To the untrained ear, most coughs sound the same. However, as you might recall from past clinical experiences, a simple cough can lead to a patient diagnosis of a common cold, pneumonia, or even a chronic obstructive pulmonary disease (COPD). Although it can sometimes be challenging to diagnose a patient based on common respiratory symptoms such as congestion, coughing, and wheezing, it is important to be able to distinguish minor differences as even mild symptoms might require intervention with drug treatments. When recommending potential treatment options, advanced practice nurses must consider how individual patient factors might impact the effects of prescribed drugs.<\/span>\u00a0<\/span><\/p>\n With these thoughts in mind:<\/span>\u00a0<\/span><\/p>\n Post<\/span><\/b> a description of the respiratory disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. Then, explain how the factor you selected might impact effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.<\/span>\u00a0<\/span><\/p>\n Read<\/span><\/b> a selection of your colleagues\u2019 responses and <\/span>respond <\/span><\/b>to <\/span>at least two<\/span><\/b> of your colleagues on <\/span>two different days<\/span><\/b> who selected a different respiratory disorder than you did. <\/span>If the disorder you selected is primarily associated with the upper respiratory system, respond to colleagues who selected disorders primarily associated with the lower respiratory system.<\/span><\/i> Provide alternative recommendations for drug treatments.<\/span>\u00a0<\/span><\/p>\n Note:<\/span><\/b> For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues\u2019 postings. Begin by clicking on the \u201cPost to Discussion Question\u201d link and then select \u201cCreate Thread\u201d to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on <\/span>Submit!<\/span><\/b>\u00a0<\/span><\/p>\n Submission and Grading Information<\/span><\/b>\u00a0<\/span><\/p>\n Grading Criteria\u00a0<\/span><\/b>\u00a0<\/span><\/p>\n In the United States, 12 million people suffer from chronic obstructive pulmonary disease (National Heart Lung and Blood Institute, n.d.), and about 25 million people suffer from asthma (CDC, 2011). Since various symptoms are associated with chronic obstructive pulmonary disease, asthma, and other common respiratory disorders, a single patient might be prescribed multiple drugs for treatment. Consider an 8-year-old asthmatic patient who frequently presents with acute asthma exacerbations that are triggered by seasonal allergies. As a result of his disorder, he might be prescribed albuterol to treat asthma attacks and Clarinex to treat allergic reactions. This requires you, as the advanced practice nurse, to be aware of risks of polypharmacy and patient factors that impact the effects of drugs.<\/span>\u00a0<\/span><\/p>\n This week you examine types of drugs prescribed to patients with respiratory disorders, as well as the impact of patient factors on the effects of drugs. You also explore ways to improve patient treatment plans including suggested drug therapies. Finally, you examine asthma treatment and management.<\/span>\u00a0<\/span><\/p>\n By the end of this week, students will:<\/span><\/b>\u00a0<\/span><\/p>\n Photo Credit: lovleah\/iStock\/Getty Images Plus\/Getty Images<\/span>\u00a0<\/span><\/p>\n This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.<\/span>\u00a0<\/span><\/p>\n Arcangelo, V. P.,\u202fPeterson, A. M., Wilbur, V., & Reinhold, J. A.\u202f(Eds.). (2017). <\/span>Pharmacotherapeutics for advanced practice: A practical approach<\/span><\/i> (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.<\/span>\u00a0<\/span><\/p>\n Asthma is a recurrent and complex disease that affects the minute airways resulting in difficulties in breathing, coughing and wheezing, particularly in the morning or at night (Horak, Doberer, Eber, Horak, Pohl, Riedler, and Studnicka (2016). Asthma is naturally episodic and reversible through treatment or spontaneously. However, for chronic inflammation the airways remodeling which could be completely impossible to reverse. Therefore, nurses and pharmacists need to ensure the medicines are appropriately administered. As a result, they should have the relevant knowledge in pharmacology that entails pharmacodynamics as well as pharmacokinetics. This enables nurses to understand the major targets to aim for drug actions.\u00a0<\/span>\u00a0<\/span><\/p>\n Long-term medications are asthma pharmacotherapeutic techniques used in preventing a flare-up of symptoms as well as controlling the impacts of asthmatic conditions (Arcanglo & Peterson, 2013). Long-term medications work for considerably a longer period to ease the inflammation of airways and assist in preventing the asthma symptoms. Significantly, these medications should be taken daily to affect its actions. It is a highly effective medication for controlling chronic asthmatic symptoms. Precisely, long-term medications comprise inhaled corticosteroids, leukotriene modifiers, long-acting beta-antagonists (LABAs), theophylline, as well as corticosteroids combined with LABAs (Sobieraj et al., 2018). This type of medication acts by preventing the passage as well as the stimulation of the inflammatory cells. As a result, it prevents the hyperresponsiveness of airways and improves the functioning of respiratory systems (Arcanglo & Peterson, 2013). Patients can experience such symptoms as coughing, bruising, course voice and fungus in the mouth from corticosteroids that are inhaled.\u00a0 Normally, children encounter delayed growth as part of the major side effects.\u00a0<\/span>\u00a0<\/span><\/p>\n Quick-relief medications functions immediately to relieve the potential asthma symptoms in case they occur (Arcanglo & Peterson, 2013). Typically, these treatment mechanisms involve direct inhalation of the drugs into the lungs from which they lead to the opening of airways and elimination of the common symptoms within a few minutes. These medications are expected to cause a decrease in symptoms such as, relieving difficulties with breathing, wheezing and uncontrollable coughing that is severe in nature. These treatments are bronchodilators since they cause relaxation of airway muscles through the elimination of the symptoms. Importantly, asthma patients need to keep rescue inhalers around them always. Generally, these medications comprise Metaproterenol, Pirbuterol, Terbutaline, Albuterol, Bitolterol, and Levalbuterol (Sobieraj, Weeda, Nguyen, Coleman, White, Lazarus, and Baker, 2018). Some of the most common side effects of these medications can be headaches, increase anxiety, agitation, increase restlessness and tremors (Sobieraj et al., 2018).<\/span>\u00a0<\/span><\/p>\n The stepwise approach is used by practice nurses or other healthcare providers to decide on the therapeutic approach to use on the established level of severity of asthmatic conditions (Arcanglo & Peterson, 2013). Therefore, its major purpose is to commence an intensive therapy for attaining rapid control of the disease. Generally, the stepwise approach includes six major steps. Step 1 involves caring for the patients through the admission of short-acting beta-agonist (SABA) for at least 2 days a week. The second phase of treatment would consist of medications that are utilized long term. The most preferred medication for this step is the administration of low-dose of inhaled corticosteroid doses (ICS) or alternatively Leukotriene receptor antagonists (LTRA), nedocromil, and theophylline drugs. Step 3 that comprise of the addition of LABA to low-dose ICS or continued use ICS as a monotherapy through the increased administering of medium-dose ICS. Step 4 entails care and long-term control treatment through the administration of medium-dose ICS and LABA. In step 5, care and long-term control medications are provided with high-dose ICS in addition to LABA drugs for treating the patients. Lastly, step 6 entails care and long-term control medications through the addition of oral corticosteroids to the therapy process in a step which was mentioned in step five process.<\/span>\u00a0<\/span><\/p>\n Stepwise management of asthma enables health care providers to provide therapy for controlling and reducing the impairments and risks associated with chronic conditions (Kelly, Massoumi & Lazarus, 2015). Health care providers use this management plan to determine the common risks and recommended treatment actions at each step of asthma control. Commonly, inhaled corticosteroids are used for prevention purposes while inhaled beta-antagonists are employed for relieving the asthmatic symptoms. Through the stepwise care and management system, healthcare providers can determine the level of asthma impacts in the body and the necessary maintenance therapies to be applied at a given step of the control strategies. Accordingly, patients use the mechanism to be educated on the drugs intake to reduce the effects of the allergens in the breathing system.<\/span>\u00a0<\/span><\/p>\n Considering that asthma is a recurrent condition, proper care and control mechanisms need to be developed to handle its impacts.\u00a0 There are two classifications of medications that are used in the management of asthma t by clinicians, they are fast acting and long-term controls. Long-term medication involves administering dosages that take time to effect in the body while quick-relief medication encompasses drugs that offer immediate action on the allergens. Essentially, healthcare practitioners play a vital role in systematically evaluating and reviewing the patients\u2019 conditions and administering appropriate medication by using the stepwise management plan. This strategy helps in stepping up the treatment and medications as well as assisting patients to avoid the triggers associated with the asthmatic conditions.\u00a0<\/span>\u00a0<\/span><\/p>\n \u00a0<\/span><\/p>\n Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J. & Studnicka, M. (2016).\u00a0<\/span>\u00a0<\/span><\/p>\n Diagnosis and management of asthma\u2013Statement on the 2015 GINA Guidelines. <\/span>Wiener Klinische Wochenschrift<\/span><\/i>, <\/span>128<\/span><\/i>(15-16), 541-554.<\/span>\u00a0<\/span><\/p>\n Kelly, W., Massoumi, A., & Lazarus, A. (2015). Asthma in pregnancy: Physiology,\u00a0<\/span>\u00a0<\/span><\/p>\n diagnosis, and management. <\/span>Postgraduate medicine<\/span><\/i>, <\/span>127<\/span><\/i>(4), 349-358.<\/span>\u00a0<\/span><\/p>\n Sobieraj, D. M., Weeda, E. R., Nguyen, E., Coleman, C. I., White, C. M., Lazarus, S. C.&\u00a0<\/span>\u00a0<\/span><\/p>\n Baker, W. L. (2018). Association of Inhaled Corticosteroids and Long-Acting \u03b2-Agonists as Controller and Quick Relief Therapy With Exacerbations and Symptom Control in Persistent Asthma: A Systematic Review and Meta-analysis. <\/span>JAMA<\/span><\/i>, <\/span>319<\/span><\/i>(14), 1485-1496.<\/span>\u00a0<\/span><\/p>\n Arcanglo, V.P., & Peterson, A.M., (Eds). (2013). <\/span>Pharmacotherapeutics for advanced<\/span><\/i>\u00a0<\/span><\/p>\n practice: A practical approach <\/span><\/i>(3<\/span>rd<\/span>). Ambler, PA: Lippincott Williams & Wilkins<\/span>\u00a0<\/span><\/p>\n Asthma is a chronic inflammatory disease affecting the airways. It causes airway hyperresponsiveness, mucosal edema, and mucus production. Asthma is characterized by exaggerated bronchoconstrictor response resulting in narrowing of the airways (Bush, 2019). The inflammation leads to recurrent episodes of asthma symptoms. The classic symptoms of asthma are Cough, Dyspnea, and Wheezing.<\/p>\n This presentation will describe long-term control and quick-relief treatment options used for asthma patients in my practice and their impact. In addition, I will outline the stepwise approach to asthma treatment and management. I will also explain how stepwise management assists health care providers and patients gain and maintaining asthma control.<\/p>\n Long-term control treatment options used for patients in our practice include:<\/p>\n Combination ICS and LABA: Used to minimize asthma exacerbations when inhaled Short-acting beta-agonists and corticosteroids are unsuccessful.<\/p>\n Inhaled Corticosteroids (ICSs): Reduce asthma symptoms, improve airway function, and reduce peak flow variability (Papi et al., 2020).<\/p>\n Long-acting beta2-adrenergic agonists (LABA): They reduce asthma attacks at night.<\/p>\n Methylxanthines: Usually prescribed alongside ICS. They alleviate nighttime asthma symptoms.<\/p>\n Leukotriene receptor antagonist (LRTA): They have an anti-inflammatory effect. They prevent bronchoconstriction caused by the actions of leukotrienes (Papi et al., 2020).<\/p>\n Quick-relief treatment options are used to relieve acute asthma exacerbations and prevent exercise-induced bronchoconstriction symptoms. The quick-relief treatment options used in our facility include:<\/p>\n 1.Short-acting beta-agonists (SABAs): Are bronchodilators and relieve bronchospasms in acute asthma episodes (Sharma et al., 2019). They also prevent exercise-induced asthma symptoms and nocturnal asthma. SABAs are the first-line for alleviating acute symptoms and preventing exercise-induced asthma due to their rapid onset of action.<\/p>\n 2.Anticholinergics- Administered only in severe exacerbations.<\/p>\n 3.Systemic corticosteroids:\u00a0 Prescribed for short periods to gain fast control of inadequately controlled acute asthmatic attacks (Sharma et al., 2019). They promote fast recovery from acute exacerbations.<\/p>\n Step 1<\/b>: For intermittent asthma in all ages.<\/p>\n Controller medication is not indicated. The reliever medication is a SABA to control asthma symptoms.<\/p>\n However, if a SABA is used for more than two days per week except during exercise, it is considered an inadequate control, and the clinician considers Stepping up to Step 2<\/p>\n Step 2: <\/b>For mild persistent asthma and all ages. The preferred controller medication is low-dose ICS. Alternatives include Leukotriene receptor antagonist (LTRA), cromolyn, or theophylline. If symptoms are not adequately controlled, treatment is stepped up in patients from 5 years. Children aged 0-4 years are referred to an allergist (Quirt et al., 2018).<\/p>\n Step 3: <\/b>For moderate persistent asthma<\/p>\n The preferred controller medication is a low-dose ICS plus a LABA. Alternatives include a low-dose ICS in addition to either a Leukotriene receptor antagonist or theophylline (Quirt et al., 2018).<\/p>\n Step 4<\/b>: For moderate-to-severe persistent asthma.<\/p>\n Controller medication is an inhaled medium-dose corticosteroid plus a LABA.<\/p>\n Alternatives include an inhaled medium-dose corticosteroid plus either an LTRA or theophylline (Quirt et al., 2018).<\/p>\n Step 5:<\/b> For severe persistent asthma.<\/p>\n The preferred controller medication is an inhaled high-dose corticosteroid plus LABA.<\/p>\n Step 6<\/b>: For severe persistent asthma.<\/p>\n Preferred controller medication is an inhaled high-dose corticosteroid plus LABA plus oral corticosteroid. Omalizumab is prescribed in patients with known allergies (Quirt et al., 2018).<\/p>\n The stepwise approach has assisted health providers and patients gain and maintaining control of asthma symptoms. It has done this by:<\/p>\n Promoting normal activity levels, including physical exercise.<\/p>\n Maintaining near-to-normal pulmonary function.<\/p>\n Preventing asthma exacerbations<\/p>\n Preventing side effects from asthma medications<\/p>\n Reducing asthma mortality<\/p>\n Promoting drug adherence since patients are encouraged to comply with the prescribed treatment to gain control of asthma.<\/p>\n \u00a1Bush, A. (2019). Pathophysiological Mechanisms of Asthma.\u00a0Frontiers in pediatrics,\u00a07, 68. https:\/\/doi.org\/10.3389\/fped.2019.00068<\/a><\/p>\n \u00a1Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: reshaping the concept of asthma management.\u00a0Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clinical Immunology<\/i>,\u00a016<\/i>, 75. https:\/\/doi.org\/10.1186\/s13223-020-00472-8<\/a><\/p>\nTo prepare:<\/span><\/b>\u00a0<\/span><\/h2>\n
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By Day 3<\/span><\/b>\u00a0<\/span><\/h2>\n
By Day 6<\/span><\/b>\u00a0<\/span><\/h2>\n
Learning Objectives<\/span><\/b>\u00a0<\/span><\/h2>\n
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Learning Resources<\/span><\/b>\u00a0<\/span><\/h2>\n
Required Readings<\/span><\/b>\u00a0<\/span><\/h2>\n
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\nThis chapter compares the causes and pathophysiology of two common ear infections\u2014otitis media and otitis externa. It also identifies types of drugs used to treat these ear infections.\u00a0<\/span>\u00a0<\/span><\/li>\n<\/ul>\nA Sample Answer For the Assignment: NURS 6521 Week 4: Respiratory System<\/strong><\/h2>\n
Title: NURS 6521 Week 4: Respiratory System<\/strong><\/h2>\n
Management of Asthma\u00a0<\/span><\/b>\u00a0<\/span><\/h3>\n
Long-Term Control and Quick Relief Treatment<\/span><\/b>\u00a0<\/span><\/h2>\n
Long-Term Control<\/span><\/b>\u00a0<\/span><\/h3>\n
Quick-Relief Treatment<\/span><\/b>\u00a0<\/span><\/h2>\n
A stepwise approach to asthma treatment and management<\/span><\/b>\u00a0<\/span><\/h2>\n
Importance of stepwise management in gaining and maintaining control of the disease<\/span><\/b>\u00a0<\/span><\/h2>\n
References\u00a0<\/span>\u00a0<\/span><\/h2>\n
A Sample Answer 2 For the Assignment: NURS 6521 Week 4: Respiratory System<\/strong><\/h2>\n
Title: NURS 6521 Week 4: Respiratory System<\/strong><\/h2>\n
Introduction<\/b><\/span><\/h3>\n
Long-Term Control<\/b><\/h2>\n
Quick-Relief Treatment<\/b><\/h2>\n
Stepwise Approach <\/b>to <\/b>Asthma Treatment <\/b>& <\/b>Management<\/b><\/h2>\n
Impact of <\/b>the <\/b>Stepwise Approach<\/b><\/h2>\n
\nReferences<\/b>
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