Reference no: EM133310952

Case Study: L.B. is a 30-year-old secretary who is seen with 6 weeks of a dry, hacking cough after recovering from bronchitis this winter. The cough is worse at night and associated with shortness of breath (SOB). In the past she has experienced coughing spells after running a 5K race. She does have hay fever that seems to be year-round and has eczema in the winter. Both of her children and her maternal grandmother have asthma.

Question 1. As the intake nurse working in the clinic, what routine information would you want to obtain from L.B.?

Question 2. L.B.'s chief complaint (C/C) is a cough. What are the main causes of chronic cough, and what questions should you ask to elicit information about each cause?

Question 3. L.B. denies symptoms in answer to all of your questions except those given in the initial interview. She is not taking any medication other than a multiple vitamin. What would you include in your physical examination and why?

L.B. was not in acute distress. Vital signs (VS) were 110/60, 55, 18, peak fl ow at 350 L/min with good effort. Expected peak flow for her height and age was 512 L/min, so her response is 68% of predicted. She had no sinus tenderness, ears were negative, nasal mucosa was pale and boggy, mouth was negative, there was no cervical adenopathy, lungs were clear to auscultation (CTA), but forced expiration using the peak flow meter (PFM) seemed to generate a cough. Abdomen was soft and nontender. Skin was dry, and hands were erythematous in the web spaces but had no inflammation in the antecubital, trapezius, or popliteal areas (common location of adult eczema).

Question 4. The provider orders a pre and post pulmonary function test (PFT). What is the purpose of completing the PFTs pre and post?

Question 5. The diagnosis of asthma is confirmed, and L.B. returns to the clinic for asthma education. What topics should you address?

Question 6. What is a PFM, and what is the purpose of the peak expiratory flow rate (PEFR) measurement?

Question 7. Give L.B. precise instructions to perform the PFM maneuver.

Question 8. The provider ordered triamcinolone (Azmacort) 2 puffs bid and albuterol 2 puffs q6h prn. What points should you include when teaching L.B. about her medications?

Question 9. You instruct L.B. in the proper use of the MDI using a spacer. How would you explain proper MDI use?