1-A.G

Childhood asthma is a frequent clinical occurrence associated with respiratory impairments and airway inflammation, which requires immediate treatment and long-term care. The discussed disorder can considerably worsen overall health conditions, reduce the quality of life, and increase the risk of life-threatening implications. The provided asthma-associated case study can be beneficial for reviewing short-term and long-term treatment options efficient for treating the given patient. Furthermore, one’s potential education can be ultimately useful for achieving sufficient treatment outcomes as well as organizing appropriate preventive and therapeutic actions.  

   The provided clinical case exemplifies moderate persistent asthma that requires immediate intervention. It is evident that short-acting beta2-adrenergic agonists (SABA), systemic and inhaled corticosteroids, as well as anti-inflammatory medications, can provide quick symptomatic relief by reducing such aberrations as wheezing and bronchoconstriction present in the reviewed patient, normalizing respiration, and improving overall health. Furthermore, such drugs as inhaled steroids, leukotriene modifiers, nedocromil, cromolyn sodium, and methylxanthine can assist in providing long-term asthma control, stabilizing respiratory functions, and preventing possible asthma exacerbations and inappropriate lung growth in children (Woo & Robinson, 2015). It is estimated that a combination of SABAs and inhaled corticosteroids is useful for managing acute asthmatic exacerbations and maintaining normal respiratory functions (Arcangelo & Peterson, 2013). The beta2-adrenergic agonists like albuterol and levalbuterol are capable of exerting “their bronchodilatory effects through β2 adrenoceptors (β2ARs) located on airway smooth muscle (ASM) cells” and providing significant airway relaxation by activating the aforementioned receptors, whereas the steroid medications are efficient in decreasing airway inflammation and airway hyperresponsiveness by lessening the number of circulating inflammatory mast cells and eosinophils in the respiratory tract (Billington, Penn, & Hall, 2017, p. 23). Furthermore, the use of inhaled corticosteroids can be also beneficial for relieving airway obstruction, normalizing respiratory functions, asthma control, and minimizing the risk of asthmatic exacerbations. 

   Patient education is important for achieving sufficient treatment outcomes. Patients, as well as their caregivers, have to be aware that adherence to the prescribed treatment regimen and recommendations, reporting adverse effects, and regular physical evaluation along with cooperative communication with a physician can assist in stabilizing the patient’s condition and preventing asthma progression. Therefore, asthma is a severe acute or chronic respiratory abnormality that requires competent treatment and care. It is estimated that inhaled SABA, as well as inhaled and systemic corticosteroids, are efficient for achieving short-term therapy goals, whereas leukotriene modifiers, methylxanthines, and anti-inflammatory agents demonstrate normal heir efficacy in providing long-term asthma control and maintaining normal respiratory functioning. Lastly, a patient’s teaching is a critical component of successful medication. 

2-michael V.

The short-term option for this child diagnosed with asthma will be bronchodilators to quickly relieve his symptoms by opening swollen airways that are limiting breathing (Saglani, Fleming, Sonnappa, & Bush, 2019).  Long-term options include Inhaled corticosteroids, Leukotriene modifiers, Long-acting beta agonists, and Combination inhalers. Corticosteroids are the first line of treatment for severe acute asthma, because of the inflammatory process.  Steroids control airway inflammation through a number of mechanisms, such as reducing the number and activation of lymphocytes, eosinophils, mast cells, and macrophages; suppressing the production of cytokines, tumor necrosis factor-α, granulocyte-macrophage colony-stimulating factor, adhesion molecules, and inducible enzymes, including nitric oxide synthase and cyclooxygenase-2.  The step-up approach involves beginning with low-dose treatment and increasing intensity at subsequent visits if control is not achieved (Bateman et al., 2019). When selecting the medication and dosage, the provider must take into account the risk to the patient, severity of disease, and potential for impairment.

The goal of asthma treatment is to decrease symptoms and reduce airway inflammation and hyperreactivity.  Healthcare provider should develop written asthma action plan with the patient and his mother for self-management, so they know how to recognize the severity of its symptoms (peak flow) and what to do (Bateman et al., 2019).  Patient should be educated on ways to control exposures to allergens.  An allergy test will be a good plan to identify the patient’s allergy (Bateman et al., 2019).  The patient may need a referral to a pulmonologist if symptoms are uncontrolled with the current regiment.  Pulmonary function testing may be necessary in this child’s case.

References

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 Reply Cathy

Asking the patient about any breast changes including size change, dimpling, or nipple discharge would be helpful (Centers for Disease Control and Prevention, 2018). In addition, asking the patient about any family history of breast cancer and her menstrual cycle timing could be helpful. A  breast exam would be appropriate during this patient’s physical exam. The patient reported feeling a lump in the shower. By the provider doing their own exam, the patient’s technique and lump placement could be verified (Centers for Disease Control and Prevention, 2018). 

       Some possible differential diagnosis for this patient include breast cancer, a cyst, fibroadenoma, lipoma, mastitis, and breast injury (Mayo Clinic, 2018). Getting a full health history and ordering tests would be needed to know for sure. Some tests that may be ordered include imaging to see what the potential lump looks like and placement.  A mammogram is commonly used along with a biopsy to test the breast tissue cells to determine if they could be cancerous (Mayo Clinic, 2018).  

       Based on the results for this patient, it is possible that a referral could be necessary. This patient may need to see an oncologist or even a surgeon. If this patient has cancer, radiation or chemotherapy may be an necessary intervention (Mayo Clinic, 2018). Making sure this patient has access to information and support is also important when considering management of care.  

Reference
 

Centers for Disease Control and Prevention. (2018). “What Are the Symptoms of Breast Cancer”. Retrieved from:  (Links to an external site.)Links to an external site.https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm
 

Mayo Clinic. (2018). Breast lumps. Retrieved from https://www.mayoclinic.org/symptoms/breast-lumps/basics/causes/sym-20050619 (Links to an external site.)Links to an external site. 

 Reply Quiana

A 35-y.o. woman is seen in the office with a chief complaint of a breast mass. She states she found the lump when she was in the shower, and she is quite visibly distressed. Her medical history is unremarkable, although she reports that she has not had a mammogram. She takes no prescription medications.

What additional questions should you ask the patient and why?

• Additional questions to ask this patient would be if the lump is painful, pain in fibrocystic disease is bilateral and increases before the monthly menstruation.
• Has the lump changed in size or remained the same, has she ever noticed a lump before, is she menstruating. Cyst gets smaller and pain decreases when the menstrual cycle starts. If the patient is menstruating it is important to have her come back at the end of her menstrual period. This is because the breast cysts can fluctuate during the menstrual cycle (So you found a lump, now what? 2015).
• Does she have a nipple discharge? A nipple discharge that is unilateral, pink or bloody, non-milky or associated with a mass is an indicator of breast cancer.
• Ask at what age did she begin menstruating because early menarche increases the risk of breast cancer.
• Does she have a family history of breast cancer? If a mother or sister had breast cancer there is twice the risk and if both have it there is three times the risk of developing breast cancer.
• Does she have any children? Null parity increases your risk of breast cancer (Seller, & Symons, 2018).

What should be included in the physical examination at this visit?

            A complete breast exam should be included in this visit. The breast lump should be assessed to determine if it is firm, with indistinct borders and if it is attached to the skin. Assessment should include if there is any dimpling or nipple retraction, and unilateral nipple discharge, all of which are a signs of breast cancer. Benign lumps usually have well-defined borders and are mobile (Sellers, & Symons, 2018).

Possible differential diagnoses at this time are as follows:

• Breast cancer–Patients that develop breast cancer with no family history are normally older than 40 years.
• Fibrocystic breast disease-Patients have cyclic bilateral breast pain, especially near and during menstruation. The pain and tenderness worsen before menstruation.
• Fibroadenoma- Usually presents in patients 20-40 years. Usually, a solitary lump that is firm, mobile, smooth, and rubbery (Seller, & Symons, 2018).

What tests should you order and why?

            A mammogram is the first test to order. If the mammogram is inconclusive or the breast has dense tissue then a breast ultrasound should be ordered to differentiate between a cystic mass and a solid mass. If needed a needle aspiration breast biopsy should be ordered. In some cases an MRI can be ordered, especially in high-risk patients (Sellers, & Symons, 2018).

How should this patient be managed?

            If it is fibrocystic breast disease the patient should be advised to wear a firm bra even at night. Dietary restrictions will include coffee, chocolate, and tea. The patient should also take 400 IU of vitamin E daily. If the patient is experiencing pain or moderate to severe fibrocystic breast disease, the therapeutics to prescribe are oral contraceptives, NSAIDs and/or progestin. The patient should also be educated on the importance of conducting breast self-exams monthly even though the breasts may be lumpy (Dunphy, Winland-Brown, Porter, & Thomas, 2015).

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. A. (2015). Primary

care. The art and science of advanced practice nursing. (4th Ed.). Philadelphia, PA. F. A. Davis Company.

Seller, R. H., & Symons, A. B. (2018). Differential diagnosis of common complaints. (7th Ed.). Philadelphia, PA. Elsevier, Inc.

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 Please,reply this post

 The difference between research utilization and evidence-based practice

            Research utilization is basically conducted to process the research and to obtain more data for the research that was conducted earlier. It is a method of incorporating and applying research based intervention practically. Results of a certain study are implemented into a practice that are not related to the study, this is referred to as research utilization. It focuses specifically on applying scientific research findings in nursing practices. Research utilization is used to alter the impact on the practice of nursing. It includes application of opinions from the experts and patients’ reports, which can be applied in the treatment process (Schaffer, Sandau & Diedrick, 2014).

Evidence based practice involves the practice and performance of care and the treatment process which has already been implemented successfully or given positive results. Evidence based practice enhances the nursing practices in healthcare and ensures the quality of the care given to the patients is improved. Hence, implementing evidence based research in nursing practices helps to increase knowledge and elevate the nursing care standards. Evidence based practice implements the best current evidences to come up with better decisions on health care. It is very useful to researches related to nursing since it supports the hypothesis of the nursing research and scientific literature, which helps in the clinical trials (LoBiondo-Wood & Haber, 2017).

Evidence based practice is research utilization that employs other considerations specific to the problem that is being solved. Evidence based practice uses the present evidences to make better decisions regarding the patients while research utilization aims to put in practice the implementation of the research study.

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