Download Medical Case Studies: Treatment Plans for COPD, Asthma, and Alzheimer's Disease and more Cheat Sheet Nursing in PDF only on Docsity!
WEEK 4 ASSIGNMENT
SCENARIO 1
Donald is a 60 year old male presenting with dyspnea (shortness of breath), chronic productive cough, wheezing, and fatigue. He smokes 1 pack of cigarettes per day for the last 40 years. Post-bronchodilator FEV1/FVC ratio < 0.70 confirms persistent airflow limitation. What treatment plan would you implement for this patient? The goal is to relieve symptoms, slowing the progression of COPD, and improving the quality of life of the patient. So, the treatment plan would include lifestyle changes such as smoking cessation. This can slow the progression of COPD. Pulmonary rehabilitation which includes exercise training, education, and behavior changes that improve physical and psychological condition of people with COPD. Recommend regular exercise and a healthy diet to improve overall health. I would also encourage medications to reduce symptoms, decrease severity and the frequency of COPD exacerbations (Hurst et al., 2020). What medication(s) would you prescribe? I would recommend a bronchodilator which are prescribed to relax the muscles around the patients airways. They can be long or short acting depending on quick relief or daily control. Tiotropium (Spiriva) 18 mcg inhalation capsule, take one capsule by inhalation daily The second medication would be inhaled corticosteroids because they reduce inflammation in the airways. Fluticasone (Flovent) 110 mcg inhaler, take two puffs by inhalation twice daily The third medication would be phosphodiesterase-4 inhibitors because it can reduce symptoms, reduce inflammation, prevent flare-ups, and improve lung function. Roflumilast (Daliresp) 500 mcg tablet, take one tablet orally daily (GOLD, 2021) How would you monitor the effectiveness of this plan? To monitor the effectiveness of this plan I would have regular follow-up visits to assess symptom control and disease progression. Assess and measure lung function with spirometry. I would monitor for potential side effects of ordered medications and assess the patient’s smoking status. Also assess for any changes in patient's ability to carry out daily activities. It's important to regularly reassess the patient's condition and adjust the treatment plan as necessary (Agarwal et al., 2023).
References Agarwal, A. K., Raja, A., & Brown, B. D. (2023, August 7). Chronic obstructive pulmonary disease. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK559281/ COPD Diagnosis and Management At-A-Glance Desk Reference - 2016 - Global Initiative for Chronic Obstructive Lung Disease - GOLD. (2021, November 23). https://goldcopd.org/copd-diagnosis-management-glance-desk-reference-2016/ Hurst, J. R., Skolnik, N., Hansen, G. J., Anzueto, A., Donaldson, G. C., Dransfield, M. T., & Varghese, P. (2020). Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. European Journal of Internal Medicine , 73 , 1–6. https://doi.org/10.1016/j.ejim.2019.12. SCENARIO 2 Allen is a 49 year-year-old man seeking evaluation for “a burning sensation in my chest,” often after eating and worse at night. He has frequent feelings of bloating and occasional nausea. Allen consumes a diet high in fatty foods and caffeine. He drinks alcohol socially on weekends. PMH includes asthma, diabetes and hypertension. His current medications include prn albuterol, metformin 1000 mg po BID, nifedipine ER 60 mg po daily. How would you improve his drug therapy plan? What changes would you make? Allen's current medications include albuterol for asthma, metformin for diabetes, and nifedipine for hypertension. Here are some suggestions to improve his drug therapy plan. His Albuterol medication is used as needed, so no changes are necessary unless Allen's asthma symptoms worsen. His metformin is appropriate for managing diabetes. However,
Young, A., Kumar, M. A., & Thota, P. N. (2020). GERD: A practical approach. Cleveland Clinic Journal of Medicine , 87 (4), 223–230. https://doi.org/10.3949/ccjm.87a. SCENARIO 3 Jessica is a 37-year-old female diagnosed with mild persistent asthma. During her visit today, she reports having to use her albuterol 4 days per week over the past month. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough five nights during the last month. Her current medications include: fluticasone HFA 44 mcg, two puffs BID, albuterol MDI two puffs Q 4–6 H PRN shortness of breath, Medrol Dosepak, metformin 500 mg PO BID, Inderal LA 160 mg po daily. How would you step up therapy for this patient? Jessica's asthma symptoms suggest that her current therapy is not adequately controlling her condition. Her asthma seems to be poorly controlled, as she is using her rescue inhaler more frequently than recommended and her symptoms are interfering with her sleep and exercise. Using a short-acting beta-agonist more than 2 days per week and experiencing nighttime symptoms are signs that her asthma is no longer well-controlled, indicating a need to step up therapy (Lommatzsch et al., 2020). I would increase the dose of fluticasone, consider adding a long-acting beta agonist, and evaluate the role of propranolol. What medication changes would you make? The current dose of Flovent HFA 44 mcg, two puffs BID, is not sufficient to control her symptoms so I would increase the dose to Flovent HFA 110 mcg, two puffs BID (Papi et al., 2020). If increasing the Flovent dose does not fully control symptoms, the next step would be to combine the Flovent with salmeterol. A common combination is Advair Diskus 100/50 mcg, 1 puff BID (Papi et al., 2020). How would you monitor the effectiveness of this plan? Ask Jessica to keep a symptom diary, noting frequency of symptoms, rescue inhaler use, nighttime awakenings, activity limitations, and any triggers. Encourage regular use of a peak flow meter to track lung function. Schedule a follow-up visit in 2 to 4 weeks to assess symptom control and adjust the treatment plan if needed (Lommatzsch et al., 2020). What patient teaching would you provide?
I would review proper inhaler techniques and teach Jessica on how to properly use both her fluticasone and albuterol inhalers to ensure effective delivery of the medication. I would discuss common asthma triggers such as allergens, smoke, stress, and cold air and ways to avoid them (Di Cicco et al., 2021). Also provide an asthma action plan detailing what steps to take when her symptoms worsen, including when to use albuterol and when to seek medical attention. Lastly, spirometry can be used to monitor her lung function over time. By stepping up her asthma treatment and addressing potential exacerbating factors, Jessica should achieve better symptom control. References Di Cicco, M. E., Leone, M., Scavone, M., Del Giudice, M. M., Licari, A., Duse, M., Brambilla, I., Ciprandi, G., Caffarelli, C., & Tosca, M. (2021). Intermittent and mild persistent asthma: how therapy has changed. PubMed , 92 (S7), e2021523. https://doi.org/10.23750/abm.v92is7. Lommatzsch, M., Buhl, R., & Korn, S. (2020). The treatment of mild and moderate asthma in adults. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2020. Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: reshaping the concept of asthma management. Allergy Asthma and Clinical Immunology , 16 (1). https://doi.org/10.1186/s13223-020-00472- SCENARIO 4 June is a 71-year-old female and has Alzheimer’s Disease x 2 years. She presents with daytime dizziness, fatigue and increasing forgetfulness. Labs: TSH 5 mU/L, vitamin D 29 ng/mL, B12 350 pg/mL, Hb 12.1 g/dL, HgA1C = 5.5% Meds: donepezil 5mg po qhs, zolpidem 10mg po qhs Updated drug therapy plan with complete medication orders Donepezil: 10mg po qhs (increased from 5mg) Increasing forgetfulness suggests worsening Alzheimer's and up dosing to 10mg may help manage symptoms (Kriebel- Gasparro, 2020).
