Exam (elaborations)
NR 603 Week 2 Case Discussion: Pulmonary (Part One)
- Course
- NR 603
- Institution
- Chamberlain College Of Nursing
NR 603 Week 2 Case Discussion: Pulmonary (Part One)
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NR i603 iWeek i2iCase iDiscussion: iPulmonary i(Part iOne) 1. What iisiyour iprimary idiagnosis ifor iMichelle igiven ithe ipattern iofioccurrence iofisymptoms, iexam iresults, iand irecent ihistory? iInclude ithe irationale iand iaireference ifor i
your idiagnoses. 2. What iisiyour ifirst-
line itreatment iplan ifor iMichelle iincluding imedications, ilabs, ieducation, ireferrals, ia
nd ifollow -
up? iIdentify ithe idrug iclass iofieach imedication iyou iprescribe iand iexactly iwhat isym
ptom iitiisitargeted itoiaddress. 3. Address iMichelle's irequest ifor ian iantibiotic Dr. iDeering iand iclass, Primary iDiagnosis: Based ion ithe ipresenting isymptoms iand iassessment ifindings iwithin ithis icase istudy, ithe iprimary idiag
nosis ifor iMichelle iisioccupational iasthma. iOccupational iasthma i(OA), ioriwork -
related iasthma i(WRA), iisithe imost icommon ioccupational ilung idisease iinithe iUnited iStates i(Global iIn
itiative ifor iAsthma i[GINA], i2019). iOA iresults ifrom iexposure itoiaistimulus, isuch ias idust, igrain, iflour, ilat
ex, iinsects, iand imold, ifound iinithe iworkplace ienvironment i(Jolly ietial., i2015). iExposure itoithese itypes
iofiallergens icauses isymptoms iofiasthma, iincluding icoughing, iwheezing, ichest itightness, iand ishortn
ess iofibreath i(Dao i&iBernstein, i2018). iNasal icongestion iand ieye iirritation ican ialso ioccur ias iairesult iofi
OA. iInithisicase istudy, iMichelle ipresents iwith ishortness iofibreath iwhile ishe iisiatiwork. iWhen ishe iisinot i
atiwork, ishe ihas irelief iand ino ilonger iexperiences idifficulty ibreathing. iEven ion iweekends iwhen ishe iisia
tihome, ishe idenies irespiratory isymptoms. Individuals idiagnosed iwith iOA itend itoihave imore isymptomatic idays iand iexacerbations iofiasthma isy
mptoms iwhile ithey iare iexposed idaily itoiaiparticular iallergen iinithe iworkplace. iSince iMichelle ihas iaihist
ory iofiseasonal iallergies, ishe iisiatian iincreased irisk iofideveloping ioccupational iasthma. iOne iofithe im
ain irisk ifactors ifor ioccupational iasthma iisiatopy, iwhich iisicharacterized iby iaisensitivity itoiallergens i(D
ao i&iBernstein, i2018). iTherefore, iindividuals iwith iatopy ioften ihave iseasonal iallergies, iallergic iskin ira
shes, iand ifood iallergies. iInithis icase istudy, iMichelle ihas iaihistory iofiseasonal iallergies iand ihas iseen ia
niallergy ispecialist. Upon iphysical iexamination, iMichelle iwas inoted itoihave iinspiratory iand iexpiratory iwheezing, ithin iex
udates itoibilateral inares, iand iaipale, iboggy imucosa. iThese ifindings iare iindicative iofiinflammation iwit
hin ithe irespiratory imucosa ifrom ithe iirritant. iThe ithin iexudates iwithin ithe inares iare irelated itoiallergic irh
initis, iwhich iisian iinflammation icaused iby ithe iimmune isystem’s iresponse itoian iallergen i(Pralong i&iCa
rtier, i2017). iThe iwheezing iisiairesult iofiairway inarrowing ifrom ibronchoconstriction iorimucosal iedema i
(Pralong i&iCartier, i2017). iMichelle’s irespiratory isymptoms ioccur iwithin iaifew ihours iofiworking iinithe i
bakery. iShe istarts ievery imorning ibaking ibread iand ipastries ifor ithe iday ias iaiBaker’s iassistant. iTheref
ore, iitican ibe isafe itoiassume ithat iMichelle iisiexperiencing iOA idue itoithe itype iofiflour iused iatithe ibaker
y.iEven ithough istaying iaway ifrom ithe iirritantiisithe ibest iway itoiimprove ioutcomes, iwe imust iinitiate iso
me itests itoiproperly idiagnose iher ibefore itaking iindividuals iaway ifrom iwork. iInithe ioffice, iMichelle ihad
iaipulmonary ifunction itest i(PFT) iperformed. iAirflow iobstructions ioccurs iwhen iFEV1/FVC iisiless ithan i
70%. iTherefore, ithe iresult iofiFEV1/FVC i60% ibefore ithe ibronchodilator iisiindicative iofiairflow iobstruc
tion. iAfter ithe ibronchodilator iwas igiven, ithere iwas ian iincrease iofi15% iin FEV1/FVC. iThis iisiconsidered ian iappropriate ibronchodilator iresponse. iThe iexistence iofiairflow iobst
ruction icoupled iwith iaipositive ibronchodilator iresponse iisisuggestive iofiasthma idiagnosis i(Pralong i&
iCartier, i2017). iCurrently, iMichelle iexperiences isymptoms iofishortness iofibreath iand iwheezing ifive id
ays iaiweek iwithin iaifew ihours iofiworking iinithe ibakery. iShe idenies iexacerbations iatinight, iand iisiable it
oisleep ithrough ithe inight iwith ino iissues. iBased ion iMichelle’s ifrequency iofisymptoms iand iPFT iresults
,ishe iisiconsidered iaimild ipersistent iasthmatic. First -line iTreatment iPlan: The itreatment ifor ioccupational iasthma iisithe isame itreatment ifor iasthma. iFor imild ipersistent iasthma, i
inhaled icorticosteroids i(ICSs) iare ithe ipreferred ifirst iline imedication itreatment i(GINA, i2019). iIiwould i
prescribe ifluticasone ipropionate i88 imcg iinhaled iBID. iLow idose iICS itarget ithe ismall iairways iand iredu
ce iinflammation iby idecreasing iactivity iofiinflammatory icells iand imediators i(Hollier, i2018). iThe ireduc
tion iofiinflammation iwill ihelp idecrease imucosal iedema iand imucus iproduction ithat icause irhinorrhea, i
cough, iwheeze, iand ishortness iofibreath i(Hollier, i2018). iAtithe isame itime, iaishort -
acting ibronchodilator, isuch ias ialbuterol ,ishould ibe iprescribed itoitreat iexacerbations. iIiwould iprescri
be ialbuterol i2ipuffs ievery i4-6ihours ias ineeded ifor ishortness iofibreath. iShort -
acting ibronchodilators iare iconsidered irescue iinhalers, iwhich ihelp idilate ithe ibronchi iinithe ilungs iand ii
ncrease iairflow i(GINA, i2019). iWidening ithe iairways iwill ihelp irelieve ibreathing idifficulties. iLastly, iIiwo
uld iprescribe iaileukotriene iblocker, isuch ias iSingulair i10 img idaily, itoiprevent iasthma isymptoms iand im
anage iseasonal iallergies. iIiwould ieducate iMichelle itoidiscontinu eiher icurrent iuse iofiZyrtec. iLeukotri
ene iantagonists iblock ithe irelease iofimast icells iresponsible ifor iairway iedema iand iinflammation i(Holli
er, i2018). iThis iclass iofimedication iwill ihelp ireduce iwheezing iand irunny inose ifrom ithe iinflammation. While istaying iaway ifrom ithe iirritant iwill idrastically iimprove iasthmatic isymptoms, iitimay ibe idifficult ifor i
Michelle itoiquit ithis icurrent ijob isince ishe iisitemporarily iworking iatithe ibakery ifor ifinancial ireasons. iTh
erefore, iIiwould irefer iher itoian iallergist itoihave iaiskin iprickitesting idone. iAccording itoithe iAmerican iCo
llege iofiOccupational iand iEnvironmental iMedicine i(Jolly ietial., i2015), iaiskin iprick itesting iisistrongly ir
ecommended ifor idiagnostic itesting ifor ioccupational iasthma. iCereal iflour, iparticularly iwheat iflour, iisi
consi dered ione iofithe imost icommon itypes iofioccupational iasthma i(Jolly ietial., i2015). iWhile ithere iisiai
high iprobability ithat ithe iflour iused iinithe ibakery iisithe iallergen, iaiskin iprick itest ican ihelp iidentify iother ia
llergens ithat imay iplay iairole iiniMichelle’s ioccupational iasthma. iThis iincludes irye, ibarley, irice, iand ioat
s.iHouse idust imites, istorage imites, iand ifungus ishould ialso ibe ichecked i(Jolly ietial., i2015). Itiisiimportant itoieducate iMichelle ion iways itoimanage ioccupational iasthma. iAvoiding itriggers iisithe ibe
stiway itoitreat iOA. iInithis icase, istaying iaway ifrom ithe itype iofiflour iused iinibaking ibreads iand ipastries iw
illihelp ialleviate iasthmatic isymptoms. iIfithis iisinot ipossible idue itoifinancial ireasons, itaking imedication
sitoiprevent isymptoms iand itreating iacute iasthma iepisodes iare iimportant ieducational itopics. iThe igo
aliofiasthma iself-
management iisitoicontrol iand iprevent iasthma iattacks i(Pralong i&iCartier, i2017). iTherefore, iIiwould ie
ducate iMichelle ion iaipersonalized iasthma iaction iplan. iIiwould iinclud eieducation ion ihow itoitake ieach i
medication ito
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