Patient Care Plan
our 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. Asthma as a child, diagnosed at age 8 for which she used a SABA when needed. She has not had the need to use an inhaler since she was 19. She takes only her prenatal vitamin. 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 in this area 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 and wakes 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%
Construct a narrative document of 4-5 pages (not including cover page or reference page)
Diagnose the patient based on the above findings and provide your rationale for how you arrived at the diagnosis.● An accurate diagnosis with correct staging is provided
● Rationale for arrival at the diagnosis with support from national guidelines is provided
Develop a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.● Correct medications are prescribed to treat the diagnosis
● Rational for medications prescribed adheres to national guidelines● Five or more non-pharmacologic interventions are provided
Describe community resources (using your own community) currently available in your state/city to support this patient.● Three or more local community resources are provided
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.● A communication plan which includes principles of therapeutic communication is developed
Utilize national standards, your pharm(Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th ED) and/or patho (Porths Pathophysiology Concepts 10th ED) 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. ● Professional, peer-reviewed, advanced practice references are used not more than 5 years old
● Grammar and mechanics of writing demonstrate graduate level work
● Adheres to page number requirements
Patient Care Plan
Patient Care Plan
Course Name and Number
Patient Care Plan
All patients presenting to a health facility deserve the best quality healthcare, safe, evidence-based, and effective in addressing their health conditions. This will help provide relief by alleviating the symptoms and improving their health outcomes and quality of life. Providing such effective care requires proper diagnosis by obtaining a good history from the patient regarding their symptoms, doing a targeted physical examination, and ordering and interpreting relevant investigations. This will help determine the exact diagnosis, which makes the process of planning for the treatment easier, and the treatment to be more effective in improving patients’ health outcomes (Shelledy & Peters, 2021). This paper describes the care plan for a 23-year-old female who is 25 weeks pregnant and presented with cough and wheezing for three weeks.
Diagnosis and Rationale
From the patient’s clinical presentation, the most likely diagnosis is asthma exacerbated by various factors. These factors include; the pregnancy, stress, and anxiety due to the reported abusive domestic situation and difficulties adapting to the new environment where the patient relocated after fleeing from the abusive situation(Landeo-Gutierrez et al., 2020). Being a known asthmatic patient, the factor mentioned earlier would significantly exacerbate her condition. This causes increased inflammation, increased mucus secretion, and bronchospasm of bronchial smooth muscles that eventually narrows the airway, causing difficulty in breathing that presents as a wheeze and cough to clear the airway by eliminating the secreted mucus. Recognizing the various exacerbating factors helps in the treatment and management plan. It is essentially based on controlling these factors and minimizing the exposure to allergens as much as possible.
The lack of social support and having psychological issues due to the domestic problems she had before could be the significant contributors, as these can lead to asthma-related stress (Landeo-Gutierrez et al., 2020). Asthma-related stress is a significant indicator of coping mechanism to stress among known asthmatic patients. Even waking her up from sleep could add more to the psychological trauma, further exacerbating the condition (Landeo-Gutierrez et al., 2020). Pregnancy is also associated with various physiological changes across all body systems, which may also be responsible for her exacerbation.
Besides, pregnant women require more support, which the patient lacks and could worsen her stress. Having relocated to a new environment, the environmental conditions in her current location could also exacerbate her condition until she develops tolerance and adapts fully to the new environment (Landeo-Gutierrez et al., 2020). Asthma management during pregnancy requires close monitoring and evaluation to prevent the side effects which some medications may have on both the fetus and the mother. Therefore, the required treatment protocol should guide the choice of drug to ensure safety for both the patient and the unborn baby.
As mentioned earlier, the treatment plan should aim at providing relief to the patient while at the same time not compromising the safety of both the mother and the unborn baby. This can affect the fetus’s growth and development, thereby resulting in poor pregnancy outcomes, not sidelining the fatal consequences on the mother. Asthma affects the oxygen supply to the body, which will affect not only the mother but also the fetus. Therefore, the associated benefits of controlling asthma in pregnant women supersede the risks associated with some asthma-relieving medications (Albertson et al., 2020). The management guidelines for asthma for pregnant women take two forms, which include pharmacological and non-pharmacological interventions.
The pharmacological treatment guidelines include beta-2 agonists, montelukast, and inhaled corticosteroids. The beta2agonist commonly used is albuterol sulfate with the brand name Proventil also known as the rescue inhaler. It is used in the management of acute symptoms of asthma, such as shortness of breath. Therefore, it is used at any time a patient experiences asthma exacerbation (Albertson et al., 2020). It is given as a puff every four to six hours, with the loading dose being 90 micrograms. The puffs can be repeated at 10 to 15 minutes, depending on the number of exacerbations a patient experiences. The drug is available in different pharmacies where the patient can easily have refills done.
The use of montelukast is also another pharmacological intervention applied. Under the brand name Singulair, Sole is often referred to as “asthma maintenance” since it is used to prevent wheezing and coughing which may exacerbate asthma and relieve shortness of breath (Albertson et al., 2020). It is given s one tablet per oral every afternoon and has a loading dose of 10 milligrams. Budesonide, an inhaled corticosteroid, is also used to manage asthma exacerbation. It is given a loading dose of 0.25mg/mm after every six hours. However, the dose can be adjusted depending on the need (Albertson et al., 2020).
The pharmacological interventions should be supplemented with non-pharmacological interventions for maximum effectiveness in addressing the patient’s condition (Tan et al., 2020). The patient should be taught on the need to avoid any known allergen which could be notorious for exacerbating their conditions. Besides, the patient should be counseled on coping mechanisms and stress management techniques given her current status, which predisposes her to psychological unwellness that can exacerbate her condition (Tan et al., 2020). The patient should also receive a dietician review to advise her on an appropriate diet to prevent exacerbation of her condition. At the same time enhance the health and development of the fetus. Lastly, the patient needs to be advised on follow-ups to monitor her progress, asthma, and pregnancy (Tan et al., 2020). This will help in the early identification of any issue that may affect the patient and the fetus. If possible, follow-ups at home are highly recommended.
Community Resources Available To Support the Patient
Various states, including mine, offer affordable prenatal care services to all pregnant women at various local health centers. Some agencies aim to increase prenatal coverage so that no woman is left behind, including those from low-income backgrounds. Besides, various local health departments have been established to examine maternal health, the infants’ health, and the children’s health (Bellin et al., 2017). These various departments can help manage and monitor the patient’s situation and the unborn baby. There is also an organization consisting of volunteers who aim to prevent asthma and assist asthmatic patients. It offers patient education and management of the condition and would therefore be helpful to the patient.
There is also a program that helps cover the costs of prescriptions for uninsured and underinsured residents within the state (Bellin et al., 2017). This could also help the patient reduce the cost of the medications, given that she has no health insurance cover at the moment. Lastly, a state department also deals with domestic violence by advocating for its prevention and helping the affected victims recover and live a quality life. This will help the patient with stress management, an essential exacerbating factor for her condition, most likely due to the domestic violence she recently experienced (Bellin et al., 2017).
Therapeutic Communication Plan
Proper communication is essential in ensuring that the various concerns of the patients are addressed, and the patient is better placed to facilitate her management. This could be enhanced by encouraging the patient to express herself freely and any concerns she may have and addressing them appropriately. Offering counseling services to the patient may also provide more information on her need and the factors which may affect her management and thus can then be addressed (Shelledy & Peters, 2021). Providing clear instructions regarding the patient’s requirements through effective communication will ensure that the patient is well informed regarding what is required of her. This can further be assessed using the teach-back method, where the patient gets to explain what is required of her in various appointments she has and during the follow-up visits.
Albertson, T. E., Chenoweth, J. A., Pearson, S. J., & Murin, S. (2020). The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Expert Opinion on Pharmacotherapy, 21(2), 213-231. https://www.tandfonline.com/doi/abs/10.1080/14656566.2019.1701656
Bellin, M. H., Collins, K. S., Osteen, P., Kub, J., Bollinger, M. E., Newsome, A., … & Butz, A. M. (2017). Characterization of stress in low-income, inner-city mothers of children with poorly controlled asthma. Journal of Urban Health, 94(6), 814-823. https://link.springer.com/article/10.1007/s11524-017-0162-1
Landeo-Gutierrez, J., Forno, E., Miller, G. E., & Celedón, J. C. (2020). Exposure to violence, psychosocial stress, and asthma. American journal of respiratory and critical care medicine, 201(8), 917-922. https://www.atsjournals.org/doi/full/10.1164/rccm.201905-1073PP
Shelledy, D. C., & Peters, J. I. (2021). Respiratory care: patient assessment and care plan development. Jones & Bartlett Learning. https://books.google.com/books?hl=en&lr=&id=iLAPEAAAQBAJ&oi=fnd&pg=PP1&dq=patient+care+plan&ots=69jGySXgJy&sig=_A7IUhsWlY2JwWTeqnu1KrBYqO8
Tan, D. J., Burgess, J. A., Perret, J. L., Bui, D. S., Abramson, M. J., Dharmage, S. C., & Walters, E. H. (2020). Non-pharmacological management of adult asthma in Australia: cross-sectional analysis of a population-based cohort study. Journal of Asthma, 57(1), 105-112. https://www.tandfonline.com/doi/abs/10.1080/02770903.2018.1545030