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Please read post-   The pulmonary system is a system that comprises of the mouth, larynx, pharynx, trachea, bronchus, bronchioles, lungs and alveoli. The purpose is to provide gas exchange of oxygen and carbon dioxide during inhalation and exhalation. Many different disorders arise from the pulmonary system that causes difficulties with ventilation. Asthma is one disorder that results from an obstructed airway. Allergies, air pollutants, airway infections and mucus are just some causative factors. This leads to bronchospasms and airway constriction that limits air to pass. Mr. D.R. presented to the nurse practitioner with a moderate persistent asthmatic episode. His asthma is classified as moderate due to complaints of nighttime symptoms 3 nights a week and a peak expiratory flow rate between 65%-70% (Dlugasch & Story, 2021, p.224).

Triggers are factors that initiate asthma to exacerbate that include allergic, non-allergic and/or infections. These triggers are described as: pollen, pets, cigarette smoke, cool weather, stress, common cold, and physical exercise just to name a few (Kansen et al., 2019). Women also have experienced triggers prior to menstruation due to hormonal changes (Dlugasch & Story, 2021). The triggers start the inflammatory process in the airway which in then increases mucus production. Based on the symptoms presented by Mr. D.R., he developed worsening of the disease due to an infectious process. During any upper respiratory infection (more specifically viral), patient’s display coughing, watery eyes, stuffy nose, runny nose and fatigue in which Mr. D.R. manifested.

As stated previously, Mr. D.R. exhibited signs of an asthmatic patient that had an upper respiratory infection. The infection allowed inflammatory mediators to be released in the cells in response to the antigen. The process is branched into two phases that is called an early and late response (Dlugasch & Story, 2021). The early response is linked to bronchospasm and bronchoconstriction and the late response will result in airway edema and mucus production (Dlugasch & Story, 2021). Subsequently Mr. D.R. will then and has revealed symptoms that affect his airway such as wheezing, cough and SOB.

                                                                         Fluid, Electrolyte and Acid-Base Homeostasis Case Study

Fluid and electrolytes within the body is found within the intracellular, extracellular and intravascular compartments of the body. Ms. Brown is an elderly woman with type 2 diabetes mellitus and she has been feeling ill for the past two days. Based on her electrolyte laboratory findings, I can conclude that she has several electrolyte imbalances. The imbalance goes as follows: hyperglycemia, hypernatremia, hyperkalemia, and hyperchloremia. From the arterial blood gas findings the results show that she has metabolic acidosis with hypoxemia.

Electrolyte imbalances cause a disruption in homeostasis within the body. Symptoms of hyperglycemia include the three P’s (polydipsia, polyphagia and polyuria). With chloride being bound to sodium, it also mimics the behavior of sodium. All things considered, hypernatremia and hyperchloremia may display the same symptoms, which include lethargy, headache, confusion, hypovolemia and decreased urine output (Dlugasch & Story, 2021). Hyperchloremia also manifests metabolic acidosis that may contribute to the ABG results. Ms. Brown has a potassium level of 5.6 mEq/L which she may exhibit signs such as anxiety, parasthesias, respiratory depression, nausea/vomiting, diarrhea and cramping (Dlugasch & Story, 2021).

The treatment for Ms. Brown’s condition would be to correct the underlying issue. She is in a diabetic ketoacidosis state and her blood glucose level is 412 mg/dl. Insulin therapy and IV fluids to correct the hyperglycemia and metabolic acidosis is the recommended treatment (Laliberte et al., 2017). Insulin will not only decrease the glucose but it will also decrease the potassium by shifting it back into the cells. A hypotonic IV solution is also necessary to correct the hypernatremia and a diuretic is necessary to correct the elevated chloride levels that will be excreted via the kidneys.

The anion gap is a tool to measure the difference between cations and anions in the blood when metabolic acidosis is presented (Ruiz-Ramos et al., 2021). Normally the cations and anions are equal in the extracellular fluid however in an acidotic state they will be unmeasured (Dlugasch & Story, 2021).

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