MN5633 Mild Chronic Asthma

Your patient is a 23-year-old female. She presents with coughing and wheezing which she stated started about three weeks ago. She is currently 25 weeks pregnant. Her last prenatal visit was one month ago in another state. She has an appointment with the prenatal care provider next week, however her respiratory symptoms brought her to your office today.

History – Chickenpox as a child. Asthma as a child, diagnosed at age 8 for which she used a SABA when needed. She has not had the need to use an inhaler since she was 19. She takes only her prenatal vitamin. No other acute or chronic problems. She advises you that she is up to date on all immunizations except she has not had a flu shot (it is October).
Social – Non-smoker, no drug use. She relocated to your state two weeks ago to get away from an abusive domestic situation. She has no support network in this area and has not yet found employment. She has no medical insurance.

HPA – Non-productive cough x 3 weeks. Wheezing audible from across the room. She states it is like this all day and wakes her from sleep every night. She reports that she is fatigued even in the morning. No other complaints.

PE/ROS – Pt appears disheveled but clean. Wheezing in all lung fields. T 98, P 82 regular, R 28 no stridor. FH 130 regular. The remainder of the exam is WNL.

02 98% and FEV 70%

Directions:

  1. Construct a narrative document of 4-5 pages (not including cover page or reference page)
  2. Diagnose the patient based on the above findings and provide your rationale for how you arrived at the diagnosis.
  3. Develop a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.
  4. Describe community resources (using your own community) currently available in your state/city to support this patient.
  5. Provide a communication plan that you will use to ensure the patient is an active participant in the treatment plan. Refer to therapeutic communication concepts.
  6. Utilize national standards, your pharm and/or patho book, and medical or advanced practice professional sources. Do not use patient-facing sources or general nursing texts.
  7. Use references to support your concepts. Utilize correct APA formatting (7th edition) and mechanics of professional communication.

Answer

MN5633 Assignment Mild Chronic Asthma

Healthcare providers face various challenges in diagnosing patients who come with different problems in the hospital. Nurses must perform a comprehensive assessment entailing detailed health history and physical examination for a definitive diagnosis. Some conditions have similar characteristics hence the need for careful review and consideration of differential diagnosis. More so, each disease has specific management depending on the cause and severity. Healthcare providers leverage both pharmacologic and non-pharmacologic treatment methods for better patient outcomes. This essay analyzes pharmacological and non-pharmacologic asthma management and community resources.

Wheezing is a persistent coarse whistling sound produced by the narrowed upper airways. It results from inflammation in the trachea or bronchi caused by allergic reactions, infections, or physical obstructions (such as a tumor or foreign body) of the larger upper airways. A diagnosis causing wheezing must thus be from an infectious or allergic cause causing swelling or narrowing of the upper airway. The patient reports a non-productive cough. Other symptoms such as sputum, a runny nose, malaise, and body ache associated with upper respiratory infections are absent. Barnes (2018) state that asthma and chronic obstructive pulmonary disease are the primary cause of recurrent wheezing. However, signs of inflammation are missing, thus ruling out infection.

The patient has a history of asthma diagnosed in childhood. She stopped taking her medications at 19. According to existing evidence, asthma relapses are common even after defeating at around 18. The major risk factors are weakened immunity (pregnancy or missed flu vaccination), traveling, and exposure to precipitating/ causative factors (Trivedi & Denton, 2019). The asthma signs and symptoms have been on and off since childhood, and this incident is a relapse. For this patient, the diagnosis is chronic mild intermittent asthma- an upper respiratory condition that causes narrowing of the airway, wheezing, disturbed sleep due to changes in breathing patterns, and fatigue associated with labored breathing (Stern et al., 2020).

Treatment Plan

Asthma is a chronic illness without a definitive cure. Although individuals, especially children, exhibit symptoms, the disease often relapses later in life. The nursing and medical management of asthma are symptomatic. Eliminating the causative agents can also help in managing asthma. The Global Initiative for Asthma (GINA) is the global strategy responsible for preventing and managing asthma. GINA works with public health officers and other professionals to reduce the global prevalence, morbidity, and mortality. It states that asthma management strategies aim at symptom control and risk reduction in asthma. These strategies also help prevent asthma exacerbation, mortality, and medication side effects (GINA, 2019). Asthma management also entails patient goals and initiatives. Management in pregnancy also entails cushioning the baby against asthma and its medications side effects. Asthma management entails pharmacologic and non-pharmacologic interventions.

Pharmacological treatment is low-dose regular ICS-Formoterol (maintenance and reliever). ICS-budesonide formoterol, SABA, or an inhaler with both ICS and SABA are optional asthma management therapies (GINA, 2019). According to Robijn et al. (2019), ICS-containing drugs have low risks for severe exacerbations such as status asthmaticus. GINA 2019 strategy changes remove SABA as a daily treatment because the drug has a high relapse rate. It will also help reduce reliance that develops when patients take SABA from the early development of the disease. Treatment in pregnancy increases intensity and aggressiveness, and asthma control surpasses any potential drug risk (Robijn et al., 2019). The absence of an ICS-formoterol calls for a SABA inhaler to prevent worsening of the symptoms. According to GINA, a low-dose maintenance therapy (200-500mcg) is integral.

There are various non-pharmacologic modalities for managing asthma. These methods are often underappreciated and include pulmonary rehabilitation, and focused breathing techniques (yoga and breath retraining) are the choice of non-pharmacologic interventions for this patient (Tan et al., 2020). Other interventions include vitamin B and C supplements, determining and avoiding allergens/ asthma triggers, and keeping warm. Pulmonary rehabilitation entails an exercise program that focuses on exercising to train the lung alveoli to open up adequately to support breathing. Exercises force open closed alveoli and promote bronchodilation, improving the integrity of the respiratory effort. It also reduces respiratory effort. It is also important to assess for occupation-related asthma exacerbation and advise on risk reduction.

Communication Plan

Therapeutic patient communication is integral when handling the patient. It begins with understanding relevant patient data and creating a rapport and ends with making mutual goals and objectives. The communication plan will also include retraining in inhaler use. Establishing adherence is integral and entails pointing out the importance of adherence and the consequences of non-adherence to the drugs (GINA, 2019). Teaching about the side effects that are mild and self-limiting such as agitation and muscle and leg cramps, is equally crucial. Keeping warm is integral because cold exposure is a leading cause of asthma attacks. Wearing warm clothes and dressing according to the weather will help reduce exacerbations. GINA requires pregnant women with asthma exacerbation to attend a follow-up clinic after one week; hence booking a clinic after one week with the patient will be integral (GINA, 2019). A review every 3-4 weeks will also be necessary for this pregnant woman. It is vital to make the woman understand that she can come back to the clinic at any time if the symptoms persist.

Community Resources

The Asthma and Allergy Foundation of America (AAFA) Support Community connects patients, families, and caregivers (Cassalia, 2018). The community is an excellent online resource that allows families to interact with their care providers, discuss and consult on asthma problems, and garner support for all individuals. The community resource is available in all states because it is an online platform. The organization also works with local support groups in managing asthma. The community resource majorly works to identify gaps in asthma management and support the passage of laws that positively impact asthma patients and their families. It also focuses on drug availability and costs and new research on better patient management. The resource will help patients access other support groups that meet their specific needs depending on their differences. Other community resources include the asthma community network, online asthma community, Airnow, and Burnwise organizations, which are resources that target asthma risks and help individuals avoid them hence managing asthma.

Conclusion

Patient management requires proper physical assessment and history taking. Asthma is a chronic illness that causes narrowing of the upper airway hence wheezing, fatigue, and disturbed sleep patterns. Asthma is common in childhood, and individuals can acquire remission, but relapse is common, especially with SABA use. The global initiative for asthma is responsible for asthma management and recommends ICS-containing medications as a reliever and maintenance therapy. SABA is avoided due to its risk for relapse. Non-pharmacologic management interventions such as pulmonary rehabilitation are also integral in managing asthma symptoms. Healthcare providers can refer patients to community resources such as AAFA for further management and social support.

References

Barnes, P. J. (2018). Targeting cytokines to treat asthma and chronic obstructive pulmonary disease. Nature Reviews Immunology18(7), 454-466. https://doi.org/10.1038/s41577-018-0006-6

Beasley, R., Braithwaite, I., Semprini, A., Kearns, C., Weatherall, M., Harrison, T. W., … & Pavord, I. D. (2020). ICS-formoterol reliever therapy stepwise treatment algorithm for adult asthma. European Respiratory Journal, 55(1). https://doi.org/10.1183/13993003.01407-2019

Cassalia, M. (2018). AAFA and Allergy Standards Host Allergy Summit to Elevate Industry and Consumer Perspectives to Improve Products for Allergy Aware. Retrieved from https://www.globenewswire.com/news-release/2018/11/01/1640881/0/en/AAFA-and-Allergy-Standards-Host-Allergy-Summit-to-Elevate-Industry-and-Consumer-Perspectives-to-Improve-Products-for-Allergy-Aware-Consumers.html

Global Initiative for Asthma (GINA), (2019). A Pocket Guide for Asthma Management and Prevention (for adults and children above five years). Retrieved from https://ginasthma.org/wp-content/uploads/2019/04/GINA-2019-main-Pocket-Guide-wms.pdf

Robijn, A. L., Murphy, V. E., & Gibson, P. G. (2019). Recent developments in asthma in pregnancy. Current Opinion In Pulmonary Medicine25(1), 11-17. https://doi.org/10.1097/MCP.0000000000000538

Stern, J., Pier, J., & Litonjua, A. A. (2020, February). Asthma epidemiology and risk factors. In Seminars in Immunopathology (Vol. 42, No. 1, pp. 5-15). Springer Berlin Heidelberg. https://doi.org/10.1007/s00281-020-00785-1

Tan, D. J., Burgess, J. A., Perret, J. L., Bui, D. S., Abramson, M. J., Dharmage, S. C., & Walters, E. H. (2020). Non-pharmacological management of adult asthma in Australia: a cross-sectional analysis of a population-based cohort study. Journal of Asthma57(1), 105-112. https://doi.org/10.1080/02770903.2018.1545030

Trivedi, M., & Denton, E. (2019). Asthma in children and adults—what are the differences, and what can they tell us about asthma?. Frontiers in Pediatrics7, 256. https://doi.org/10.3389/fped.2019.00256

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