Response to cerrato

Classifying the Severity of D.R. Asthma Attack

According to D.R’s symptoms he would be classified under persistent mild asthma. His symptoms began four days ago, and his peak flow rates have maintained within 65%-70%, staying within the yellow zone. He has experienced three days with nighttime symptoms and albuterol usage has been indicated. Mild persistent asthma is indicated when symptoms have occurred greater than two days per week, nighttime symptoms are greater than two days a month and the utilization of short acting beta agonist such as albuterol is used greater than two days per week (Quirt et al, 2018).

Common Triggers

The most common triggers for asthma include dust mites, mold, pets, pollen, tobacco smoke, upper respiratory infections, stress, changes in weather or temperature, and exercise (Dlugasch & Story, 2021). In D.R.’s case I would consider the symptoms he is experiencing contribute to an upper respiratory infection such as rhinovirus. Viral infections such as rhinovirus contribute to asthma exacerbations due to the deterioration of epithelial tissue within the throat and nasal passages. This results in increased mucous production that will cause the airway to narrow and the chest to constrict from congestion (Ortega, Nickle & Carter, 2020). These symptoms induce asthmatic episodes and can result in exacerbations.

Etiology of D.R.’s Asthma

There are many possible etiologies that can be the cause of D.R. being asthmatic. He could possibly have a family or genetic history that predisposes him to having asthma as it has been found that family history combined with environmental factors enhance the likelihood of asthma development (book). It may be related to D.R.s occupational status or environment as exaggerated IGE responses to allergens and irritants such as pollen, smoking, chemicals or dust can cause asthma (Dlugasch & Story, 2021).

Case Study 2

Laboratory Values

According to Ms.Brown’s laboratory values it can be determined that she has hyperglycemia, hypernatremia, hyperkalemia, hyperchloremia. The ABG results indicate metabolic acidosis.

Signs and Symptoms of The Water Imbalances

Hypernatremia manifestations include lethargy, headache, confusion, irritability, seizures, coma, hypovolemia, dry mucous membranes, thirst and decreased urine output. Hyperchloremia does not have clinical manifestations but can be seen within the signs and symptoms of metabolic acidosis. Ms.Brown may demonstrate clinical manifestations of hyperkalemia such as hyperreflexia, flaccid paralysis, anxiety, nausea, vomiting, dysrhythmias, cardiac arrest, respiratory depression and respiratory arrest (Dlugasch & Story, 2021).

Treatment

Due to Ms. Brown’s elevated potassium level aggressive treatment is needed in order to correct the electrolyte imbalance. Multiple treatment courses are available, and they include providing calcium therapy in order to prevent cardiac toxicity. Cardiac gluconate is the initial drug of choice. Calcium chloride can be provided to patients through central lines or peripherally in the cases of cardiac arrest due to the possibility of tissue necrosis with extravasation (Simon, L., Hasmi, M, F., & Farrell, M, W., 2022). Ms. Brown will need insulin therapy due to her hyperglycemia as the insulin will drive the potassium back into the cells and therefore lower the serum potassium (Simon, Hashmi, & Farrell, 2022). In order to correct the hypernatremia 5% dextrose should be given.

Acid Base Imbalance

Ms. Browns ABG indicates that she has Metabolic acidosis. The PH was 7.30 making the PH acidic, PCO2 is 32 mmHg and HCO3 20 creating a base environment. The PCO2 is determines if the acidosis will be respiratory or metabolic (Burger & Shaller, 2022). The respiratory system is compensating due to the alterations in bicarbonate and PH acidity (Burger & Shaller, 2022)

Anion Gaps

Diagnostic procedures utilized to evaluate metabolic acidosis include anion gaps. Anion gaps are used to determine the cause of the metabolic acidosis (Dlugasch & Story, 2021). This specific exam identifies anions such as albumin, sulfates, and phosphates that can contribute to the metabolic acidosis. In Ms. Browns case the anion gap measurement will help determine if the excess acid causing the metabolic acidosis is from excess production or decreased excretion (Dlugasch & Story, 2021).

 

 

References

Burger, M., & Schaller, D. (2022). Metabolic acidosis. 
National library of medicine. Available         

         from: https://www.ncbi.nlm.nih.gov/books/NBK482146/

Dlugasch, L., & Story, L. (2021). 
Applied pathophysiology for the advanced practice nurse.

         Jones & Bartlett Learning.

Ortega, H., Nickle, D., & Carter, L. (2020). Rhinovirus and asthma: challenges and opportunities

          Rev med virol. Available from: https://doi.org/10.1002/rmv.2193

Quirt, J., Hildebrand, J,K., Mazza, J., Noya, F., Kim, H. (2018). Asthma. 
Allergy, asthma & 

          clinical immunology. Available from: https://doi.org/10.1186/s13223-018-0279-0

Simon, L., Hashmi, M, F., & Farrell, M, W. (2022). Hyperkalemia. 
National library of medicine. 

          Available: https://www.ncbi.nlm.nih.gov/books/NBK470284/