Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours. He is accompanied by his mother, who is a good historian. She reports that her son started having symptoms of a viral upper respiratory infection 2 to 3 days ago, beginning with a runny nose, low-grade fever of 101.0 degrees F orally, and loose cough. Wheezing started on the day before the visit, so Johnathan’s mother started administering albuterol metered-dose inhaler (MDI) two puffs before bed and then two puffs at around 2 AM. The cough and wheezing appear worse today, according to the mother. He had difficulty taking deep-enough breaths to inhale this morning's dose of albuterol, even using the spacer. Johnathan has been a patient at the clinic since birth and is up to date on his immunizations. His growth and development have been normal, and he is generally healthy except for mild intermittent asthma. This is his first asthma exacerbation of the school year, and his mother expresses a concern about sending him to school with an inhaler. Johnathan is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs 45 pounds (20.5 kgs.). The examination is all within normal limits except for his breath sounds. He has diffused expiratory wheezes and mild retractions. Pulse oximetry readings have been 93% of oxygen saturation. What are the appropriate pharmacological therapies to be prescribed for Johnathan? Johnathan presents with complaints consistent with a viral respiratory infection and subsequent asthma exacerbation. As a Nurse Practitioner, it’s imperative to use a stepwise approach in selecting medication and delivery devices that meet the client' needs and circumstances, to consider the domain of relevance to the client (risk, impairment, or both), and the client’s history of response to the medication, along with their willingness and ability to use it; this approach is required to identify appropriate treatment options. Relief medications for an acute asthma exacerbation include short-acting bronchodilators, systemic corticosteroids, and immediate DuoNeb® (Ipratropium Bromide / Albuterol Sulfate) therapy. The National Asthma Education and Prevention Program Expert Panel recommend 1.5 mL (containing 1.25 mg Albuterol; 0.25 mg Ipratropium Bromide per 1.5 mL) inhaled via nebulizer every 20 minutes for 3 doses, then as needed (Prescribers Desk Reference, 2018). For viral respiratory infection, a short “burst” of systemic corticosteroids is recommended in order to establish moderate or severe asthma control in children; dosing is 1 to 2 mg/kg/d (maximum 30 mg/d) of Prednisone in two divided doses for 3 to 10 days (Woo & Robinson, 2015). Johnathan will be prescribed Prednisone Liquid 20 MG PO twice daily for ten days.
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- Summer '16
- asthma control