Darla Thomas, a 25 y.o. 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. Advanced Pathophysiology Essay Paper 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.
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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. Advanced Pathophysiology Essay Paper
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria
Episodic Shortness of Breath and Chest Tightness in a 25 Year-Old African American Female
Patient D.T. reports having shortness of breath and tightness of the chest that is episodic and associated with specific environmental and seasonal agents. In particular, the information that the symptoms worsen in Spring and the fact that her roommate has a cat all point to triggering by environmental allergens (Hammer & McPhee, 2018). This means that the patient’s symptoms are related to allergy. She has significant family history of asthma, which indicates that her allergy symptoms are probably due to hereditary transmission of asthma from her father’s side. As a result, the most likely diagnosis for patient D.T. is Mild Persistent Asthma. The pathogenetic mechanisms responsible for patient D.T.’s symptoms are inflammation, spasms of the bronchial involuntary muscles, and mucus secretion. The environmental allergens such as pollen and cat fur trigger inflammation of the airways when inhaled. Cholinergic activity is triggered as acetylcholine is released in large quantities on to bronchial muscarinic receptors. The result is increased mucus secretion, bronchoconstriction, and infiltration by macrophages and lymphocytes causing inflammation. The lumen of airways becomes small and expiration produces a wheeze (Suau & DeBlieux, 2016). Enough oxygen does not reach the lungs causing dyspnea and the labored breathing produces chest tightness.
I expect the results of her pulmonary function tests (PFTs) to be abnormal with regard to her forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) ratio. That is, her FVC1/FVC ratio will be lower than normal (AIM, 2017). The reason for this is that there is difficulty in exhaling air from the lungs because of the bronchoconstriction and blockage by mucus. Her plan of care will include medications in the form of a short-acting beta-agonist or SABA such as ventolin inhaler for quick relief; and a corticosteroid like methylprednisolone 8 mg orally daily to discourage the inflammation (Rosenthal & Burchum, 2018; Katzung, 2018). Patient education would be on avoidance of the environmental triggers such as cat fur. This may mean moving out of the shared room. Achieving these outcomes will require the establishment of concordance with the patient.
Asthma Institute of Michigan [AIM] (2017). Pulmonary function tests (PFTs). https://getasthmahelp.org/pft.aspx#:~:text=The%20ratio%20between%20your%20FEV,any%20time%20during%20a%20FVC
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. McGraw-Hill Education.
Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for nurse practitioners and physician assistants. Elsevier.
Suau, S.J. & DeBlieux, P.M.C. (2016). Management of acute exacerbation of asthma and chronic obstructive pulmonary disease in the emergency department. Emergency Medicine Clinics of North America, 34(1), 15–37. https://doi.org/10.1016/j.emc.2015.08.002
Advanced Pathophysiology Essay Paper