Respiratory Case Study week 4 pharm

Based on the subjective and objective date presented, it appears Jonathon is having an asthma exacerbation. His symptoms reflect moderate persistent asthma. According to Up to Date (2017), children with an asthma exacerbation experience a lower risk of admission to the hospital if they are treated with the combination of inhaled short-acting beta agonists plus anticholinergic versus SABA alone, systemic glucocorticoids, and supplemental oxygen, when necessary. I would give him an albuterol 2.5mg nebulizer treatment due to his respiratory distress and start him on oral steroid. A short burst of oral corticosteroids may be needed to establish control of asthma in children with moderate or severe asthma (Woo & Robinson, 2015). A “burst” dose is 1 to 2 mg/kg/d (maximum 30 mg/d) of prednisone in two divided doses for 3 to 10 days. Per Jonathon’s weight, I would put him on 20mg of liquid prednisone twice a day for ten days. If the “burst” treatment is unsuccessful, the patient would need to be reevaluated and possibly a higher level of care would be warranted.

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

The first step in parent and patient education would be the explanation of avoiding asthma triggers. Common asthma triggers include allergens, respiratory infections, irritants, physical activity, cold air, and emotional stress (Fanta, 2019). Also creating an action plan that includes triggers, emergency medications and routine medications will be important for not only Johnathan and his mother but also his school and babysitters as well.

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

One of the most important clinical assessment tools to use when examining Johnathan would be a thorough physical exam and patient history. This includes information about daily routines, medications, sleep patterns, triggers, ect (Dinakar & Chipps, 2017). Objective assessments for monitoring Johnathan’s asthma would be the Childhood Asthma Control Test (C-ACT). The C-ACT is for use in children 4 through 11 years of age and consists of 4 pictorial items and 3 verbal items that are scored by the children and parents (Dinakar & Chipps, 2017). Subjective data would include the use of Peak Flow Meters and spirometry.

What are the classifications of asthma?

Asthma classifications are based on ages. The two age categories are children ages 5 to 11 and adults and children 12 and older. Children ages 5 to 11 classification is determined based on severity and frequency of asthma symptoms. Adults and children 12 and older classification is based on clinical features prior to treatment (Woo & Robinson, 2015). In adults and children 12 years and older, asthma classifications are as followed:

· Mild intermittent asthma: Symptoms occur less often than twice a week and patient is asymptomatic between exacerbations; nighttime symptoms occur less than twice a month; and short acting medications are used less than biweekly.

· Mild persistent asthma: Symptoms occur more often than twice a week but less often than once a day; nighttime symptoms occur 3 to 4 times a month; short-acting beta2 agonists maybe used more than twice a week but not daily, and not more than once daily.

· Moderate persistent asthma: symptoms are experienced daily and require daily use of beta2 agonist; nighttime symptoms occur more often than once a week.

· Severe persistent asthma, experiences some degree of symptoms all the time; extremely limited physical activity; frequent nighttime symptoms, often 7 days a week; and decreased lung function

In children ages 5 to 11 asthma classifications are:

· Mild intermittent asthma: Symptoms occur less often than twice a week and asymptomatic between exacerbations, nighttime symptoms less than twice a month, short-acting beta2 agonists are used less than two times and oral systemic corticosteroids no more than once a year.

· Mild persistent asthma: Symptoms occur more often than twice a week but less than once a daily and may affect activity, nighttime symptoms occur 3 to 4 times a month; short-acting beta2 agonists more than twice a week but not daily

· Moderate persistent asthma: daily symptoms; requires daily use of a beta2 agonist; and exacerbations affect normal activity; nighttime symptoms occur more than once a week but not nightly

· Severe persistent asthma: some degree of symptoms all the time; extremely limited physical activity; frequent nighttime symptoms

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

I would explain to his mother the importance of carrying his rescue inhaler at school. The NAEPP has endorsed students to carry and self-administer with parent and provider consent in accordance with a school official (Woo, 2015). To ease his mother’s concerns, I would ensure that Johnathan could correctly use his inhaler and spacer but return demonstration. I would also help coordinate Johnathan’s Asthma Action Plan as previously mentioned that would include his dosing and frequency. The plan could then be carried by Johnathan where he could readily obtain it as well as providing copies to his school nurse and teachers.

What is an appropriate plan of care for Johnathan?

Johnathan’s plan includes reassessing his condition after his initial treatment and oral steroids. Oxygen therapy maybe necessary depending on how he responds to treatment to get him through this exacerbation. If his symptoms improve, he will be sent home with his oral prednisone and continued use of his inhaler. I would instruct his mother to follow up with in the office in a week to evaluate his asthma and medication therapy. In the meantime, I would have his mom and Johnathan keep an asthma diary recording triggers that bring on symptoms as well as alleviating factors. I would also help them create the Asthma Action Plan that was previously mentioned, as this will be important to help manage Johnathan’s day to day symptoms.

References

Dinakar, C., & Chipps, B. E. (2017). Clinical Tools to Assess Asthma Control in Children. Pediatrics,139(1). doi:10.1542/peds.2016-3438

Fanta, C. (2019, January 8). Patient education: Asthma treatment in adolescents and adults (Beyond the Basics). Retrieved from https://www.uptodate.com/contents/asthma-treatment-in-adolescents-and-adults-beyond-the-basics

Sawicki, G., & Haver, K. (2017, November 29). Acute asthma exacerbations in children: Inpatient management. Retrieved from https://www.uptodate.com/contents/acute-asthma-exacerbations-in-children-inpatient-management