Pathophysiology Case Studies
!
RESPIRATORY CASE STUDY
!
!
Chief Complaint: “Increased shortness of breath with activity, and sometimes even at rest.” !
!
Initial Information
!
!
!
Date & Time: 7-3-14 @ 2:45 p.m.
Name: JM
Age: 30, DOB 2-18-1984
Gender: F
Marital Status: M
Race: Caucasian
Culture: Northern US, urban
Occupation: Stay at home mom
Health Insurance: BC/BS
Source: Pt, reliable
RF: Allergies in family
Medications: Claritin prn
Allergies: NKDA, questionable seasonal allergies
Tobacco use: No personal use or exposure to second hand smoke currently. Previously tended bar, exposed to smoke there, but that was 4 years ago.
Alcohol Use: Occasional; 4-5 drinks /week
Drug Use: None
History of Present Illness
!
Location: …show more content…
NP: “So I understand this occurs in your lungs, is there any other location you experiencing any problems?”
• Patient: “No, mainly just my lungs.”
!
Characteristic:
NP: “Can you describe to me how you feel when you are short of breath?”
• Patient: “My chest feels tight and it feels like I can’t take in a deep enough breath.” !
Severity:
NP: “Have the shortness of breath episodes gotten any worse since they have started?
Does it affect your ability to be active?”
• Patient: “It has been interfering with my daily activities, I can’t play with my kids like I use to. Cleaning the house has become difficult. Just at rest it seems to be worsening a little.”
!
Timing, onset, duration:
NP: “When does the shortness of breath occur? How long are you short of breath once it starts?” • Patient: “It worsens within the first 5-10 minutes of activity. Takes me about 30 minutes after activity to feel like I can catch my breath, but still I am not completely relieved.”
!
NP: “How often do you think that it occurs?
• Patient: “It is happening more frequently now. I would say at least once a day.”
!
Aggravating or Alleviating:
NP: “Is activity the only thing that seems to trigger your shortness of breath?”
• Patient: “Yes, it worsens with activity, but seems to be increasingly constantly present.” NP: “Is there anything that makes it better, besides rest?”
•
Patient: “I have tried Claritin for allergies, but I don’t think it helped.”
!
Associated symptoms:
NP: “Are there any other symptoms that occur with your shortness of breath episodes?
Any chest pain, cough, or dizziness?”
• Patient: “Chest tightness, I feel like I can hear my lungs wheezing. I feel a little dizzy when it happens, like I am lightheaded. It also makes me feel anxious, but no other symptoms that I can think of.”
!
Exposures:
NP: “Have you had any recent colds or infections? Do you smoke or around second hand smoke?”
• Patient: “I have never been a smoker and I am not around much second hand smoke. I used to be a bartender and was around a lot of smoke then, but that has been a few years. I haven’t had any recent colds or infections.”
!
!
Childhood Illnesses: Chicken pox
!
Medical: None
!
Past History
Surgical: T&A 2000, C-section 2011
!
Ob/Gyn: Gravida 2/Para 2 Vag delivery 2010, C-section 2011
!
Psychiatric: None
!
Immunizations: Current. Tdap 2011, Flu shot Oct 2013.
!
Screening Test: Pap 2013
!
Personal and Social History
!
Education: Associated degree, general studies.
!
Support system: Husband, 2 children. Denies marital stress. Parents, family, and friends
!
Leisure activities: Reading, activities with kids
!
Diet: Reports balanced diet. Weight conscious, tries to eat healthy and limit sweets.
!
Sleep: Denies interrupted sleep. Reports 7-8 hours per night.
!
!
ECOMAP
Family- Husband, kids and parents.
Recreation- Spending time with husband, kids and friends. Enjoys reading.
Social- Gets together with friends monthly for dinner.
Religion- Attends a Christian church weekly.
!
GENOGRAM
Maternal grandmother (70) - living: HTN, arthritis
Maternal grandfather (65) - deceased: MI, smoker
Paternal grandmother (69) - living: Diabetes, obesity
Paternal grandfather (72) - living: HTN
Mother (50) - living: Depression, asthma, seasonal allergies
Father (52) - living: HTN
Sister (28) - living: Asthma
Brother (26) - living: Smoker
!
!
Complete History and Physical
!
General: States feeling healthy other than the respiratory issues. Denies any other complications or concerns.
!
Skin: Denies any abnormal or concerning moles. Denies edema, denies any rashes, itching, or bruising.
!
HEENT: Head: Denies headaches and dizziness, other than when SOB. Denies any recent head trauma or syncope. Eyes: Wears glasses, no contacts. Denies any visual disturbances, such eyes diplopia, blurred vision, or recent changes in visual acuity.
Denies any excessive tears or discharge. Last eye exam Nov 2013. Ears: Denies tinnitus, ear pain, vertigo, discharge, excessive cerumen, or hearing loss or difficulty hearing. Nose: Denies rhinorrhea, congestion, and epistaxis. Denies nasal tenderness.
Denies history of nasal trauma. Questions having allergies due to SOB. Throat: Denies dysphagia, sore throat, swelling, or hoarseness.
!
Neck: Denies any swollen nodes, pain, stiffness, decreased ROM.
!
Breast: Performs SBE monthly. Denies lumps, pain, discharge, asymmetry, or growths.
!
Respiratory: Complains of SOB, wheezing. Difficulty performing activities due to the
SOB. Denies cough, sputum production, or recent infection. Denies hx of pneumonia.
Questions if she has asthma or allergies. Denies history of smoking or exposure to second hand smoke.
!
Cardiovascular: Denies history of cardiac anomalies, palpitations, chest pain, and tachycardia. Denies peripheral edema. Denies history or murmurs. Denies CP with the
SOB, just a generalized chest tightening. Reports, “I don’t feel it in my heart, other than a little anxious when it happens, maybe my heart speeding up”.
!
Gastrointestinal: Denies nausea, vomiting, diarrhea. Denies bloody stools. Reports daily BM with no constipation. Denies reflux, excessive gas, and abdominal pain.
!
Peripheral Vascular Disease: Denies leg pain or swelling, minor spider veins in lower extremities bilaterally. Denies numbness or tingling, discolorations, or redness.
!
Urinary: Denies pain or difficulty urinating. C/O stress incontinence with coughing/ sneezing; reports performing Kegel exercises when she remembers. Denies hx of UTI’s.
!
Genital: Menarche age 14, LMP last week. Reports regular periods. IUD for birth control, placed 2011. Hx one vaginal birth, one c-section. Had last pelvic exam
November 2013. Denies vaginal discharge, pain, itching. Denies history of vaginal infections or STI’s.
!
Musculoskeletal: Denies muscle pain or stiffness. Reports full ROM. Denies joint pain or swelling.
!
Psychiatric: Denies any hx of depression, mood changes. Feels some anxiety with the
SOB episodes.
!
Neurologic: Denies history of seizures, syncope, headaches, aphasia, memory loss. Mild dizziness with SOB episodes.
!
Hematologic: Denies any abnormal bleeding or bruising. Denies hx of anemia. Denies hx of menorrhagia. Denies hx of blood transfusion. No history of cancer.
!
Endocrine: Denies heat or cold intolerance. Had thyroid levels checked previously with no abnormalities reported to patient. Denies history of diabetes or signs of polyphagia or polydipsia. Denies tremors.
!
!
Physical Exam
General: Height 5’8”, Weight of 140lbs. BMI 21. Well groom appearance, no s/s of distress. Gait normal. Cooperative with questioning. Appears no respiratory distress at this time. Alone for exam. No body odors.
!
Vital Signs: BP 117/62, HR 102, R 24, T 98.1, Pain 0. SpO2 92% on RA.
!
Skin: Intact with no lesions present. Warm, dry. No masses, rashes, or discolorations.
No bruising present.
!
HEENT: Head: Normocephalic, no lesions or trauma present. Hair clean with normal distribution, no dry scalp noted. No lumps or masses palpated. Temporal arteries palpable bilaterally. Eyes: Glasses on, no drainage noted. Symmetrical, no ptosis, no astigmatism. Follows objects well with eyes, can see all visual fields. Pupils reactive to light, red reflex noted. Conjunctiva clear, sclera white. Ears: Symmetrical, intact. NO lesions or masses noted on pinna. No excessive cerumen or drainage notes. Tympanic membrane intact. No redness noted. Positive whisper test. Nose: Negative for drainage or bleeding. No lesions or masses noted. Septum midline without deviation. NO sinus tenderness with palpation. Throat: Oral mucosa pink, moist, without lesions or petechiae noted. Gag reflex present. Good oral hygiene noted, no halitosis.
!
Neck: Trachea midline. No lumps, tenderness, or masses palpated. Neck supple, no stiffness or decreased ROM noted. Thyroid non-tender, no goiter or nodules present. No
JVD noted. …show more content…
!
Thorax and Lungs: AP/transverse ratio 1:2. Breath expansion equal bilaterally. Lungs auscultated, wheezing present on expiration near end of cycle. No signs of cyanosis, no tachypnea, mild labored breathing present.
!
Lymph Nodes: No enlarged or tender lymph nodes palpated.
!
Cardiovascular System: Apical pulse strong and regular, PMI located at 5th intercostal space at MCL. S1 and S2 present with no extra heart sounds or murmurs noted. Regular rhythm with tachycardia present. No JVD present. No carotid bruit present.
!
Peripheral Vascular: Strong radial and dorsalis pedis pulses present, +3. Cap refill 2 seconds in all extremities. No signs of clubbing or cyanosis at nail beds. No edema present. Spider veins to posterior legs bilaterally. No tenderness upon palpation. No redness or swelling in lower extremities.
!
Nervous System: Alert and oriented x 3. Clear speech, no slurring of words noted.
Cranial nerves I to XII intact. DTR’s +2 at brachioradialis and patella.
!
!
!
Differential Diagnosis
1.
2.
3.
4.
5.
6.
7.
8.
Asthma
Allergies (environmental)
Bronchitis
Pneumonia
Pulmonary Embolism
Heart Failure
URI
Anemia
!
!
!
!
Diagnostic Tests
!
CBC with differential. Chest X-Ray. Spirometer (measurement of FVC and FEV
!
Diagnostic Impression
!
CBC: Within normal limits. No elevation of eosinophil counts
!
Chest X-Ray: Hyperinflation noted with no evidence of consolidation noted.
!
1).
Spirometer: FEV1: FVC: 75 % predicted
FEV1: 70%
!
!
Treated with Albuterol inhaler, then repeated spirometer testing
FEV1: Improved to 83%, a 13% increase
Diagnosis: Asthma
!
!
List of why some diagnosis were eliminated
!
Asthma was the ruled in diagnoses following the results of the history and labs. The spirometer testing showed a reduced FEV1 compared to the FVC, which is consistent with asthma. Improvement in long function testing noted after albuterol administration.
!
1. Bronchitis: Negative chest x-ray, history not consistent with this dx.
Afebrile.
!
!
!
!
!
2. Pneumonia: Negative chest x-ray, CBC WNL. No elevated white count.
3. Pulmonary Embolism: History not consistent with dx. Negative on chest x-ray. 4. Heart Failure: Negative history, no edema, swelling, liver enlargement, or cardiac murmurs present.
5. URI: Negative for fever, elevated WBC count, productive cough.
6. Anemia: CBC WNL. No evidence of bleeding.
!
!
Plan of care-follow up
!
Send patient home with short-acting bronchodilator, such as albuterol, to use as needed for SOB. Patient will be started on an inhaled low-dose corticosteroid. Will follow up with patient in 1-2 weeks to monitor asthma and treatment effectiveness. After that, if treatment is effective will follow up in 1 month for re-eval. Then follow every 6 months unless exacerbations occur or as needed.
!
Patient will be sent home with prescription for PEF meter. Will be educated on use, to use during symptom free period or after utilizing maximum therapy (albuterol). To measure twice daily and bring record to follow up visits.
!
Medications
!
•
•
•
!
busdesonide (Pulmocort) 90µg/inh, take 2 inhalations BID.
Albuterol 90µg/inh, take 1-2 inhalations as needed every 4-6 hours
Peek Flow Meter
Education
!
Record PEF twice daily, and how to use meter. To bring log to next visit in 1-2 weeks.
Red zone signifies a medical emergency, take albuterol inhaler asap and seek emergency treatment. Yellow signifies worsening asthma, and albuterol inhaler should be used asap, and follow up with provider if consistently in yellow zone or using rescue inhaler
(albuterol) in less than one month. Green signifies appropriate asthma therapy and continues treatment as usual.
!
Avoid environmental stimulants that may worsen asthma such as smoke, dust, and pollen.
Exposure to cold may also exacerbate symptoms. Perfumes and fragrances may also aggravate symptoms.
!
Following use of inhaled corticosteroid, rinse mouth well to prevent development of candida. !
Emergency plan
!
If PEF showing in red zone, seek medical treatment, and utilize albuterol inhaler.
Keep albuterol inhaler with you at all times. Get albuterol inhaler refilled before
running out of the one you have.
!
!
References
!
Arcangelo, V. P. & Peterson, A. M. (2013). Pharmacotherapeutics for advanced practice:
A practical approach (3rd ed.). Philadelphia: Lippincott.
Fanta, C. H. (2014). Diagnosis of asthma in adolescents and adults. Retrieved from http://www.uptodate.com.xlib1.intermountain.net/contents/diagnosis-of-asthmain-adolescents-and-adults? source=search_result&search=asthma&selectedTitle=3~150#H3
GroupHealth (2013). Asthma diagnosis and treatment guidelines. Retrieved from https:// provider.ghc.org/all-sites/guidelines/asthma.pdf Morris, M. J. (2014). Asthma. Retrieved from http://emedicine.medscape.com/article/
296301-overview
RESPIRATORY CASE STUDY
!
!
Chief Complaint: “Increased shortness of breath with activity, and sometimes even at rest.” !
!
Initial Information
!
!
!
Date & Time: 7-3-14 @ 2:45 p.m.
Name: JM
Age: 30, DOB 2-18-1984
Gender: F
Marital Status: M
Race: Caucasian
Culture: Northern US, urban
Occupation: Stay at home mom
Health Insurance: BC/BS
Source: Pt, reliable
RF: Allergies in family
Medications: Claritin prn
Allergies: NKDA, questionable seasonal allergies
Tobacco use: No personal use or exposure to second hand smoke currently. Previously tended bar, exposed to smoke there, but that was 4 years ago.
Alcohol Use: Occasional; 4-5 drinks /week
Drug Use: None
History of Present Illness
!
Location: …show more content…
NP: “So I understand this occurs in your lungs, is there any other location you experiencing any problems?”
• Patient: “No, mainly just my lungs.”
!
Characteristic:
NP: “Can you describe to me how you feel when you are short of breath?”
• Patient: “My chest feels tight and it feels like I can’t take in a deep enough breath.” !
Severity:
NP: “Have the shortness of breath episodes gotten any worse since they have started?
Does it affect your ability to be active?”
• Patient: “It has been interfering with my daily activities, I can’t play with my kids like I use to. Cleaning the house has become difficult. Just at rest it seems to be worsening a little.”
!
Timing, onset, duration:
NP: “When does the shortness of breath occur? How long are you short of breath once it starts?” • Patient: “It worsens within the first 5-10 minutes of activity. Takes me about 30 minutes after activity to feel like I can catch my breath, but still I am not completely relieved.”
!
NP: “How often do you think that it occurs?
• Patient: “It is happening more frequently now. I would say at least once a day.”
!
Aggravating or Alleviating:
NP: “Is activity the only thing that seems to trigger your shortness of breath?”
• Patient: “Yes, it worsens with activity, but seems to be increasingly constantly present.” NP: “Is there anything that makes it better, besides rest?”
•
Patient: “I have tried Claritin for allergies, but I don’t think it helped.”
!
Associated symptoms:
NP: “Are there any other symptoms that occur with your shortness of breath episodes?
Any chest pain, cough, or dizziness?”
• Patient: “Chest tightness, I feel like I can hear my lungs wheezing. I feel a little dizzy when it happens, like I am lightheaded. It also makes me feel anxious, but no other symptoms that I can think of.”
!
Exposures:
NP: “Have you had any recent colds or infections? Do you smoke or around second hand smoke?”
• Patient: “I have never been a smoker and I am not around much second hand smoke. I used to be a bartender and was around a lot of smoke then, but that has been a few years. I haven’t had any recent colds or infections.”
!
!
Childhood Illnesses: Chicken pox
!
Medical: None
!
Past History
Surgical: T&A 2000, C-section 2011
!
Ob/Gyn: Gravida 2/Para 2 Vag delivery 2010, C-section 2011
!
Psychiatric: None
!
Immunizations: Current. Tdap 2011, Flu shot Oct 2013.
!
Screening Test: Pap 2013
!
Personal and Social History
!
Education: Associated degree, general studies.
!
Support system: Husband, 2 children. Denies marital stress. Parents, family, and friends
!
Leisure activities: Reading, activities with kids
!
Diet: Reports balanced diet. Weight conscious, tries to eat healthy and limit sweets.
!
Sleep: Denies interrupted sleep. Reports 7-8 hours per night.
!
!
ECOMAP
Family- Husband, kids and parents.
Recreation- Spending time with husband, kids and friends. Enjoys reading.
Social- Gets together with friends monthly for dinner.
Religion- Attends a Christian church weekly.
!
GENOGRAM
Maternal grandmother (70) - living: HTN, arthritis
Maternal grandfather (65) - deceased: MI, smoker
Paternal grandmother (69) - living: Diabetes, obesity
Paternal grandfather (72) - living: HTN
Mother (50) - living: Depression, asthma, seasonal allergies
Father (52) - living: HTN
Sister (28) - living: Asthma
Brother (26) - living: Smoker
!
!
Complete History and Physical
!
General: States feeling healthy other than the respiratory issues. Denies any other complications or concerns.
!
Skin: Denies any abnormal or concerning moles. Denies edema, denies any rashes, itching, or bruising.
!
HEENT: Head: Denies headaches and dizziness, other than when SOB. Denies any recent head trauma or syncope. Eyes: Wears glasses, no contacts. Denies any visual disturbances, such eyes diplopia, blurred vision, or recent changes in visual acuity.
Denies any excessive tears or discharge. Last eye exam Nov 2013. Ears: Denies tinnitus, ear pain, vertigo, discharge, excessive cerumen, or hearing loss or difficulty hearing. Nose: Denies rhinorrhea, congestion, and epistaxis. Denies nasal tenderness.
Denies history of nasal trauma. Questions having allergies due to SOB. Throat: Denies dysphagia, sore throat, swelling, or hoarseness.
!
Neck: Denies any swollen nodes, pain, stiffness, decreased ROM.
!
Breast: Performs SBE monthly. Denies lumps, pain, discharge, asymmetry, or growths.
!
Respiratory: Complains of SOB, wheezing. Difficulty performing activities due to the
SOB. Denies cough, sputum production, or recent infection. Denies hx of pneumonia.
Questions if she has asthma or allergies. Denies history of smoking or exposure to second hand smoke.
!
Cardiovascular: Denies history of cardiac anomalies, palpitations, chest pain, and tachycardia. Denies peripheral edema. Denies history or murmurs. Denies CP with the
SOB, just a generalized chest tightening. Reports, “I don’t feel it in my heart, other than a little anxious when it happens, maybe my heart speeding up”.
!
Gastrointestinal: Denies nausea, vomiting, diarrhea. Denies bloody stools. Reports daily BM with no constipation. Denies reflux, excessive gas, and abdominal pain.
!
Peripheral Vascular Disease: Denies leg pain or swelling, minor spider veins in lower extremities bilaterally. Denies numbness or tingling, discolorations, or redness.
!
Urinary: Denies pain or difficulty urinating. C/O stress incontinence with coughing/ sneezing; reports performing Kegel exercises when she remembers. Denies hx of UTI’s.
!
Genital: Menarche age 14, LMP last week. Reports regular periods. IUD for birth control, placed 2011. Hx one vaginal birth, one c-section. Had last pelvic exam
November 2013. Denies vaginal discharge, pain, itching. Denies history of vaginal infections or STI’s.
!
Musculoskeletal: Denies muscle pain or stiffness. Reports full ROM. Denies joint pain or swelling.
!
Psychiatric: Denies any hx of depression, mood changes. Feels some anxiety with the
SOB episodes.
!
Neurologic: Denies history of seizures, syncope, headaches, aphasia, memory loss. Mild dizziness with SOB episodes.
!
Hematologic: Denies any abnormal bleeding or bruising. Denies hx of anemia. Denies hx of menorrhagia. Denies hx of blood transfusion. No history of cancer.
!
Endocrine: Denies heat or cold intolerance. Had thyroid levels checked previously with no abnormalities reported to patient. Denies history of diabetes or signs of polyphagia or polydipsia. Denies tremors.
!
!
Physical Exam
General: Height 5’8”, Weight of 140lbs. BMI 21. Well groom appearance, no s/s of distress. Gait normal. Cooperative with questioning. Appears no respiratory distress at this time. Alone for exam. No body odors.
!
Vital Signs: BP 117/62, HR 102, R 24, T 98.1, Pain 0. SpO2 92% on RA.
!
Skin: Intact with no lesions present. Warm, dry. No masses, rashes, or discolorations.
No bruising present.
!
HEENT: Head: Normocephalic, no lesions or trauma present. Hair clean with normal distribution, no dry scalp noted. No lumps or masses palpated. Temporal arteries palpable bilaterally. Eyes: Glasses on, no drainage noted. Symmetrical, no ptosis, no astigmatism. Follows objects well with eyes, can see all visual fields. Pupils reactive to light, red reflex noted. Conjunctiva clear, sclera white. Ears: Symmetrical, intact. NO lesions or masses noted on pinna. No excessive cerumen or drainage notes. Tympanic membrane intact. No redness noted. Positive whisper test. Nose: Negative for drainage or bleeding. No lesions or masses noted. Septum midline without deviation. NO sinus tenderness with palpation. Throat: Oral mucosa pink, moist, without lesions or petechiae noted. Gag reflex present. Good oral hygiene noted, no halitosis.
!
Neck: Trachea midline. No lumps, tenderness, or masses palpated. Neck supple, no stiffness or decreased ROM noted. Thyroid non-tender, no goiter or nodules present. No
JVD noted. …show more content…
!
Thorax and Lungs: AP/transverse ratio 1:2. Breath expansion equal bilaterally. Lungs auscultated, wheezing present on expiration near end of cycle. No signs of cyanosis, no tachypnea, mild labored breathing present.
!
Lymph Nodes: No enlarged or tender lymph nodes palpated.
!
Cardiovascular System: Apical pulse strong and regular, PMI located at 5th intercostal space at MCL. S1 and S2 present with no extra heart sounds or murmurs noted. Regular rhythm with tachycardia present. No JVD present. No carotid bruit present.
!
Peripheral Vascular: Strong radial and dorsalis pedis pulses present, +3. Cap refill 2 seconds in all extremities. No signs of clubbing or cyanosis at nail beds. No edema present. Spider veins to posterior legs bilaterally. No tenderness upon palpation. No redness or swelling in lower extremities.
!
Nervous System: Alert and oriented x 3. Clear speech, no slurring of words noted.
Cranial nerves I to XII intact. DTR’s +2 at brachioradialis and patella.
!
!
!
Differential Diagnosis
1.
2.
3.
4.
5.
6.
7.
8.
Asthma
Allergies (environmental)
Bronchitis
Pneumonia
Pulmonary Embolism
Heart Failure
URI
Anemia
!
!
!
!
Diagnostic Tests
!
CBC with differential. Chest X-Ray. Spirometer (measurement of FVC and FEV
!
Diagnostic Impression
!
CBC: Within normal limits. No elevation of eosinophil counts
!
Chest X-Ray: Hyperinflation noted with no evidence of consolidation noted.
!
1).
Spirometer: FEV1: FVC: 75 % predicted
FEV1: 70%
!
!
Treated with Albuterol inhaler, then repeated spirometer testing
FEV1: Improved to 83%, a 13% increase
Diagnosis: Asthma
!
!
List of why some diagnosis were eliminated
!
Asthma was the ruled in diagnoses following the results of the history and labs. The spirometer testing showed a reduced FEV1 compared to the FVC, which is consistent with asthma. Improvement in long function testing noted after albuterol administration.
!
1. Bronchitis: Negative chest x-ray, history not consistent with this dx.
Afebrile.
!
!
!
!
!
2. Pneumonia: Negative chest x-ray, CBC WNL. No elevated white count.
3. Pulmonary Embolism: History not consistent with dx. Negative on chest x-ray. 4. Heart Failure: Negative history, no edema, swelling, liver enlargement, or cardiac murmurs present.
5. URI: Negative for fever, elevated WBC count, productive cough.
6. Anemia: CBC WNL. No evidence of bleeding.
!
!
Plan of care-follow up
!
Send patient home with short-acting bronchodilator, such as albuterol, to use as needed for SOB. Patient will be started on an inhaled low-dose corticosteroid. Will follow up with patient in 1-2 weeks to monitor asthma and treatment effectiveness. After that, if treatment is effective will follow up in 1 month for re-eval. Then follow every 6 months unless exacerbations occur or as needed.
!
Patient will be sent home with prescription for PEF meter. Will be educated on use, to use during symptom free period or after utilizing maximum therapy (albuterol). To measure twice daily and bring record to follow up visits.
!
Medications
!
•
•
•
!
busdesonide (Pulmocort) 90µg/inh, take 2 inhalations BID.
Albuterol 90µg/inh, take 1-2 inhalations as needed every 4-6 hours
Peek Flow Meter
Education
!
Record PEF twice daily, and how to use meter. To bring log to next visit in 1-2 weeks.
Red zone signifies a medical emergency, take albuterol inhaler asap and seek emergency treatment. Yellow signifies worsening asthma, and albuterol inhaler should be used asap, and follow up with provider if consistently in yellow zone or using rescue inhaler
(albuterol) in less than one month. Green signifies appropriate asthma therapy and continues treatment as usual.
!
Avoid environmental stimulants that may worsen asthma such as smoke, dust, and pollen.
Exposure to cold may also exacerbate symptoms. Perfumes and fragrances may also aggravate symptoms.
!
Following use of inhaled corticosteroid, rinse mouth well to prevent development of candida. !
Emergency plan
!
If PEF showing in red zone, seek medical treatment, and utilize albuterol inhaler.
Keep albuterol inhaler with you at all times. Get albuterol inhaler refilled before
running out of the one you have.
!
!
References
!
Arcangelo, V. P. & Peterson, A. M. (2013). Pharmacotherapeutics for advanced practice:
A practical approach (3rd ed.). Philadelphia: Lippincott.
Fanta, C. H. (2014). Diagnosis of asthma in adolescents and adults. Retrieved from http://www.uptodate.com.xlib1.intermountain.net/contents/diagnosis-of-asthmain-adolescents-and-adults? source=search_result&search=asthma&selectedTitle=3~150#H3
GroupHealth (2013). Asthma diagnosis and treatment guidelines. Retrieved from https:// provider.ghc.org/all-sites/guidelines/asthma.pdf Morris, M. J. (2014). Asthma. Retrieved from http://emedicine.medscape.com/article/
296301-overview