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Maria, Gonzalez

NUR-502

6-11-20

Module 3

D.R is 27 years-old man, who present to the nurse practitioner at the Family Care Clinic

complaining of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage- all of which began four days ago. Three days ago, he began monitoring his peak flow rates several times a day. His peak flow rates have ranged from 65-70% of his regular baseline with nighttime symptoms for 3 nights on the last week and often have been at the lower limit of that range in the morning. Three day ago, he also began self-treat with albuterol nebulizer therapy. He reports that usually his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer is enough treatment for this asthmatic episode.

According to Healthline (2020), Asthma is a condition that causes breathing difficulties. These difficulties result from airway narrowing and swelling . Asthma also led to the production of mucus in airways. Asthma causes wheezing, shortness of breath, coughing.

D.R. shows mild intermittent asthma, the symptoms are mild. This classification means that Mr. D.R has symptoms up to days per week or two nights per month. This asthma will usually hinder any activities and include exercises.

Symptoms

· Wheezing or whistling when breathing

· Coughing

· Swollen airway

· Development of mucous in the airwa

The largest number of people with asthma have mild intermittent and mid persistent are the most common types of asthma. Mild asthma is more likely than any other types to be untreated since the symptoms are so mild. (healthline,2020).

Identifying triggers forms the basis of environmental secondary prevention. These triggers maybe allergenic or nonallergenic. Allergenic triggers include indoor allergens, such as house dust mites, mold, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. (Gautier et al.,2017). A number of triggers increase for this kind of asthma. These include smoking or expose to secondhand smoke, expose to pollution or exercises, I would encourage M.R to avoid places or people who smoke and avoid secondhand smoke. At home I would encourage him to avoid pets and reduce the use any cleaning product with strong odor example (bleach), avoid carpets inside his home the dust could trigger his asthma also exercises in moderation.

Mild intermittent asthma provides for and interesting paradox. As a chronic disease, asthma always present in affected individual, yet the disease may be quiescent and produce no symptoms for months. However, the potential for onset of symptoms or even an asthma exacerbation, exists even for patients with very intermittent symptoms. In addition, airway inflammation can be present at low levels, below threshold that would cause discernible symptoms or measurable changes in lung function, in patients with so-called intermittent asthma. Therefore this term is somewhat misleading, since it is not possible to discern easily whether it is the disease process that is present only intermittently or the symptoms.( Veler , 2005).

In conclusion, Asthma is a chronic inflammation of the lungs airways that cause coughing, chest tightness, wheezing or shortness of breath . 8.3% Of Americans have asthma of these 26.5 million,20.4 million are adults and 6.1 million are children.

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References

Gautier, C., & Charpin, D. (2017). Environmental triggers and avoidance in the management

Of asthma. Journal of asthma and allergy vol. 10,47-56.

htt://doi.org/10.2147/JAA.S121276

Health Line . ( 2020, July 12) Asthma Classification . Retrieved from

https://www.healthline.com/health/asthma-classification#mild-persistent-asthma

Veler, H (2005). Classification of asthma severity. Retrieve from

https://www.sciencedirect,com/topics/ medicine-and- dentist-/mild-

interm

ittent-asthma

Maria, Gonzalez

NUR-502

7-12-2020

Case study #2

Ms. Brown is 70-year-old women with type diabetes mellitus who has been too ill to get out of bed for 2 days. She has had severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:

· Severe glucose 412 mg/dL

· Serum sodium (Na+) 156 mEq/L

· Serum Potassium (K+) 5.6 mEq/L

· Serum chloride (CL-) 115 mEpL

· Arterial blood gases ( ABCs): pH 7,30; PaCO2 32 mmHq; Pao2 70 mmHq; HCO3-20 meq/L

Normal Values

· Glucose 72-99mg/Dl

· Serum Sodium (Na+) 135-145 mEq/L

· Serum potassium (K+) 3.5- 5 mEq.L

· Serum chloride (CL-) 95-105 mEq/L

Normal Values Arterial Blood Gases.

· pH 7-35-7-45

· Partial pressure of carbon dioxide (Pa C02):35-45mmHg

· Partial pressure of oxygen (PaO2): 35-45 mmHg

· Bicarbonate (HCO3): 22-26

· Oxygen saturation (O2Sat): 94-100%

Ms. Brown show in her results is compensate metabolic acidosis

Hyperkalemia is caused by excess of potassium intake, impaired potassium excretion, or transcellular shift, The etiology of hyperkalemia is often multifactorial, with impaired renal function , medication use, and hyperglycemia as the most common contributors. (Paice et al., 1986). Because healthy individuals can adapt to excess potassium consumption by incretion, increased potassium intake is rarely the sole cause of hyperkalemia, and underlying renal function is common. The most serious manifestation of hyperkalemia are muscle weakness or paralysis , cardiac conduction abnormalities, and cardiac arrythmia

(Montfort, 2003). These manifestations usually occur when the serum concentration is >7.0 mEq/L which chronic hyperkalemia or possibly at lower levels with acute rise in serum potassium. Cardiac manifestations typically have one or more of the characteristics EGG abnormalities associated with hyperkalemia. Other manifestations in hyperkalemia may show polyuria and polydipsia with uncontrolled diabetes.

The aggressiveness of therapy for hyperkalemia is directly relate to the rapidly with which the condition has developed. The absolute level of serum potassium, and evidence of toxicity. The faster the rise in the potassium level, the higher it has reached and the greater the evidence of cardiotoxicity the more aggressive therapy should be. According to Lederer 2020, If the patient has only moderate elevation in potassium level and no electrocardiographic (ECG) abnormalities, excretion can be increased by using a cation exchange resin or diuretics , and the source of excess potassium(eg, increased intake or inhibited excretion) can be corrected.

The ABG from Ms. Brown indicate regarding her acid imbalance is her ( pH) value which is 7.30 and normal value is 7.35-7.45

The anion gap test tells how much acid is in the blood . Acid levels that are higher or lower that normal can tip nurse practitioner off to a health problem and help them find the right treatment. Too much acid in the blood can be a sign of short-term problems like dehydration and diarrhea ,or long-term conditions like diabetes. It is not common ,but too little acid may point to serious problem like heart disease.

In conclusion, Hyperkalemia is a potentially life-threatening metabolic problem cause by inability of the kidneys to excrete potassium , impairment of the mechanism that move potassium from the circulation into the cells, or a combination of these factors.

References

Paice BJ, Paterson KR,Onyanga-Omara F,Donnelly T, Gray JM , Lawson DH. Record

Linkage study of hypokalemia in hospitalized patients. Postgrad Med J. 1986;62(725):

187-191….

Level E, (2020) Hyperkalemia treatment and management . Retrieved from

htt:ps//www.emedicine.medscape.com

Montfort JR ,Linas S. How Dangerous is hyperkalemia ? J Am Soc Nephrol Dial Transplant

2003:18:2215.