My past three weeks have been characterized by coughing, fatigue, sneezing, and wheezing throughout the day and night. In my childhood, I was diagnosed with chickenpox, at the age of 8, and asthma. For this reason, I have been using SABA when the need arises. However, I stopped using an inhaler at 19. Currently, I am only using pre-natal vitamins and I have been up to date with all my immunization. Pertaining to social life, I am a non-smoker and I relocated to this state as an escape from an abusive relationship. Therefore, I have no support network. Currently, I am unemployed and I have no medical insurance.
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The patient appears disheveled but clean, she experiences wheezing in both lungs. Her vital signs include a temperature of 98, 28 breathing rate per minute with no stridor, pulse rate is 82, which is regular, and the fetal heart rate is regular at 130.
A normal respiratory rate for adults ranges from 12–20 breaths per minute. The patient registered a fast breathing rate of about 28 breathes per minute, which is linked to lung diseases (Bonham et al., 2018). The lack of fever excludes diseases such as acute bronchitis, pneumonia, and pulmonary infection from this case study diagnosis (Robijn et al., 2019). The high respiration rate, wheezing, and coughing experienced by the patient indicate conditions such as chronic obstructive pulmonary disease (COPD), asthma, pulmonary embolism, and dyspnea in pregnancy.
Pulmonary embolism with symptoms like dyspnea and cough is common in pregnant women. It is characterized by cough with blood-streaked mucus, chest pain, and rapid heartbeat. However, these symptoms were not exhibited by this patient. Furthermore, the patient has a normal heart rate. Thus, this disease is ruled out in the diagnosis. Shortness of breath with a lack of breathing sound is a sign of severe asthma and COPD. Nevertheless, COPD is mostly associated with a history of smoking and old age of more than 50 (Robijn et al., 2019). It is also characterized by persistent coughing and the release of phlegm for at least two years, and since the patient has been coughing for about three weeks only and she is a nonsmoker with no known chronic disease, COPD is not the cause of her illness. The woman had fled from an abusive relationship and her disheveled appearance shows that she is in distress. Emotional factors such as panic, anxiety, and frustration exacerbate asthma and dyspnea. Chest tightness and shortness of breath are common in two-thirds of women during pregnancy (Global Initiative for Asthma, 2016). It is caused by gestational hormones and physiological changes of pregnancy.
All the respiratory symptoms exhibited by the patient such as wheezing, persistent coughing for about two weeks, and shortness of breath are the symptoms of asthma. This disease is worsened in the presence of stress and allergens. Bronchodilator reversibility test and PEF variability can be used to confirm the diagnosis. However, based on the patient’s medical history, she has asthma. The differential diagnosis in this case study is dyspnea in pregnancy.
The goal of this treatment plan is to maintain optimal respiratory function, prevent chronic symptoms, and to reduce exacerbation. In addition, fetal oxygenation should be maintained by preventing incidents of hypoxia in the mother. Short-acting β-agonists (SABA) is recommended as a pain-relieving medication for asthmatic patients (Bonham et al., 2018). Inhaled corticosteroids (ICS) especially budesonide are also effective in preventing readmissions and acute exacerbation risk.
In pregnant women, specific immunotherapy and anti-IgE monoclonal antibodies are not recommended. Effective and safe drugs used by pregnant women include beta2-agonist, glucocorticoids, anticholinergics, leukotriene receptor antagonists (LTRAs), and theophylline (Global Initiative for Asthma, 2016). A stepwise approach coupled with patient education, management of comorbidities, and environmental control will be undertaken. In each phase, evaluation of asthma control level will be conducted after every three weeks of intervention. Step down from a rank will be done if asthma is controlled for more than 3 months. However, an increase in severity of asthma, when adherence to comorbid condition and environmental control is maintained, will result in a step up.
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Step Wise Therapy
In the first step of this therapy, short-acting acting β-agonists (SABA PRN) alone are offered. However, since the patient is predisposed to anxiety, which is a risk factor, treatment will start from the second phase. Treatment with a low dose of inhaled corticosteroid (ICS) is effective in stage two (Becker & Abrams, 2017). Alternatively, edocromil, Leukotriene receptor antagonist (LTRA), and cromlyn can be used at this point. In the third step, low dose ICS and LABA or Medium dose ICS and SABA PRN can be offered. The fourth phase requires a high dose of ICS and LABA, while the fifth stage needs a high dose of ICS and LABA and an oral corticosteroid is appropriate.
Non -Pharmacologic Intervention
The patient will be taught to properly manage asthma condition at home and the lessons offered will aim at improving drug compliance and self-monitoring. The woman will also learn how to use inhalers properly. Evading triggers is an effective and cheap intervention, and the client will, therefore, learn the importance and ways of eluding irritants that may trigger an asthmatic attack. For instance, risk factors such as drugs, climate change, specific environments, and allergens should be avoided.
Community Resources to Support the Patient
The Asthma and Allergy Foundation of America (AAFA) was founded in 1953 as a nonprofit organization. It is an advocacy group that provides practical information to patients with allergies and asthma through national networks and support groups. In addition, this association is known for funding research activities involved in developing better cure and treatment. AAFA is an important resource in my community and it will provide a support network and health education materials for my patient.
The patient’s participation in the imlementation of the treatment plan is vital. This is because it encourages self-management and compliance with a chosen care strategy. Application of therapeutic communication techniques such as active listening, providing leads, focusing, clarification, exploring, and reflecting are beneficial to the client. A good relationship between a patient and a healthcare provider enables feelings verbalization and support from the client. It also enhances a nurse’s assess to nonverbal and verbal communication needs of a sick person.
Therapeutic communication techniques will be achieved by building trust, using time and sequence when describing events, and giving patients a chance to communicate directly. Additionally, I will offer the patient to chat with her by sparing at least 10 minutes after taking the vitals every day. As a health care provider, I endeavor to show interest and respect for the client through acknowledgment, recognition, and acceptance. This is important because it allows her to be open when discussing the treatment plan.
Becker, A. B., & Abrams, E. M. (2017). Asthma guidelines: The Global Initiative For Asthma in relation to national guidelines. Current Opinion in Allergy and Clinical Immunology, 17(2), 99-103.
Bonham, C. A., Patterson, K. C., & Strek, M. E. (2018). Asthma outcomes and management during pregnancy. Chest, 153(2), 515-527.
Global Initiative for Asthma (GINA). (2016). Global strategy for asthma management and prevention. [PDF document]. Web.
Robijn, A. L., Jensen, M. E., Gibson, P. G., Powell, H., Giles, W. B., Clifton, V. L., & Callaway, L. K. (2019). Trends in asthma self-management skills and inhaled corticosteroid use during pregnancy and postpartum from 2004 to 2017. Journal of Asthma, 56(6), 594-602.