Complaint “I need a refill for my inhaler.” History Rick, age 25,…

Question Answered step-by-step Complaint “I need a refill for my inhaler.” History Rick, age 25,… Complaint “I need a refill for my inhaler.” History Rick, age 25, is being seen in your clinic for the first time. He recently moved to the area and is establishing with you as a primary provider. His chief complaint is that he needs a refill for his asthma inhalers and is hoping that you “know more about asthma than the last provider” because his asthma has “never” been under control in spite of trying many different inhalers. He has never seen an asthma specialist and has never had a written asthma treatment plan. He has symptoms 2-3 days per week, about 2-3 night time awakenings per month and uses SABA 3 days per week.Rick reports having asthma “all his life,” beginning in early childhood. As a child, he remembers being hospitalized a couple of times for asthma. He reports the mainstay of his treatment has been to use an albuterol inhaler the past few years. He remembers using oral medicine before but cannot remember the name. He has no other health problems except that he smokes one pack of cigarettes per day. Upon further exploration, he reports that he used the different inhalers for only a short time, because “they did not work.”Assessment: Mild Persistent Asthma not well controlledRick’s examination is normal except for soft expiratory wheezes. He did have his albuterol inhaler with him, and when asked to demonstrate the use of his inhaler, he demonstrated poor technique. 1.What medication needs to be added to Rick’s treatment plan?Group of answer choicesA. Omalizumab 150 mg subQ every 2 weeksB. Montelukast 10 mg by mouth every eveningC. Beclamethasone 80 mcg/puff 1 puff 2 every 12 hoursD. Fomoterol DPI (12 mg/inhalation 1 inhalation every 12 hours 2.Which of the following should be included in the treatment plan?Group of answer choices (select all that apply) demonstration on correct inhaler techniqueavoid exerciseuse short acting beta agonist several times per dayuse of a peak flow meter with asthma action plansmoking cessation counseling including nicotine replacement 3.When should Rick follow up?Group of answer choicesA.2-4 weeksB.No follow up neededC.3 monthsD.6 months 4.Six months later Rick is back and asthma is not controlled with the short acting beta agonist (SABA) and inhaled glucocorticoid.Which of the following medications should be added?Group of answer choices A.High dose IGC and omalizumabB.high dose inhaled glucocorticoid (IGC) plus LABAC.Long acting beta agonist (LABA)D.Tiotropium Janis, a 59 year old female, presents with tachypnea, dyspnea on exertion, and mild chest discomfort. She was diagnosed with emphysema 4 years ago and was placed on bronchodilator therapy. She has an 80 pack year history of smoking. “I feel short of breath when I walk, and my chest is sore.” She describes her chest soreness as mild pressure, rated as 2 on a 1-10 scale. The pain is over the anterior thorax, more pronounced in the ribs, which she believes has developed from coughing hard. She states that she has had a nonproductive cough for 4 days and feels more fatigued than usual.Past Medical History: She has osteoarthritis in the hands and knees. She has a surgical history of appendectomy and cholecystectomy. In the past year, she has had 2 exacerbations of her COPD and has attempted to stop smoking, using nicotine gum replacement unsuccessfully.Family History: Noncontributory.Social History: She lives with her husband who also smokes 2 packs of cigarettes per day and cares for her elderly mother, who lives with them and is frail but ambulatory.Medications: Albuterol MDI, 90 mcg/inhalation, 2 puffs as needed every 4-6 hours; ipratropium bromide MDI, 18 mcg/inhalation, 2 puffs 4 times/day; ibuprofen as needed for arthritic pain.Allergies:  Allergic to Keflex and penicillin.Diagnostics: PFT conducted today showed obstructive flow patterns and reduced FEV1/FVC.·       Spirometry: FEV1/FVC <70; FEV1 50% predicted·       Chest Xray: Overdistention of lungs/ flattened diaphragm; mild cardiomegaly.·       CBC: WNL except slight elevation of RBCs·       ABGs: PH 7.36; PCO2 55; PO2 60; HCO3 29; SaO2 89·       ECG: Sinus tachycardia; frequent PVCs ; no ischemia; right axis deviation.  5.What COPD classification is this patient?A.moderateB.very severeC.severeD.mild 6.Janis is diagnosed with COPD exacerbation. What is your plan of treatment for Janis today? Check all that applyGroup of answer choicesAddformoterol12 mcg/Aclidium 400mcg DPI 1 inhalation twice dailyreferral to pulmonologistsmoking cessation counseling and either prescription or OTC nicotine replacement therapymacrolide antibioticpulmonary rehabilitationinfluenza and pneumonia vaccine   Health Science Science Nursing Share QuestionEmailCopy link Comments (0)