The management of asthma requires an integrated approach to mitigation and prevention
Introduction
Disease management is an essential element that influences the outcomes of the care process. It is imperative that each strategy that is adopted addresses the aspects of the disease intending to make positive changes to the patient. Analysis of the patient’s subjective and objective data provides the practitioner with an in-depth understanding of the various elements that would determine the care for this patient. It is also necessary that critical variables are considered in the delivery of care. The care process must also find a teaching plan that would enhance the level of awareness that the patient develops regarding their condition. Further, a treatment plan that is hinged on a differential diagnosis will also provide a more accurate response in the management of disease and supporting Medicare. Asthma is one of the cardiovascular diseases whose impact varies depending on diverse factors that influence the severity of the condition. The management of asthma requires an integrated approach to mitigation and prevention.
History and Physical exam
Subjective
Chief complaint: “I have labored breath that is followed by the tightness of the chest and wheezing, especially in the cold evenings.”
HPI: CC recently moved to Austria after getting a promotion at work. The weather in Austria has been classified as one of the coldest across the region. For someone who works evening shifts, the chances are that he is always at work in the evenings when it is coldest in the area. Working overnight also exposes him to the cold weather significantly. After the first day of reporting, he started experiencing severe difficulties with his breath. Often, he would have to struggle to breathe, especially as his chest would tighten and make breathing quite difficult. CC notes that despite the efforts to remain warm by having warm clothing, the condition does not resolve. Sometimes, the loss of breath is marked by constant wheezing that forces him to use an inhaler to avert the struggle for air. The wheezing sometimes leads to painful coughs that limit his ability to work efficiently. Recently a doctor noted the possibility of a respiratory infection that may have worsened the respiratory issues that the CC presented. The condition seems to have worsened since he lives close to a farm, and there is the possibility of pollen allergies that may have increased the intensity of the asthma attacks. Notably, the condition seems to lighten with the use of air conditioners to clean the air in the room, although sometimes, he is expected to work in places without air conditioners. CC reports that the struggle to breathe always leaves him tired and unable to accomplish even simple tasks that involve a lot of movement. He wheezes whenever he climbs the stairs, and he often has to pause and catch his breath. In other instances, he has had to use the Albuterol inhaler, which is considered a fast-acting relief for acute asthma symptoms. Before the move to Austria, CC’s asthma had been dormant as he lived in a reasonably warm area, although the move to the colder regions of Austria seems to have triggered asthma.
Allergies: Ceclor,
Current Medication: Cinqair, Albuterol Inhaler, Claritin 10mg PO daily, Mucinex 1-2 tab PO PRN bronchial secretions.
Family History: Father had a history of hay fever, Mother had asthma.
Objective/ Physical Exam
The patient presents difficulty in breathing. Pale and dry skin with pink conjunctiva. The patient presents mild fever, and the bilateral eye sclera is white. The patient looks weak and tired, and the nose canal indicates reddened mucosa. The patient also presents wheezing upon inspiration and has dyspnea. Cyanosis is also noted, and the patient manifests restlessness while waiting on the bench.
(A) Assessment
Problem: #1 Labored breathing
Diagnosis: Atopic Asthma
Allergic asthma is a type of asthma that is influenced by different allergens. Durack et al. (2019) note that the changes in the environment have been considered as some of the factors that trigger the occurrence of this type of asthma. It is essential to recognize the impact of different allergens, including changes in the environment marked by dust and cold environments. Durack et al. (2018) highlight the need to identify these triggers and establish the required response that would mitigate and limit the progression or worsening of the condition.
There is a need to recognize the increasing prevalence of asthma across society, primarily based on the influences of the environment. Durack et al. (2018) discuss the need to seek medical interventions to avert the potential worsening of the condition. In instances where the allergens are avoidable, there is a need to avoid possible contact, for example, staying warm in cold environments, among other strategies (Durack et al., 2019).
Differential Diagnosis: COPD, congestive heart failure, cardiomyopathy, asthma, pulmonary fibrosis
Problem: #2 Wheezing
Diagnosis: Epiglottis
Epiglottis has been defied as a life-threatening condition that leads to a blockage of the windpipe and hence limits breathing (Torre et al., 2016). Injuries and infections are some of the common causes of the epiglottis, which is a closing of the small cartilage that covers the windpipe. Torre et al. (2016) note that any struggle with breath should necessitate a visit to the ER. Issues such as difficulty in breathing and swallowing, fever, and sore throat should call for an appointment to the hospital (Chmielewski, 2019).
Differential diagnosis: Anaphylaxis, bronchial asthma.
(P) Plan
Testing
Imaging scans
Spirometry
Cold Air challenge test
Management
Medication (At work): short acting Albuterol inhaler-1,1,1,2-tetrafluoroethane.
Medication (at home ):antibiotic-Doxycycline 100mg twice daily
Education
The patient must remain vigilant and adhere to the use of antibiotics as a means of mitigating the potential effects of the condition. The patient should also report to the emergency room in case of any of the exacerbations and worsening of the symptoms.
Further, there is a need to remain truthful, especially in the interaction with the doctor, as this will enhance the efficiency of the management practices that will be adopted in the plan of care.
Follow up
The patient should report to the doctor weekly until the condition is effectively managed.
Differential Diagnosis
#1: The first differential diagnosis centered on the possibility of allergies as the cause of the problematic breathing that the patient presented. The consideration of atopic asthma was influenced by the patient’s history as well as other comorbid factors such as the working environment. The evaluation of this diagnosis relies on issues such as family history as well as the subjective data presented by the patient. The patient notes a worsening and reoccurrence of the somewhat dormant asthma after the change of environment. The cold climate seems to have triggered the asthma attacks leading to the tightening of the chest (Chapman, 2018). Further, the history of asthma in the family remains a central factor in the confirmation of this diagnosis. Pavord et al. (2018) note that a patient has a higher chance of having atopic asthma if the mother suffers from the condition. The patients’ mother has asthma, and as such, CC is predisposed to the disease. The father also has a hay fiver, which provides a slight chance of atopic asthma in the patient. This differential diagnosis is confirmed as an issue arising from inheritance and the environment.
#2: epiglottis is the second differential diagnosis established as the cause of the wheezing that the patient presents. Epiglottis is defined as a condition that emerges from infection or injury that affects the status of the windpipe. However, different tests indicate a different element altogether. The cold air test provided substantial evidence of the impact of changes in the environment on the patient. Upon exposure to cold, the patient started wheezing uncontrollably. This is unlike the expectations for a patient with epiglottis. The x-ray indicates no significant blockage of the windpipe, and the wheezing subsides with the use of the Albuterol inhaler (Fanta & Hockberger, 2019). The inhaler opens the blocked airways and also reduces the pressure on the chest (Gelfand et al. 2018). Therefore, the patient could not be suffering from Epiglottis as earlier thought.
Orders
After the determination of the patient’s condition as atopic asthma that had led to the different symptoms. The doctor ordered oxygen therapy to relieve the pressure on the chest and also reduce the wheezing that was evident. The patient is subjected to this therapy, considering the need to avert the challenges caused by the allergens that have led to the occurrence of the attack. However, Fergeson et al. (2017) caution on the dangers associated with oxygen therapy, especially in causing atelectasis and intrapulmonary shunting. These are the potential issue that must be considered in this type of therapy. The national guidelines advocate for the saturation of the oxygen to be higher than 92%, which is within the threshold for asthma management (Fanta & Hockberger, 2019). Further, considering the condition of the first differential diagnosis, no other tests were ordered for the patient.
First and Second-Line Treatment
The first response for the patient upon visiting the hospital is the determination for hospitalization. Pavord et al. (2018) note that acute asthma attacks may necessitate admission, pending the response to the given medications at the hospital. During this time, there is a need for additional tests to determine potential factors that influence the patient’s condition. Chapman (2018) notes the significance of patient history, including the number of visits to the ER. The treatment at this stage will rely on nebulizers and bronchodilators (Gelfand et al. 2018).
CC presented evidence of moderate asthma attack, and as such short-acting beta-agonists were prescribed to facilitate recuperation (Navanandan et al., 2017). It was fundamental that the patient understands the necessary environmental changes that would limit exposure and enhance the prevention of such attacks.
Prescribed management comparison
The potential risks of bacterial infection, including additional respiratory distress, could be potentially dangerous and that administration of antibiotics, even though a bacterial infection was not confirmed, out weighted the risk of a pending disease on the patients overall health (Li et al., 2017).
When a patient has an allergic response from an environmental allergen as the patient in this case study presented with the body must react with an immune response to decrease the impact that the allergen has on the patient’s respiratory system (Pavord et al., 2018). These are critical elements of the care process that are defined by choice of management strategies. Notably, limited patient education was provided, although the doctor shared with the patient on the critical areas of managing the condition about the environment where the patent operates.
Conclusion
Proper management is an essential element in the provision of care. There is a need to explore the underlying factors that influence the patient’s condition. Every visit to the hospital should necessitate the establishment of viable management strategies for all presented symptoms. Asthma attacks are varied, and as such. Differential diagnosis must be considered as a means of identifying the leading causes of a patient’s condition. The outcomes of care are tied to the strategies that are adopted in managing the patient’s disease as well as the level of awareness that the doctor gives the patient in the process of providing care.