NR 565 Week 6: Asthma Case Study

Sample Answer for NR 565 Week 6: Asthma Case Study

Asthma Treatment Algorithm for NR 565 Week 6: Asthma Case Study: To successfully treat asthma, you must first classify it and then be familiar with step therapy. For this assignment and in this course, we will focus on patients 12 years and older. Complete the blanks in the following table to create an algorithm for asthma care using your textbook as well as GINA guidelines .

Step Asthma Classification Asthma symptoms and frequency as noted in textbook Controller and Preferred Reliever: (Drug Class and frequency if provided from GINA guidelines) Controller and Alternative Reliever: (Drug Class and frequency if provided from GINA guidelines)

Step 1 Intermittent Daytime symptoms 2 or less days per week Drug class: ICS-formoterol Frequency: As needed (low dose) Drug class: ICS Frequency: regular/daily (low dose) Nighttime awakenings 2 or less times per month

Step 2 Mild Daytime symptoms More than two days per week (not daily) Drug class: SABA Nighttime awakenings 3 to 4 times per month

Step 3 Moderate Daytime symptoms Everyday Drug class: ICS-formoterol Drug class: ICS-LABA plus as needed SABA Nighttime awakenings More that once every week but not nightly

Starting treatment for NR 565 Week 6: Asthma Case Study:

Complete this section using the GINA guidelines provided. First Assess:

1. Diagnosis Confirmation

2. Symptom Control and modifiable risk factors

3. Comorbidities

4. Inhaler technique and adherence

5. Patient Preferences and goals

6. Click or tap here to enter text. Fill in the blank: 1. Using ICS-formoterolas reliever reduces the risk of exacerbations compared with using a SABA reliever. 2. Before considering a regimen with a SABA reliever, check if the patient is likely to be adherent with daily controller therapy.

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Dosing: Low, Medium, High Low dose ICS provides most of the clinical benefit for most patients. However, ICS responsiveness varies between patients, so some patients may need medium dose ICS if asthma is uncontrolled despite good adherence and correct inhaler technique with low dose ICS. High dose ICS is needed by very few patients, and its long-term use is associated with an increased risk of local and systemic side-effects.

Adults and adolescents Inhaled corticosteroid Total daily (24 hour) ICS dose (mcg) Low Medium High

BDP (pMDI, HFA) 200-500 >500-1000 >1000

BDP (DPI or pMDI, extrafine particle, HFA) 100-200 >200-400 >400

Budesonide (DPI or PMDI, HFA) 200-400 >400-800 >800

Ciclesonide (pMDI, extrafine particle, HFA) 80-160 >160-320 >320

Fluticasone furoate 100 200

Fluticasone propionate (DPI) 100-250 >250-500 >500

Fluticasone propionate (pMDI, HFA) 100-250 >250-500 >500

Mometasone furoate (pMDI, HFA) 200-400 400

Treating Modifiable Risk Factors Exacerbation risk can be minimized by optimizing asthma medications and by identifying and treating modifiable risk factors. List the six modifiable risk factors identified in the GINA guidelines that show consistent high-quality evidence.

1. Guided Self-management

2. Use of a regime that minimizes exacerbations

3. Avoidance of exposure to tobacco smoke

4. Confirmed food allergy

5. School-based programs

6. Referral to a specialist center

Non-Pharmacological Strategies and Interventions In addition to medications, other therapies and strategies may be considered when relevant, to assist in symptom control and risk reduction. List the examples the GINA guidelines provide.

1. Advice on smoking cessation

2. Physical Activity

3. Investigation for occupational asthma

4. Identify asprin- exacerbated respiratory disease

4-5 Severe Daytime symptoms All through the day Step 4: Drug class: ICS-formoterol Drug class: ICS-LABA with as needed SABA Nighttime awakenings Often 7 times per week Step 5:

NR 565 Week 7 Patient Teaching Infographic

General instructions on contraceptive use 

Keeping our intestinal function is very important, constipation is one of the gastrointestinal (GI) problems that can cause dysfunctions to a healthy GI system. Eating food that are high in fiber, drinking lots of fluid, exercising and keeping a good eating habit and routine can help promote good intestinal motility. To keep a healthy colon, we need to pay attention to some warning signs and habits such as monitoring our nutritional intakes and some problems, abdominal pains, indigestions, some changes in GI functions such as nausea, vomiting and diarrhea. 

Treating non complicated constipation may require the use of over the counter (OTC) laxatives. 

WHEN SHOULD LAXATIVES BE USED 

Laxative should be used after the non-pharmacological interventions such as increasing fluid and fiber have failed. There are different types of Laxatives: Bulk forming laxatives, Osmotic, Stimulants, surfactants. 

Bulk forming Laxatives: This is considered one of the safest laxatives because their action is like increasing fiber in the diet. This is not habit forming, it works by combining with water to form mechanical distention which produces increased peristalsis. Examples of such drug are psyllium, methylcellulose, and polycarbophil. 

Bulk forming laxative should be used for long term management of chronic constipation, when straining of stool should be avoided, and managing chronic watery diarrhea. 

Caution should be used in clients with narrowed esophageal or intestinal lumen, those who need to avoid salt or sugar like DM2 and HTN clients since some dosage contains these items, those with fecal impactions and those that are pregnant. 

Osmotic Laxatives: Mechanism of action involves pulling water into the intestinal lumen to increase intraluminal pressure. They are hypertonic salt-based causing diffusion of fluid from plasma into the intestine to dilute the solution into isotonic state, magnesium salt also causes increase in the release of cholecystokinin by the duodenum. Drugs in this class are very powerful. Examples are magnesium hydroxide, magnesium citrate, sodium phosphate, polyethylene glycol, electrolyte solutions, and polyethylene glycol PEG 3350. 

Osmotic laxatives such as polyethylene glycol are used in cleaning the entire GI tract for diagnostic reasons, used in flushing poisons from the system, removal of parasites and for constipations especially PEG 3350. 

Caution should be used in people with renal insufficiency, because kidney may not be able to flush magnesium ions, people with hypermagnesemia, hypocalcemia, and heart blocks should not use, avoid in patients with bowel obstruction and paralytic ileus, PEG 3350 should not be used in children younger than 4 years because of electrolyte imbalances. 

Stimulant Laxative: These exert action on intestinal mucosa by stimulating the myenteric plexus thereby helping the release of prostaglandins and increase cAMP concentration. cAMP aids in stimulation pf electrolytes increasing peristalsis. Examples of these are Senna, bisacodyl, and castor oil. 

Stimulant laxatives are used in treatment for patients with reduced mobility, those using drugs that can cause constipation, with reduced intestinal motility, neurogenic bowel due to spinal cord injury, patients with IBS, it can be used also to prepare bowel for radiological or surgical procedures.  

Stimulants are to be used with caution in patients that has severe cardiovascular diseases, those with alcohol intolerance because of cascara sagrada extracts in some, also it can be excreted in breast milk of nursing mothers and may cause diarrhea for nursing mothers, castor oil is contraindicated in pregnant people because it can cause uterine contractions. 

Surfactant Laxatives: These are stool softeners. They produce emollient action by reducing the surface tension of the oil to water interface on stool causing the mixture of water and fat into the stool. Examples of drugs in this class are docusate sodium, docusate calcium, and docusate potassium.  

They are used mostly when feces are dry or hard, in the presence of anorectal condition causing stooling to be painful, and when straining to pass stool need to be avoided, it is safe in both old and young.  

Surfactants are generally safe and have no major contraindication except hypersensitivity to docusate ingredients, but could have side effects such as bloating, dehydration rectal irritation and cramping. 

CAUTIONS OF LAXATIVE OVERUSE 

Symptoms: This includes excessive bowel activity, cramping, flatulence, bloating or perineal irritations. 

Long-term health risks. Can cause laxative dependency leading to electrolyte imbalances, steatorrhea, osteomalacia, and vitamin and mineral deficiencies, may cause Tartrazine sensitivity leading to allergic type reactions because some of the products contain Tartrazine. 

Who is at risk. Those that are at risk include older patients, children, pregnant women, those with reduced mobility and those with other impaired physiological conditions that contraindicate use of laxatives. 

Possible referrals. Constipations can be effectively treated by primary physicians, family nurse practitioners, complicated cases can be referred to gastroenterologist. 

Reference 

Woo, T. M., & Robinson, M. V. (2020). F.A. Davis Company.