Please reply to the following discussion with one or more references. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
Responses must consist of at least 350 words (not including the greeting and the references), do NOT repeat the same thing your classmate is saying, try to add something of value like a resource, educational information to give to patients, possible bad outcomes associated with the medicines discussed in the case, try to include a sample case you've seen at work and discuss how you feel about how that case was handled. Try to use supportive information such as current Tx guidelines, current research related to the treatment, anything that will enhance learning in the online classroom.
References must come from peer-reviewed/professional sources (No WebMD/Mayo Clinic or wikipedia please!).
Week 2 discussion – 1st Reply
The chief complaint is “shortness of breath and a nonproductive nocturnal cough.” The 15-year-old female patient reports that her symptoms are persistent and have progressed from only have them with extreme exercise. She denies associated symptoms such as upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. She does not report alleviating or aggravating factors. She has a history of seasonal allergies and a family history of allergies, eczema, and hypertension. She does not use tobacco or recreational drugs.
Based on the presenting symptoms, the top three diagnoses include moderate persistent asthma, acute bronchitis, and sinusitis (Dunphy et al., 2017). Moderate persistent asthma presents with wheezing, shortness of breath, nocturnal symptoms, and exacerbations that affect activity two times or more per week and may last for several days (Burns et al., 2019). A family history of asthma and eczema is commonly seen, along with recurrent bronchitis episodes and seasonal exacerbations. Acute bronchitis most often presents with a cough for several weeks. It can also present with fever, malaise, chest discomfort, and wheezes (Goolsby & Grubbs, 2018). Sinusitis is common among patients with allergies and asthma. Sinusitis can present with difficulty breathing, fever, headache, severe sinus congestion, and can be triggered by allergens (Goolsby & Grubbs, 2018).
A stepwise approach is recommended for the management of asthma. The treatment of choice for moderate persistent asthma is a low-dose inhaled corticosteroid, such as Pulmicort, a long-acting beta2-agonist, such as Symbicort, and a short-acting beta-agonists, such as albuterol as needed (Pollart & Elward, 2009). A custom Asthma Action Plan tailored to the patients should also be considered. These action plans give patients and their families instructions on managing asthma with medications, recognizing warning signs of it getting worse, and what to do in an emergency (CDC, 2022). The action plan should be given using a traffic light style of green, yellow, or red to manage symptoms, that the patient and their caretaker should know what to do if the patient goes into the yellow or red zones (Burns et al., 2019). This action plan should also be provided to the patient’s school to implement appropriate interventions as needed.
Burns, C., Dunn, A., Brady, M., Starr, N., & Blosser, C. (2019). Burns' pediatric primary care (7th ed.). Elsevier.
Centers for Disease Control and Prevention. (2022). Asthma action plans. U.S. Department of Health & Human Services. https://www.cdc.gov/asthma/actionplan.html
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2017 ). Primary Care: the art and science of advanced practice nursing (5th ed.). F. A. Davis.
Goolsby, M. J. & Grubbs, L. (2018). Advanced assessment: Interpreting findings and formulating differential diagnoses (4th ed). F. A. Davis.
Pollart, S. M., & Elward, K. S. (2009). Overview of changes to asthma guidelines: diagnosis and screening. American family physician, 79(9), 761–767.
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