My Week 2 Case Discussion Pulmonary Part 2 follow up
Visit physical exam and new diagnoses.
Initial post includes the most likely diagnosis/specific treatment plan given case study
information supported by rationale and answers all questions presented in the case. Demonstrates
course knowledge/assigned readings by:
linking tests/interventions accurately to diagnoses,
applies learned knowledge specifically to the symptoms and patient information using original
dialogue
****************************************
Hello Dr. Collins and class,
Week 2 Case Discussion Pulmonary - Part 2
Michelle’s asthma is well controlled on Singular 10mg daily, and Albuterol as needed 1-2 times
per week. She still continues to work in the bakery and presents to the clinic with an acute that
started two days ago. Her respiratory rate is 24 and complains of mild shortness of breath with
exertion. Her oxygen saturation (O2 Sat) was 94% on room air and complaints of inspiratory and
expiratory wheezing. She states that her Temperature (Temp) days have been 101 to 102-degree
Fahrenheit over the last 2days; and Influenza A is going around the bakery. Her cough is
productive of white sputum. The exam findings show Michelle appears her stated age; is alert
and oriented; calm but having mild work of breathing. Her current Heat Rate (HR) is 110 beats
per minute (bpm), Blood Pressure (BP) is 150/85, Respiration Rate (RR) is 24, Temp is 101.4-
degree Fahrenheit, and the apical rate is elevated at 110. Her cough is now dry and
nonproductive. She has mild shortness of breath, a fair chest expansion, positive inspiratory and
expiratory wheezes, no rales, no rhonchi. On auscultation, no thrills, gallops, or extra heart
sounds are noted, so the physical exam is otherwise unremarkable. She was swabbed and tested
positive for Influenza A (ICD-10-CM: J10.1). Based on these facts, aside from her chronic
Asthma diagnosis, the most likely diagnosis for Michelle is Influenza A (Walia, Anderson, &
Vincent, 2019). The Influenza A is a subgroup of the Influenza viral infection – a respiratory
infection that that is manifested as fever, chills, aches and pains, cough, and sore throat (US
Food and Drug Administration [FDA], 2017).
1. 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.
The appropriate treatment plan for Michelle revolves around the primary diagnosis of Influenza
A. Usually Influenza A can be treated symptomatically. However, based on a history of having
Asthma, it is important to treat the Influenza A with Oseltamivir (Tamiflu) to shorten the cause
of the disease process in reducing the intensity of the disease on the patient (Doshi, Heneghan, &
Jefferson, 2016). Thus, Tamiflu is a prescription medicine used to treat influenza in patients who
are 2 weeks of age and older who have had flu-like symptoms for up to 2 days (FDA, 2017).
Since the patient is within the two days’ time frame, Tamiflu will benefit Michelle in her
recovery process. Because Michelle’s asthma is well controlled on the current treatment plan of
a
, low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol as needed 1-2 times
per week, I will maintain the same regimen for her Asthma. I will also add the following to her
treatment plan to yield a more therapeutic health outcome.
Imaging and Blood works: Chest Xray (CXR), and CBC
Michelle stated in her description of the history of present illness that she had a productive
cough, but in the assessment, she had a non-productive cough. So, I will obtain a chest x-ray to
rule out Pneumonia (PNA). Also, I will check her complete blood count (CBC) and Complete
Metabolic Panel (CMP) to rule out infection and to determine if the respiratory symptoms are of
viral or bacterial etiology, especially since she's been febrile (Temp of 101 to 102-degree
Fahrenheit) (Kennedy-Malone, Plank, & Duffy, 2019).
Vaccination: influenza vaccine and Pneumococcal Vaccine
Respiratory infections like influenza A are more serious for patients with asthma because they
often can lead to PNA and/or acute respiratory disease (CDC, 2020). Also, patients who have
asthma should also be up to date with pneumococcal vaccination to protect against
pneumococcal diseases, such as pneumonia, bloodstream infections, and meningitis (CDC,
2020). So, if the patient, has not received her influenza vaccine and Pneumococcal Vaccine,
then I will educate her on the importance of receiving it today (Weir, & Gruber, 2016; CDC,
2020).
Durable Medical Equipment: Humidifiers
Increased humidity may ease breathing in children and adults who have asthma or allergies,
especially during a respiratory infection such as a cold (Asthma and Allergy Foundation of
America [AAFA], 2015). However, a dirty mist or increased growth of allergens in the
humidifier triggers or worsens asthma and allergy symptoms.
2. 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.
If the CXR indicated that the patient is positive for PNA, then I will treat the PNA outpatient if
the CBC and CMP are normal and the patient is stable (Normansell, Sayer, Waterson, Dennett,
Del Forno, & Dunleavy, 2018). However, I will use the CURB criteria to assess the relationship
of the patients for confusion, urea, respiratory rate, and blood pressure, to the diagnostic tests
(Liu et al, 2016). This will help in predicting the risk of mortality in the patient regarding
community-acquired pneumonia and infection of any source (Kennedy-Malone, Plank, & Duffy,
2019). More so, I will use the CURB criteria to assess the relationship of the patients for
confusion, urea, respiratory rate, and blood pressure, to the diagnostic tests and the need for
hospitalization or not (Liu et al, 2016). So, the CURB criteria qualify patients if they have fever
less than 37° C (98.6 degree- Fahrenheit); an albumin level less than 30 g/dL; confusion, BUN
greater than 7 mmol/L, RR of at least 30 bpm, systolic BP less than 90 mm Hg or diastolic blood
pressure less than or equal to 60 mm Hg, Pulse≥ 125 beats/min, and if the patient is 65years old
or have qualifying comorbidities, etc (Liu et al, 2016, p. 3). A score of 2 indicates the patient has
about a 10% risk of death and so should be considered seriously for hospital admission (Liu et al,
2016, p. 3). More specifically, elevated BUN levels (under the CMP) show a decrease in renal
perfusion and indirectly predict the severity of pneumonia (Kennedy-Malone, Plank, & Duffy,
Visit physical exam and new diagnoses.
Initial post includes the most likely diagnosis/specific treatment plan given case study
information supported by rationale and answers all questions presented in the case. Demonstrates
course knowledge/assigned readings by:
linking tests/interventions accurately to diagnoses,
applies learned knowledge specifically to the symptoms and patient information using original
dialogue
****************************************
Hello Dr. Collins and class,
Week 2 Case Discussion Pulmonary - Part 2
Michelle’s asthma is well controlled on Singular 10mg daily, and Albuterol as needed 1-2 times
per week. She still continues to work in the bakery and presents to the clinic with an acute that
started two days ago. Her respiratory rate is 24 and complains of mild shortness of breath with
exertion. Her oxygen saturation (O2 Sat) was 94% on room air and complaints of inspiratory and
expiratory wheezing. She states that her Temperature (Temp) days have been 101 to 102-degree
Fahrenheit over the last 2days; and Influenza A is going around the bakery. Her cough is
productive of white sputum. The exam findings show Michelle appears her stated age; is alert
and oriented; calm but having mild work of breathing. Her current Heat Rate (HR) is 110 beats
per minute (bpm), Blood Pressure (BP) is 150/85, Respiration Rate (RR) is 24, Temp is 101.4-
degree Fahrenheit, and the apical rate is elevated at 110. Her cough is now dry and
nonproductive. She has mild shortness of breath, a fair chest expansion, positive inspiratory and
expiratory wheezes, no rales, no rhonchi. On auscultation, no thrills, gallops, or extra heart
sounds are noted, so the physical exam is otherwise unremarkable. She was swabbed and tested
positive for Influenza A (ICD-10-CM: J10.1). Based on these facts, aside from her chronic
Asthma diagnosis, the most likely diagnosis for Michelle is Influenza A (Walia, Anderson, &
Vincent, 2019). The Influenza A is a subgroup of the Influenza viral infection – a respiratory
infection that that is manifested as fever, chills, aches and pains, cough, and sore throat (US
Food and Drug Administration [FDA], 2017).
1. 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.
The appropriate treatment plan for Michelle revolves around the primary diagnosis of Influenza
A. Usually Influenza A can be treated symptomatically. However, based on a history of having
Asthma, it is important to treat the Influenza A with Oseltamivir (Tamiflu) to shorten the cause
of the disease process in reducing the intensity of the disease on the patient (Doshi, Heneghan, &
Jefferson, 2016). Thus, Tamiflu is a prescription medicine used to treat influenza in patients who
are 2 weeks of age and older who have had flu-like symptoms for up to 2 days (FDA, 2017).
Since the patient is within the two days’ time frame, Tamiflu will benefit Michelle in her
recovery process. Because Michelle’s asthma is well controlled on the current treatment plan of
a
, low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol as needed 1-2 times
per week, I will maintain the same regimen for her Asthma. I will also add the following to her
treatment plan to yield a more therapeutic health outcome.
Imaging and Blood works: Chest Xray (CXR), and CBC
Michelle stated in her description of the history of present illness that she had a productive
cough, but in the assessment, she had a non-productive cough. So, I will obtain a chest x-ray to
rule out Pneumonia (PNA). Also, I will check her complete blood count (CBC) and Complete
Metabolic Panel (CMP) to rule out infection and to determine if the respiratory symptoms are of
viral or bacterial etiology, especially since she's been febrile (Temp of 101 to 102-degree
Fahrenheit) (Kennedy-Malone, Plank, & Duffy, 2019).
Vaccination: influenza vaccine and Pneumococcal Vaccine
Respiratory infections like influenza A are more serious for patients with asthma because they
often can lead to PNA and/or acute respiratory disease (CDC, 2020). Also, patients who have
asthma should also be up to date with pneumococcal vaccination to protect against
pneumococcal diseases, such as pneumonia, bloodstream infections, and meningitis (CDC,
2020). So, if the patient, has not received her influenza vaccine and Pneumococcal Vaccine,
then I will educate her on the importance of receiving it today (Weir, & Gruber, 2016; CDC,
2020).
Durable Medical Equipment: Humidifiers
Increased humidity may ease breathing in children and adults who have asthma or allergies,
especially during a respiratory infection such as a cold (Asthma and Allergy Foundation of
America [AAFA], 2015). However, a dirty mist or increased growth of allergens in the
humidifier triggers or worsens asthma and allergy symptoms.
2. 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.
If the CXR indicated that the patient is positive for PNA, then I will treat the PNA outpatient if
the CBC and CMP are normal and the patient is stable (Normansell, Sayer, Waterson, Dennett,
Del Forno, & Dunleavy, 2018). However, I will use the CURB criteria to assess the relationship
of the patients for confusion, urea, respiratory rate, and blood pressure, to the diagnostic tests
(Liu et al, 2016). This will help in predicting the risk of mortality in the patient regarding
community-acquired pneumonia and infection of any source (Kennedy-Malone, Plank, & Duffy,
2019). More so, I will use the CURB criteria to assess the relationship of the patients for
confusion, urea, respiratory rate, and blood pressure, to the diagnostic tests and the need for
hospitalization or not (Liu et al, 2016). So, the CURB criteria qualify patients if they have fever
less than 37° C (98.6 degree- Fahrenheit); an albumin level less than 30 g/dL; confusion, BUN
greater than 7 mmol/L, RR of at least 30 bpm, systolic BP less than 90 mm Hg or diastolic blood
pressure less than or equal to 60 mm Hg, Pulse≥ 125 beats/min, and if the patient is 65years old
or have qualifying comorbidities, etc (Liu et al, 2016, p. 3). A score of 2 indicates the patient has
about a 10% risk of death and so should be considered seriously for hospital admission (Liu et al,
2016, p. 3). More specifically, elevated BUN levels (under the CMP) show a decrease in renal
perfusion and indirectly predict the severity of pneumonia (Kennedy-Malone, Plank, & Duffy,
