What are the appropriate pharmacological therapies to be prescribed for Johnathan? Jonathan has a history of mild intermittent asthma and is experiencing an exacerbation that appears to be caused by an upper respiratory virus. His cough and wheezing are getting worse with diffuse expiratory wheezes with mild retractions and O2 sat of 93%. Since his O2 sats are greater than 90%, I would try to obtain a baseline PEF. I would immediately administer: ipratropium bromide (Atrovent) Dose: 0.25mg NEB q20min x 3 doses (Epocrates, 2018) to be administered in the office. Once Johnathan is stable I will send him home with the following orders:
Following guidelines for outpatient burst treatment of dosing: 1-2 mg/kg/day PO divided qd-bid x3-10 days; Max: 60 mg/day (Athena Health, 2018) Albuterol 2.5 mg/3ml nebulizer treatments every 6 hours for 3 days then as needed (Epocrates, 2018). Pediapred syrup 20.5 mg by mouth twice a day for 3 days I will also schedule a 5 day follow up with Johnathan to ensure that he is improving. His mother also will be educated on when to seek medical help and when to call 911. What information is necessary to provide to Johnathan and his mother regarding asthma exacerbation? I will explain that an asthma exacerbation is an acute episode of progressively worsening shortness of breath, coughing, wheezing, and chest tightness or any combination of these and early treatment of asthma exacerbations is the best strategy for management (Camargo, Rachelefsky, & Schatz, 2009). I will send them home with a written asthma action plan stressing the importance of recognizing worsening symptoms or symptoms that are not improving. I will advise them to avoid triggers such as allergens, no smoking around him. I will educate Johnathan’s mother on the medication he is taking specifically oral steroids. She should give the Pediapred with food and make sure that he takes the medication exactly as prescribed including Johnathan’s nebulizer treatments. What is an appropriate clinical assessment tool to be used with Johnathan?
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- Fall '16