomiya, A., Ishizuka, K., Hattori, M., & Hattori, M. (2022). Analysis of water and electrolyte imbalance in a patient with adipsic hypernatremia associated with subfornical organ-targeting antibody. CEN Case Reports, 11(1), 110-115.
