NR 603 Week 2 Case Discussion: Pulmonary (Part One)-1. What is your primary diagnosis for Michelle given the pattern of occurrence of symptoms, exam
... [Show More] results, and recent history? Include the rationale and a reference for your diagnoses.
2. What is your first-line treatment plan for Michelle including medications, labs, education, referrals, and follow-up? Identify the drug class of each medication you prescribe and exactly what symptom it is targeted to address.
3. Address Michelle's request for an antibiotic
Dr. Deering and class,
Primary Diagnosis:
Based on the presenting symptoms and assessment findings within this case study, the primary diagnosis for Michelle is occupational asthma. Occupational asthma (OA), or work-related asthma (WRA), is the most common occupational lung disease in the United States (Global Initiative for Asthma [GINA], 2019). OA results from exposure to a stimulus, such as dust, grain, flour, latex, insects, and mold, found in the workplace environment (Jolly et al., 2015). Exposure to these types of allergens causes symptoms of asthma, including coughing, wheezing, chest tightness, and shortness of breath (Dao & Bernstein, 2018). Nasal congestion and eye irritation can also occur as a result of OA. In this case study, Michelle presents with shortness of breath while she is at work. When she is not at work, she has relief and no longer experiences difficulty breathing. Even on weekends when she is at home, she denies respiratory symptoms.
Individuals diagnosed with OA tend to have more symptomatic days and exacerbations of asthma symptoms while they are exposed daily to a particular allergen in the workplace. Since Michelle has a history of seasonal allergies, she is at an increased risk of developing occupational asthma. One of the main risk factors for occupational asthma is atopy, which is characterized by a sensitivity to allergens (Dao & Bernstein, 2018). Therefore, individuals with atopy often have seasonal allergies, allergic skin rashes, and food allergies. In this case study, Michelle has a history of seasonal allergies and has seen an allergy specialist.
Upon physical examination, Michelle was noted to have inspiratory and expiratory wheezing, thin exudates to bilateral nares, and a pale, boggy mucosa. These findings are indicative of inflammation within the respiratory mucosa from the irritant. The thin exudates within the nares are related to allergic rhinitis, which is an inflammation caused by the immune system’s response to an allergen (Pralong & Cartier, 2017). The wheezing is a result of airway narrowing from bronchoconstriction or mucosal edema (Pralong & Cartier, 2017). Michelle’s respiratory symptoms occur within a few hours of working in the bakery. She starts every morning baking bread and pastries for the day as a Baker’s assistant. Therefore, it can be safe to assume that Michelle is experiencing OA due to the type of flour used at the bakery. Even though staying away from the irritant is the best way to improve outcomes, we must initiate some tests to properly diagnose her before taking individuals away from work. In the office, Michelle had a pulmonary function test (PFT) performed. Airflow obstructions occurs when FEV1/FVC is less than 70%. Therefore, the result of FEV1/FVC 60% before the bronchodilator is indicative of airflow obstruction. After the bronchodilator was given, there was an increase of 15% in [Show Less]