NRP/507 Advanced pharmacology

Type: Case Study

Subject: Advanced Pharmacology

Subject area: Nursing

Education Level: Family Nurse Practioner Masters program

Length: 5 pages

Referencing style: APA

Preferred English: US English

Spacing Option: Double

Instructions: file attached below is the actual case study that needs to be completed with all required field filled out as requested. i also sent the grading rubric below and what is expected.

Focus: rubric details maximum score 100 points grading rubic analysis using evidence-based practice (ebp) guidelines 30% of total grade accomplished 90 - 100% thoroughly synthesized the patient’s overall social and medical history, clinical symptoms, and clinical assessment; included accurate and comprehensive details classifying the asthma stage using detailed support from evidence-based guidelines (ebg); thoroughly explained the danger of current treatment plan execution regarding saba from a detailed pathophysiology perspective plan of care & prescription writing 40% of total grade accomplished 90 - 100% thoroughly synthesized the patient’s overall social and medical history, clinical symptoms, and clinical assessment; included accurate and comprehensive details classifying the asthma stage using detailed support from evidence-based guidelines (ebg); thoroughly explained the danger of current treatment plan execution regarding saba from a detailed pathophysiology perspective mechanism of action, monitoring, and patient education 30% of total grade accomplished 90 - 100% clearly and accurately explained the mechanism of action of each medication and how it addresses patient’s asthma exacerbation; included clearly defined details about appropriate monitoring; comprehensively discussed realistic lifestyle interventions necessary to facilitate treatment adherence and understanding

Suggested: file sent below is the actual case study that needs to be completed 

Patient Case Study: Asthma

Student’s Name

Institutional Affiliation

Course Number: Course Name

Instructor

Date Due

Patient Case Study: Asthma

Summary of Nancy’s overall Social and Medical History and Clinical symptoms 

According to the case study, Nancy Smith, a 35-year-old female, was diagnosed with asthma at 20. Whenever necessary, she uses a albuterol inhaler p.r.n. Over the past year, she has used urgent care a few times, the recent one being four months ago. The doctor prescribed an albuterol inhaler, oral steroids, and inhaled steroid that she never bothered filling.  Two weeks ago, her asthma symptoms worsened. Smith has been using albuterol three to four times daily. She complains of shortness of breath when walking or using stairs. Smith also experiences nighttime coughing that affects her breathing. She claims that she experienced the same flares previously and wants more asteroid pills and albuterol. Smith takes the following medication Proair HFA and Claritin prn to control her asthma. Her pulse ox is 93% on RA; FEV1/FVC ratio is 69%, and spirometry: FEVI is 58%

Clinical Assessment to classify her Asthma using Evidence-Based Guidelines

The National Asthma Education and Prevention program classifies asthma into intermittent, mild persistent, moderate persistent, and severe persistent asthma (Michigan Medicine, n.d). The classification is based on lung function tests and symptoms. The classifications are as discussed below

Intermittent Asthma

 Asthma is considered intermittent if the following symptoms are evident without treatment: difficulty breathing, coughing, chest tightness, and wheezing. These symptoms present less than two days a week and do not interfere with individuals’ involvement with normal activities (Padem & Saltoun, 2019). Nighttime symptoms are also prevalent on less than two days a month.  Lung function tests are normal when the patient is not having an asthma attack (Padem & Saltoun, 2019). 

Mild persistent

Patients with mild persistent asthma present the following symptoms without treatment: symptoms lasting for more than two days a week but not every day. Asthma attacks do not interfere with individuals’ normal functioning (Padem & Saltoun, 2019). Nighttime symptoms are evident three to four times a month. Normal lung function tests without an asthma attack. 

Moderate persistent

Moderate persistent asthma is characterized by symptoms occurring daily. The patient uses inhaled short-acting asthma medications.  Nighttime symptoms are present one time a week, but not every day and symptom undermines individual daily function (Padem & Saltoun, 2019). Abnormal lung function tests (more than 60% to < 80% of the expected values). 

Severe persistent

A patient is diagnosed with severe persistent asthma if symptoms are evident daily and severely interferes with a person’s routine physical activities.  The patients experience nighttime symptoms more often, at times every night (Padem & Saltoun, 2019). Abnormal lung function tests (60% or< the expected value). PEF varies more than thirty percent from morning to afternoon (Michigan Medicine, n.d). According to Smith’s symptoms, she suffers from severe persistent asthma. Her lung function tests are abnormal. For instance, her spirometry FEV1 is 58%,  and FEV1/FVC ratio is 69%. FEV I of 80% or more is considered normal, 70%-79% mildly abnormal, 50%-50% moderate to severely abnormal (Padem & Saltoun, 2019).  Smith’s FEV I is 58%, suggesting it is moderate to severely abnormal. Additionally, her FEVI/FVC is less than 70% suggesting that something is blocking her airways. Additionally, asthma symptoms are interfering with her daily activities. For instance, she experiences shortness of breath when walking or climbing stairs to the mailbox. Her nighttime coughing spells occur every day. The symptoms and lung function tests suggest that Smith suffers severe persistent asthma.

Dangers with Nancy Smith’s Current Treatment Plan Execution Regarding SABA Use

Nancy Smith uses Proair HFA and Claritin prn to manage her condition.  They are the frontline defense for treating acute asthma symptoms.  Also known as SABAs, they are either inhaled as a dry powder or via a metered-dose inhaler. These medications are also available as syrups, tablets, injectable solutions, nebulized solutions, or intravenous solutions (Nwaru et al., 2020). However, SABA medication use increases a patient’s susceptibility to excessive use and risk of exacerbations. Before exacerbating, SABA use affects patients for several weeks resulting in severe exacerbations (Nwaru et al., 2020). According to the case study, Nancy Smith uses albuterol three to four times daily. Her excessive use of SABA resulted in her asthma exacerbation. Additionally, her overuse of SABA increases her risk of death. Nwaru et al.(2020) associate SABA overuse with dose-dependent vulnerability, respiratory-related death, and exacerbations. Therefore, monitoring Smith’s SABA usage is necessary to improve her asthma control. 

  

 

Evidence-Based Medication Treatment Plan

Excellence in Health Care, LLC. Student’s Name 1000 Professional Plaza Phoenix, AZ 85000 480-555-1234 DEA____RX_____________ Name__ Nancy Smith__________________      Date____2/03/2021_________ Address_____________________________      DOB__2/03/1984____________ Rx: Oral inhalation Sig: Two oral inhalations twice a day(morning and evening, about 12hours apart) Qty: _45/21(45mcg fluticasone/21mcg salmeterol per inhalation); 115/21 or 230/21. Maximum two oral inhalations of 230/21 daily RF: _____________ Signature  Dispense at Written__________________Substitution Permissible______________

 

Excellence in Health Care, LLC. Student’s Name 1000 Professional Plaza Phoenix, AZ 85000 480-555-1234 DEA__RX OTC_______________ Name________Nancy Smith______________      Date__2/03/2021___________ Address_______________________________      Age 35______________ Rx: Oral inhalation Sig: 55mcg (single 55mcg/actuation oral inhalation) twice daily. If the condition remains uncontrolled after two weeks, increase dosage to 113mcg. Maximum dosage 232 mcg Qty: ___55mcg/single oral inhalation__________ RF: _____________ Signature  Dispense at Written__________________Substitution Permissible______________

Excellence in Health Care, LLC. Student’s Name 1000 Professional Plaza Phoenix, AZ 85000 480-555-1234 DEA_____RX____________ Name___Nancy Smith_______________________      Date____2/03/2021_____ Address_______________________________      Age___35___________ Rx: Oral Sig: 40 to 80 mg/day PO until PEF is 70% of personal or predicted best.  Qty: ____40 to80mg/day for 3 to 10 days_________ RF: _____________ Signature  Dispense at Written__________________Substitution Permissible______________

Mechanism of Action of Each Medication and How it Addresses Nancy’s Asthma Exacerbation

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The medications prescribed for Nancy Smith are steroid burst, Fluticasone and salmeterol. Steroid bursts act by reducing the severity of asthma attacks and preventing hospitalization or emergency room visit. The prescription may last two days to a week, and a gradual decrease of dosage is unnecessary. However, decreasing burst dosage gradually is necessary for some patients, especially if the burst continues for several weeks. Salmeterol and fluticasone’s combination treats asthma-associated symptoms, including wheezing, difficulty breathing, coughing, shortness of breath, and chest tightness (Mayo Clinic, n.d). Fluticasone reduces airway swelling and tightening. In contrast, Salmeterol reduces swelling and opens airway for about 12 hours (Mayo Clinic, n.d). Nancy Smith should use the medication regularly to prevent nighttime symptoms and control severe or moderate asthma. Despite these prescriptions, Nancy Smith will be required to engage in frequent and regular follow-up visits to minimize her susceptibility to asthma exacerbation to achieve a good prognosis

Appropriate Monitoring For Drug Side Effects and Laboratory Monitoring With Rationale and Follow-Up

Watchful and ongoing monitoring is a crucial aspect of asthma management. Monitoring’s primary objective is to maintain and achieve optimum asthma control at the least dosage (Kaur& Singh, 2018). The disease severity, treatment response, risk factors for adverse outcomes in the future, caregivers’ training, and age will determine the frequency of follow-ups. Given Nancy Smith’s asthma severity, her follow-up visit will occur 2-4 weeks following treatment.  Afterward, the follow-up will occur monthly and weekly in case of an exacerbation. The patient’s monitoring will consider Nancy’s response to drugs, symptoms and exacerbations control, and adverse effects of drugs, medication adherence, and inhalation technique.  The monitoring will also consider measuring spirometry to assess Nancy’s effective asthma control. The monitoring of these aspects optimizes treatment effectiveness with fewer prescriptions. 

Patient Education to Facilitate Treatment Adherence and Understanding

Nancy needs to comply with various guidelines to control her asthma. For instance, she needs to have a thorough understanding of her condition, when and how to use her medication and seek immediate help. Nancy also needs to understand things that worsen her symptoms, track her asthma symptoms, and understand the importance of regular monitoring. Therefore, Nancy’s education plan will ensure that she learns and understands the following:

•  Asthma disease: The education plan will focus on how to recognize signs and symptoms of an attack and the role of each medication in self-managing asthma attack
• Appropriate use of medication: The education plan will enhance Nancy’s understanding of each medication’s role.  She will differentiate between prescriptions that manage asthma symptoms quickly and those that prevent these symptoms from resurfacing.  She will also be educated on the importance of an asthma action plan in preparing her to manage her symptoms whenever they occur.
• Inhalers use:  Nancy may be required to utilize multiple inhales requiring different techniques. The education will consider Nancy’s competence in using different inhalers to enhance her treatment adherence
• Asthma triggers: Nancy will be educated on factors that trigger her asthma to avoid her contact with things that worsens her symptoms 

 The education will use Nancy’s preferred learning style and will reflect her health literacy level.

References

Kaur, S., & Singh, V. (2018). Asthma and medicines–long-term side-effects, monitoring and dose titration. The Indian Journal of Pediatrics, 85(9), 748-756.

Mayo Clinic.(n.d). Asthma medications: Know your options. https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-medications/art-20045557

 Michigan Medicine.(n.d). Classification of asthma. https://www.uofmhealth.org/health-library/hw161158

Nwaru, B. I., Ekström, M., Hasvold, P., Wiklund, F., Telg, G., & Janson, C. (2020). Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. European Respiratory Journal, 55(4), 1-9. https:/doi.org/10.1183/1393003.congress-2017.PA4051

Padem, N., & Saltoun, C. (2019). Classification of asthma.  Allergy & Asthma Proceedings , 40(6), 385-388. https:/doi.org/10.2500/aap.2019.40.4253