Question

Module 6 Case Analysis Data

15-year-old Tommy reports to urgent care with shortness of breath. He was diagnosed with asthma a year and a half ago and was prescribed an albuterol metered-dose inhaler (MDI) every 4- 6 hours as needed. History of Present Illness (HPI) Tommy is currently reporting shortness of breath and chest tightness. He just used his inhaler while sitting in the waiting room. He reports using his inhaler about 3-4 times a week for the past month. He reports awakening at night with asthma attacks about 4 times this past month. He has occasional interference with daily activities - just like today when he was unable to participate in basketball practice because of his breathing difficulty. This interruption in daily activities is atypical, however, usually occurring no more than once per month. He required oral glucocorticoids for an exacerbation about 4 months ago. He reports cold-like symptoms for the past 3-4 days, and Tommy’s mother has been giving him over-the-counter (OTC) medications to help treat his symptoms. Specifically, he has been taking Claritin-D daily for the past 3 days and Delsym for his cough as needed. Physical Assessment Findings T 99.2°F, P 116, R 26, BP 94/62, SpO2 90% in room air at rest HEENT: Nasal flaring Heart: Regular rhythm, no murmurs Lungs: I&E wheezing bilaterally, prolonged expiratory phase, moderate retractions Clinical Spirometer  FEV1 (% of predicted ) - pre-nebulizer treatment: 61%  FEV1 (% of predicted) - post albuterol nebulizer treatment 78%  Peak expiratory flow (PEF) – 70% Asthma Severity Classification Tommy is classified as having mild persistent asthma and is placed in Step 2 level of asthma care Prescribed Mediations  Beclomethasone (Qvar) 80 mcg; 1 puff AM and 2 puffs PM  Albuterol metered-dose inhaler (MDI) every 4- 6 hours as needed but no more than 12 inhalations per day

Module 6 Case Analysis Discussion Points

1. Discuss the relationship between the pathophysiology of asthma to specific findings in Tommy’s clinical manifestations. Consider only the abnormal signs and symptoms that could be a direct result of the asthma. Include abnormal diagnostic tests as applicable. When discussing the diagnostic tests, relate Tommy’s values to normal values and discuss their significance. What do they tell us? Provide references to support your response.

2. Discuss Tommy’s prescribed drug therapy (beclomethasone and albuterol) in relation to drug purpose, mechanism of action, metabolism and excretion, dosage and adverse effects. Address both medications and include a discussion regarding how they work together to help manage Tommy’s asthma. Provide references to support your response.

3. Tommy was diagnosed as having mild persistent asthma and was placed in Step 2 level of asthma care. Based upon the data provided and parameters included in the guidelines for the diagnosis and management of astha, do you agree with this diagnosis? Pull in specific data and compare it to the parameters required in order to classify as having mild persistent asthma. Do his manifestations align with those parameters? Lastly, based upon your analysis, is a Step 2 level of care appropriate for his management? Why or why not?

4. Analyze ALL of Tommy’s prescribed and OTC medications for potential drug-drug interactions. Discuss any potential interactions and precautions that should take place because of those risks (i.e., should a medication be discontinued or should there be close monitoring of certain things, etc...).

Answer 1

1. Discuss relationship between pathophysiology and spcific findingsin Tommy's clinical manifestaions

The pathopysiology of asthma is the result of airway inflammation due to mucosal edema ,bronchospasm and increased mucus production.Bronchial muscles and mucus gland enlarged and thick sputum produced and hyperinflation occur.Mast cell,neutrophil,esinophil and lymphocytes responsible for inflammation.

Three major Clinical manifestation of asthma are cough, dyspnea and wheezing.Asthma attack usally worsen at night and early morning.

Here tommy have shortnes of breath ,wheezing and he reports awakening at night due to asthma.He also have breathing difficulty during activity.SPO2 90% Hypoxemia indicate asthma attacks.

2.Drug tberapy : beclamethasone and albuterol

Beclomethasone is used to relieve inflammation caused by asthma.

Mechanism of action: It is corticosteroid hormone receptor antogonist which inhibit inflammatory cells and release inflammatory mediators.

Adverse reaction: Urticaria,angiderma,rash,bronchospasm,oral candidiasis

It is metabolised in liver and excreted via biliary elimination

Albuterol is used to dialate the bronchiole

Mechanism of action: It dialate the airway of lung.

Side effects : migrane or non migrane head ache, nausea, stomach upset, flu like symptom , otitis. media

It is metabolised in liver and excreted through urine.

Beclomethasone and albutero work together is very effective .

4. Parameters shows the patient has moderate persistent asthma because he reports nocturnal. asthma attack 4 times a month and asthma occur during activities.These parameters comes under moderate persistent asthma.

Step2 level care is appropriate for moderate persistent asthma .

5. Claritrin D and Delsym have no interaction.so no need of any precautions.

  Referance

1. Hinkle,J.L and Cheever K. H(2018), Brunner and suddharth's text book of medical - surgical nursing (14th edn).Philadelphia:Wolters Kluwer

2. US department of health and human service,NIH, Asthma care quick referanve- Diagnosting and managing asthma. NIH publication