5. How would you as the NP address his mother’s concern regarding providing an inhaler at school? Initially, the patient would be re-educated on the use of the inhalers with spacers then he would be asked to demonstrate correct administration of the medication to ensure
proper technique. Instructions for when to use the inhaler, how to use the inhaler, and a detailed written action plan would be formulated then copies would be given to the patient and the school nurse or teacher responsible for administering the medications at school to ensure proper and safe drug administration (Woo & Robinson, 2016). The written action plan should also be given to any daycares or camps involved with the patient (NHLBI, 2007). The SABA inhaler should always be kept with the patient in case of emergency. 6.What is an appropriate plan of care for Johnathan? Frequent handwashing should be advised to deter from future infections. Adherence to all prescribed medications and the written action plan is pertinent to long term asthma management (NHLBI, 2007). Continue to perform peak flow meter readings daily and log data. Follow-up is recommended every 2-6 weeks initially when asthma is uncontrolled and then every 1-6 months thereafter (NHLBI, 2007). Promotion of physical activities, exercise, and sports is an essential part of a child’s life even when suffering from asthma ( NHLBI, 2007 ). The written asthma action plan should include the overall treatment plan, information about drug therapy, reasons for taking the drug, how the drugs make up the entire treatment regimen, and adherence matters (Woo & Robinson, 2016). Patient should continue the use of the albuterol metered-dose inhaler as needed. Symbicort is a respiratory inhalant combo drug that contains both an inhaled corticosteroid and a LABA (Drugs.com, 2018). The medication is only to be taken as prescribed above and not for rescue therapy
(Drugs.com, 2018). It is contraindicated in those with hypersensitivity and LABAs should not be used as monotherapy without corticosteroids due to increased risk of asthma related death (Drugs.com, 2018). Side effects of Symbicort include: body aches, pain, chills, cough, dyspnea, ear congestion, fever, headache, loss of voice, myalgia, pain or tenderness around the eyes or cheekbones, sneezing, sore throat, stuffy or runny nose, chest tightness, lethargy, or weakness (Drugs.com, 2018). There are currently no black box warnings for this medication (Drugs.com, 2018). Symbicort has a half-life of 17 hours, is metabolized through the liver by CYP3A4 and CYP2D6, and excreted 60-62% via urine with the remainder through feces (Drugs.com, 2018). The patient should be instructed to rinse mouth with water and spit after inhalation to prevent oral candidiasis (Drugs.com, 2018). Medication requires priming with two test sprays prior to first use and should always be shaken for five seconds before using (Drugs.com, 2018). Health
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