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NR603 Week 2 Case Discussion Pulmonary Part 1.
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Week 2: Case DiscussionPulmonary – Part 1
1. What is your primary diagnosis for Michelle given the pattern of occurrence of
symptoms, exam results, and recent history? Include the rationale and a
reference for your diagnoses.
Diagnosis: Mild to moderate persistent asthma with episode of shortness of breath
(SOB) related to occupational problems/ work circumstances.
ICD code: J45.30 and Z56.9
Asthma
Asthma is a chronic airway inflammation characterize by respiratory symptoms such as
SOB, coughing, wheezing and tightness of the chest, along with a variable of expiratory
airflow limitation. A diagnosis of asthma be confirmed by a history of various
respiratory symptoms and pulmonary function test (PFT). A diagnosis of asthma can be
diagnosed by the patient past respiratory symptoms and a FEV1 greater than 12%
difference between a pre-and-post PFT (GINA, 2020).
Rationale:
The patient has a history of seasonal allergies, recent episodes of SOB and a few
months ago visited an urgent care for her SOB. The patient’s physical exam presents
slight wheezing on inspiration and forced expiration with wheezing that does not clear
with forceful coughing. The patient pre-PFT resulted in a FEV1/FVC of 60% and the
post- PFT resulted in a FEV1/FVC of 75%, which is greater than 12% improvement
indicating a diagnosis of asthma as per the GOLD guidelines (GINA, 2020).
Occupational asthma is an exposure of substance(s) that causes an exacerbation or
contribute to worsening of preexisting condition in the workplace. Classic symptoms of
occupational asthma may include coughing, difficulty breathing, wheezing, and
tightening of the chest (Bepko and Mansalis, 2016).
Rationale:
HPI: The patient reports SOB mostly occurs at work and resolves before arriving home.
Upon returning to work, the patient reports her SOB returns. The episodes of SOB do
not occur on the weekends. Based on her HPI the patient symptoms are associated with
occupational asthma.
2. What is your first-line treatment plan for Michelle including medications, labs,
education, referrals, and follow-up? Identify the drug class of each medication
you prescribe and exactly what symptom it is targeted to address.
Medications
Based on the GINA guidelines, Michelle should be started on a following medication:
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