NRNP 6566 Week 6 KC

• Question 1

A 54 year old female has a 30 year pack smoking history. She recently underwent pulmonary function testing

which showed moderate obstructive lung disease. What would your treatment plan (including medications)

include for this patient?

Correct

Answer: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 suggests that smoking

cessation should be immediately pursued if the patient is still smoking. Nicotine replacement

(gum, inhaler, nasal spray, patch, lozenge, or sublingual tablet) are reliable methods to assist in

long term smoking cessation. Varenicline, bupropion, and nortriptyline also increase long term

quit rates but should be one part of an intervention program and not the sole intervention.

Professional counseling and support have a positive impact on smoking cessation.

Bronchodilators are the baseline medication for COPD patients. Patients can be initiated on short

acting beta agonists (SABA) or long term beta agonists (LABA) based on their symptoms. Short

acting medications come in various forms including inhaler, nebulizer, pills, or liquid syrup. Long

acting bronchodilators are delivered via inhaler or nebulizer. Combinations of SABA and LABA s

are common in treatment plans for COPD patients. LABA have a duration of action of 12 hours

while SABA last for about 4-6 hours. SABA can provide immediate symptom relief.

• Question 2

A 23-year-old male with Type 1 diabetes presents to the ER complaining of fatigue and malaise. He tells you he

has skipped his insulin injections the previous two days. His labs are:

PH 7.10 Na 140 BUN 35

PCO2 10 K 4.1 Crt 1.1

PO2 112 Cl 105 BS 845

HCO3 4 CO2 5 + ketonemia

What is this patient's acid base status? What is your working diagnosis for this patient?

Correct

Answer: Metabolic acidosis with respiratory alkalosis

pH is low Normal HCO3 is 22-26 so 4 is low causing acidosis

Leading diagnosis – Diabetic Ketoacidosis

Anion gap is elevated at 31

Elevated blood sugar with positive ketones present are key symptoms of diabetic

ketoacidosis

• Question 3

For the following ABGs, identify the level of hypoxemia, the primary acid base disorder, and the type of

compensation. Example - acute respiratory acidosis with metabolic alkalosis and severe hypoxemia