Week 2 Part 2 Case Study health care

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. Influenza infections are a respiratory disease that can trigger asthma attacks and cause worsening asthma symptoms (CDC, 2019). Adults that have asthma and become infected with influenza are more likely to develop pneumonia after getting sick with influenza than those who do not have asthma (CDC, 2019). Treatment with antiviral medications work best when started within 48 hours after symptoms start (Gaitonde, et al., 2019). Antiviral medications work by fighting against influenza and preventing the virus from making more viruses in the body (CDC, 2019). Oseltamivir or Peramivir are the two antiviral medications that can be used in patients with asthma (Gaitonde, et al., 2019). A different antiviral medication, Relenza, should not be used in patients with asthma due to the risk of causing wheezing (CDC, 2019). Michelle your symptoms began 2 days ago (within the 48 hour window), therefore allowing you to be a candidate for antiviral therapy. Michelle you also have an allergy to strawberries and erythromycin. These allergies will allow you to take Oseltamivir. Influenza can cause a dry or productive cough, fever, muscle aches, congestion, increased shortness of breath, or wheezing (CDC, 2019). The Infectious Disease Society of America (IDSA) recommend that providers who have a diagnosis of influenza are discouraged to use unnecessary antibiotics (Uyeki, et al., 2018). If a patient with confirmed influenza, such as Michelle, does not demonstrate clinical improvement with antiviral treatment or demonstrates clinical deterioration during or after treatment, additional testing should be considered to rule out other infectious diseases, such as pneumonia (Uyeki, et al., 2018). Symptom relief is a goal for those diagnosed with influenza (CDC, 2019). Staying home and getting plenty of rest, drinking lots of fluid to avoid dehydration, and treating fever are all ways to help relief symptoms (Kennedy-Malone, et al., 2019). NSAIDs can exacerbate symptoms of asthma and should not be used (Kennedy-Malone, et al., 2019). Acetaminophen is a good alternative to relieve fever or pain and does not exacerbate asthma (Kennedy-Malone, et al., 2019). Michelle, I want you to avoid NSAIDs, such as, ibuprofen and to take acetaminophen as needed over-the-counter for fever. Your asthma symptoms have been well-controlled with a low-dose inhaled corticosteroid inhaler, Singulair, and Albuterol as needed. If asthma symptoms are well-controlled there is no need to modify current treatment rather the goal is to treat the risk factor that is causing symptoms (GINA, 2020). Spirometry and peak flow testing should be avoided unless there is an urgent need to prevent the spread of viral particles (GINA, 2020). The appropriate test has already been completed to confirm a diagnosis of influenza-A. 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. This study source was downloaded by from CourseH on :34:39 GMT -05:00 Michelle I am sending you home on Oseltamivir as discussed above. Oral corticosteroids are a common treatment for acute asthma flare-ups or exacerbations by another illness to reduce inflammation and swelling in the airways (Castillo, et al., 2017). Oral corticosteroids have been proven to reduce emergency room visits and hospitalizations for asthma (Castillo, et al., 2017). Oral steroids should be given for asthma exacerbations preferably in the morning for no more than 5-7 days at either 40-50mg per dose (GINA, 2020). Michelle, these are the following medications I am ordering for you today: Oseltamivir 75mg Capsule Sig: Take 1 capsule by mouth twice daily for 5 days Disp: 10 Refills: 0 (Gaitonde, et al., 2019). Predisone 50mg tablets Sig: take one each morning by mouth for 5 days Disp: 5 Refills: 0 (GINA, 2020). Acetaminophen 500mg capsules/tablet Sig: Take 2 caplets by mouth every six hours as needed for fever Over-the-counter Features such as a history of near-fatal asthma requiring intubation, poor adherence to medication, or lack of a written action plan should raise concern for asthma-related deaths and should be triggered for further intervention (GINA, 2020). If the patient is confused, drowsy, silent chest, and/or has low oxygen saturations (below 90%) in a primary care setting, they should be transferred to an acute care facility (GINA, 2020). Appropriate oxygen saturations for adults with asthma are 94-98% on room air (GINA, 2020). Michelle does not present with confusion, drowsiness, or low oxygen saturation, she has audible respiratory sounds, and is compliant with her medications, therefore making it safe for her to return to home. Michelle does not require a referral to a higher level of care. Discuss relevant education and follow up plan. Michelle I am providing you with a written action plan appropriate for your level of asthma control and health literacy, so you will be able to recognize and respond to worsening asthma (GINA, 2020 & Kennedy-Malone, et al., 2019). The written action plan includes your regular asthma medication, when to start the oral corticosteroid, and how to access medical care if This study source was downloaded by from CourseH on :34:39 GMT -05:00 symptoms fail to respond (GINA, 2020). Michelle the following are signs of worsening asthma: difficulty breathing, confusion, dizziness, seizure, not urinating, fever or cough that improves but then returns or worsens, and severe weakness (CDC, 2019). You will need to return to the office in 1 week for re-evaluation of the symptoms and treatment. Early follow-up after an exacerbation of no longer than 7 days is recommended (GINA, 2020 & Kennedy-Malone, et al., 2019). Ben References: Castillo, J., Peters, S., & Busse, W. (2017). Asthma exacerbations: pathogensis, prevention, and treatment. Journal of Allergy Clinical Immunology Practice, 5 (4): 918-927. Doi: 10.1016/.2017.05.001 Center for Disease Control and Prevention (2019). Flu and People with Asthma. Gaitonde, D., Moore, F., & Morgan, M. (2019). Influenza: diagnosis and treatment. American Family Physician. A Global Initiative for Asthma (2020). Pocket Guide for Asthma Management and Prevention. Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Advanced Practice Nursing in the Care of Older Adults (2nd ed). F.A. Davis Company: Philadelphia, PA. Uyeki, T., Bernstein, H., Bradley, J., Englund, J., File Jr, T., Fry, A., Gravenstein, S., Hayden, F., Harper, S., Hirshon, J., Ison, M., Johnston, L., Knight, S., McGeer, A., Riley, L., Wolfe, C., Alexander, P., & Pavia, A. (2019). Clinical practice guidelines by the infectious diseases society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clinical Infectious Diseases, 68 (6): e1-e47.