Michelle continues to work in the bakery and her asthma has been well controlled on a

low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which

she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that

developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2

saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to

speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is

productive of white sputum. Influenza A is going around the bakery. Exam findings show

a woman who appears her stated age and is alert and oriented and though calm, is

having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She

has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, +

inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills,

gallops or extra heart sounds. Apical rate is elevated at 110. Physical exam is otherwise

unremarkable. The MA has swabbed her for Influenza A- test is positive.

Discussion Questions Part Two:

 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.

 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.

 Discuss relevant education and follow up.

Dr. Ameri and class,

Treatment planThe student is curious as to when the patient used her albuterol last. If the patient hasn’t used the

albuterol in the past 4 hours, then the student would order an albuterol 2.5mg nebulizer treatment

for her shortness of breath and inspiratory and expiratory wheezes. Patients that are able to talk

in complete sentences are experiencing a mild to moderate acute asthma exacerbation and a

nebulizer treatment is recommended (Maselli & Peters, 2018). The student would auscultate the

patient’s lung sounds before and after the treatment to assess improvement of airways and

recheck the pulse ox.

The patient has been using her rescue inhaler 1-2 times a week which means her asthma is being

controlled but in this situation the student would prescribe oral corticosteroids. According to

Maselli & Peters (2018), patients with acute exacerbation of asthma symptoms benefit from

prednisolone 50mg daily for 5-7 days. The goal of the oral corticosteroids is to reduce airway

inflammation and improve breathing.

Rx: Prednisolone 50mg tablet

Sig: Take half (1/2) tablet BID for 5 days

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