Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7

3.
 
Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age
7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days
per week over the past 2 months. Over the past week she has been using
albuterol at least once per day. She reports being awakened by a cough three
nights during the last month. She is becoming more short of breath with exercise.
She also has a fluticasone MDI, which she uses “most days of the week.” Her
current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA
two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80
mg PO BID. What treatment plan would you implement for this patient? What
medication changes would you make? How would you monitor the effectiveness
of this plan?

Case Study 3: Beatrice Case (Uncontrolled Asthma)

Beatrice’s presentation indicates uncontrolled asthma, given the frequency with which she uses short-acting beta agonist (SABA), nighttime awakenings, and dyspnea on exertion. Therefore, the goal of her management is to control her asthma attacks, minimize side effects associated with asthma medications, and improve her general quality of life. Therefore, the treatment plan includes reviewing her medications and determining dose adjustments necessary for managing her asthma. Since Beatrice is on low-dose inhaled corticosteroids (ICS, Flovent HFA 44mcg 2 puffs), the guidelines indicate the need to increase the dose or add a long-acting beta-agonist to minimize the frequency of her asthma exacerbation features (Global Initiative for Asthma, 2023). The approach will prevent the frequency of asthma attacks and allow her to engage in activities without experiencing dyspnea.  Propanol is a non-selective beta blocker that increases bronchospasms and increases the frequency of asthma attacks. The initial treatment approach is to change a selective beta-1 blocker such as atenolol. Therefore, in this case, it would be recommended to use an inhaled corticosteroid and a long-acting beta-2 agonist. The recommended treatment plan will be as follows:

Medication change: Switch Flovent HFA to Fluticasone/Salmeterol 250/50mcg

Direction: 1 Puff twice daily; rinse the mouth with warm saline water after use.

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The nurse practitioner should monitor adherence and the administration techniques that contribute to the gaps in management before discharging the patient. However, the patient should be followed up after 4-6 weeks to determine if there is any improvement to the adjusted treatment. Pulmonary function tests such as peak flow monitoring spirometry may be used to assess asthma control objectively. It is necessary to provide an asthma action plan, such as how to use maintenance drugs, quick relief agents, and the emergency department consultation if features are not timely. Hinkle et al. (2021) indicate that the nurse practitioner should review potential triggers such as allergens, irritants, infections, and exercise and discuss appropriate measures for minimizing patient exposures. Therefore, after several weeks of adherence to the recommended treatment, the client is encouraged to exercise moderately per tolerance to prevent exertion. and provide rest periods between activities to prevent exacerbations. Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7