Pulmonary Function:
D.R. is a 27-year-old man, who presents 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 days ago, he also began to self-treat with frequent albuterol nebulizer therapy. He reports that usually his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer enough treatment for this asthmatic episode.

Case Study Questions

1. According to the case study information, how would you classify the severity of D.R. asthma attack?
2. 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.
3. Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.

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

• Serum glucose 412 mg/dL
• Serum sodium (Na+) 156 mEq/L
• Serum potassium (K+) 5.6 mEq/L
• Serum chloride (Cl–) 115 mEq/L
• Arterial blood gases (ABGs): pH 7.30; PaCO2 32 mmHg; PaO2 70 mmHg; HCO3– 20 mEq/L

Case Study Questions

1. Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?
2. 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.
3. In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
4. What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
5. Based on your readings and your research define and describe Anion Gaps and its clinical significance.

Submission Instructions:

• You must complete both case studies
• Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources

 

Response # 1: Carefully read the initial posts made by the other students in your small group.

• Respond to the initial post of one of your peers in your discussion group. Identify 1 differential diagnosis for the case study presented. Identify the underlying pathophysiology and clinical presentation of the Differential Diagnosis you identified in your response to your peers. Please Note: you may not duplicate a differential diagnosis posted by another peer in the discussion thread.

 Response of one peer

1. Evidence indicating the absence of an acute severe infection
2. One of the main evidences indicating that Anna does not have an acute severe infection is because of the normality of all her vital signs. This means that all symptoms that Anna is displaying and experiencing are within the normal range. If there was an infection, Anna would be experiencing wheezing, watery eyes, running nose, itchy eyes, and difficulty breathing. Therefore, there is no evidence that Anna has a severe infection.
3. Type of hypersensitivity action involved
4. Hay fever or allergic rhinitis is a common condition, often caused by exposure to pollen (Baghlaf & Eid, 2021). Therefore, individuals sensitive to pollen can experience immediate and sometimes severe effects or reactions. Therefore, if Anna has allergic rhinitis, the type of hypersensitivity action involved would be immediate hypersensitivity. The main reason is that during the examination, Anna states that she often gets colds whenever the fall and spring seasons arrive when flowers are sprouting and blooming. Hence, once the flowers release pollen and Anna gets exposed to the pollen, she reacts immediately, resulting in coughs.
5. Reasons why Anna’s symptoms did not start immediately
6. Anna has been living a normal life and never displayed symptoms of being allergic to cat dander. The main reason for the delay of symptoms is because Anna was probably at the symptom-free period. During this period, the body is exposed to the offending allergen and is determining how to react (Biermé et al., 2017). Besides, during this stage, the B lymphocytes were releasing a significant number of antibodies to fight the allergens, resulting in a delay in symptoms. Therefore, it is vital for Anna to get further tests to determine her level of sensitivity to cat dander and whether she might be allergic to other allergens that she might be aware of.
7. Class of antibodies that bind to mast cells
8. Antibodies help the body to fight and eliminate foreign matter that could potentially harm the body, affecting one’s health and wellness (Anvari et al., 2018). Immunoglobulin E is a class of antibodies that bind to mast cells, providing a safety barrier that protects the body and keeps it healthy. Oftentimes, Immunoglobulin E attaches themselves to receptors on the surface of blood basophils and mast cells. A unique feature of mast cells that have Immunoglobulin E on the surfaces is that all are sensitized. Moreover, the link between Immunoglobulin E and sensitized cells strengthens, causing a release of mediators that prevent allergic reactions from worsening and protect the body from harm.
9. Psychological mechanisms causing the redness of Anna’s nasal mucosa
10. Usually, allergens attach themselves to the useful and reliable immunoglobulin E antibodies, resulting in the degranulation and the release of inflammatory mediators (Biermé et al., 2017). In Anna’s case, it is likely that some mediators could have promoted the occurrence of vasodilation, resulting in the redness of Anna’s nasal mucosa. If this is the case, the best strategy for Anna would be avoiding the exposure and contact with cat dander to prevent further reaction because of the offending allergen. Alternatively, the physician can prescribe effective drugs like antihistamine drugs to reduce the redness of Anna’s nose and offer much-needed temporary relief.
11. Mechanisms that caused Anna’s clear postnasal drainage
12. One of the symptoms that Anna is displaying is a clear postnasal discharge. The discharge could be the result of the cold Anna experienced during spring and fall, meaning that the discharge can disappear on its own after the two seasons end. The increase of vasodilation and vascular permeabilities are other possible reasons or contributors of the clear postnasal discharge. Therefore, Anna can avoid cats, or the physician can administer drugs to stop the discharge and prevent further reactions to cat dander.
    References 
    Anvari, S., Miller, J., Yeh, C.-Y., & Davis, C. M. (2018). IgE-mediated food allergy. Clinical
    Reviews in Allergy & Immunology, 57(2), 244–260. https://doi.org/10.1007/s12016-018-8710-3
    Baghlaf, M. A., & Eid, N. M. S. (2021). Prevalence, risk factors, clinical manifestation,
    diagnosis aspects and nutrition therapy in relation to both IgE and IgG cow’s milk protein allergies among a population of Saudi Arabia: A literature review. Current Research in Nutrition and Food Science Journal, 9(2), 375–389. https://www.foodandnutritionjournal.org/volume9number2/prevalence-risk-factors-clinical-manifestation-diagnosis-aspects-and-nutrition-therapy-in-relation-to-both-ige-and-igg-cows-milk-protein-allergies-among-a-population-of-saudi-arabia-a-lit/
    Biermé, P., Nowak-Wegrzyn, A., & Caubet, J.-C. (2017). Non-IgE-mediated gastrointestinal
    food allergies. Current Opinion in Pediatrics, 29(6), 697–703. https://doi.org/10.1097/mop.0000000000000554
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Due: Facilitating group to post by Day 1; all other students post to discussion prompt by Day 4 and one other peer initial discussion prompt post by Day 7

Initial Post: Created by Facilitating Group

This is a student-led discussion.

• The facilitating group should choose one member from their group who will be responsible for the initial post.
• On Day 1 of this week, the chosen group member will create an initial post that is to include the group’s discussion prompts, resources, and the instructions for what your classmates are to do with the resources.
• During this week, each member of your group is to participate in the facilitation of the discussion. This means making certain that everyone is engaged, questions from students are being answered, and the discussion is expanding.
• It is the expectation that the facilitating group will address all initial peer response posts by Day 7.

Reply Posts: Non-Facilitating Students

• If you are not a member of the facilitating group, you are to post a discussion prompt response according to the facilitating group’s instructions by Day 4. Your reply posts should include substantive reflection directed to the presenters.
• You are also expected to respond to at least two other peer’s initial discussion prompt posts.