NR603 Week 2 Part 2 (Total Points Possible: 40)
Requirements:
Michelle continues to work in the bakery and her asthma has been well controlledon a
low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she
uses 1-2 times per week. Michelle presents to the clinic with an acute illness that
developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2
saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to
speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is
productive of white sputum.
Influenza A is going around the bakery. Exam findings show a woman who appears her
stated age and is alert and oriented and though calm, is having mildwork of breathing.
AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough,
is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales,
no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is
elevated at 110. Physical exam is otherwise unremarkable. The MA has swabbed her
for Influenza A- testis positive.
Discussion Questions Part Two:
1. Determine appropriate treatment plan for Michelle. Discuss medications, doses,
Durable Medical Equipment, and any testing, and apply these directly toher case.
Provide your rationale with evidence.
2. Decide whether she is safe to return home, include any prescriptions, or if a
referral to a higher level of care is required. Discuss the criteria used to make your
decision, how a referral is made and defend your position.
3. Discuss relevant education and follow up plan.
Week 2: Case Discussion Pulmonary - Part 2 Follow up Visit
Hello Dr. Martin and Class,
Influenza is a self-limiting virus that can become complicated thus requiring immediate
care. Patients who can have complications from the influenza includethe elderly, children
under 6 months of age, pregnant women, and people with chronic conditions or
immunosuppression (Ghebrehewet, MacPherson, & Ho, 2016).
Determine appropriate treatment plan for Michelle. Discuss medications,doses,
Durable Medical Equipment, and any testing, and apply these directly to her
case. Provide your rationale with evidence.
Aside from the fact that multiple people in her job have contracted the influenza virus,
Michelle is now exhibiting signs and symptoms consistent with influenza A.
Today, she tested positive for influenza A virus after already having her symptoms for
the last 2 days. Because Michelle has a history of asthma, it isimportant for her to seek
medical attention as soon as possible to prevent complications.
A nasopharyngeal swab can confirm diagnosis by collecting a sample from the upper
respiratory tract. Rapid testing methods are typically done outpatient, andbecause of its
quick turn-around rate, the test can have some false negatives.
Therefore, results should be correlated with symptoms and treat as appropriate(CDC,
2019).
