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M. L. is a 15-year-old Hispanic female who plays soccer for her school team. She has noticed
that when running, she sometimes has trouble catching her breath. She also reports an
increased runny nose and itchy eyes. She has a frequent dry cough and is awakened with
coughing spells at least four times a week. Her mother and father have seasonal allergies
and her mother has asthma. This morning she woke up and heard “funny sounds” when she
took a breath. Her coughing increased when she took a deep breath. In her nose, the
mucosa is pale and swollen bilaterally. Her lungs have bilateral expiratory wheezing;
respirations are 22 and PEF is 400. Her heart shows a normal sinus rhythm, with no murmurs
or gallops; pulse is 72; and there is no cyanosis.
Diagnosis: Mild Persistent Asthma
In this discussion forum:
1. Discuss specific goals of pharmacotherapy for treating M. L.’s mild persistent asthma.
2. Discuss the drug therapy a CNP would likely prescribe and why.
3. Discuss the parameters for monitoring the success of the therapy.
4. Discuss age appropriate health promotion recommendations you would consider for
M. L.
M. L. is a 15 y/o Hispanic Female presenting in the office today with increased runny nose,
itchy eyes, and SOB with physical activity. She wakes up with dry cough at least four times
per week. Today she noticed wheezing upon wakening and coughing increased with deep
breaths. Upon examination her mucosa is pale and nasal passages are swollen bilaterally.
Her lungs have bilateral expiratory wheezing. RR are 22 and PEF is 400. Normal sinus
rhythm. HR 72. No cyanosis noted.
It is apparent that M. L. is presenting today with Mild Persistent Asthma. Audible wheezing
with increased expiratory phase in respiration aid in the diagnosis. Given that she likely also
has allergies, allergy skin testing can be helpful in assessing timing of asthma exacerbations.
The more positive skin tests she has the more likely it is for her asthma to be worse.
Immunotherapy decreases the clinical asthma burden on the patient. M. L. and her family
should be educated that common triggers of asthma include Alternaria fungi, house dust
mites and cockroach droppings.
The specific goals of pharmacotherapy for M. L. would be to stop any instances of being
awoken in the night, to get her feeling better during physical activity from the asthma and
stop the runny nose and itchy eyes from allergies.
The most likely drug therapy a CNP would prescribe is a low dose inhaled corticosteroid
according to age specific NAEPP chronic disease recommendations. Anyone with asthma
regardless of the severity needs a short acting beta2 adrenergic agonist (SABA)
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bronchodilator such as Proventil or Ventolin for quick relief of acute symptoms. (Arcangelo,
2017) The GINA guidelines recommend reassessing 1 to 3 months after starting treatment.
(GINA, 2015) Treatment may be stepped up or stepped down depending on if the
symptoms are managed or exacerbated. If well controlled for three months, a less intensive
regimen is permitted. If asthma symptoms are not well controlled despite two to three
months of treatment then a long term control medication should be added but an
alternative should be tried before adding this long term control just in case the patient is
more responsive to it. The CNS would likely also prescribe an OTC allergy medication such
as Zyrtec or Claritin.
Age appropriate health promotion recommendations include discussing the adherence to
her asthma treatment plan as a priority, including regular monitoring and any adjustments
needed to be made quickly as well as self-care. It is important at M. L. age that she
understand that cleaning to control pet dander and dust is important, that she and her
parents should keep an eye on the pollen counts through the weather apps to know when it
is safe to be outside for prolonged periods. It is important that she understand that some
household cleaning products, perfumes, candles, and other scents can be an irritant or even
a trigger for an asthma exacerbation. She should stick to her allergy medication regimen
and inhaler very closely. Should these medications need to be taken in front of friends it
may be a cause for embarrassment, it is important to assess for depression or anxiety
around this new diagnosis and medication regimen.

Unformatted Attachment Preview

M. L. is a 15-year-old Hispanic female who plays soccer for her school team. She has noticed that when running, she sometimes has trouble catching her breath. She also reports an increased runny nose and itchy eyes. She has a frequent dry cough and is awakened with coughing spells at least four times a week. Her mother and father have seasonal allergies and her mother has asthma. This morning she woke up and heard “funny sounds” when she took a breath. Her coughing increased when she took a deep breath. In her nose, the mucosa is pale and swollen bilaterally. Her lungs have bilateral expiratory wheezing; respirations are 22 and PEF is 400. Her heart shows a normal sinus rhythm, with no murmurs or gallops; pulse is 72; and there is no cyanosis. Diagnosis: Mild Persistent Asthma In this discussion forum: 1. 2. 3. 4. Discuss specific goals of pharmacotherapy for treating M. L.’s mild persistent asthma. Discuss the drug therapy a CNP would likely prescribe and why. Discuss the parameters for monitoring the success of the therapy. Discuss age appropriate health promotion recommendations you would consider for M. L. M. L. is a 15 y/o Hispanic Female presenting in the office today with increased runny nose, itchy eyes, and SOB with physical activity. She wakes up with dry cough at least four times per week. Today she noticed wheezing upon wakening and coughing increased with deep breaths. Upon examination her mucosa is pale and nasal passages are swollen bilaterally. Her lungs have bilateral expiratory wheezing. RR are 22 and PEF is 400. Normal sinus rhythm. HR 72. No cyanosis noted. It is apparent that M. L. is presenting today with Mild Persistent Asthma. Audible wheezing with increased expiratory phase in respiration aid in the diagnosis. Given that she likely also has allergies, allergy skin testing can be helpful in assessing timing of asthma exacerbations. The more positive skin tests she has the more likely it is for her asthma to be worse. Immunotherapy decreases the clinical asthma burden on the patient. M. L. and her family should be educated that common triggers of asthma include Alternaria fungi, house dust mites and cockroach droppings. The specific goals of pharmacotherapy for M. L. would be to stop any instances of being awoken in the night, to get her feeling better during physical activity from the asthma and stop the runny nose and itchy eyes from allergies. The most likely drug therapy a CNP would prescribe is a low dose inhaled corticosteroid according to age specific NAEPP chronic disease recommendations. Anyone with asthma regardless of the severity needs a short acting beta2 adrenergic agonist (SABA) bronchodilator such as Proventil or Ventolin for quick relief of acute symptoms. (Arcangelo, 2017) The GINA guidelines recommend reassessing 1 to 3 months after starting treatment. (GINA, 2015) Treatment may be stepped up or stepped down depending on if the symptoms are managed or exacerbated. If well controlled for three months, a less intensive regimen is permitted. If asthma symptoms are not well controlled despite two to three months of treatment then a long term control medication should be added but an alternative should be tried before adding this long term control just in case the patient is more responsive to it. The CNS would likely also prescribe an OTC allergy medication such as Zyrtec or Claritin. Age appropriate health promotion recommendations include discussing the adherence to her asthma treatment plan as a priority, including regular monitoring and any adjustments needed to be made quickly as well as self-care. It is important at M. L. age that she understand that cleaning to control pet dander and dust is important, that she and her parents should keep an eye on the pollen counts through the weather apps to know when it is safe to be outside for prolonged periods. It is important that she understand that some household cleaning products, perfumes, candles, and other scents can be an irritant or even a trigger for an asthma exacerbation. She should stick to her allergy medication regimen and inhaler very closely. Should these medications need to be taken in front of friends it may be a cause for embarrassment, it is important to assess for depression or anxiety around this new diagnosis and medication regimen. Name: Description: ...
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