JR is a 56 yo man with h/o bronchial asthma, HTN and hyperlipidemia. He presents to the ER at the moment with h/o shortness of breath for 45 minutes at relaxation. He reviews that he was feeling properly and in his traditional state of well being till about an hour in the past, when he smelled one thing burning. 20 minutes later, he started to really feel wanting breath and was wheezing. He tried utilizing his albuterol inhaler with out success, so he proceeded to the ER. Upon arrival, he was tachycardic, tachypneic, wheezing, utilizing accent muscle tissues and hypertensive. His final admission for an bronchial asthma assault was 2 months in the past. He denies a current chilly or URI and says the albuterol often helps him when he feels an assault approaching and tends to make use of it each day. He usually has wheezing and shortness of breath each day. JR reviews poor sleep on account of waking about 2 instances every week for shortness of breath. He has 2 cats, which sleep subsequent to him on his pillow and he lives in an residence advanced. JR doesn’t smoke, however his neighbor smokes. JR is a carpenter by occupation. He displays his peak circulation as soon as every week at residence. He reviews that his peak circulation usually runs about 325 L/min and his private greatest is 480 L/min. His present peak circulation is 175 L/min.
Medicine Previous to Admission:
Albuterol MDI 2 puffs BID-QID PRN
Salmeterol Diskus 1 inhalation QID
Ipratropium bromide MDI 2 puffs QID
Lovastatin 20 mg po HS
Lisinopril 10 mg po QD
Questions:
Classify JR’s bronchial asthma severity and management primarily based on indicators and signs previous to this most up-to-date exacerbation and go to to the ED.
Classify JR’s exacerbation severity primarily based on PEF and signs.
Determine the assorted triggers in JR’s life which will exacerbate bronchial asthma and forestall management.
Which step ought to JR have been on previous to ER primarily based on severity and present medicines?
Which medicines are dosed incorrectly and/or inappropriate for JR’s bronchial asthma severity?
Would a short-burst of oral corticosteroid be indicated presently? In that case, what dose and period?
How would you assess that JR is well-controlled?
If JR is well-controlled, how would you step down in remedy?
Put up your preliminary response by Wednesday at midnight. Reply to at least one pupil by Sunday at midnight. Each responses needs to be a minimal of 150 phrases, scholarly written, APA formatted, and referenced. A minimal of two references are required (apart from your textual content).
