Reference no: EM133881157

Question

Utilize the GINA to answer the following questions:

1. Compare and contrast asthma versus COPD.

2. How is asthma diagnosed and what are the signs and symptoms of an exacerbation (including chest x-ray findings)?

3. Using the GINA guidelines, develop a treatment plan for STEP 5 (provide medication names).

A 28-year-old female that is 5'3" and 105 lbs. presents to the ED with marked shortness of breath, she has a history of wheezing with exercise and is allergic to shellfish, hay, animal dander, and bee venom. She smokes approximately 1 pack of cigarettes per day and has done so for approximately 10 years; she is malnourished, and she currently lives with a friend who owns two cats and one dog. She states that both she and her roommate smoke in the house. She has an Albuterol MDI prescribed for PRN use as well as Advair 250/50 mcg 2 puffs BID, she states that she only uses them periodically due to their high cost. She has been hospitalized for asthma exacerbations two times in the past 12 months. She stated that she began having trouble breathing after petting her friend's cat.

Her physical assessment is as follows: RR 29/min with a prolonged expiratory phase, SpO2 87% on 8L oxymask, BP 130/85 mm Hg. Her lungs are diminished with expiratory wheezes in the upper lobes. She had moderate accessory muscle use with intercostal retractions. She was given 5 mg Albuterol via SVN on the Ambulance and had another 5 mg of Albuterol since arrival at the hospital, her post-bronchodilator PEFR is 45% of predicted. An ABG was drawn, and the following was found pH 7.30, PaCO2 55 mm Hg, PaO2 62 mm Hg, HCO3- 23 mEq/L, SaO2 87%.

1. Is this patient suffering from asthma, COPD, or ACOS? Justify your answer.

2. What medication treatment regimen would you suggest for her acute exacerbation?

3. Would she be a candidate for NIV or invasive MV? What VT would you target for either NIV or invasive MV? Justify your answer.

4. What, if any, lifestyle changes should be suggested for this patient?