Michelle continues to work in the bakery and her asthma has been well
controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily,
and Albuterol prn which she uses 1-2 times per week. Michelle presents to
the clinic with an acute illness that developed 2 days ago and has a
respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and
complaint of inspiratory and expiratory wheezing. She is able to speak and
states her temperature over the last 2 days has been 101 to 102 F. Cough is
productive of white sputum. Influenza A is going around the bakery. Exam
findings show a woman who appears her stated age and is alert and
oriented and though calm, is having mild work of breathing. AR 110 BPM, BP
is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is
mildly short of breath, fair chest expansion, + inspiratory/expiratory
wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or
extra heart sounds. Apical rate is elevated at 110. Physical exam is
otherwise unremarkable. The MA has swabbed her for Influenza A- test is
positive.
Discussion Questions Part Two:
• Determine appropriate treatment plan for Michelle. Discuss
medications, doses, Durable Medical Equipment, and any testing, and
apply these directly to her case. Provide your rationale with evidence.
• Decide whether she is safe to return home, include any
prescriptions, or if a referral to a higher level of care is required.
Discuss the criteria used to make your decision, how a referral is made
and defend your position.
• Discuss relevant education and follow up.
Dr. Ameri and class,
Treatment plan-
The student is curious as to when the patient used her albuterol last. If the patient hasn’t used the
albuterol in the past 4 hours, then the student would order an albuterol 2.5mg nebulizer treatment
for her shortness of breath and inspiratory and expiratory wheezes. Patients that are able to talk
in complete sentences are experiencing a mild to moderate acute asthma exacerbation and a
nebulizer treatment is recommended (Maselli & Peters, 2018). The student would auscultate the
patient’s lung sounds before and after the treatment to assess improvement of airways and
recheck the pulse ox.
The patient has been using her rescue inhaler 1-2 times a week which means her asthma is being
controlled but in this situation the student would prescribe oral corticosteroids. According to
Maselli & Peters (2018), patients with acute exacerbation of asthma symptoms benefit from
prednisolone 50mg daily for 5-7 days. The goal of the oral corticosteroids is to reduce airway
inflammation and improve breathing.
Rx: Prednisolone 50mg tablet
controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily,
and Albuterol prn which she uses 1-2 times per week. Michelle presents to
the clinic with an acute illness that developed 2 days ago and has a
respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and
complaint of inspiratory and expiratory wheezing. She is able to speak and
states her temperature over the last 2 days has been 101 to 102 F. Cough is
productive of white sputum. Influenza A is going around the bakery. Exam
findings show a woman who appears her stated age and is alert and
oriented and though calm, is having mild work of breathing. AR 110 BPM, BP
is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is
mildly short of breath, fair chest expansion, + inspiratory/expiratory
wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or
extra heart sounds. Apical rate is elevated at 110. Physical exam is
otherwise unremarkable. The MA has swabbed her for Influenza A- test is
positive.
Discussion Questions Part Two:
• Determine appropriate treatment plan for Michelle. Discuss
medications, doses, Durable Medical Equipment, and any testing, and
apply these directly to her case. Provide your rationale with evidence.
• Decide whether she is safe to return home, include any
prescriptions, or if a referral to a higher level of care is required.
Discuss the criteria used to make your decision, how a referral is made
and defend your position.
• Discuss relevant education and follow up.
Dr. Ameri and class,
Treatment plan-
The student is curious as to when the patient used her albuterol last. If the patient hasn’t used the
albuterol in the past 4 hours, then the student would order an albuterol 2.5mg nebulizer treatment
for her shortness of breath and inspiratory and expiratory wheezes. Patients that are able to talk
in complete sentences are experiencing a mild to moderate acute asthma exacerbation and a
nebulizer treatment is recommended (Maselli & Peters, 2018). The student would auscultate the
patient’s lung sounds before and after the treatment to assess improvement of airways and
recheck the pulse ox.
The patient has been using her rescue inhaler 1-2 times a week which means her asthma is being
controlled but in this situation the student would prescribe oral corticosteroids. According to
Maselli & Peters (2018), patients with acute exacerbation of asthma symptoms benefit from
prednisolone 50mg daily for 5-7 days. The goal of the oral corticosteroids is to reduce airway
inflammation and improve breathing.
Rx: Prednisolone 50mg tablet
