NUR 502 Module 3 Discussion

Sample Answer for NUR 502 Module 3 Discussion

Pulmonary Function 

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Severity of D.R. asthma attack 

D.R. is having a moderate persistent asthma attack. The peak flow measures have ranged from 65-70% of his baseline for the last three days. He has experienced night-time symptoms for three nights, and his symptoms do not respond to his usual albuterol nebulizer therapy despite its frequent use. 

Common asthma triggers 

Gauthier and Charpin (2017) classified the common asthma triggers as allergenic and nonallergenic. Allergenic triggers include mold, animal droppings such as rodents and cockroaches, dust mites, animal hair and dander, and pollen. Nonallergenic triggers include infections, air pollutants, meteorological conditions, physical activity, and some medications. 

Respiratory infections such as the common cold and influenza virus infections can trigger and exacerbate asthma attacks. Air pollutants or irritants from patients’ immediate environment, like tobacco smoke and particulate matter, can induce an asthma attack and significantly impede asthma control (Cevhertas et al., 2020). Dlugash and Story (2021) reported an association between asthma and exercise. It occurs mainly in children and resolves rapidly with rest. In addition, the literature showed evidence of asthma-inducing effects of medication such as aspirin (Cevhertas et al., 2020).   

In D.R.’s case, respiratory infection and allergens seem to be the triggers for his asthma attack. D.R.’s complaints of cough, fatigue, stuffy nose, post-nasal drainage, and watery eyes are powerfully evocative of a respiratory infection, common cold, or allergic rhinitis that could have triggered his asthma attack. 

Asthma etiologic factors 

Asthma is the most common non-communicable respiratory disease. Chronic airway inflammation combined with airway hyperreactivity are mainstays in the development of asthma (Dlugash & Story, 2021). Research proposed that asthma is a disorder resulting from the interaction of environmental factors and patients’ genetic predispositions (Dharmage et al., 2019). 

A genetic predisposition known as atopy causes hypersensitivity to allergens. Over 100 genes have been affected. These alterations lead to genetic immune dysregulation and hyperreactiveness. Exposure to environmental factors will trigger a cascade of immunologic and inflammatory reactions involving the secretion of inflammatory mediators, leukotrienes, prostaglandins, and cytokines (Bereda, 2022). 

Other asthma phenotypes are not associated with atopy. Some examples are a high eosinophil levels condition more common in adults and the aspirin-exacerbated respiratory disease associated with drugs such as aspirin and non-steroidal anti-inflammatory drugs. 

References 

Bereda, G. (2022). Bronchial asthma: Etiology, pathophysiology, diagnosis and management. Austin J Pulm Respir Med., 9(1), 1085. 

Cevhertas, L., Ogulur, I., Maurer, D.J. et al. (2020). Advances and recent developments in asthma in 2020. Allergy, 75, 3124–3146. https://doi.org/10.1111/all.14607  

Links to an external site. 

Dharmage, S. C., Perret, J. L., Custovic, A. (2019). Epidemiology of asthma in children and adults. Frontiers in Pediatrics,7. DOI=10.3389/fped.2019.00246   https://www.frontiersin.org/articles/10.3389/fped.2019.00246    

Dlugash, L. & Story, L. (2021). Applied pathophysiology for the advanced Nurse Practitioner. Jones and Bartlett Learning.   

Gautier, C., & Charpin, D. (2017). Environmental triggers and avoidance in the management of asthma. Journal of asthma and allergy, 10, 47–56. https://doi.org/10.2147/JAA.S121276  

Links to an external site. 

Fluid, Electrolyte, and Acid-Base Homeostasis 

Ms. Brown’s water and electrolyte imbalance 

Ms. Brown’s admission laboratory values showed elevated serum glucose, sodium, potassium, and chloride levels. These values may result from dehydration secondary to osmotic diuresis caused by hyperglycemia. In addition, a fluid deficit may come from insensible loss from respiration, her severe cough, and decreased water intake, as the patient could not intake water or food. These laboratory values are consistent with a hypertonic imbalance. 

Types of water imbalance 

Water imbalances result from changes in the body fluids. Two major types of water imbalances are fluid excess and fluid deficit. Fluid excesses include hypervolemia, when fluids increase in the intravascular space, and edema when fluid shifts to the interstitial space. The clinical manifestations range from confusion, anxiety, irritability, and generalized or localized edema to hypertension, headaches, tachycardia, dyspnea, crackles, pleural effusion, ascites, and weight gain (Dlugash & Story, 2021) 

Hypovolemia, also called dehydration, entails a decrease of fluid in the intravascular space, most likely related to a deficit in sodium with water loss. Yan et al. (2023) described the signs and symptoms of fluid deficit as water depletion with intense thirst sensation, dry oral mucosa, decreased skin turgor, weight loss, oliguria, hypotension, dizziness, tachycardia, and altered level of consciousness. 

These changes in body fluids may also cause concentration or dilution of the electrolytes. They are isotonic when the water loss equals the electrolytes loss, hypertonic when water loss is more significant than electrolytes loss, and hypotonic when the electrolytes shift is more significant. 

Hyperkalemia 

Hyperkalemia refers to high potassium blood levels. Average values of potassium range from 3.5 to 5.0 mEq/L. Ms. Brown has a potassium level of 5.6. Therefore, she has hyperkalemia. 

According to Dlugash and Story (2021), potassium plays a crucial role in maintaining several body systems, such as cardiac, respiratory, central nervous system, and gastrointestinal.  Any changes in the potassium value yield manifestations in those systems. The most common manifestations are neuromuscular, such as paresthesia, muscle cramps, flaccid paralysis, hyper-reflexivity, and weakness. 

 Hyperkalemia is associated with cardiac symptoms: electrocardiogram changes, dysrhythmias, and cardiac arrest. Patients with electrolyte disorders may experience respiratory depression, respiratory arrest, and diaphragm weakness. Gastrointestinal symptoms include nausea, vomiting, diarrhea, and cramping (Dlugash & Story, 2021). 

Water and electrolyte imbalance treatment 

Based on Ms. Brown’s history and laboratory values, she is in a hypertonic dehydration state with metabolic acidosis. Correcting the fluid deficit with an isotonic solution is the most appropriate treatment. Dextrose  Water 5% will provide 1 liter of free water for each liter of solution with no addition of sodium (Lobo et al., 2022). 

In addition, the HCP should address the cause of the imbalance and manage the hyperglycemia and the associated electrolyte imbalance (hypernatremia, hyperkalemia, and hyperchloremia). Glucose level regulation will stop the osmotic diuresis and progressively decrease the sodium levels, resulting in a fluid shift into the intracellular space and restoring homeostasis. 

Arterial Blood Gases (ABGs) interpretation 

The ABG values indicate metabolic acidosis. The pH is more acidic as it is lower than the normal values range, most likely caused by decreased blood bicarbonate (HCO3) concentration. The decrease of PaCO2 indicates a partial compensation from the lungs to restore the acid-base balance. 

Anion Gaps clinical significance 

Dlugash and Story (2021) defined anion gaps as the difference between the positively charged ions, such as sodium and potassium, and the negatively charged ions, like chloride and bicarbonate, in the organism. Anion gaps represent deviations from homeostatic state values. For instance, positive anion gap values accompany electrolyte abnormalities such as ketoacidosis, lactic acidosis, and drug toxicity. 

 The cause for the negative anion gap value is not well defined. However, in studies, negative anion gaps are identified in critically ill patients (Laakman & Krasowski, 2021). In addition, the authors asserted that anion gaps help determine acid-base disorders and the appropriate interventions to correct electrolyte concentration and restore homeostasis.  

References 

Dlugash, L. & Story, L. (2021). Applied pathophysiology for the advanced Nurse Practitioner. Jones and Bartlett Learning.   

Laakman, J. & Krasowski, M. (2021). Frequency and clinical significance of negative Anion Gap values in an academic medical center population. American Journal of Clinical Pathology, 156(1), S16–S17, https://doi.org/10.1093/ajcp/aqab189.029  

Links to an external site. 

Lobo, D. N., Lewington, A. J., & Allison, S. P. (2022). Basic concepts of fluid and electrolyte therapy (2nd ed).Dileep N. Lobo | Andrew J. P. Lewington | Simon P. Allison. https://nottingham-repository.worktribe.com/output/18520015  

Links to an external site. 

Yun, G., Baek, S. H., Kim, S. (2023). Evaluation and management of hypernatremia in adults: Clinical perspectives. The Korean Journal of Internal Medicine,38(3), 290-302. DOI: https://doi.org10.3904/kjim.2022.346  

Links to an external site. 

Sample Response

Case 1: Pulmonary Function 

The Severity of D.R. Asthma Attack 

           I would classify DR’s asthma attack as a persistent moderate asthma attack. The symptoms occur daily, with nighttime awakenings, and reduced lung function (60-80%) (Bagnasco et al., 2021). 

 The Most Common Triggers for Asthma in Any Given Patients 

            The most common asthma triggers in any patient include exposure to indoor and outdoor allergens such as mold, mites, dander, pollen, and mold. The other triggers include stress such as strenuous physical exercise and exposure to extreme weather conditions (Côté et al., 2020). Indoor or outdoor triggers apply to DR due to his presenting symptoms such as stuffy nose and watery eyes. The symptoms imply that he also has allergic rhinitis due to the presence of post-nasal drainage. Therefore, indoor, and outdoor triggers are the primary causes of his asthma attack. 

The Factors That Might Be the Etiology of D.R. Being an Asthmatic Patient 

            The factors that might be the etiology of DR being an asthmatic patient are varied. Firstly, a history of allergies could contribute to his asthma. Asthma is an allergic reaction to an allergen. The other risk factor is race or ethnicity. Puerto Ricans and African Americans have a higher risk of asthma as compared to other races. Sex is the other factor since asthma is more common in males than females (Sockrider & Fussner, 2020). DR’s occupation is also another factor since regular exposure to chemicals or industrial dust increases the risk of asthma. DR is likely to develop asthma if he works in an environment where he is constantly exposed to chemicals and dust. 

References 

Bagnasco, D., Paggiaro, P., Latorre, M., Folli, C., Testino, E., Bassi, A., Milanese, M., Heffler, E., Manfredi, A., Riccio, A. M., De Ferrari, L., Blasi, F., Canevari, R. F., Canonica, G. W., Passalacqua, G., Guarnieri, G., Patella, V., Maria Pia, F. B., Carpagnano, G. E., … Lo Cicero, S. (2021). Severe asthma: One disease and multiple definitions. World Allergy Organization Journal, 14(11), 100606. https://doi.org/10.1016/j.waojou.2021.100606 

Côté, A., Godbout, K., & Boulet, L.-P. (2020). The management of severe asthma in 2020. Biochemical Pharmacology, 179, 114112. https://doi.org/10.1016/j.bcp.2020.114112 

Sockrider, M., & Fussner, L. (2020). What Is Asthma? American Journal of Respiratory and Critical Care Medicine, 202(9), P25–P26. https://doi.org/10.1164/rccm.2029P25 

Case 2: Fluid, Electrolyte, and Acid-Base Homeostasis 

Ms. Brown’s Type of Water and Electrolyte Imbalance  

            Ms. Brown has hypernatremia, hyperkalemia, and hyperchloremia. 

Signs and Symptoms to The Different Types of Water Imbalance and The Clinical Manifestation  

            The different signs and symptoms of hyperkalemia Ms. Brown has include muscle weakness, nausea, numbness, tingling, chest pain, palpitations, irregular heartbeats, diarrhea, abdominal pain, nausea, and vomiting. The clinical manifestations that might be discovered include cardiac arrhythmias, cardiac conduction abnormalities such as tall T waves, muscle weakness, and muscle paralysis (Brown & Paloian, 2023). 

The Most Appropriate Treatment for Ms. Brown  

            The appropriate treatment for Ms. Brown would be the administration of insulin and sodium or calcium bicarbonate combination. This treatment will lower the blood glucose level while shifting potassium into the cells and prevent acidosis. Ms. Brown has hyperglycemia with electrolyte imbalances that include hyperkalemia, hypernatremia, and hyperchloremia. She is at risk of developing acidosis due to elevated blood glucose levels and electrolyte imbalances (Palmer et al., 2021). Therefore, insulin administration with glucose, sodium, or calcium combination is appropriate to shunt potassium to the cells while lowering the blood glucose level simultaneously. 

What The ABGS from Ms. Brown Indicate Regarding Her Acid-Base Imbalance 

            Ms. Brown has metabolic acidosis. 

Anion Gaps and Its Clinical Significance 

            Anion gap refers to the difference between positively and negatively charged electrolytes in the blood. The anion gap helps determine if the blood is acidic or basic. The gap also helps diagnose patients with electrolyte imbalances in the body. Healthcare providers use the knowledge of the anion gap to determine the patient’s risk of developing health problems such as diabetic ketoacidosis in case of metabolic acidosis. The anion gap also helps determine the body’s ability to handle, metabolize, and eliminate toxic wastes. For example, hyperkalemia might be associated with health problems such as decreased renal clearance of electrolytes from the body (Pandey & Sharma, 2023). Therefore, the anion gap guides the diagnosis, management, and monitoring of fluid and electrolyte disorders.  

References 

Brown, D. H., & Paloian, N. J. (2023). Hypokalemia/hyperkalemia and hyponatremia/hypernatremia. Pediatrics In Review, 44(7), 349–362. https://doi.org/10.1542/pir.2021-005119 

Palmer, B. F., Carrero, J. J., Clegg, D. J., Colbert, G. B., Emmett, M., Fishbane, S., Hain, D. J., Lerma, E., Onuigbo, M., Rastogi, A., Roger, S. D., Spinowitz, B. S., & Weir, M. R. (2021). Clinical management of hyperkalemia. Mayo Clinic Proceedings, 96(3), 744–762. https://doi.org/10.1016/j.mayocp.2020.06.014 

Pandey, D. G., & Sharma, S. (2023). Biochemistry, anion gap. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK539757/