Case Study – 23-year-old Female Diagnosed with Relapsed Asthma
The case is of a 23-year-old female who presented with coughing and wheezing that started three weeks before she visited the hospital. The cough is unproductive, and the wheezing is audible and can be heard across the room. She states that her symptoms have been like that all day and that she is fatigued even in the morning. She has a history of chickenpox in her childhood and was diagnosed with asthma at the age of eight, prompting her to use SABA when needed. She has, however, not needed to use an inhaler since she was 19. She is currently taking her prenatal vitamins. She has no other chronic illnesses and is up to date with all her immunizations except for the flu shot she is scheduled to receive. Her social history is negative for smoking or drug use. She recently moved to the state to get away from an abusive domestic situation. She is unemployed and lacks insurance. Assessment findings revealed that the patient is disheveled but clean, has a body temperature of 98F, a pulse rate of 82 bpm, a respiratory rate of 28 bpm, and is wheezing in all lung fields.
Diagnosis
The patient has had an asthmatic relapse. Asthma is a chronic airway disease characterized by an inflamed and narrowed airway. The classical presentations of wheezing, shortness of breath, and coughs are indicative of asthma. Fatigue is another common presentation among asthmatics and has been linked to low blood oxygen, which is a result of being accustomed to airway blockade. Asthmatic relapse is the presentation of asthma symptoms in patients who have had remission for more than three years (Ramsahai et al., 2019). The patient, in the case, presented with wheezing, coughs, and fatigue after a period of not needing to use her inhaler medications. This is indicative of relapsed asthma. Additionally, a positive history of asthma reported by the patient confirmed the asthmatic relapse diagnosis.
Treatment Plan for Relapsed Asthma
The therapeutic target for asthma management is to lessen asthmatic symptom severity and identify and eliminate asthmatic triggers. A combination of pharmacologic and non-pharmacologic interventions is valuable in this regard. Non-pharmacological conservative measures have been shown to lower the likelihood of asthmatic relapse. These measures include weight reduction in obese asthmatics and environmental control to lessen exposure of individuals with a history of asthma to environmental triggers such as pollen and industrial chemicals (Schuers et al., 2019). For the patient in the case provided, identifying environmental factors that may be precipitating her disease is important. This includes asking her where she lives to help identify what may have caused the relapse. Implementing these conservative measures may lower the chances of further asthmatic attacks occurring.
Pharmacotherapy with antiasthmatic medications remains effective in the symptomatic management of asthma. Reliever medications such as short-acting beta-agonists (SABA) and controller medications such as corticosteroids can alleviate asthmatic symptoms and prevent disease exacerbations. The most commonly used SABA reliever medications are terbutaline and albuterol. These medications offer fast relief from airway blockade through their bronchodilatory effects. Controller medications such as inhaled corticosteroids (e.g., fluticasone and budesonide), long-acting beta-agonists (e.g., salmeterol), anticholinergics (e.g., ipratropium bromide), and leukotriene antagonists (e.g., montelukast) maintain effectiveness in asthma pharmacotherapy.
The asthma therapeutic plan utilizes a stepwise approach. Inhaler SABA, when needed, is the first step in asthma management. In the case above, the patient will be given an inhaled SABA for quick relief of her asthmatic symptoms and advised to use it only when necessary. If optimal asthmatic control is not achieved, a low-dose inhaled corticosteroid may be added, and the dose may be optimized to a medium dose as per the asthmatic response. Failure to achieve optimal asthmatic control will prompt the addition of either a long-acting beta-agonist or a leukotriene antagonist. This will then be followed by optimization of the inhaled corticosteroid dose to a maximum dose if asthmatic control has not been achieved. The final step in this stepwise asthmatic management approach is the use of oral systemic corticosteroids. Patient education and environmental control are significant in this stepwise approach (Papi et al., 2020). Patients should be educated on the right inhaler technique to optimize the inhaler’s effectiveness. Additionally, their environment should be assessed, and asthmatic triggers should be eliminated.
Community Resources
Several community resources are available in Oakdale, MN, and in the vast state of Minnesota that raise awareness of asthma and help patients with the disease. The American Lung Association in Minnesota (ALAM) is an organization that seeks to create awareness of various lung pathologies. This organization can educate community members on aspects of the disease and patient-centered interventions that are valuable in managing them. Through their series of events, they have impacted communities positively. The Allergy and Asthma Network is another non-profit organization whose mission is to end asthma-related mortalities through robust community education programs on the disease, advocacy, and research on innovative measures in managing asthma. The Asthma Community Network is another organization that is valuable in asthma management. This organization draws asthma patients and other stakeholders involved in managing the disease, such as health plans, environmental agencies, caregivers, and other care organizations, to educate communities on asthma and provide them with the necessary support. These resources can be leveraged to inform better management strategies and ensure the well-being of asthmatics.
Communication Plan
An effective communication plan is integral to patient-caregiver engagements. The chronicity of asthma, coupled with the complexities in its management, warrants an elaborate communication plan with the patients that starts with establishing a good therapeutic rapport with the patients. This can be attained using principles of effective therapeutic communication such as active listening, giving broad openings, seeking clarification, and silencing (Kwame & Petrucka, 2021). The essential components of a communication plan that ensure the patients stick to the therapeutic plan include time, compassion, honesty, communication, and technique. Caregiver-patient engagements should be wary of time. In this regard, caregivers should give their patients enough time to perform their assigned tasks without interference from the caregiver. This will not only inculcate a culture of following instructions but will also ease any tension the patient may have.
Caregivers should also maintain compassion when engaging their patients. Compassion assists in the fast recovery of patients and increases their compliance with clinical instructions. It is for this reason that caregivers’ compassion is warranted. Caregivers should also be honest with their patients when educating them on presentation aspects. In this regard, they must educate the patients on the asthma disease process and its harmful effect on their well-being. This may enhance patients’ accountability in following clinical instructions and taking their medications. Respect for patients’ beliefs and values is paramount in the entire patient-caregiver interactions. Recognition of patients’ beliefs promotes patient-centered care and the patient’s acceptability of therapeutic interventions. Through these approaches, caregivers can ensure that the patient in question abides by their treatment plan.
References
Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00684-2.
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 & Clinical Immunology, 16(1). https://doi.org/10.1186/s13223-020-00472-8.
Ramsahai, J. M., Hansbro, P. M., & Wark, P. A. (2019). Mechanisms and management of asthma exacerbations. American Journal of Respiratory and Critical Care Medicine, 199(4), 423–432. https://doi.org/10.1164/rccm.201810-1931ci.
Schuers, M., Chapron, A., Guihard, H., Bouchez, T., & Darmon, D. (2019). Impact of non-drug therapies on asthma control: A systematic review of the literature. European Journal of General Practice, 25(2), 65–76. https://doi.org/10.1080/13814788.2019.1574742.
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Question 
Case Study – 23-year-old Female Diagnosed with Relapsed Asthma
Your patient is a 23-year-old female. She presents with coughing and wheezing, which she stated started about three weeks ago. She is currently 25 weeks pregnant. Her last prenatal visit was one month ago in another state. She has an appointment with the prenatal care provider next week. However, her respiratory symptoms brought her to your office today.
History – Chickenpox as a child. She had asthma as a child, diagnosed at age 8, for which she used an SABA when needed. She has not needed to use an inhaler since she was 19. She takes only her prenatal vitamins. No other acute or chronic problems. She advises you that she is up to date on all immunizations, except she has not had a flu shot (it is October).
Social – Non-smoker, no drug use. She relocated to your state two weeks ago to get away from an abusive domestic situation. She has no support network and has not yet found employment. She has no medical insurance.
HPA – Non-productive cough x 3 weeks. Wheezing audible from across the room. She states it is like this all day, waking her from sleep every night. She reports that she is fatigued even in the morning. No other complaints.
PE/ROS – Pt appears disheveled but clean. Wheezing in all lung fields. T 98, P 82 regular, R 28 no stridor. FH 130 regular. The remainder of the exam is WNL.
02 98% and FEV 70%
Directions:
- Construct a narrative document of 4-5 pages (not including the cover page or reference page)
- Diagnose the patient based on the above findings and explain how you arrived at the diagnosis.
- Develop a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.
- Describe community resources (using your community) currently available in your state/city to support this patient.
- Provide a communication plan that you will use to ensure the patient is an active participant in the treatment plan. Refer to therapeutic communication concepts.
- Utilize national standards, your pharm and/or patho book, and medical or advanced practice professional sources. Do not use patient-facing sources or general nursing texts.
- Use references to support your concepts. Utilize correct APA formatting (7th edition) and mechanics of professional communication.