discussion response

 

Peer Response

Instructions:

Please read and respond to at least two of your peers' initial responses. 

Review the plans posted by your peers from your advanced practice nursing role perspective (educator, leader or nurse practitioner).  From this mindset, reflect upon a discussion you would like to have with your colleagues about their plan.

For example:

• If you are a nurse educator (clinical or academic) what are your thoughts about the patient education provided in the plan, or do you want to comment on or add to the education provided?  
• If you a nurse leader what are your thoughts about the risk profile or cost effectiveness of the plan.?
• If you are a nurse practitioner did your peer develop a plan that aligns with evidence-based practice and current clinical guidelines? Etc.

Please be sure to validate your opinions and ideas with citations and references in APA format. 

Reply from Daniel Munoz

Unit 1: Management of the Asthma Patient 

The diagnosis of our patient in this scenario is Mild Persistent Asthma. The patient currently exhibits symptoms more than twice a week, reports awakening at night more than twice per month, and uses her albuterol inhaler an average of three times a week. Due to the signs and symptoms she is reporting, she may need some medication adjustments to her regimen to control her asthma. Adolescents with mild persistent asthma who are not well controlled on a low-dose inhaled corticosteroid can benefit from adding a long-acting beta antagonist to their medication regimen (Arcangelo & Peterson, 2021). The treatment I would recommend would include Budesonide-formoterol (Symbicort) 160/4.5mcg. One puff twice a day and one puff as needed for breakthrough symptoms. Special instructions include always rinsing the mouth after use to prevent oral thrush. This plan, also known as the SMART approach, has been proven to reduce exacerbations and improve control in adolescents and adults. SMART stands for Single Maintenance And Reliever Therapy. Symbicort also works quickly and lasts up to 12 hours, making it an effective quick reliever and a PRN to use when needed. The patient education I would provide about the treatment plan would be ensuring the patient knows the proper inhaler technique. Patients often do not know the proper technique, and allowing them to demonstrate or teach back what they were taught is the only way to know for sure. Furthermore, by engaging in patient teaching, we can discuss the symptoms to report and how to avoid common asthma triggers, such as dust. Regarding follow up, I will follow up with my patient in four to six weeks, depending on how the symptoms are, and assess how the new medication regimen is currently controlling her asthma. If no improvement has occurred or symptoms have worsened, it may be necessary to look into possible allergy triggers and refer the patient to an allergist. 

Reference

Arcangelo, V. & Peterson, A. (2021). Pharmacotherapeutics for advanced practice: A practical approach. (5th ed.). Wolters Kluwer

Reply from Cori Studzinski

I would agree with the diagnosis of asthma for this patient. According to the Global Initiative for Asthma Symptom control the patient does not have well controlled asthma as evidenced by her needing her rescue inhaler 3 times a week and waking up with asthma symptoms 2 times per week (Arcangelo, 2021).  

According to Arcangelo (2021), every patient with asthma should be prescribed an ICS-containing controller drug. She is currently taking beclomethasone dipropionate which does not seem to be controlling her asthma well. I think it is worth switching this medication to Fluticasone Propionate MDI 110 mcg/inhalation 2 puffs twice daily. She should continue with the rescue inhaler of albuterol 90 mcg/inhalation 2 puffs every 4 hours as needed for shortness of breath or wheezing.  

This patient also needs an asthma action plan which will help her to monitor symptoms and treat accordingly. The importance of medication adherence is also something that I would touch on so that the medications have the best chance of controlling her asthma. She would also benefit from seeing a pulmonary specialist since she is already on an ICS-containing controller drug and it is not adequately controlling her symptoms. I would want to follow up with this patient after 2-3 months since according to Arcangelo (2021), most inhaled controller drugs will not show the best results until 3-4 months after taking them. They recommend follow up initially at 1-3 months and then every 3-12 months after.   

References: 

Arcangelo, V. P. Peterson, A. M. Wilbur, V. Kang, T. M. (2021) Pharmacotherapeutics for advanced practice. [eBook edition]. Wolters Kluwer Health.