nr 603My Week 2 Case Discussion Pulmonary Part 2 follow up Visit

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

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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).

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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

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