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ASTHMA
Asthma
I. AP Note
A. Present the problem:
FC presented today with asthma complications and wanting medication refill.
Reports shortness of breath, wheezing, difficulty performing exercise, and “can
not work out like she use to”.
B. Risk Factors
Age
Overweight
Asthma x 10 years
Family Hx of HTN, COPD, and asthma
Roommate is a smoker and has a cat
Tachycardia
C. Assessment:
1. Evaluation:
FC is a 25 yo female who presents to her PCP today for persistent
SOB, wheezing, and difficulty performing exercise. FC has been to the
emergency room 4 times in the past year for complications. Today she is
tachycardic and has audible diffuse wheezing bilaterally on exhalation
with dyspnea. BP is 135/75, P 100, and RR 30. Due to her family hx of
COPD, HTX, and asthma she is at high risk for adverse effects and fatal
asthma attacks. FC needs lifestyle modifications and a change in
pharmacotherapy to prevent these attacks.
Home medications:
Proventil HFA 2 puffs every 4-6 hours
Ortho Evra–Apply 1 patch each week for 3 weeks followed
by 1 week patch-free
2. Determine appropriateness of medications:
Proventil HFA- appropriate for sudden asthma attacks but not long term
effective
a. Indication: Management of acute asthma attacks
b. Interactions: Taken PRN for acute attacks. In patients with EIB
they are taken prior to exercise to prevent attacks. Using the
medication to often can cause tachydysrhythmias, angina, and
seizures. This can lead to cardiac arrest.
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ASTHMA
c. Drug dose: Initial dosing in adults is 2 inhalations every 4-6 hours
PRN
d. Compliance: FC does not state or indicate how the medication is
being used but does indicate the need for a refill.
e. Outcome: FC asthma is not being well controlled; she has daily
symptoms. FC has moderate persistant asthma and the current
medication regimn is not adequate for control. The addition of a
glucocorticoid on set schedule of administration will assist with
minimizing symptoms and reoccurant attacks.
3. Additional information:
4. State desired therapeutic outcomes:
a. Short term goal(s)
b. Long term goals(s)
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ASTHMA
D. Plan (P):
1. Recommendations:
a. Nonpharmacologic therapy (e.g. diet changes, exercise, stop
smoking, and rationale for this method)
b. Pharmacologic therapy (SPECIFIC drugs and dose) and rationale
(1) Drugs
(2) Dose
(3) Route
(4) Length of therapy
2. Monitoring (summarize in the grid):
a. Efficacy:
Improvement and/or resolution of the patient’s signs and symptoms.
b. Adverse reactions:
Parameters determined by frequency and severity of reaction.
c. State method for monitoring.
d. State how you will know the goal has been achieved.
e. State when you would choose to make changes in the
pharmacotherapy plan.
Monitoring Grid
Efficacy (E)
or Adverse
Effect (AE) Parameter Method Goal
Alter THx
when/if
E Pain patient diary no pain Pt pain
AE hypokalemia potassium
blood levels
K nml
(3.5-5)
K not
nml
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