Reference no: EM133976515

Question

Case Presentation: Self- Management

Margaret is a 5-year-old with a past medical history of an acute asthma attack at age 3 years requiring 5 days of hospitalization, 2 of which were in the pediatric intensive care unit. Her parents made an appointment with the nurse practitioner (NP) to get advice on how to better manage Margaret's asthma. In the previous year, they had taken Margaret to the emergency department three times and to urgent care twice. She has been on oral steroids (prednisolone) four times in the previous 12 months, and she uses her rescue inhaler (albuterol) at least twice weekly when she is well. In the first 4 months of the school year, Margaret missed 12 days of kindergarten due to asthma.

The NP evaluates Margaret. Her vital signs and BMI are within the normal rage. Her parents report that Margaret receives her maintenance medications most days, missing on average 1 or 2 days per week. The NP asks about the family's living situation and learns that Margaret lives with her biological parents and a 7-year-old Labrador retriever, which is an indoor dog. Her paternal grandmother, a smoker, also lives with the family during the winter months. The family's house is 76 years old with carpeted living and sleeping areas and a basement. The parents do not have Margaret's bedding encased with dust mite protectors. The parents deny any mold, mice, or cockroaches in the home. The parents report that Margaret occasionally wheezes during activity, but she does not pretreat with her rescue inhaler.

The NP discusses with Margaret's parents the importance of daily medication adherence as the first line of defense. When she investigates further, she learns that the nebulizer administration sometimes gets in the way of her parents adhering to their daily schedule. The NP discusses with them increasing the daily dose and changing the administration route to the metered dose inhaler with spacer, which they already use for the rescue medications. The parents agree this would make daily adherence easier. The NP also educates the family on asthma triggers and the role of smoking. She asks the parents to discuss with the grandmother smoking outdoors when she is visiting. The parents agree that they will discuss with each other how to approach the conversation. The NP educates the parents about bedding encasements for mattresses and pillows and provides a flyer listing online stores that sell them. The parents agree to purchase these encasements. Due to the parents' report of coughing with physical activity, the NP recommends pretreating Margaret with two puffs of the rescue inhaler before exercise, and the parents agree. Finally, the NP discusses the importance of keeping track of medication administration and symptoms using an application on a phone or paper-based recording tool in order to determine triggers and patterns in symptoms. The mother downloads a tool in the office to begin tracking. Based on the conversation, the parents and NP together update the asthma action plan and agree on a follow-up plan. The NP asks the family to follow up in 3 months or sooner if Margaret needs to go to the emergency department or urgent care.

Case Analysis Questions

1. What information exists suggesting that Margaret's condition is not being managed optimally?

2. What specific measures are described that would improve the management of Margaret's asthma?

3. As a group, use the above case presentation to identify an example of how each attribute of self-management is showcased in the case study.

Attribute of Self-Management

Application of Case Presentation

Self-efficacy

Patient engagement

Health education

Patient-provider relationship

Disease management