The respiratory system provides the means for gas exchange necessary for livings cells. As cells engage in aerobic cellular respiration they need both an interrupted supply of oxygen and the removal of carbon dioxide waste that is produced. The continuous exchange of oxygen and carbon dioxide between the atmosphere and body cells occurs through collective processes called respiration. Respiration requires both coordinated physiologic processes of a number systems including the respiratory, skeletal, muscular, nervous, and cardiovascular systems.

Asthma is a chronic reversible disease caused by increased reactivity of the tracheobronchial tree to various stimuli. Because of D.R. 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, range the severity of his classification at step 3, moderate persistent.

Asthma may be triggered by exposure to occupational allergens, chemicals, some medications, irritants, rhinitis, stress, hormonal changes, and physical activities. In the case of D.R., stuffy nose, watery eyes, and postnasal drainage may be considered as triggers induced asthma.

Asthma is strongly associated with a hereditary factor. It is also the result of hyperactive and hypersensitive bronchial tubes. The bronchial spasm can be triggered by many extrinsic (allergic) and intrinsic (non-allergic) factors. Since adult-onset asthma occurs for the first time in their middle age or older, the etiology of hereditary factors is to be considered on R.D. case because of his age 27-year-old. Clinical signs such as the stuffy nose, watery eyes, and postnasal drainage are indicative of rhinosinusitis which is an upper respiratory infection condition that increases inflammation or mucus production related to asthma.

Since R.D. asthma attack is not responding to treatment, he should be encouraged to avoid known triggering allergens that can lead to status asthmaticus, which is a life-threatening due to hypoxemia, hypercarbia, and secondary respiratory failure.

Fluid, Electrolyte and Acid-Base Homeostasis

The human body requires a delicate balance, or homeostasis, to function optimally. The body continuously employs strategies to maintain this balance. Fluids, electrolytes, and PH all play critical roles in sustaining homeostasis. Fluids are distributed in various body compartments to preserve equilibrium. Electrolytes are vital for cellular function, and they work with the various fluids to maintain stability.

Base on Ms. Brown’s lab values reveals sodium, chloride, potassium imbalance.

Ms. Brown has a fluid excess (hypernatremia). The manifestations are edema that could be generalized, or periorbital; headache, confusion, irritability, anxiety, nausea, vomiting, dyspnea, tachycardia, hypertension, jugular vein distention, crackles, pleural effusion, pulmonary edema, and ascites. Chloride does not have its own clinical manifestation, but the companion condition may cause signs and symptoms of metabolic acidosis.

Ms. has high potassium (hyperkalemia) levels. High potassium level manifestations are paresthesia, muscle cramps, weakness, fatigue, hyperreflexia, anxiety, EKG changes and dysrhythmias, cardiac arrest, respiratory depression or arrest, diaphragm weakness, nausea, vomiting, diarrhea, and cramping. Besides the signs mentioned earlier, Ms. Brown will experience a decrease in her renal excretion.

Since Ms. Brown is experiencing metabolic acidosis, treatment of the underlying cause will be vital in the achievement of her outcomes. IV fluids, oxygenation, Insulin, oral sodium bicarbonate may be given. Last, the correction of the electrolyte disturbance.

Base on the ABG lab values. Ms. Brown is experiencing the metabolic acidosis partially compensated due to low chloride, PH, Paco2, and HCO3.

The anion gap is a measurement of the difference or gap between the negatively charged and positively charged electrolytes. If the anion gap is either too high or too low, it may be a sign of a disorder in your lungs, kidneys, or other organ systems. The signs and symptoms are shortness of breath, vomiting, abnormal heart rate, and confusion.

References

Lucie D., Lachel S. (2020). Applied Pathophysiology for The Advanced Practice (1st ed.). Jones & Bartlett Learning). Margareth S.F., Jeanette W. D. (2013). Essentials of Human Diseases and Conditions (5th ed.). St Louis MO, Elsevier. McKinley O’L. B. (2013). Anatomy and physiology An Integrative Approach 9 International ed.). Mc Graw Hill. https://medlineplus.gov/lab-tests/anion-gap-blood-test/