Classifying the Severity of D.R. Asthma Attack According to D.R’s symptoms he would be classified under persistent mild asthma. His symptoms began four days ago, and his peak flow rates have maintained within 65%-70%, staying within the yellow zone. He has experienced three days with nighttime symptoms and albuterol usage has been indicated. Mild persistent asthma is indicated when symptoms have occurred greater than two days per week, nighttime symptoms are greater than two days a month and the utilization of short acting beta agonist such as albuterol is used greater than two days per week (Quirt et al, 2018). Common Triggers The most common triggers for asthma include dust mites, mold, pets, pollen, tobacco smoke, upper respiratory infections, stress, changes in weather or temperature, and exercise (Dlugasch & Story, 2021). In D.R.’s case I would consider the symptoms he is experiencing contribute to an upper respiratory infection such as rhinovirus. Viral infections such as rhinovirus contribute to asthma exacerbations due to the deterioration of epithelial tissue within the throat and nasal passages. This results in increased mucous production that will cause the airway to narrow and the chest to constrict from congestion (Ortega, Nickle & Carter, 2020). These symptoms induce asthmatic episodes and can result in exacerbations. Etiology of D.R.’s Asthma There are many possible etiologies that can be the cause of D.R. being asthmatic. He could possibly have a family or genetic history that predisposes him to having asthma as it has been found that family history combined with environmental factors enhance the likelihood of asthma development (book). It may be related to D.R.s occupational status or environment as exaggerated IGE responses to allergens and irritants such as pollen, smoking, chemicals or dust can cause asthma (Dlugasch & Story, 2021). Case Study 2 Laboratory Values According to Ms.Brown’s laboratory values it can be determined that she has hyperglycemia, hypernatremia, hyperkalemia, hyperchloremia. The ABG results indicate metabolic acidosis. Signs and Symptoms of The Water Imbalances Hypernatremia manifestations include lethargy, headache, confusion, irritability, seizures, coma, hypovolemia, dry mucous membranes, thirst and decreased urine output. Hyperchloremia does not have clinical manifestations but can be seen within the signs and symptoms of metabolic acidosis. Ms.Brown may demonstrate clinical manifestations of hyperkalemia such as hyperreflexia, flaccid paralysis, anxiety, nausea, vomiting, dysrhythmias, cardiac arrest, respiratory depression and respiratory arrest (Dlugasch & Story, 2021). Treatment Due to Ms. Brown’s elevated potassium level aggressive treatment is needed in order to correct the electrolyte imbalance. Multiple treatment courses are available, and they include providing calcium therapy in order to prevent cardiac toxicity. Cardiac gluconate is the initial drug of choice. Calcium chloride can be pr.

1. Classifying the Severity of D.R. Asthma Attack
According to D.R’s symptoms he would be classified under
persistent mild asthma. His symptoms began four days ago, and
his peak flow rates have maintained within 65%-70%, staying
within the yellow zone. He has experienced three days with
nighttime symptoms and albuterol usage has been indicated.
Mild persistent asthma is indicated when symptoms have
occurred greater than two days per week, nighttime symptoms
are greater than two days a month and the utilization of short
acting beta agonist such as albuterol is used greater than two
days per week (Quirt et al, 2018).
Common Triggers
The most common triggers for asthma include dust mites, mold,
pets, pollen, tobacco smoke, upper respiratory infections, stress,
changes in weather or temperature, and exercise (Dlugasch &
Story, 2021). In D.R.’s case I would consider the symptoms he
is experiencing contribute to an upper respiratory infection such
as rhinovirus. Viral infections such as rhinovirus contribute to
asthma exacerbations due to the deterioration of epithelial
tissue within the throat and nasal passages. This results in
increased mucous production that will cause the airway to
narrow and the chest to constrict from congestion (Ortega,
Nickle & Carter, 2020). These symptoms induce asthmatic
episodes and can result in exacerbations.
Etiology of D.R.’s Asthma
There are many possible etiologies that can be the cause of D.R.
being asthmatic. He could possibly have a family or genetic
history that predisposes him to having asthma as it has been
found that family history combined with environmental factors
enhance the likelihood of asthma development (book). It may be
related to D.R.s occupational status or environment as
exaggerated IGE responses to allergens and irritants such as
pollen, smoking, chemicals or dust can cause asthma (Dlugasch
& Story, 2021).

2. Case Study 2
Laboratory Values
According to Ms.Brown’s laboratory values it can be
determined that she has hyperglycemia, hypernatremia,
hyperkalemia, hyperchloremia. The ABG results indicate
metabolic acidosis.
Signs and Symptoms of The Water Imbalances
Hypernatremia manifestations include lethargy, headache,
confusion, irritability, seizures, coma, hypovolemia, dry mucous
membranes, thirst and decreased urine output. Hyperchloremia
does not have clinical manifestations but can be seen within the
signs and symptoms of metabolic acidosis. Ms.Brown may
demonstrate clinical manifestations of hyperkalemia such as
hyperreflexia, flaccid paralysis, anxiety, nausea, vomiting,
dysrhythmias, cardiac arrest, respiratory depression and
respiratory arrest (Dlugasch & Story, 2021).
Treatment
Due to Ms. Brown’s elevated potassium level aggressive
treatment is needed in order to correct the electrolyte
imbalance. Multiple treatment courses are available, and they
include providing calcium therapy in order to prevent cardiac
toxicity. Cardiac gluconate is the initial drug of choice.
Calcium chloride can be provided to patients through central
lines or peripherally in the cases of cardiac arrest due to the
possibility of tissue necrosis with extravasation (Simon, L.,
Hasmi, M, F., & Farrell, M, W., 2022). Ms. Brown will need
insulin therapy due to her hyperglycemia as the insulin will
drive the potassium back into the cells and therefore lower the
serum potassium (Simon, Hashmi, & Farrell, 2022). In order to
correct the hypernatremia 5% dextrose should be given.
Acid Base Imbalance
Ms. Browns ABG indicates that she has Metabolic acidosis. The
PH was 7.30 making the PH acidic, PCO2 is 32 mmHg and
HCO3 20 creating a base environment. The PCO2 is determines
if the acidosis will be respiratory or metabolic (Burger &
Shaller, 2022). The respiratory system is compensating due to

3. the alterations in bicarbonate and PH acidity (Burger & Shaller,
2022)
Anion Gaps
Diagnostic procedures utilized to evaluate metabolic acidosis
include anion gaps. Anion gaps are used to determine the cause
of the metabolic acidosis (Dlugasch & Story, 2021). This
specific exam identifies anions such as albumin, sulfates, and
phosphates that can contribute to the metabolic acidosis. In Ms.
Browns case the anion gap measurement will help determine if
the excess acid causing the metabolic acidosis is from excess
production or decreased excretion (Dlugasch & Story, 2021).
References
Burger, M., & Schaller, D. (2022). Metabolic acidosis.
National library of medicine. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK482146/
Dlugasch, L., & Story, L. (2021).
Applied pathophysiology for the advanced practice
nurse.
Jones & Bartlett Learning.
Ortega, H., Nickle, D., & Carter, L. (2020). Rhinovirus and
asthma: challenges and opportunities
Rev med virol. Available from:
https://doi.org/10.1002/rmv.2193
Quirt, J., Hildebrand, J,K., Mazza, J., Noya, F., Kim, H. (2018).
Asthma.
Allergy, asthma &
clinical immunology. Available from:
https://doi.org/10.1186/s13223-018-0279-0
Simon, L., Hashmi, M, F., & Farrell, M, W. (2022).
Hyperkalemia.

4. National library of medicine.
Available:
https://www.ncbi.nlm.nih.gov/books/NBK470284/