According to the case study information, how would you classify the severity of D.R. asthma attack?

According to the case study information, how would you classify the severity of D.R. asthma attack? nursing discussion question

Please respond to discussion below using APA current 7th edition and 2-3 references within the past 4-5 years max. Must be at least 150 words minimum and try to respond to both case studies overall.

Case Study 1
According to the case study information, how would you classify the severity of D.R. asthma attack?
The severity of D.R. asthma could be classified as moderate persistent due to his symptoms. Moderate persistent is looked at as daily daytime symptoms, nighttime symptoms greater than 1 night per week but less than daily, and a peak expiratory flow of 60-80% (Dlugasch & Story, 2019). In D.R.?s case he has had daytime symptoms of SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drip for the last 4 days in a row. As well as nighttime symptoms for 3 days in the past week with a peak flow rate of 65-70%. All this falls into the moderate persistent criteria.
Name the most common triggers for asthma in any given patients and specify in your answer which ones you consider applied to D.R. on the case study.
Asthma has many triggers associated with it. Some of the more common triggers are indoor or outdoor allergens, stress, physical activity/exercise, weather changes, and infections (Wenli & Ram, 2020). Things like certain medications, and nocturnal triggers can be causes for an attack as well (Dlugasch & Story, 2019). In D.R.?s case he may have a couple triggers that apply to him. Things like his nighttime symptoms may be caused due to some nocturnal triggers, as well as some outdoor or indoor allergens due to the symptoms he is exhibiting throughout the day. Nocturnal triggers usually occur between 3:00 and 7:00 a.m. and are caused because at night cortisol and epinephrine levels decrease, while histamine levels increase which may lead to bronchoconstriction (Dlugasch & Story, 2019). Which can explain why in the case D.R. wakes up with his PEF lowest in the morning. Weather and environmental factors are another big trigger. In the United States almost 55% of asthma exacerbations are caused by environment-related factors (Wenli & Ram, 2020). This can be a cause of his stuffy nose, water eyes, and cough.
Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.
There are many contributing factors to asthma, and a couple that could be the cause of D.R. being an asthmatic patient. D.R. etiology can be caused due to atopic asthmas, or nonatopic asthma. Both are more common in adults. Atopy is a genetic predisposition to producing a usually exaggerated IgE response to allergens or irritants, and it?s a more common cause in those with mild-to-moderate disease (approximately 50%) (Dlugasch & Story, 2019). Which D.R. being an adult and classified as a moderate persistent severity would be a fit for this being a factor of his asthma. Furthermore, considering his daytime symptoms can be triggered due to allergens further supports an atopy etiology. Etiology can also have nonatopic asthma due to it being more common amongst adults, and individuals with high eosinophil levels, but due to the limited patient history and lab work atopic etiology seems like the best cause.

Case Study 2
Based on Ms. Brown admission?s laboratory values, could you determine what type of water and electrolyte imbalance does she has?
Her sodium (Na+), chloride (Cl-), and potassium (K+) are all elevated. Normal levels are Na+ 135-145, Cl- 98-108, and K+ 3.5-5 (Dlugasch & Story, 2019). Now Water and sodium balances are intricately linked, and Chloride is attracted to sodium so whatever sodium does chloride follows (Dlugasch & Story, 2019). Since sodium is high chloride will be high as well. Due to her hypernatremia she will have a high serum osmolarity due to sodium levels rising, hypertonicity occurs, and water shifts out of the intracellular space and into the intravascular compartment (Dlugasch & Story, 2019). This causes intracellular dehydration. This form of fluid excess is due to the water u=in the cell going into the interstitial compartment due to the high sodium in the ECF (Dlugasch & Story, 2019). According to her case she has been unable to drink or eat for 2 days, so the lack of water she is intaking is causing that high serum osmolarity, since Hypertonic shifts are mainly due to excess sodium with insufficient water (Dlugasch & Story, 2019). Now Ms. Browns hyperkalemia can be due to the lack of insulin in her system. With her being type 2 and her sugars being so high she is either not producing much insulin or very resistant to insulin. Insulin and catecholamines are used for the activation of the sodium?potassium pump causing potassium to shift back into cells (Dlugasch & Story, 2019). This sodium potassium pump regulates ICF and ECF potassium exchange.
Describe the signs and symptoms to the different types of water imbalance and described clinical manifestation she might exhibit with the potassium level she has.
Ms. Brown is currently hyperkalemic, which can be extremely dangerous. High potassium levels can directly cause increased risk for cardiovascular complication and cardiac arrythmias (Rakisheva et al., 2020). Certain EKG changes seen can be caused by hyperkalemia. Typically seen in hyperkalemia are wide/flat P waves, widened QRS (more seen with K+ >7), ST depression, and peaked T waves (Dlugasch & Story, 2019). As well she may be having other symptoms like fatigue, hyperreflexia, and cramps (due to Na+/K+ exchange in the muscle) due to her hyperkalemia (Dlugasch & Story, 2019). Also due to her fluid excess she may develop edema if all her excess is going into the interstitial compartment, as well as some pleural effusion due to the excess fluid (Dlugasch & Story, 2019). This can be indictive of the severe cough she has been experiencing.
In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
In this case the administration of diuretics, as well as restricting sodium and fluids will be a good start to treat Ms. Brown (Dlugasch & Story, 2019). Diuretics will help get rid of excess fluid as well as help correct electrolyte imbalances. Loop diuretics like furosemide inhibit tubular reabsorption of sodium and chloride in the proximal and distal tubules resulting in excessive excretion of water along with sodium, chloride, magnesium, calcium, and some potassium (Khan et al., 2022). As well as insulin administration will need to be done. Ms. Browns sugar level is currently 412. The administration of insulin will help the sugar lower as well as help the K+ levels lower due to the activation of the sodium-potassium pump (Dlugasch & Story, 2019).
What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
Her ABGs are all low her pH is 7.30 normal is 7.35-7.45, PaCO2 is 32 normal is 35-45mmhg, PaO2 is 70 normal is 95-100mmhg, HCO3? is 20 normal is 22-26mEq/L (Dlugasch & Story, 2019). With all her levels being low its indicative of metabolic acidosis. Metabolic acidosis occurs when the bicarbonate and pH levels are lower than normal (Dlugasch & Story, 2019).
Based on your readings and your research define and describe Anion Gaps and its clinical significance.
The anion gap is a mathematical calculation that provides us with insight to plan for managing current problems associated with acid-base balance, fluids, and electrolytes (Pandey, & Sharma, 2022). The anion gap measures the anions that are not typically measured, such as albumin, sulfates, and phosphates (Dlugasch & Story, 2019). The anion gap gives us a measure to see how level all anions and cations are in the body. Under normal conditions, the sum of cations is approximately equal to the sum of anions in the extracellular fluid (Dlugasch & Story, 2019). When there is a balance in these levels it can mean the patient is in a state of acidosis or alkalosis. Increases in acid bases like Co2 will cause a bigger anion gap. Knowing the significance of the anion gap gives us the ability to help correct these imbalances quickly and more accurately.
Requirements: at least 150 words | .doc file

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