Reply 1 and 2 by 04/15/2022 at 6 pm, please add references and

Reply 1

 amilka Zulueta posted Apr 12, 2022 1:11 PMSubscribe

a) The Pharmacological Therapies Prescription for Jonathan

Jonathan is a patient who has been a frequent visitor to the clinic with a healthy report save for a history of mild asthma. The treatment of the patient major clinical symptoms of cough wheezing will rely on the patient history with the suspected asthma clinical manifestations. The respiratory abnormality of the lung will need to be solved using medication that can clear the respiratory tract to make breathing easier. The corticosteroid can be used as a respiratory tract medication that is used to ease breathing, reduce airways inflammation and manage cough from asthmatic attack (Maselli, & Peters, 2018). The type of corticosteroid that will be ideal for Jonathan is Flunisolide dosage of a spry on the nostril with the need to monitor the breathing pattern of the child. 

b) The Necessary Information to Be Provided to Johnathan and His Mother Regarding Asthma Exacerbation

The information about asthma needs to be provided to the duo on preventable measures and management of the asthma exacerbation preventing the damage to the respiratory system. The patient needs to avoid smoking both as a first user and a secondary consumer to limit the respiratory tract risk and other related allergens that are part of the environment such as cold, animal dander, and dust. The management of the asthma exacerbation will also need the right use of the prescribed medication taking the doses as advised. The self-administer Corticosteroid needs to be illustrated to the 7-years-old on how to use it and how to keep it safe from other children. The mother will need to show emotional support to the patient. 

c)The Appropriate Clinical Assessment Tool to Be Use with Johnathan

The asthmatic clinical assessment is part of the patient care that will be formulated with the effort of the patient to keep records about the management of the symptoms. The available clinical assessment that will best for Jonathan’s asthma control is the Childhood Asthma Control Test with a scale of up to 5 used in identifying the symptoms and management findings. The Childhood Asthma Control Test has a questionnaire calibration of the asthma control for children with frequent asthma exacerbation which can be used for children and adolescent patients (Tosca et al., 2021). The parent will need to be guided on how to use the Childhood Asthma Control Test for a clear understanding of the asthma control and management achieved at home.

d)The Classification of Asthma

According to Plaza et al., (2021), the classification of asthma can be categorized according to the manifestation of the illness, the medication needs, the effect of the illness on the functions of the lungs, and the symptoms interference with the activities of the patients as classified below;

Intermittent Stage. The first stage with no major symptoms can easily be managed with the rare use of the rescue inhaler. There is more than 80% FEV1/FVC which institutes a normal functioning of the lungs and two days or less indication of symptoms in a week.

1. Mild persistent. 

The illness at this stage is still controllable with the normal activities of the patients reported. The patient can experience minimal nighttime symptoms with rare 3 times in a month having normal functions of the lung during breathing out and breathing in.

1. Moderate persistent.

 This is where more patient care is required with the interference with the functions of the lungs showing the hindrance to the school or work activities. There will be rampant nighttime symptoms more than twice a week but not daily. The patient will be needed to have a rescue inhaler with them for any emergency.

1. Severe persistent. 

At severe persistent, the lung is affected with the struggling functionality with the serious symptoms. The management of the symptoms cannot be done by the patient with the need of the healthcare specialist to develop a combination of medications that can clear the lungs’ airways.

e) The Mother’s Concern Regarding Providing an Inhaler at School as The NP

The use of an inhaler needs the analysis and the review of environmental such as exposure to the allergens such as smoke, classification of asthma, and exercise tolerance in managing the pulmonary functions (Kilbride et al., 2019). The analysis of the patient will support the use of a rescue inhaler in school as though the patient has a history of mild asthma he has reported wheezing and coughing for the last 24 hours plus and the environment as a young student who may need exercise tolerance inhaler in school to be used before engaging in exercise as he will probably need to play with other students.

f) The Appropriate Plan of Care for Johnathan

The necessary patient care plan for asthmatic patients should take care of breathing patterns, airways clearance, deficient knowledge, anxiety, and activity intolerance (Hancox et al., 2021). The guidance that will be suitable for Johnathan will be inclusive of self-care education on how and when to take the medication prescribed, avoiding airway blockage risks such as smoke and dust, and management of activity intolerance. There will also need parent and teacher efforts in managing illness anxiety supporting the patient during the treatment journey mentally and socially among the peers.

                                                        References

Hancox, R. J., Jones, S., Baggott, C., Chen, D., Corna, N., Davies, C., … & Young, R. (2021). New Zealand COPD Guidelines: Quick Reference Guide. The New Zealand Medical Journal (Online), 134(1530), 76-110.

Kilbride, H., Escobar, H., Holmes, A., Teson, K., & Truog, W. (2019). Childhood pulmonary function, exercise capacity, and exhaled nitric oxide levels: outcomes following neonatal treatment with inhaled nitric oxide to prevent bronchopulmonary dysplasia. American journal of perinatology, 36(04), 360-365. DOI: 10.1055/s-0038-1668556

Maselli, D. J., & Peters, J. I. (2018). Medication regimens for managing acute asthma. Respiratory Care, 63(6), 783-796. https://doi.org/10.4187/respcare.05953

Plaza, V., Alobid, I., Alvarez, C., Blanco, M., Ferreira, J., García, G., … & Sanz, J. (2021). Spanish Asthma Management Guidelines (GEMA) v. 5.1. Highlights and Controversies. Archivos de Bronconeumología (English Edition). https://doi.org/10.1016/j.arbr.2021.05.028

Tosca, M. A., Marseglia, G. L., & Ciprandi, G. (2021). The Real-World “Control’asma” Study: a nationwide taskforce on asthma control in children and adolescents. Allergologia et Immunopathologia, 49(1), 32-39.

Reply 2 

 Norma Boone posted Apr 13, 2022 10:28 PMSubscribe

What are the appropriate pharmacological therapies to be prescribed for Johnathan?

A classic characteristic of asthma is airway hyperresponsiveness which includes the clinical symptoms of wheezing, chest tightness and dyspnea (Woo, 2019). Clinical symptoms of asthma appear after exposure to stimuli from allergens and environmental irritants such as air pollution, dust mites, mold, cockroach antigen, and tobacco smoke (Brashers & Rote, 2019). Additional risk factors for asthma include viral respiratory tract infections, exercise, cold air, gastroesophageal reflux, preterm birth, and childhood obesity (Brashers & Rote, 2019, Woo, 2019). Jonathan has a recent history of having an upper air infection at which time he started experiencing wheezing. He presents for his doctor appointment with diffused expiratory wheezing and mild retractions. According to Woo (2019) “children with persistent asthma require daily anti-inflammatory therapy” (p. 363). The Global Initiative for Asthma (GINA) provides guidelines to assist healthcare providers in the pharmacological management of asthma through step therapy (Woo, 2019). Step 2 therapy suggest that mild persistent asthma in young children should be treated with a low-dose inhaled corticosteroid (via nebulizer or MDI and mask), coupled with leukotriene modifier. The treatment prescribed for Jonathan will be a low dose generic corticosteroid nebulizer solution of 0.5mg daily with montelukast chewable tablet 5mg at bedtime. In addition, Jonathan will continue with the use of his Albuterol inhaler. GINA guidelines recommend that patients suffering from mild intermittent asthma should continue to use their short acting beta2 antagonist bronchodilator (Woo, 2019). Continued use of the SABA enables the patient to feel in control of their asthma. Although Jonathan is being prescribed two new medications for his asthma, both are once a day dosage. Healthcare providers must be cognizant when adding medications to a patient’s medication regimen, prescribing combination medications facilitates medication compliance.

What information is necessary to provide to Johnathan and his mother regarding asthma exacerbation?

Asthma exacerbation is classified as mild, moderate, severe, or life threatening. An essential component of asthma therapy is to achieve long-term control by reducing episodes of impairment and risk (Brashers & Rote, 2019). The first step is to educate Jonathan and his mother on allergen avoidance. In addition, early treatment, which starts at home, is an essential strategy for managing and reducing episodes of asthma exacerbation. Teaching Jonathan and his mother the signs and symptoms to monitor for and to take immediate action is critical in the success of managing his asthma. Providing Jonathan and his mother with a written asthma action plan and appropriate medications is another critical part of his asthma exacerbation management plan. Castillo, Peters, and Busse (2017) discussed the use of a home treatment plan that consist of four components to reduce or prevent emergency room visits and or hospitalizations. The home management of asthma exacerbation plan includes written for monitoring of symptoms and lung function, criteria based on symptoms that trigger action, and two or three actions points that include written instructions on the use of inhaled or oral corticosteroids (Castillo et al., 2017).

What is an appropriate clinical assessment tool to be use with Johnathan?

Woo (2019) discussed the importance of monitoring lung function to determine normal airway function. GINA recommends the use of spirometry after initial treatment for asthma exacerbation and at 3 to 6 months as follow-up (Woo, 2019). GINA also recommends the use of a home peak flow meter to monitor lung function in patients who are classified as moderate to severe. Utilizing a peak flow meter to monitor PEF readings help detect early changes in asthma status, evaluate response to changes in medication therapy, and provide a quantitative measure of airflow obstruction. However, GINA does not recommend long term monitoring with a home peak flow meter for asthmatics classified as mild intermittent or mild persistent (Woo, 2019).

What are the classification of asthma?

Asthma severity is determined by evaluating an asthmatic patient who has achieved control of their asthma after being on asthma control medication for several months along with step-down treatment therapy (Woo, 2019). There are three classifications of asthma: mild, moderate, and severe. For purposes of the patient presented in this case study, Jonathan, will hopefully be classified as mild. His treatment plan was selected from the step one and step two treatment choices which consist of a short-acting reliever, a leukotriene modifier, and a low/medium dose corticosteroid).

How would you as the NP address his mother’s concern regarding providing an inhaler at school?

Addressing concerns of patients as well as their caregivers in a caring and authentic manner is paramount in building trusting provider-client relationships. In the case of Jonathan, inquiring from the mother whether his school has policies on self-administration of rescue inhalers is important. The 2005 National Association of School Nurses (NASN) position statement argued that “for the majority of children with asthma, proper monitoring and management ensures that the child is able to participate in normal, everyday activities. Rescue inhalers are prescribed medications that act rapidly upon the airway to relieve shortness of breath and compromised respiratory status. Timely and rapid administration of the rescue inhaler can be crucial for a student with asthma. Because children spend a good portion of their day in the school setting, students must have appropriate access to rescue medication to control asthma at school. The NASN (2017) position statement addressed the need and responsibility of school nurses to develop individualized healthcare plans for students who may have risk for physical and mental health needs. In addition, providing resources that provide education for the child as well as the parent is essential for compliance and control of illnesses and disease. The CDC  (2020) offers variety educational information on the treatment of asthma and school age children, including videos that demonstrate the proper techniques in administering inhaler when self-administered by children. Having the proper resources is essential for Jonathan’s mother to make informed decisions about his health and control of his asthma.

What is an appropriate plan of care for Johnathan?

An appropriate plan of care for Johnathan includes both pharmacologic therapy and non-

pharmacological management. A review of medications, technique, and adherence are covered

at this visit and during each follow-up session. Asthma therapy is guided by the necessity to

control episodes of exacerbation; therefore, a detailed individualized asthma care plan providing appropriate medications is critical to a home management plan. The four components included in the home management plan reduce and prevent emergency room visits and or hospitalizations (Castillo et al., 2017). Inhaled corticosteroids (ICSs) are the most effective long-term control therapy, combined with short-acting beta agonists, such as Albuterol. Achieving and maintaining appropriate asthma control requires providing uncomplicated and appropriate medication regimen, addressing environmental factors that cause worsening symptoms, helping patients learn self-management skills, and monitoring over the long term to assess control and adjust therapy accordingly. Johnathan should also be instructed on proper hand-hygiene which facilitates the prevention of unwanted viral or bacterial illnesses.

Reference

Brasher, V. L. & Huether, S. E. (2019). Alterations of pulmonary function in children. In V. L. Brashers & N. S. Rote (Eds.). Pathophysiology the biologic basis for disease in adults and children (pp. 1202-1227). St. Louis Missouri: Elsevier.

Castillo, J. R., Peters, S. P., & Busse, W. W. (2017). Asthma Exacerbations: Pathogenesis, Prevention, and Treatment. The journal of allergy and clinical immunology. In practice, 5(4), 918–927. https://doi.org/10.1016/j.jaip.2017.05.001

Centers for Disease Control and Prevention. (2020). Asthma: School and Childcare Providers. Retrieved from httsp://www.cdc.gov/asthma/school.html

National Association of School Nurses. (2017). Position Statement: Use of Individualized Healthcare Plans to Support School Health Services. Retrieved from https://www.nasn.org/nasn-resources/

National Association of School Nurses. (2005). Position Statement: The Use of Asthma Rescue Inhalers in the School Setting. Retrieved from https://www.files.nwesd.org/website/

Woo, T. M. (2019). Pharmacotherapeutics for Advanced Practice Nurse Prescribers with 3-yr access to Davis Edge (5th Edition). F. A. Davis Company. https://digitalbookshelf.southuniversity.edu/books/9781719641531

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