You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points
150 word each respond
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Discussion 1 Luna
Pulmonary Function and Electrolytic Imbalance
According to the case study information, how would you classify the severity of the D.R. asthma attack?
D.R. is experiencing moderate persistent asthma based on the National Asthma Education and Prevention Program (NAEPP). This classification scheme uses a patient’s clinical presentation and lung capacity measured before treatment to estimate the severity of an asthmatic episode. A moderate persistent asthma classification ranks second in severity and requires daily attacks that interfere with daily activities. Patients experience nighttime symptoms more than once a week and the peak flow rate ranges between 60% and 80% of normal readings (Henderson, 2019). Also, medications used previously for asthma attacks may prove ineffective in relieving the symptoms. The patient’s presentation is consistent with these requirements and a moderate persistent classification.
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.
Triggers initiate immuno-response mechanisms in respiratory organs which results in asthmatic episodes. Some common triggers include allergens, respiratory infections, and pharmaceutical compounds. Allergens refer to substances whose inhalation triggers immune responses despite their harmlessness. Some people’s genetic makeup predisposes them to such responses when exposed to dust, smoke, pollen, animals, latex, foods like nuts, and insect stings. Contact with these compounds results in inflammation and asthma attacks whose severity varies with the amount and period of exposure (Henderson, 2019).
Similarly, respiratory infections trigger asthma as well. These infections contribute to disease morbidity and mortality through consistent stimulation of inflammation with disregard for compliance with asthma prescriptions. This stimulation takes the guise of cellular damage resulting from pathogenic invasion of respiratory organs. The body’s immune response targets leukocytes, antibodies, and protective compounds at invaded sites to eliminate exogenous threats. Respiratory organs, which are hypersensitive to such material, react by exhibiting different behaviors including constrictions that hinder normal physiological mechanisms and present asthmatic attacks. Examples of such infections include colds, flu, pneumonia, COVID-19, and tuberculosis (Henderson, 2019).
D.R’s asthma attacks resulted from a secondary respiratory infection. The second condition is evidenced by the presentation of additional symptoms inconsistent with common asthma episodes. Nocturnal cough, chest tightness, and wheezing are the most common presentations since more than 30% of patients report one of the three (Narendra & Hanania, 2018). Tachypnea and reduced peak flow rates are consistent with asthma symptoms. However, some of D.R’s clinical presentations suggest a second condition. Symptoms like watery eyes, congested nose, and post-nasal drainage prevail in the common cold than in asthma. More than half of common cold patients complain of both watery eyes and stuffed noses while less than 5% of asthma patients report similar presentations (Narendra & Hanania, 2018). This prevalence suggests that D.R. is suffering from the common cold as well, which triggers moderate persistent episodes.
Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.
Multiple factors attribute to the asthma condition and its development is a product of environmental factors and genetic make-up. Numerous susceptibility genes are responsible for the impaired inflammatory regulation and hyperresponsiveness of respiratory organs. For example, the FCER1B genes responsible for high-affinity immunoglobin receptors, interleukins, and the monocyte-stimulating factor participate in immune response, and their manipulation can cause dysregulation of inflammatory compounds while the ADAM33 gene has a stimulating effect on airway smooth muscles that cause bronchoconstriction during episodes (Henderson, 2019). Activation of such genes by environmental stimuli results in the asthma condition. These genes could run in D.R’s family and are responsible for his condition.
Fluid, Electrolyte, and Acid-Base Homeostasis
Based on Ms. Brown’s admission’s laboratory values, could you determine what type of water and electrolyte imbalance she has?
Ms. Brown is experiencing hypertonic dehydration. The condition resulted from reduced hydration despite sustained excretion of water for two days. Diabetes mellitus worsened water loss given its dehydration properties through elevated blood sugar levels (Damanik & Yunir, 2021). Ms. Brown’s high serum glucose, which is four times the normal range, is the most probable cause of dehydration. In addition, Ms. Brown is experiencing metabolic acidosis. The low blood pH indicates increased serum acidity, disqualifying alkalosis as a possible diagnosis. Similarly, low partial pressure of carbon dioxide and low serum bicarbonate concentration eliminates respiratory acidosis as a diagnosis. Hypernatremia, hyperchloremia, and hyperkalemia are effects of the patient’s uncontrolled blood sugar and symptoms of metabolic acidosis.
Describe the signs and symptoms of the different types of water imbalance and described the clinical manifestation she might exhibit with the potassium level she has.
Several symptoms accompany water imbalance including constipation, general malaise, and lethargy. Urination frequency and amount reduce and urine adopts a strong smell and a dark yellow coloration. Patients may experience dry mouth and eyes. Ms. Brown may present additional symptoms given her elevated potassium levels, including diarrhea, chest pain, and arrhythmia. Her muscles may feel weak and numb. If persistent, hyperkalemia can cause vomiting, nausea, and confusion (Damanik & Yunir, 2021).
In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
Ms. Brown requires several interventions and one of them is diabetic therapy. The patient’s blood glucose is at 412 mg/dL, which is above the normal 100 mg/dL threshold indicating impaired homeostatic mechanisms of glucose (Kong et al., 2019). Given a previous diabetes diagnosis, a glucose control intervention is the most appropriate involving administration of insulin. Biguanides and Sulfonylureas pharmaceuticals are also applicable in leveling serum glucose. In addition, the patient requires rehydration treatment to address dehydration evidenced by the hypernatremia presentations. This intervention involves the intravenous infusion of 20 to 30 mL/kg of Ringer’s lactate solution in the first 2 hours and adjusting this rate with patient outcomes. Administration of oral rehydration solution is an option if the patient’s capacity for ingestion is unaltered as determined by a physician through a physical evaluation. These steps will improve the patient’s health.
What do the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
Arterial blood gases reveal the nature of an acid-base imbalance. Ms. Brown’s readings indicate metabolic acidosis because her arterial pH is 7.3 which is below the normal minimum of 7.35 (Gooch, 2019). A pH reading above 7.45 would imply an alkalosis. Low pH and low partial pressure of carbon dioxide eliminate respiratory factors as a cause of Ms. Brown’s condition. Respiratory causes would have elevated carbon dioxide, serum bicarbonate, and a basic pH. The metabolic cause is confirmed by her low bicarbonate levels.
Based on your readings and your research define and describe Anion Gaps and their clinical significance.
Anion gap refers to the difference in charge between positively and negatively charged ions (Heireman et al., 2018). Salts dissociate into ions when they dissolve into electrolyte solutions like serum and extracellular fluid. Depending on the solutes, the solution can contain more cations than anions. Examples of positively charged ions include hydrogen ions, potassium, and sodium ions. Bicarbonate ions are the most common anions in serum. If every cation is matched to an anion, any remnant ions constitute the anion gap. Normal anion gap ranges between 10 and 13 mEq/L and deviations from this range indicate electrolytic derangements (Heireman et al., 2018). Ms. Brown’s anion gap, which sums up to 25 mEq/L suggests an acidosis. A low anion gap below 10 mEq/L would have indicated a deficiency of hydrogen ions. Such insights provide additional information for the diagnosis and correction of acid-base irregularities
Damanik, J., & Yunir, E. (2021). Type 2 Diabetes Mellitus and Cognitive Impairment. Acta Medica Indonesiana, 53(2).
Gooch, M. D. (2019). Acid–Base Imbalances. In A Guide to Mastery in Clinical Nursing. https://doi.org/10.1891/9780826150325.0003
Heireman, L., Mahieu, B., Helbert, M., Uyttenbroeck, W., Stroobants, J., & Piqueur, M. (2018). High anion gap metabolic acidosis induced by cumulation of ketones, L- and D-lactate, 5-oxoproline and acute renal failure. Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine, 73(4). https://doi.org/10.1080/17843286.2017.1358504
Discussion 2 Brito
Classification of severity of D.R. asthma attack
Because J.D is having symptoms daily for the past 3 days including nights and his peak flow rate has been between 60-80% I would classify his asthma as moderate persistent.
Clinical manifestation of asthma and which ones apply to D.R.
Some of the most common manifestation of asthma include wheezing, dyspnea, chest tightness, cough, anxiety, tachypnea, and tachycardia. Some triggers of asthma vary in age. For example, asthma during childhood is triggered by atopy which is a genetic tendency to develop allergic diseases like rhinitis and eczema. This means that the immune response is heightened to common allergens and food allergies (American Academy of Allergy, Asthma and Immunology, 2022). The cause in adults varies atopy is more common in those with mild to moderate disease; if they have severe disease atopy is not the cause. Individuals that have high eosinophil (where production of IGE responds to allergens but does not mean these people have allergies) levels (Dlugasch, 2020). I have come to believe that D.R. might be experiencing a nocturnal trigger which can be related to the circadian rhythm. To explain: cortisol levels and epinephrine decrease, and histamine levels increase; these changes cause bronchoconstriction.
Factors that might be the etiology of D.R. being an asthmatic patient.
Because the case study did not provide any medical history of the patient and the only medication we know he is on is an albuterol inhaler there are many factors why the patient is an asthmatic and these include: having a blood relative with asthma (parent or sibling), having atopic dermatitis, obesity, smoking or exposure, exposure to pollution and exposure to occupational triggers (Mayo Clinic, 2022).
Fluid, Electrolyte and Acid-Base Homeostasis
What type of water and electrolyte imbalance does Ms. Brown have?
Ms. Brown seems to have excessive sodium, this can happen if her dietary intake is high in sodium products such as processed foods, canned foods, corticosteroid disorder or near drowning in salt water. Her electrolyte imbalance include: sodium – normal range is 135-145 mEq/L and her level is currently 156 mEq/L. Serum potassium – normal range is 3.5-5 mEq/L and her level is 5.6 mEq/L and serum chloride – normal range is 98-108 mEq/L and her level is 115 mEq/L.
Clinical Manifestations of water imbalance and hyperkalemia
Ms. Brown is experiencing hypernatremia which is high serum sodium levels. Patient might be experiencing some type of water loss which can occur with extra-renal conditions such as gastroenteritis, vomiting, prolong nasogastric drainage, burns and excessive sweating (National Center for Biotechnical Information, 2022). People may experience dehydration, thirst, fatigue, irritability, restlessness, altered mental status, dry mouth, tachycardia, headache, lethargy, and decreased urine output.
Clinical Manifestations of hyperkalemia
Hyperkalemia can affect severe body systems in which potassium plays key functions like the nervous system, cardiac, respiratory, and GI. Hyperkalemia makes things excitable. In the neuromuscular system it causes paresthesia, muscle craps, weakness, fatigue, hyperreflexia, and anxiety. In the Cardiovascular system it causes EKG changes and dysrhythmias. In the respiratory system it causes diaphragm weakness and in the GI system it causes nausea and vomiting, diarrhea, and cramping (Dlugasch, 2020).
What does the ABG from Ms. Brown Indicate?
Her ABG indicates that she is in Metabolic Acidosis hence, they symptoms the patient is presenting with. In metabolic acidosis toxins from the body build up along with kidney failure and ingestion of certain drugs or toxins, such as methanol or large doses of aspirin.
Dlugasch, L. (2020). Applied Pathophysiology. In Applied Pathophysiology for the Advanced Practice Nurse (p. 97).
Mayo Clinic. (2022, 5 21). Retrieved from https://mayoclinic.org