...ASTHMA PHARMACOTHERAPEUTICS ASTHMA CASE STUDY RICK, 44 YO MALE COMES TO CLINIC COMPLAINING OF ALLERGIES AND ASTHMA. HE HAS HAD MILD INTERMITTENT ASTHMA FOR YEARS THAT IS TRIGGERED BY ALLERGIES AND RESPIRATORY INFECTIONS. THE PAST FEW WEEKS HIS SEASONAL ALLERGIES HAVE BEEN BOTHERING HIM, HE HAS BEEN USING HIS ALBUTEROL A COUPLE TIMES A DAY FOR A WHEEZY COUGH. HAS BEEN TAKING BENADRYL FOR HIS ALLERGIES, BUT IT MAKES HIM SLEEPY AND HE CAN’T TAKE IT AT WORK. HE IS ABLE TO WORK, BUT HE CANNOT FINISH HIS ROUTINE 5-MILE RUN EACH DAY DUE TO COUGHING. PHYSICAL EXAM: AFEBRILE, 02 SAT 95% ROOM AIR, SPIROMETRY FEV1 75% MEDICATIONS: ALBUTEROL INHALER & BENADRYL ETIOLOGY OF ASTHMA • The complete causes of asthma are unknown. Heredity does seem to play a role as do allergens and environmental factors. Atopy – genetic predisposition for developing IgE-mediated response to common aeroallergens, is strongest predisposing factor for development of asthma. • Allergic/extrinsic asthma – result of antigen/antibody reaction on mast cells in respiratory tract. Causes release of inflammatory mediators from mast cells which elicit clinical response associated with an asthma attack. Usual onset 5 15 yrs. • Idiosyncratic asthma- neurological imbalance in ANS in which alpha and beta adrenergic as well as cholinergic sites of the ANS are not properly coordinated. Usual onset later in life. PATHOPHYSIOLOGY OF ASTHMA • Chronic inflammatory disorder of the airways...
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...The patient, G.S., was admitted to the emergency department due to an asthma exacerbation. His mother reported that his medication had run out quickly and she didn’t have the money to refill his medications. After assessment and treatment of his respiratory distress, it was discovered that G.S. has had many episodes such as the one that brought him into the E.D. In addition, G.S.’s household environment isn’t conducive to repressing asthma exacerbations as both his mother and father have pets; it is know that dander/fur can trigger episodes. In addition, G.S.’s parents both smoke, which is also an irritant to patients with asthma. The behaviors reported show a need for education, so they may need more resources regarding the etiology/pathophysiology/triggers for asthma....
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...After a thorough history and physical exam, I then decided to consult with the mom regarding the presumptive diagnosis of asthma for the child due to her history and physical. The mother then voices her belief that if one believes they have asthma, then it becomes true; however, if we do not believe that is, then we will not have the disease. The mother states firmly “ my child does not have asthma.” I provide education regarding asthma and the risks of undertreatment of the condition and offer the patient to be evaluated by an asthma specialist to confirm. The mother initially refuses and repeats, “my child does not have asthma.” While keeping my composure, I decided to sit with the patient’s mother to discuss her beliefs, to better understand why she is strong in her disbelief that her child could have asthma and refuses to take precautions and treatment even after discussing the risks to the mother. The mother goes on to state that “God is our number one, and you are our number two.., we first go to him for our troubles and we follow his way, when we feel it may be too much for us to handle, we then come to...
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...Ben Marshall is a 25 year-old male (DOB: 05/03/1993), who was admitted into the emergency department with a principal diagnosis of severe asthma. Before his admission, Mr Marshall was out for a jog, when he developed symptoms of a severe shortness of breath and a constant tightness in the chest. An ambulance was then called, and the patient was then transported to the hospital. The patient complains of severe dyspnoea (severe shortness of breath) however, there was no loss of consciousness. Mr Marshall is a recent university graduate, whom lives with his parents and two younger siblings. Ben is a young adult male, and is very fit and regularly plays competition football. The patient’s current health status was examined upon his admission....
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...current asthma (61.9% female; 54.8% African American; Mage = 34.72, SD = 13.58). Participants were included in the study if they: (1) were between the ages of 18 and 65; (2) met biochemical cutoff values for being a nonsmoker, indexed by an expired carbon monoxide level of (-- removed HTML --) 4 on the Asthma Screening Questionnaire, which is indicative of an asthma diagnosis (Shin et al., 2010). In terms of the racial composition of the sample, 54.8% self-identified as African American, 41.9% as Caucasian, and 3.2% as Other. Only one participant reported Hispanic ethnicity. Participants were, on average, 16.48 (SD = 14.13) years of age when diagnosed with asthma. Nearly 80% of participants reported having experienced at least one asthma attack in the past six months, and 47.6% reported an emergency room or urgent care visit for asthma symptoms in the past six months. Participants reported a mean Asthma Control Test (Nathan et al., 2004) score of 15.98 (SD = 4.54), indicating poorly controlled asthma. Measures Expired carbon monoxide. Smoking status was biochemically...
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...treatment before exercise (I), compared to albuterol treatment after exercise (C) in preventing the asthma attacks (O) in school settings during physical education (T) Key words: exercise induced asthma, albuterol, teenage, school setting, and physical education Assignment Questions Guidelines What two guidelines were used? (AHRQ, n.d.) “Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter.” (John M. Weiler, September 26, 2010) “Evidence-based care guideline for management of acute exacerbation of asthma in children aged 0 to 18 years.” (Acute Asthma Guideline, Cincinnati Children's Hospital...
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...CASE INCIDENT The Asthma Attack In March of 2013, a teenage boy visiting a Tim Hortons franchise in London, Ontario suffered an asthma attack. The 17-year old boy was having difficulty breathing and gasping for air as her tried to get the attention of employees. According to a customer who witnessed the incident, an employee asked “What do you want?” kind of rudely and all the boy could say was, “Help” and “Phone”. Employees told him the phone wasn’t for customers and directed him to a payphone across the street at a variety store. According to the witness, “The teen boy was going between the two tills, there were five or six employees… he was visibly in distress. They didn’t ask if he needed help. The whole time, not of them came out from behind the counter to see if he was OK.” The customer who witness the incident called 911 and stayed with the boy until paramedics arrived. However, when they arrive they found themselves at an exit-only door, the employees did not open to the door to let them in, so the paramedics had to pry the door open to get to the boy and take him to the hospital. Instructions QUESTIONS 1. Run the asthma attack incident through the needs analysis process. What is the performance problem and is it important? Who are the stakeholders? What information would you collect by doing an organizational, task, and person analysis? What are some of the outcomes that would result from the needs analysis process? Needs analysis...
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...Asthma, one of the most common chronic diseases, is a significant cause of disability, as it is responsible for population morbidity and causes a large healthcare burden worldwide and thus remains a global health concern (Edwards et al. 2012). Atopic asthma is considered an inappropriate immune T-helper cell type 2 (Th2) mediated response (Navarro et al. 2010; Allan & Devereux 2011). Dendritic cell persistence and activation of the adaptive immune response upon antigen detection are important in in the clearance of pathogens via this Th2 pathway. However, in an atopic asthmatic patient, the homeostatic equilibrium between this inflammatory Th2 mediated response and the T regulatory (Treg) cell response that dampen and suppress both effector...
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...had at Cotabato Regional and Medical Center opened the door of opportunity to experience things that broadened our knowledge and enhanced our skills. We were exposed to different cases of various clients. We became accustomed with the routines in the hospital and interacting with our patients, even with their watchers. We encountered some difficulties and struggles, yet that didn’t hinder us in giving our best to do our job. That exposure gave us an opportunity to handle different cases. With all those we’ve encountered, we chose one to be the subject of our case study. We are presenting to you Bronchial Asthma which is the case of our patient at Medicine Ward Room C whom we will call Mr. Theodore for the purpose of confidentiality. Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways. Bronchial asthma is the more correct name for the common form of asthma. The term 'bronchial' is used to differentiate it from 'cardiac' asthma, which is a separate condition that is caused by heart failure. Although the two types of asthma have similar symptoms, including wheezing (a whistling sound in the chest) and shortness of breath, they have quite different causes. Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath. The cause is a sharply elevated resistance...
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...Comparison of Ouiser’s asthma symptoms to the asthma severity components listed in the table, lead to her asthma treatment step. This includes asthma symptoms, nighttime wakening, inhaled short-acting beta2 - agonist (SABAs) use for symptom control, the degree of interference of normal activity, and lung function (U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, 2007). Ouiser’s mother reports that she has daily symptoms during soccer practice, placing her in the “persistent asthma” category. The number of nighttime wakening of 2-3 times a week, places her in the “moderate” category of “persistent asthma.” While Ouiser has never used SABAs for symptom control, her symptoms required her to sit out of her soccer games at least once or twice a game, limiting her time on the field, placing her at “Step 3” for her treatment course. The preferred treatment plan for “Step 3” is the use of medium-dose inhaled glucocorticoids (IGC) along with as-needed quick-relief medication such as SABAs for all patients (U.S. Department of...
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...Asthma in the District of Columbia Name: Institution: Authors Note Introduction One of the most common public health issue in Washington’s District of Columbia is Asthma. This condition affects mostly children and almost 12% of the children in the District suffer from asthma. During the late 1990’s, numerous children died from asthma each year. Asthma is a chronic disease that causes inflammation and swelling of the airways. It affects around 8.2% of children in the United States. Asthma attacks have led to 750,000 emergency departments’ visits and 200,000 hospitalizations each year. In fact, it is the leading cause of hospitalizations in children. In the United States, direct costs incurred from asthma related issues is approximated...
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...Health Assessment Case Study Introduction The focus of this case study is to examine further focused assessments that should be undertaken after Mr S's initial presentation of acute exacerbation of asthma. Reasoning for recommended focused assessments will be discussed with consideration of Mr S's presentation of symptoms, history, pathophysiology and risk factors for asthma exacerbation. Research on current asthma assessment protocols will guide recommendations, and assessment parameters will be described. Follow up care and self-management options for Mr S will also be explored. Asthma Asthma is a chronic inflammatory disease of the lungs. It is characterised by airflow obstruction and lung inflammation (Johnson, 2010). Asthma symptoms include wheezing, chest tightness, shortness of breath and cough (Johnson, 2010). Potential triggers for asthma include allergens, viral respiratory infections, irritants, stimuli such as cold air or exercise and gastro-oesophageal reflux (Estes et al, 2013). Airway obstruction in asthmatics is variable and reversible. However poorly managed asthma can leave lasting structural changes in the cells and tissues of the lower respiratory tract, resulting in airway remodelling and permanent fibrotic damage (Kaufman, 2011). There is currently no cure for asthma, therefore the disease needs to be managed (NACA, 2014). Pathophysiology and assessment parameters It is important to understand the underlying pathophysiology of Mr Saunders’ presentation...
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...Questions and Discussion 1. Explain the basis of Josh’s chest tightness and radiographic findings. Due to his asthma Josh’s airways can become inflamed and the smooth muscle constricted, this can resulting in negative pressure in the airways during inspiration and positive pressure during expiration causing a narrowing of the airways. Air can become trapped in the lungs due to the narrowing of the airways resulting in an increased residual lung volume at the end of expiration. A high residual lung volume causes the muscles to work harder and therefore chest tightness can be felt. The high residual lung volume can also account for the hyperinflation of lungs which was seen on Josh’s radiograph, the peribronchial inflammation in asthma causes bronical marking around the airways, which occurs when excess mucus builds up in the small airway passages of the lungs. 2. Explain the failure of Josh’s asthma to improve despite frequent use of bronchodilators, and his response to steroid therapy. Bronchodilators simply cause the smooth tissue to relax, allow the airways in the lungs to open up, but in severe/ chronic cases of allergic asthma there are multiple symptoms other than constriction of the smooth muscles. Patients with chronic allergic asthma also experience production of excess mucus and...
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...1 What environmental risk factors contributing to disease and other health conditions are illustrated in this case? Classify each as unaltered, altered, or built environmental factor? This village has several environmental factors, which puts the inhabitants at risk. These factors may be categorized as unaltered factors, altered factors, and built factors. Unaltered environmental risk factors include mosquitoes, bad water, mold from the land slide, and goiters from lack of iodine in the soil. Altered environmental factors include, improper pesticide use and malaria and hook worm for those who work in the farm. Built environmental factors include bad ventilation and high motor vehicle teen death incidents. 2. Discuss at least two examples of how disease or other conditions found in the village can be explained by the environmental risk factors In some cases, environmental risk factors may explain the presence of disease. In the case of this village, the presence of asthma, goiter, and unexplained neurological disease may be explained by the environmental factors. Asthma may be caused from improper ventilation in the houses....
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...Severe asthma had a massive influence on Georges wellbeing. I recommend services such as the GP and pharmacy and gym. George greatly benefited from visiting the GP as he was able to monitor and observe his wellbeing. The general practitioners were able to analyses if his asthma did improve and helped him by prescribing medication which helped by easing his symptoms that was cause by his sever asthma. The GP helped by detecting If George had any allergies, in order for George to live healthy and happily. The GP also provided many services such as the pharmacy in order for George to learn about what his medications where and how it affected his condition. George recognized what triggered his asthma attacks therefore his asthma attacks where less frequent. Intellectually the practitioner helped George learn what to do in asthma attacks, as he knew that asthma attacks could be fatal. He learnt that you need to stand up straight, take long deep breaths and stay clam whilst having an asthma attack. This has allowed George to get further insight on how to improve his condition. Socially...
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