NR 603 Week 2: Case Discussion Pulmonary Part 2 Follow-up visit
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.
Treatment Plan:
Part of the treatment plan is to ensure Michelle can purchase her medications since she is
visiting a free medical clinic for the under-insured. All medications prescribed should be
available in generic form. Michelle presents to the office with acute symptoms that
developed 2 days ago, mild SOB with exertion, a respiratory rate of 24, temperature of
101.4, oxygen saturation of 94%, a nonproductive dry cough, fair chest expansion, and
wheezing with inspiratory and expiratory. During her visit, Michelle received an
influenza nasal swab test such as a rapid influenza diagnostic tests (RIDTs), which
consist of swabbing the nasal cavity to detect influenza viral antigens. Results can take
approximately 15 minutes (CDC, 2019c). Michelle’s results were positive for Influenza
A and she is also experiencing associated symptoms. The CDC recommends an antiviral
drug to treat Influenza such as Oseltamivir (Tamiflu) or peramivir (Rapivab). The
antiviral drug Zanamivir (Relenza) should not be used due to the high risk of wheezing
and other associated lung complications in asthmatic patients (CDC, 2020a). Antiviral
drugs work best when used within 48 hours after symptoms begin. Michelle is within the
48-hours to receive Tamiflu (oseltamivir), which will helps reduce the duration of her flu
symptoms and it is also available in generic form (CDC, 2020a and Epocrates, 2020a).
Michelle also presented to the clinic with a temperature of 101.4. A fever is a
physiological protective response of the body to help host defenses. An infection can
stimulate the body thermoregulatory system, resulting in increased heat production.
Hyperthermia is caused when the body thermoregulatory continues increase beyond 38.3
°C, to prevent irreversible tissues damage it is important to treat the fevers (Doyle, J.F.,
Schortgen, F., 2016). A combination alternating therapy of Acetaminophen (Tylenol)
and ibuprofen (Advil) is effective in reducing fevers. Michelle will receive one Tylenol
extra strength of 500mg tablet during her office visit to help reduce her fever (Barbi, E.,
Marzuillo, P., el at., 2017).
Medications:
Rx: Tamiflu (oseltamivir) 75 mg
Sig: Take one capsule twice daily for 5 days (Epocrates, 2020c).
Rx: Tylenol extra strength (acetaminophen extra strength) 500mg
Sig: Take one to two tablets by mouth every 4 to 6 hours (Epocrates, 2020b).
RX: Advil (ibuprofen) 400 mg
Sig: Take one pill every four hours or two pills every 6 to 8 hours (Epocrates, 2020c).
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.
Treatment Plan:
Part of the treatment plan is to ensure Michelle can purchase her medications since she is
visiting a free medical clinic for the under-insured. All medications prescribed should be
available in generic form. Michelle presents to the office with acute symptoms that
developed 2 days ago, mild SOB with exertion, a respiratory rate of 24, temperature of
101.4, oxygen saturation of 94%, a nonproductive dry cough, fair chest expansion, and
wheezing with inspiratory and expiratory. During her visit, Michelle received an
influenza nasal swab test such as a rapid influenza diagnostic tests (RIDTs), which
consist of swabbing the nasal cavity to detect influenza viral antigens. Results can take
approximately 15 minutes (CDC, 2019c). Michelle’s results were positive for Influenza
A and she is also experiencing associated symptoms. The CDC recommends an antiviral
drug to treat Influenza such as Oseltamivir (Tamiflu) or peramivir (Rapivab). The
antiviral drug Zanamivir (Relenza) should not be used due to the high risk of wheezing
and other associated lung complications in asthmatic patients (CDC, 2020a). Antiviral
drugs work best when used within 48 hours after symptoms begin. Michelle is within the
48-hours to receive Tamiflu (oseltamivir), which will helps reduce the duration of her flu
symptoms and it is also available in generic form (CDC, 2020a and Epocrates, 2020a).
Michelle also presented to the clinic with a temperature of 101.4. A fever is a
physiological protective response of the body to help host defenses. An infection can
stimulate the body thermoregulatory system, resulting in increased heat production.
Hyperthermia is caused when the body thermoregulatory continues increase beyond 38.3
°C, to prevent irreversible tissues damage it is important to treat the fevers (Doyle, J.F.,
Schortgen, F., 2016). A combination alternating therapy of Acetaminophen (Tylenol)
and ibuprofen (Advil) is effective in reducing fevers. Michelle will receive one Tylenol
extra strength of 500mg tablet during her office visit to help reduce her fever (Barbi, E.,
Marzuillo, P., el at., 2017).
Medications:
Rx: Tamiflu (oseltamivir) 75 mg
Sig: Take one capsule twice daily for 5 days (Epocrates, 2020c).
Rx: Tylenol extra strength (acetaminophen extra strength) 500mg
Sig: Take one to two tablets by mouth every 4 to 6 hours (Epocrates, 2020b).
RX: Advil (ibuprofen) 400 mg
Sig: Take one pill every four hours or two pills every 6 to 8 hours (Epocrates, 2020c).
