Pulmonary/Endorcrine/GI

Asthma

Michael, age 13, presents to the pediatrician’s office for his annual Well Child Exam. He has a form from his elementary school asking for an asthma action plan.
PMH: Had tonsillectomy at age 5. Had been relatively healthy, but has asthma. His first episode of asthma was at age 5 and required oral steroids and albuterol
nebulizer treatments. He has about 2-3 asthma exacerbations annually, mostly in the fall and early spring. He has been hospitalized twice with asthma exacerbations,
the last being 6 months ago.
FH: He has 2 siblings with asthma, mild, and 1 sibling without asthma. Mom and dad have no medical issues.
Immunizations: Up to date.
Medications: Proventil HFA ii inhalations PRN for wheezing.
Singulair 5 mg q 24 hours
Zyrtec 10 mg q 24 hour

Height: 143 Cm, Weight: 78 lbs.,BP: 96/70, AP: 86, RR: 16, Temp.: 98
Physical exam:
General appearance: Alert, calm, cooperative, in NAD. Well dressed and pleasant.
Head: Normo-cephalic. Hair clean with well distribution. No abnormalities noted.
EENT: PERRLA, sclera – white, Nares clear and patent, Bilateral TMs clear with cone of light. Oral mucosa moist and pink, tonsils 1+ without redness or irritations.
Neck: Supple, no lymphadenopathy.
Heart: AP regular without murmur.
Respiratory: Bilateral breath sounds = and clear with good air entry. No wheezing or abnormalities heard. Peak flow today: Personal best after 3 attempts was 300.
Abdomen: Soft, flat, and non-tender on palpation. Bowel sounds active in all quadrants. No masses/megaly noted.
Extremities: Full ROM in all joints, no tenderness on palpations. Bilateral pedal pulses 2+. No pedal edema, nailbeds pink with capillary refill < 3 seconds.
Neurological: Intact.

Submit a paper utilizing APA and address the following:
What is Michael’s asthma severity classification?
What is Michael’s component of control classification?
Discuss the incidence of absenteeism from school related to asthma.
Discuss the importance of asthma management.
Develop asthma action plan for Michael.
Explain the green zone, yellow zone, and red zone as it is utilized in the asthma action plan.
What would your education plan be?

Review the American Lung Association’s website regarding asthma:
http://www.lung.org/associations/states/colorado/asthma/Asthma.html
http://www.lung.org/associations/states/colorado/asthma/asthma-action-plan.html
http://www.lung.org/associations/states/colorado/asthma/back-to-school.html
http://kidshealth.org/parent/medical/asthma/peak_flow_meter.html#
https://www.childrensmn.org/Manuals/PFS/HomeCare/018704.pdf
Rubric for Pulmonary Case Study

Submit a paper utilizing APA and address the following:
What is Michael’s asthma severity classification?
What is Michael’s component of control classification?
Discuss the incidence of absenteeism from school related to asthma.
Discuss the importance of asthma management.
Develop asthma action plan for Michael.
Explain the green zone, yellow zone, and red zone as it is utilized in the asthma action plan.
What would your education plan be?

Criteria Points Student pts
Asthma severity classification is stated 10
Component of control classification is stated 10
Discuss the incidence of absenteeism from school related to asthma 10
Discuss the importance of asthma management 10
Develop asthma action plan 20
Explain the green zone, yellow zone, and red zone as it is utilized in the asthma action plan 10
Education plan 20
APA format 10

Connie Rodrigues, a 47-year-old overweight woman, has gradually increasing dyspnea and mild chest discomfort on exertion, fatigue, and weight gain. She has no children
and is not now pregnant. Further history reveals a family history of diabetes.
Answer the following questions about Ms. Rodrigues and diabetes.

1. In addition to questions about her chest discomfort, what other assessment questions should you ask Ms. Rodrigues? Why?

2. Ms. Rodrigues has polyuria, paresthesias in her feet, an itching rash in her groin, and blurry vision. Why is it important to measure her blood pressure and
the pain and vibration sensation in her hands and feet?

3. Her nurse practitioner ordered blood tests for glucose and HbA1C. What do you expect these values to be if Ms. Rodrigues has type 2 diabetes?

4. What information does HbA1C provide that the blood glucose level does not?

5. Ms. Rodrigues’s evaluation reveals Candida infection and mild coronary artery disease. Why does diabetes increase the risk of infection?

6. Which physiological mechanisms contribute to peripheral neuropathy in type 2 diabetes?

7. Why did her nurse practitioner refer Ms. Rodrigues to an ophthalmologist?

8. Why is it important to teach Ms. Rodrigues about diet, weight loss, and appropriate exercise, home glucose monitoring, and other ways (possibly including
medications) to manage her blood sugar?

Charlie Berger, a 58-year-old obese man, comes to a nurse practitioner because he has difficulty swallowing, heartburn, and occasional regurgitation. Answering his
nurse practitioner’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol.
Endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of
the proximal stomach into the thorax.

The nurse practitioner diagnoses gastroesophageal reflux disease (GERD) and tells Mr. Berger to do the following:
• Take proton-pump inhibitor drugs to reduce gastric acid.
• Elevate the head of his bed.
• Avoid eating large meals, especially near bedtime.
• Enter a weight-loss program.
• Reduce his use of caffeine and alcohol.

Answer the following questions about Mr. Berger and gastroesophageal reflux disease.

1. Why might reducing his use of caffeine and alcohol decrease Mr. Berger’s symptoms?

2. Why did his nurse practitioner tell Mr. Berger to elevate the head of his bed?

3. What is metaplasia? Why does it occur?

4. Why did his nurse practitioner suggest that Mr. Berger avoid eating large meals, especially near bedtime?

5. Why did his nurse practitioner check to see if Mr. Berger had movement of the proximal stomach into the thorax?

6. Are Mr. Berger’s symptoms of dysphagia, heartburn, and regurgitation specific to GERD?

7. In addition to discomfort, what is a danger of untreated GERD?

8. What is the mechanism by which obesity contributes to GERD?