Case Study – Asthma

Case Study – Asthma

Case Study – Asthma

Objectives

1. Explain the risk factors, symptoms, etiology, progression, diagnosis, treatment and prognosis. 2. Demonstrate the ability to access and critically evaluate information from a wide variety of sources (such as Library databases and internet sources). Read the case presentation and answer the questions that follow. The Case Study Rubric will be used to assess your work. The Case Study rubric lists the criteria for each question (required resources, word counts and citation requirements). Case Presentation Vivienne, an eight year old girl, is brought to the pediatrician by her father. He is concerned about a dry cough she has had for the past six weeks. Her dry cough keeps her and her sister awake most nights. She has had two rounds of antibiotics, which did not help. Vivienne’s teacher noted that her cough worsens during PE and when she plays outside. She has had a few episodes of wheezing and saying her “heart hurt”. Vivienne’s mother has eczema and asthma that is controlled. When asked about any pets, the father explained they don’t have any, but she likes to play with the neighbor’s golden retriever. Her father is concerned that Vivienne could also be developing asthma and would like testing done. Vivienne is bright and alert. Examination of the eyes, ears and throat are unremarkable. Her vital signs are all within normal limits. Vivienne’s lungs sound clear upon auscultation. Her pediatrician concludes she has a high probability of asthma due to her history and family’s medical history. He orders a chest x-ray and spirometry testing. The chest x-ray is negative. The spirogram revealed FEV1: 78% and FEV1/FVC: 80%. After Vivienne was administered a bronchodilator her FEV1 and FEV1/FVC were within normal limits. Child performing spirometry. [Digital image]. (n.d.). Retrieved from https://www.choc.org/programs-services/pulmonology/pulmonary-function-testing/ Her pediatrician diagnoses her with moderate persistent asthma. He prescribes a daily glucocorticoid inhaler. Vivienne will likely have intermittent activity throughout the day, so a daily Singulair is also prescribed. In addition a short-acting inhaler, Albuterol, is recommended too. The pediatrician advises to purchase a peak flow meter at the pharmacy. Vivienne is scheduled to follow up with the pediatrician in 4 weeks. As Vivienne’s father leaves the office, he is relieved to have an answer but is overwhelmed by the several medications he has to get filled. Questions 1. Define the bold terms. 2. Describe the cause of asthma. 3. Though Vivienne’s signs and symptoms appear straight forward, atypical cystic fibrosis is a condition that can show signs later in childhood. Differentiate asthma from cystic fibrosis, comparing the etiology, signs and symptoms, diagnosis and treatment. 4. Vivienne’s father needs to be educated on asthma. Explain why each of the prescribed drugs will help her asthma and when then they should be used. Describe what a peak flow meter is and its purpose. 5. Discuss the prognosis of asthma with Vivienne’s father. According to her history, explain to Vivienne’s father any preventative measures he can take to prevent asthma flare ups. Case Study – Influenza Objectives 1. Explain the risk factors, symptoms, etiology, progression, diagnosis, treatment and prognosis. 2. Demonstrate the ability to access and critically evaluate information from a wide variety of sources (such as Library databases and internet sources). Read the case presentation and answer the questions that follow. The Case Study Rubric will be used to assess your work. The Case Study rubric lists the criteria for each question (required resources, word counts and citation requirements). Case Presentation Brianna is a 26 year-old female presenting to the emergency department with dyspnea, myalgia, and rhinorrhea. Her symptoms began approximately 1 day ago and are continuous, steadily getting worse. She is having significant nasal discharge but minimal cough. Brianna works at a daycare center, but “hasn’t ever felt this awful this fast” with previous colds. She states that two children have been diagnosed with the flu. She received the flu vaccine three days ago. She has no significant past medical history, except she smokes half a pack of cigarettes per day for 8 years. When she remembers, she takes a daily multivitamin. Brianna appears uncomfortable. She has a body temp 101 F. Respiratory rate 22 bpm; BP 120/76. A pulse oximeter reading indicates a HR 106 bpm and O2 saturation (SaO2) 89%. A nasal cannula with 2L O2 is administered and her SaO2 increases to 100%. Auscultation of the lungs is positive for wheezes, but no crackles. Her skin is warm and diaphoretic. A chest x-ray showed patchy diffuse bilateral infiltrate suggestive of pneumonia. Her blood culture is negative. Her sputum culture contains 3+ neutrophils, but the culture is negative. A rapid flu swab test is positive for influenza A. Patient with nasal cannula. [Digital image]. (n.d.). Retrieved from http://www.flexicare.com/products/oxygen-aerosol-therapy/variable-concentration/nasal-cannulas Brianna is diagnosed with influenza. She is admitted to the hospital for respiratory support (nasal cannula) and started on Tamiflu (oseltamivir). After 24 hours, her oxygen saturation returns to normal breathing room air. You overhear her telling a friend that she is confused why she got the flu when she just received the vaccine, so she probably got the flu from the shot. You are asked to go over her at-home instructions before she is discharged. Questions 1. Define the bold terms. 2. Describe the cause of influenza. 3. Differentiate influenza from pneumonia, comparing the etiology, signs and symptoms, diagnosis and treatment. 4. Brianna needs to be educated before she leaves the hospital about treating the flu. Explain how the drug Tamiflu works. Describe any at-home-care and over the counter medications she can take to help support her recovery. 5. Explain to Brianna any preventative measures she should take to avoid the the flu. Since you overheard her conversation with her friend, include information about why the flu shot did not provide her protection and why you cannot get the flu from vaccine. What is the prognosis of the flu in an individual like Brianna?

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