T.J., an active 15 y/o high school soccer player, was brought into the ED with complaints of shortness of breath and severe expiratory wheezing

T.J., an active 15 y/o high school soccer player, was brought into the ED with complaints of shortness of breath and severe expiratory wheezing. Medical history of asthma diagnosed at nine years of age. Asthma triggers include dander and pollen. As of recent, T.C. has been experiencing exercise-induced asthma exacerbation. T.C. admits that he has difficulty remembering to take his inhalers at home and forgets to administer his albuterol before the evening game.

 

Physical Exam:

Vital signs: BP: 140/80 P: 125 RR: 38 T: 99.0, SPO2: 86% ON ROOM AIR

Wt. 170 lbs BMI 26.5

ABG: pH: 7.31, PaCO2: 55, PaO2 77, HCO3: 25

 

General:

HEENT: Normocephalic, atraumatic.

Nasal mucosa boggy and inflamed without obvious purulent discharge.

Oropharynx moist, scrapable white film noted on his tongue.

Neck: Supple, no thyromegaly or lymphadenopathy.

Cardiac: Tachycardia, Regular rate, no murmurs, rubs, or gallops.

Pulmonary: Diffusely decreased breath sounds bilateral. Diffuse expiratory wheezes,particularly evident with forced expiration.

Extremities: No edema or skin changes noted.

Radial, posterior tibial and dorsalis pedis pulses 2+ bilaterally.

 

T.C. is diagnosed with acute asthma exacerbation.

 

1. What would you anticipate the provider to order to manage T.C.’s condition? (list themedication and purpose in managing the situation)T.C. has been stabilized and will be discharged on Albuterol, Fluticasone & fluconazole.

 

2. Describe the indication and mechanism of action for these medications.

 

3. Briefly outline how and when T.C. should administer these drugs and provide any additional patient teaching regarding administration.

 

4. T.C. does not understand why he has been prescribed fluconazole. Please explain why the provider ordered this drug.

 

Shrivatsa, a 45-year-old man, presents to urgent care with new-onset abdominal pain, nausea, bloating, and dark stools. Shrivatsa has struggled with back pain since a motor vehicle accident in 2016. The pain has recently been intolerable, making it difficult for him to work. Shrivatsa admits that she has been taking several ibuprofen tablets daily, usually in the morning, afternoon, and before bed; he is unsure of the dose but states he administers anywhere from 3-4 pills each time, and sometimes maybe even 5 tablets. He has been treating his back pain with this method for the last six months. The provider

 

draws labs to include:

CBC

Urea Breath Test

Fecal Occult Stool

 

The results come back with:

Hemoglobin: 9.0

Urea Breath Test: Negative for Helicobacter Pylori

Fecal Occult Stool: Positive

 

The provider consults the gastroenterologist and schedules Shrivatsa for an EGD/Colonoscopy

 

.a. What is most likely Shrivatsa’s diagnosis?The EGD/Colonoscopy notes erosion in the duodenum.

b. The provider orders Ondansetron. What is the purpose of the order, and what side effects may you expect?

c. Shrivatsa is started on Pantoprazole, antacid and sucralfate. Develop a teaching plan for Shrivatsa describing how these medications work differently to treat his condition and their administration consideration (NSAID induced Peptic Ulcer Disease).

 

Pantoprazole:

Cimetidine:

Sucralfate:

Antacid:

 

d. What medication options should Shrivatsa have been on to prevent the occurrence of NSAID-induced PUD?

e. Shrivatsa asks you if he can take all his pills at once. What is your response, and explain how he should administer them?Shrivatsa reports back to his PCP 2 weeks later with c/o profuse diarrhea after starting his regimen. The provider is concerned and places Shrivatsa on precautions.

 

2. What may cause his diarrhea, and what may it be related to?Sundance presents to the ED with constipation x 7 days status-post colon resection. Sundance has been on Hydrocodone for pain since the surgery. Sundance states that she continues to have pain from the surgery.

 

3. What may the provider be concerned about, and what may the order be before drug therapy? (Consider complications and diagnostics)

 

4. What should Sundance be prescribed while on the opioid to prevent constipation?

 

5. The provider prescribes Docusate, MiraLAX, and Senna and one dose of Milk of Magnesia to treat constipation. Please describe how these medications work differently to treat constipation.provide side effects for each in patient teaching