N512-19A Module 3 Assignment 2: Respiratory Disease Across The Life Span
Darla Thomas, 25 year old African-American previously well woman, presents to her primary care Nurse Practitioner’s office with complaints of episodic shortness of breath and chest tightness. She has had the symptoms on and off for about 2 years but states that they have worsened lately, occurring two or three times a month. She notes that the symptoms are worse during the spring months.
She has no exercise-induced or nocturnal symptoms. The family history is notable for a father with asthma. She is single and works as a secretary in a high-tech firm. She lives with a roommate, who moved in approximately 2 months ago.
The roommate has a cat. The patient smokes occasionally when out with friends, drinks socially, and has no history of drug use. Examination is notable for mild end-expiratory wheezing. Pulmonary function tests are ordered to confirm the diagnosis.
In this discussion:
- Discuss what you think this patient’s likely diagnosis is. Why do you support this “likely” diagnosis?
- Identify the pathogenetic mechanisms that are responsible for this patient’s symptoms of wheezing, shortness of breath, and chest tightness.
- What might you expect the results of her pulmonary function tests to be? Why?
- Provide and discuss a plan of care for her. What would be your priority patient education outcomes? How would you achieve these outcomes?
- Include citations from the text or the external literature in your discussions.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.
Discussion 3 Sample Approach
Asthma is classified as an obstructive lung disease, where the airway becomes overly reactive and inflamed (Berkowitz, 2020). It also causes episodic airway obstruction, which can manifest with an increase in mucous secretion, bronchospasms, and mucosal edema (Rebar et al., 2019). According to Berkowitz (2020) common triggers for a hyper reactive airway include, exercise, allergens, and cold air, and these triggers cause the airway to constrict.
Ms. Thomas presents with intermittent chest tightness and shortness of breath that gets worse during the spring months, and these symptoms are consistent with the diagnosis of asthma. Her father also has a history of asthma, and it is common for this disease to be passed on to children (Rebar et al., 2019).
The pathogenic mechanisms responsible for this patient’s symptom of wheezing involves the increase in mucous production and retention along with smooth muscle contraction in the airway, which results in airway obstruction and narrowing of the airways (Hammer & McPhee, 2019). According to Hammer and McPhee (2019) the pathogenic mechanism for this patient’s chest tightness and shortness of breath are due to the presence of spindle stretch receptors that are needed to overcome the increasingly resistant airways.
In addition there is thoracic distension that results from decreased lung compliance, increased work of breathing, and hyperinflation of the chest. The nerves in the chest wall sense these bodily changes, and respond with shortness of breath and chest tightness (Hammer & McPhee, 2019).
According to Rebar et al. (2019) in asthma, pulmonary function tests show the findings of decreased or low vital capacity, increased total lung and residual capacities, and signs of obstructive airway disease. These tests also show O2 and CO2 that are decreased (Rebar et al., 2019).
According to Hammer and McPhee (2019) when asthma symptoms exacerbate, the pulmonary function test would show FEV, FVC, and expiratory flow rates to be low as well. In addition, the functional residual capacity, residual volume, and total lung capacity will be increased due to the lungs not completely emptying, and the airway obstruction. This patient presents with mild symptoms that occur intermittently, so in between the asthmatic attacks her pulmonary function tests could be normal (Hammer & McPhee, 2019).
As a nurse practitioner, Ms. Thomas’s plan of care should include ways to prevent the asthmatic attack by identifying factors or triggers that lead to exacerbation of her symptoms (Rebar et al., 2019). This patient’s priority patient education outcomes would be reducing the frequency of asthma attacks, and learning how to identify triggers for it. In her case smoking, and cat dander could also lead to worsening of her asthma symptoms, so education on the importance of avoiding the triggering factors should be emphasized.
According to American Family Physician (2011) early treatment is one of the most effective strategies in reducing the severity of symptoms, avoidance of triggering factors, and pharmacologic therapy (American Family Physician, 2011). Medications used to treat acute asthma attacks include bronchodilators which quickly reduce the airway constriction, and help to effectively breathe again. In this patient’s case if she needs to be outside during the spring, antihistamines can be taken preventatively to reduce the potential for an asthma attack as well (Mayo clinic, 2020).
- American Family Physician (2011, July) Management of Acute Asthma Exacerbations. Vol. 84/No. 1 https://www.aafp.org/afp/2011/0701/p40.html
- Berkowitz, A. (2019) Clinical Pathophysiology Made Ridiculously Simple. Copyright 2007 by Medmaster Inc
- Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed). McGraw-Hill.
- Rebar, C., Heimgartner, M., & Gersch, C. (2018) Pathophysiology Made Incredibly Easy. 6th Edition. Philadelphia. Wolters Kluwer.
- Mayo Clinic (2020). Asthma https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc20369660
Emil Mowry is a 62 y.o., single, Latino rancher who did not complete high school. He remembers rolling his first cigarette when he was 11 years old. He does not remember ever wanting to quit smoking. For the last five years he has had increasing difficulty breathing. Emil was diagnosed by his Family Nurse Practitioner as having emphysema. He was told that he has Chronic Obstructive Pulmonary Disease (COPD). He did not ask his Nurse Practitioner what this means, but he plans to look it up on the Internet.
The purpose of this assignment is to create an evidence-based patient-centered educational brochure on the pathophysiology and clinical manifestations of, and common treatment options for, COPD that could be used by Nurse Practitioners or Nurse Educators with their patients newly-diagnosed with this disorder. The proposed brochure should include graphics and citations from your textbook and the external, scholarly-practice literature.
You may present the content in the electronic format of your choice: single sheet, folded, tri-fold. In other words, you may use MS Word Document, MS Publisher, or any other software to develop your educational brochure. Since your audience are patients, please keep in mind the literacy and numeracy level (some literature suggests no more than 8th grade level literacy and numeracy). Also, please refer to the Assignment Rubric below for grading criteria and to help you complete this assignment.
In regards to APA format, please use the following as a guide:
- Include transitions in your brochure, if needed (i.e. headings or subheadings)
- Use in-text references throughout the brochure
- Spelling, grammar, and organization are appropriate
- Include a reference list (this could be at the end of the brochure or you may submit a separate document listing your references)
- Attempt to use primary sources only. That said, you may cite reliable electronic.