How to write a nursing Pulmonary function case study (Solved)

I would classify this attack as a persistent-severe asthma attack. The patient experienced the symptoms throughout the day and had nighttime awakenings for three nights since its onset four days ago. The patient reports that the short-acting beta-agonist he has been using is no longer effective. Also, he has reduced lung function as he reports a normal peak flow with a high inclination toward the lower end of the normal range.

The most common triggers for asthma in most patients include tobacco, dust mites, outdoor air pollution, pests, pets, mold, disinfectants, infections, and strong emotions. Also, infections such as flu, upper respiratory tract infections, and allergies also trigger asthma. Physical exercises, bad weather, and certain food can also trigger asthma. For D.R., his asthma attack could have been triggered by flu, cold, an allergy, bad weather, or outdoor air pollution.

Either flu or cold could have triggered D.R.’s condition since he is presenting with clinical signs and symptoms of both. Flu and colds can execrate an asthmatic attack. These conditions increase the inflammation and mucus production in the already inflamed and sensitive airways of an asthmatic patient. Therefore, D.R. experienced rapid bronchoconstriction and extreme shortness of breath with every attack.

Fluid, electrolyte, and acid-base hemostasis case study

Ms. Brown has marked hypernatremia, hyperkalemia, and hyperchloremia from the case study. Due to the pathophysiological mechanisms in hypernatremia which lead to renal water conservation, patients present with dehydration and production of concentrated urine. Patients with hyperchloremia present with increased heart rate, altered mental status, and tachypnea. Ms. Brown has a high potassium level of 5.6 milliequivalents per liter. Therefore, she might present with weakness, palpitations, fatigue, or syncope (Simon, Hashmi & Farell, 2022).

The most appropriate treatment for Ms. Brown is insulin therapy and rehydration within the first 24 to 48 hours of admission. Thus the patient is experiencing diabetic ketoacidosis due to unregulated high blood glucose levels. As a result, there has been an extensive fluid and electrolyte shift, causing imbalances. Administration of insulin as an intravenous fluid infusion until ketosis goes down and blood sugars fall to below 250mg per deciliter counters dehydration and corrects electrolyte imbalance simultaneously (Tran et al., 2017). I would administer one to three liters of fluid (normal saline, with 0.9% sodium chloride) in the first hour as per the recommended guidelines (Tran et al., 2017). I would administer one liter in the second hour and the following two hours. Depending on the central venous pressure readings and the patient’s state of hydration, I would administer one liter every four hours after that. I would also administer subcutaneous insulin every four hours, depending on the blood glucose level (Tran et al., 2017).

The ABGs from Ms. Brown indicates that she has partially compensated metabolic acidosis. The unregulated high blood sugars have interfered with renal function, hence metabolic acidosis. However, this problem is being corrected by the respiratory structures; thus, it is partially compensated since the blood pH has not been restored to normal.

Brubaker, Vashisht, and Meseeha (2021) describe an anion gap as a calculated value obtained from measured plasma electrolyte concentrations. Increased anion gap associated with acidosis is significant in interpreting acid-base imbalances. An anion gap of more than 25 mmol/L indicates metabolic acidosis (Brubaker et al., 2021)

References

Brubaker, R. H., Vashisht, R., & Meseeha, M. (2021). High anion gap metabolic acidosis. In StatPearls [Internet]. StatPearls Publishing.

Centers for Disease Control and Prevention (CDC). (2022). Asthma. Retrieved from https://www.cdc.gov/asthma/triggers.html#:~:text=Sinus%20infections%2C%20allergies%2C%20pollen%2C,also%20trigger%20an%20asthma%20attack

Tran, T. T., Pease, A., Wood, A. J., Zajac, J. D., Mårtensson, J., Bellomo, R., & Ekinci, E. I. (2017). Review of evidence for adult diabetic ketoacidosis management protocols. Frontiers in endocrinology, 8, 106.

How to write a nursing Pulmonary function case study (Solved)

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