reply to post 2-bet

post to read— D.R.’s asthma attack can be classified as moderate persistent asthma. We can say he has moderate persistent asthma due to his symptoms being more frequent and persistent for the past four days. A person with moderate persistent asthma usually has symptoms more than two nights a week (Horak et al., 2016). His albuterol inhaler also needs to be replaced since it no longer provides him with sufficient relief from his asthma symptoms. D.R.’s peak flow rates have shifted from the green zone, which is the area representing stability, to the yellow zone, the caution zone.
           The most common asthma triggers for patients include dust mites, pets, air pollution, tobacco smoke, perfumes, physical activity, mold, pests, cleaning products, disinfectants, etc. (Centers for Disease Control and Prevention (CDC), 2020). For D.R., the triggers that may apply are colder weather temperatures, mold which including dump areas in his home or outside, and air pollution. He might also be allergic to dust mites which are present in most homes.
           There are various factors that may have led to D.R.’s asthmatic condition. The most common risk factor includes coming from a family with a history of asthma. (Horak et al., 2016). Allergies are common in patients with asthma, especially towards dust, dust mites, and mold. Exposure to air pollution, which is difficult for him to prevent, also increases the risk for asthma and asthma attacks. Other causes of asthma include being overweight and exposure to chemicals at work.  
Fluid, Electrolyte and Acid-Base Homeostasis:
According to Ms. Brown’s laboratory values, she has hypertonic imbalance as evidenced by high-solute extracellular fluid (ECF) content. Water from the intracellular space has migrated into the extracellular area, indicating a loss in ECF water (Khanduker et al., 2017). Also, Ms. Brown is hypernatremic due to high sodium levels. The cause of her hypernatremia is loss of ECF water, which results from extreme water loss in the pulmonary system, decreased oral intake, and glucose retention in the urine, all of which are combined with the continuing loss of water via the renal system (Khanduker et al., 2017).
           The signs and symptoms associated with hypertonic imbalance and hypernatremia include postural hypotension, fever, dry mucous membranes, thirst, dry mouth, weak pulses, restlessness, doughy skin texture, altered cognitive function, changes in urine output, seizures, etc. (Liamis et al., 2014). With her high potassium levels, she may demonstrate an irregular heartbeat, abdominal cramping, vomiting, nausea, and chest pain (Liamis et al., 2014). The most appropriate treatment for Ms. Brown would be a salt-free diet and isotonic fluids such as D5W, (5 percent dextrose in water), which is used to treat hypernatremia by lowering sodium levels in the body. (Liamis et al., 2014). This will also treat her hypovolemia and acidosis by increasing the amount of fluids in her body.
           Ms. Brown’s ABG’s shows that she has metabolic acidosis, which is evidenced by a PH under 7.35. She also has compensatory hyperventilation because her PaCO2 seems to be abnormal and she has an HCO3- of less than 24 mEq/L. Her PaO2 is less than 80mmHg which means that is also hypoxemic (Khanduker et al., 2017). The anion gap is the variation between negatively charged ions such as Cl- and HCO3- (anions) and positively charged ions such as K+ and Na+ (cations) Cl- and HCO3-) (Pandey & Sharma, 2019). Anion gaps are found in the plasma, urine, and serum. Anion gaps are significant because they help identify metabolic acidosis when blood level is lower than normal (Pandey & Sharma, 2019). Anion gaps also aid in managing problems associated with electrolytes, acid-base balance, and fluid. 

Instruction- extending, refuting/correcting, or adding additional nuance to post. must be constructive and use literature where possible. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.

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