NR 603 Week 2 Case Discussion: Pulmonary Part 1
Hello to all,
Based upon the presenting symptoms and assessment findings given, the most likely
diagnosis related to this case study would be occupational asthma or baker’s asthma. This is an
active airway disease, which affects four to twenty five percent of bakers worldwide (Brittner,
Peters, Frenzel, Muskin, Brettschneider, 2015). Michelle complains of shortness of breath while
at work, however she has relief and no longer experiences shortness of breath once leaving work
and, on the weekends, while at home. Physical exam findings showed thin, exudate to bilateral
nares, boggy, pale mucosa, and wheezing noted upon inspiration and expiration. Due to
wheezing and shortness of breath while at work could be due to an allergen related to an
inhalation of a type of flour used at the bakery. With Michelle having exudate to both nares this
would be related to an allergic rhinitis. Allergic rhinitis is an inflammation of the nasal mucosa,
which is an IgE-mediated allergy causing sneezing, a stuffy nose, or a runny nose (Tanno, et al.,
2016).
In 2016, Michelle, had a pulmonary function test performed. There was an increase of
15% seen in her pulmonary function test post bronchodilator. The existence of airflow
obstruction and a good bronchodilator response is consistent with the diagnosis of asthma. Key
indicators associated with asthma include the following: recurrent difficulty in breathing or
shortness of breath, recurrent wheezing or tightness in one’s chest, and a cough (worsening at
night). The diagnosis of asthma requires these symptoms and demonstration of reversible airway
obstruction using spirometry (Mccracken, Veeranki, Ameredes, & Calhoun, 2017). Michelle is
experiencing symptoms daily, and along with this her FEV1 is >60% but less than 80%. Based
upon her severity she would be considered a moderate persistent asthmatic.
As a healthcare provider, to treat Michelle’s asthma, I would initially order a CBC, CMP,
chest x-ray, and I would refer her to an allergist to have skin testing performed. A CBC would
help to rule out infection, where as a CMP would check basic electrolytes, kidney function, and
her blood glucose. A chest x-ray would help to exclude other possible disease and give use the
opportunity to compare it with her chest x-ray from 2016. For asthmatics with a moderate
persistent severity, it is recommended to use a low-dose inhaled corticosteroid and a long-acting
inhaled beta two-agonist (Uphold & Graham, 2013). In acute asthma attacks, short beta two
agonists provide individuals with rapid relief, however a daily maintenance of asthma would
require an inhaled corticosteroid. ProAir, is a SABA, which is used as a rescue or relief inhaler
for asthmatics (Hon, Leung, & Leung, 2014). A SABA is indicative and used for
bronchospasms. A combination inhaler (corticosteroid + long-acting best-two agonist) such as
Symbicort helps to improve asthma control and is effective in controlling persistent asthma.
Singulair is a cysteinyl leukotriene receptor antagonist used for the maintenance treatment of
asthma (prevention of bronchostriction) and to relieve symptoms of seasonal allergies such as
rhinitis (Hon, Leung, & Leung, 2014). In knowing this, I would place Michelle on the Singulair
Hello to all,
Based upon the presenting symptoms and assessment findings given, the most likely
diagnosis related to this case study would be occupational asthma or baker’s asthma. This is an
active airway disease, which affects four to twenty five percent of bakers worldwide (Brittner,
Peters, Frenzel, Muskin, Brettschneider, 2015). Michelle complains of shortness of breath while
at work, however she has relief and no longer experiences shortness of breath once leaving work
and, on the weekends, while at home. Physical exam findings showed thin, exudate to bilateral
nares, boggy, pale mucosa, and wheezing noted upon inspiration and expiration. Due to
wheezing and shortness of breath while at work could be due to an allergen related to an
inhalation of a type of flour used at the bakery. With Michelle having exudate to both nares this
would be related to an allergic rhinitis. Allergic rhinitis is an inflammation of the nasal mucosa,
which is an IgE-mediated allergy causing sneezing, a stuffy nose, or a runny nose (Tanno, et al.,
2016).
In 2016, Michelle, had a pulmonary function test performed. There was an increase of
15% seen in her pulmonary function test post bronchodilator. The existence of airflow
obstruction and a good bronchodilator response is consistent with the diagnosis of asthma. Key
indicators associated with asthma include the following: recurrent difficulty in breathing or
shortness of breath, recurrent wheezing or tightness in one’s chest, and a cough (worsening at
night). The diagnosis of asthma requires these symptoms and demonstration of reversible airway
obstruction using spirometry (Mccracken, Veeranki, Ameredes, & Calhoun, 2017). Michelle is
experiencing symptoms daily, and along with this her FEV1 is >60% but less than 80%. Based
upon her severity she would be considered a moderate persistent asthmatic.
As a healthcare provider, to treat Michelle’s asthma, I would initially order a CBC, CMP,
chest x-ray, and I would refer her to an allergist to have skin testing performed. A CBC would
help to rule out infection, where as a CMP would check basic electrolytes, kidney function, and
her blood glucose. A chest x-ray would help to exclude other possible disease and give use the
opportunity to compare it with her chest x-ray from 2016. For asthmatics with a moderate
persistent severity, it is recommended to use a low-dose inhaled corticosteroid and a long-acting
inhaled beta two-agonist (Uphold & Graham, 2013). In acute asthma attacks, short beta two
agonists provide individuals with rapid relief, however a daily maintenance of asthma would
require an inhaled corticosteroid. ProAir, is a SABA, which is used as a rescue or relief inhaler
for asthmatics (Hon, Leung, & Leung, 2014). A SABA is indicative and used for
bronchospasms. A combination inhaler (corticosteroid + long-acting best-two agonist) such as
Symbicort helps to improve asthma control and is effective in controlling persistent asthma.
Singulair is a cysteinyl leukotriene receptor antagonist used for the maintenance treatment of
asthma (prevention of bronchostriction) and to relieve symptoms of seasonal allergies such as
rhinitis (Hon, Leung, & Leung, 2014). In knowing this, I would place Michelle on the Singulair
