Assignment 1: Discussion Questions
Select one of the two questions from the discussion questions listed below.
Be sure to respond to the question using the lessons and vocabulary found in the reading. Justify your answers using examples and reasoning. Support your answers with examples and research and cite your research using APA format.
Discussion Question 1
SE is a twenty-two-year-old Caucasian woman who was diagnosed with asthma at age seven. According to her medical record, she has “mild persistent” asthma. Today, she reports that she has been using her albuterol metered-dose inhaler (MDI) approximately three to four days per week over the last two months. Over the past week, she admits to using albuterol once daily. She has been awakened by a cough three nights during the last month. She states she especially becomes short of breath when she exercises. However, she also admits that the shortness of breath is not always brought on by exercise. She also has a fluticasone MDI, which she uses “most days of the week.” She has been hospitalized twice in the last year for poorly controlled asthma and has been to the emergency department (ED) three times in the last six months for the same problem. Her lab work is all within normal limits, with the exception of a positive human chorionic gonadotropin (HCG). Answer the following questions:
- What information in the case study suggests that her asthma is not well controlled?
- What factors could possibly lead to this?
- How would you classify the symptoms based upon the National Institutes of Health (NIH) guidelines?
- With the recognition that she is pregnant, how would you alter her treatment for asthma?
Support your responses with guidelines, including the NIH guidelines, for management of asthma during pregnancy. Use other peer-reviewed articles as needed to support specific aspects of your plan.
Discussion Question 2
TJ is a fifty-five-year-old police officer who presents to the clinic with complaints of epigastric pain for two weeks. He has been taking over-the-counter (OTC) Zantac without relief. He was diagnosed about a year ago with a bleeding ulcer, and he expresses concerns that the current symptoms remind him of that event. At that time, he was given “multiple prescriptions” for his stomach, but he did not complete the course of therapy because he began to feel better. He also has osteoarthritis in his wrists and hips, for which he takes OTC NSAIDs. He smokes one to two packs per week and drinks an average of one alcoholic beverage daily. His vital signs and blood work are all within normal limits. Answer the following questions:
- What additional testing would you suggest at this point?
- Describe any and all variables that could be contributing to his symptoms.
- What alterations would you suggest in his treatment? Be sure to consider additional diagnoses and whether prophylaxis would be appropriate for NSAID-induced ulcers.
Support your responses with guidelines you locate in the literature and peer-reviewed articles as needed to support your ideas.
Expert Solution Preview
Introduction:
In this case, we will be discussing the assessment and management of two different patients with different medical conditions. The first case involves a young woman diagnosed with asthma and the second case involves a middle-aged police officer with epigastric pain. We will analyze the provided information and use the relevant medical guidelines and research to answer the specific questions related to each case.
Answer to Discussion Question 1:
There are several pieces of information in the case study that indicate that the patient’s asthma is not well controlled. Firstly, the frequency of albuterol use has increased over the past two months, suggesting increased symptoms and the need for more frequent rescue medication. Secondly, the presence of nocturnal cough and awakening due to symptoms indicates poor asthma control. Additionally, the patient experiences shortness of breath not only during exercise but also at other times, which further suggests inadequate control.
Several factors could potentially contribute to the poor control of her asthma. Inadequate adherence to her prescribed medications, such as the inconsistent use of fluticasone MDI, could be a contributing factor. Environmental triggers, such as exposure to allergens or irritants, could also worsen her symptoms. It is also important to consider the possibility of an exacerbation triggered by the positive human chorionic gonadotropin (HCG) test result indicating pregnancy.
Based on the National Institutes of Health (NIH) guidelines, the symptoms can be classified as “moderate persistent” asthma. This classification is based on the frequency of symptoms, use of rescue medication, and interference with daily activities.
With the recognition that the patient is pregnant, her treatment for asthma needs to be altered to ensure the safety of both the mother and the developing fetus. The use of medications during pregnancy should prioritize drugs that have been deemed safe, such as inhaled corticosteroids (ICS) like fluticasone. Adjustments in medication dosage may be necessary, and close monitoring of symptoms and lung function should be conducted throughout the pregnancy. Collaborative care involving an obstetrician and a pulmonologist is essential in managing asthma during pregnancy.
Supporting guidelines for the management of asthma during pregnancy include the Global Initiative for Asthma (GINA) and the American College of Obstetricians and Gynecologists (ACOG) recommendations. Peer-reviewed articles can also be consulted to provide additional evidence-based information for specific aspects of the treatment plan.
Answer to Discussion Question 2:
Given the patient’s history of a bleeding ulcer, epigastric pain, and the use of NSAIDs, it is important to consider additional testing to further evaluate his condition. Upper gastrointestinal endoscopy would be a recommended test to directly visualize the gastric mucosa and assess the presence of any ulcers or other pathology. This procedure would help identify any potential sources of bleeding or abnormalities in the stomach.
Multiple variables could be contributing to the patient’s symptoms. The NSAIDs he takes for osteoarthritis can contribute to the development of gastric ulcers, especially if not used in combination with gastroprotective agents. Smoking and alcohol consumption can also increase the risk of developing gastrointestinal disorders. Therefore, these habits may worsen his symptoms and delay healing of any ulcers.
In terms of treatment, it is crucial to discontinue the use of NSAIDs or consider alternative options with a lower risk of gastric complications, especially in patients with a history of ulceration. Prophylactic therapy to prevent NSAID-induced ulcers can be considered, which may involve prescribing a proton pump inhibitor (PPI) along with the NSAID. Lifestyle modifications, such as smoking cessation and limiting alcohol intake, should also be encouraged to reduce the exacerbation of symptoms.
To support the suggested alterations in treatment, guidelines from the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) can be referenced. Additionally, peer-reviewed articles can be consulted to provide further evidence-based recommendations for the management of NSAID-induced ulcers and gastroesophageal disorders.
Conclusion:
In conclusion, by analyzing the presented case studies, we have identified the reasons for inadequate control of asthma in a young woman and the potential variables contributing to a middle-aged patient’s epigastric pain. We have utilized medical guidelines, such as those from the NIH, GINA, ACOG, AGA, and ACG, along with peer-reviewed articles, to provide evidence-based recommendations and solutions for the patients’ conditions. This approach ensures the effective evaluation and management of medical cases while incorporating the current medical knowledge for optimal patient care.
