Week 4 Discussion Pharm Discussion Week 4 Discussion Pharm Discussion According to Jonathan’s mother, 2 to 3 days before the worsening cough and wheezing, Jonat

Week 4 Discussion Pharm Discussion

Week 4 Discussion Pharm Discussion

According to Jonathan’s mother, 2 to 3 days before the worsening cough and wheezing, Jonathan had a viral upper respiratory infection with a runny nose and low-grade fever of 101.0 degrees F orally, with loose cough – that could be initial signs of acute upper respiratory infection [URI] (Beta healthy, 2019). One of the comorbid conditions or risk factors of asthma exacerbation among children is upper respiratory infection (Hollier, A., 2018). A study looking at the role of viral respiratory infections in asthma and asthma exacerbations reports that with existing asthma, viral respiratory tract infections can have a profound effect on the expression of disease (Busse, W., Lemanske, R., Gern, J., 2010). The authors go further and states that viral respiratory tract infections, most frequently with rhinovirus, are the predominant microorganisms associated with asthma exacerbations. Jonathan seems to have an asthma exacerbation induced by a URI. The appropriate pharmacological therapy for Jonathan will be a short acting bronchodilator such as albuterol, that stimulates beta 2 receptors in the lungs. (Hollier, A.). Jonathan will be prescribed albuterol 90mcg, 2 puffs q 4-6 hours that he will be using as rescue inhaler. Jonathan’s asthma is identified as mild intermittent asthma. According to Hollier, A. with mild intermittent asthma, a short acting bronchodilator is the treatment of choice for exacerbations (p.664). Furthermore, according to Tibble, H., Tsanas, A., Horne, E., Horne, R., Mizani, M., Simpson, C. Sheikh, A. (2019), asthma therapy typically follows a fairly linear path, beginning with a short-acting bronchodilator in the individuals without persistent asthma symptoms and adding preventative treatments and long-acting bronchodilators in the individuals with more persistent asthma symptoms. Week 4 Discussion Pharm Discussion

What information is necessary to provide to Johnathan and his mother regarding asthma exacerbation?

Jonathan and his mother will be provided information about how to identify and minimize known asthma triggers by avoiding allergens and irritants. Respiratory irritants can be tobacco smoke, wood smoke, perfumes, pollution dust, etc. (Hollier, A., 2018). Jonathan will be instructed to take his medications as prescribed, learn early signs and symptoms of exacerbation such as severe shortness of breath, chest tightness or pain, and coughing or wheezing, low peak expiratory flow (PEF) readings, if a peak flow meter is used and also symptoms that fail to respond to use of a quick-acting inhaler. The most important information that will be provided to Jonathan and his mother is to implement an asthma action plan, a preplanned medication plan for asthma exacerbations. The correct way to use the inhaler, spacer and other medications will be reviewed with Jonathan and his mother. Mother will also be encouraged to give the influenza vaccine to Jonathan every year to decrease his change to catch the flu that can exacerbates asthma attacks.

What is an appropriate clinical assessment tool to be use with Johnathan?

In my opinion, the best clinical assessment too to be used with Jonathan is the peak expiratory flow (PEF). Keeping tract of the PEF values is on way to know if the symptoms of asthma are in control or worsening. During an asthma attack, the smooth muscles that surrounded the airways tighten ad cause the airways to narrow. According to WebMD (2019), the PEF meter alerts the patient to the tightening of the airways often hours or even days before the onset of the asthma symptoms. By using the PEF with the asthma action plan, Jonathan will know when to take is rescue asthma inhaler.

What are the classifications of asthma?

The classification of asthma severity is as follows:

Mild intermittent. Symptoms occur less than 2 days a week or less that 2 night per months and do not interfere with normal activities and lung function test is 80% or more of the expected value. Exacerbation is brief.

Mild persistent. Symptoms occur more than 2 times a week, but less than one time per day and 3 to 4 nights per month.

Moderate persistent. In moderate persistent asthma, the symptoms occur daily with some limitation. Lung function test is abnormal with more than 60% and less that 80% of the expected value (Buttaro, T., Trybulski, J., Polgar-Bailey, P., Sandberg-Cook, J. 2017).

Severe persistent. There is continual symptoms or frequent nighttime symptoms more than one night per month with severely limited activities.

How would you as the NP address his mother’s concern regarding providing an inhaler at school?

I will suggest Jonathan’s mother to schedule a conference with teachers and other school officials to go over the details of Jonathan’s and the plan and any other details they should know including need of having his inhaler with him, the correct use of the inhaler, location of the inhaler, and signs of trouble breathing to ensure that the school nurse, the principal and his teacher has a copy of his asthma action plan and to bring his inhaler with him all the time. The school should also know when to call Jonathan’s doctor and when to call 911. The mother should ensure that the action plan has the doctor’s phone number, their preferred hospital (emergency room), as well as contact numbers for her, other guardians if applicable, and a trusted friend. Week 4 Discussion Pharm Discussion

What is an appropriate plan of care for Johnathan?

An appropriate plan of care will be to use a PEF to monitor his respiratory status and control signs and symptoms of asthma. Jonathan’s should have his rescue medication with him all the time. Jonathan will need to avoid asthma triggers such as irritants. Follow up with Healthcare provider is also imperative to monitor evolution of his asthma.

 

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