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. 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: Post should be at least

D.R. is a 27-year-old man with a chief complaint of increasing shortness of breath (SOB), wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage. These symptoms started four days ago. He also reports monitoring his peak flow rates, which have been consistently in the range of 65-70% of his regular baseline. Additionally, he has experienced nighttime symptoms for three nights in the past week, and his morning peak flow rates have often been at the lower limit of that range. D.R. has also been using frequent albuterol nebulizer therapy, as his usual albuterol inhaler has provided insufficient relief for his asthma symptoms during this exacerbation.

Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus. She has been bedridden and unable to eat or drink for the past two days due to a severe cough. On admission, her laboratory values are as follows:

– Hemoglobin (Hb): 10.7 g/dL (normal range: 12.0-16.0 g/dL)
– Hematocrit (Hct): 32% (normal range: 37-47%)
– White blood cell count (WBC): 12,000/mm³ (normal range: 4,000-11,000/mm³)
– Sodium (Na+): 136 mEq/L (normal range: 135-145 mEq/L)
– Potassium (K+): 3.7 mEq/L (normal range: 3.5-5.0 mEq/L)
– Blood glucose: 190 mg/dL (normal range: 70-99 mg/dL)
– Creatinine: 1.2 mg/dL (normal range: 0.6-1.2 mg/dL)
– BUN (blood urea nitrogen): 30 mg/dL (normal range: 7-20 mg/dL)

Based on these findings, both D.R. and Ms. Brown present with clinical signs and symptoms of respiratory illness. D.R.’s symptoms are consistent with an asthma exacerbation, while Ms. Brown’s symptoms and laboratory values suggest a possible respiratory infection or pneumonia.

Asthma is a chronic inflammatory disease of the airways characterized by recurring episodes of wheezing, breathlessness, chest tightness, and coughing. Acute exacerbations, such as the one D.R. is experiencing, can be triggered by various factors including allergens, respiratory infections, irritants, exercise, and emotional stress. The symptoms and peak flow rates indicate that D.R.’s asthma is not well controlled at the moment, as his baseline peak flow rates have decreased and he has required additional therapy with albuterol nebulizer. This suggests that his current treatment plan may need adjustment.

In contrast, Ms. Brown’s symptoms and laboratory values point towards a possible respiratory infection. The presence of a severe cough, inability to eat or drink, and an elevated white blood cell count suggest an acute inflammatory response. The low hemoglobin and hematocrit levels could be indicative of anemia, which may be secondary to chronic illness or acute blood loss. Additionally, her mildly elevated blood glucose level may be due to stress from illness or could indicate poorly controlled diabetes.

Given the clinical presentation of both patients, the nurse practitioner should consider a comprehensive approach to management. For D.R., the treatment plan may involve adjusting his asthma medication regimen, potentially adding or increasing the dose of long-acting bronchodilators and corticosteroids. Education regarding correct inhaler technique, asthma triggers avoidance, and the importance of adhering to prescribed medications should also be provided. Follow-up with a pulmonary function test may be warranted to assess his lung function and response to treatment.

For Ms. Brown, further investigation is needed to determine the underlying cause of her respiratory symptoms and abnormal laboratory values. This may involve obtaining a chest X-ray to assess for the presence of pneumonia or other lung pathologies. Blood cultures and sputum analysis could help identify the specific infectious agent responsible for her symptoms. In addition, supportive measures such as hydration, pain relief, and management of her diabetes should be initiated. Antibiotics may be considered if a bacterial infection is suspected.

In conclusion, D.R. and Ms. Brown both present with respiratory symptoms, but their underlying conditions and treatment plans differ. D.R.’s symptoms are consistent with an asthma exacerbation, while Ms. Brown’s symptoms and laboratory values suggest a possible respiratory infection. Appropriate management strategies should be implemented based on their individual clinical presentations and diagnostic findings.