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Assignment 12.2 Shadow health D. O Connor
Community Health Nursing (NUR 4636C)
Santa Fe College
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Assignment 12: Shadow Health-Focused Exam: COPD and Anti- asthmatics Concept Lab Case Study Patient: Debbie O’Connor DOB: 10/05/ Height: 5’ Weight: 195lbs Allergy: NKDA Previous diagnosis: COPD Group B – chronic bronchitis Current diagnosis: COPD Class C – chronic bronchitis Scenario: Ms. O’Connor is a 55-year old Caucasian female who has come to the doctor’s office reporting worsening of COPD symptoms and a recent, frightening episode of bronchospasm. She is a long-term smoker (37 years) and would like assistance with smoking cessation. Home medications: Formoterol inhaler 12mcg single-use q12 hours Vitals: Temp 37C (Temporal), Blood pressure 129/79 (Automatic), Heart rate 90 (NSR), O2 sat 92% (room air), Respiratory rate 26. Assessment: Ms. O’Connor is in today stating she feels her lungs “are falling apart” due to worsening shortness of breath. She reports that three days ago she had an episode of bronchospasm causing a coughing fit that made her apprehensive about her pulmonary health. She has been a smoker
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since the age of 15 and has had trouble breathing for years being hospitalized for a COPD exacerbation two years ago. She complains of feeling very uncomfortable with breathing difficulty being a 6 out of 10. Patient states symptoms have progressed in the recent 4 months as she has been getting more fatigued with worsening shortness of breath on minimal exertion, and a productive cough expectorating phlegm. She
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49% of her goal therapy. She reports no exercise due to symptoms. Reports no major eyesight issues other than nearsightedness, no surgeries, one miscarriage at a young age. Reports yellow discoloration of the skin around the mouth, teeth, nails, and fingers. Denies any cyanosis. She is postmenopausal, not sexually active.
Family History: - Father – deceased, smoker, heart attack at age 42. - Mother – deceased, smoker, pneumonia is the cause of death. - Husband – deceased, smoker, lung cancer. Prescriptions:
Elena Peterson, M. 11/16/ Patient: Debbie O’Connor DOB: 10/05/ Allergy: NKDA
Budesonide/Formoterol 160mcg/4 MDI 2 (two) actuations twice daily inhaled every 12 (twelve) hours for 30 (thirty) days. Dispense 1 (one) canister; 3 (three) refills. Please dispense as written. Shake bottle before using it, recap after use. Indication: COPD
Albuterol/Ipratropium bromide 100mcg/20mcg MDI 1 (one) actuation inhaled four (4) times daily as needed for COPD exacerbations for 30 (thirty) days. Dispense 1 (one) canister, 120 (one hundred and twenty) metered doses; 3 (three) refills. Please dispense as written. Indication: COPD exacerbation
Varenicline starting convenience pack 0 1 (one) tablet by mouth daily for 3 (three) days then increase to 2 (two) times daily for 7 (seven) days. Increase to 1mg 2 (two) times daily after 7 (seven) days and continue for a month. Dispense 1 (one) starting package for a 1 (one) month supply; no refills. Indication: Smoking cessation
Lastly, she was educated on Varenicline, her drug therapy to quit smoking. She was instructed to take missed doses as soon as possible, to take after meals with a full glass of water, not to take extra doses and to begin smoking cessation counseling also as it has a mental health aspect linked to it. Common side effects she may experience include GI problems, insomnia and she may still experience nicotine withdrawal symptoms in the begin which should subside with time. She was instructed to take medication after meals with a full glass of water and to contact
the healthcare provider immediately if she has mood or behavior problems, such as suicidal ideation or depression while on this drug. Learning outcome 1) What did you learn? I enjoyed this module because it allowed me to explore the pulmonary system on a deeper level looking at COPD and its pathophysiology. The first module was interesting because shadow health is excellent in providing visual explanations of the information it is trying to relay. I particularly found it interesting to move the dial and look at how certain receptors and drugs affect different systems in the body at the same time. I was very familiar with albuterol/ipratropium as I work with these medications often in cardiac recovery but the management of chronic COPD with anti-inflammatory therapy was very interesting to learn. One topic I went back researched more about was smoking cessation therapies and it was interesting to see the options available and what we know so far about these drugs. Varenicline (Chantix) was the drug used in the shadow health module however, prescribers also have the option of using bupropion as an option. Medicine still knows very little about the use of smoking cessation drug therapy and research is currently underway to establish the most effective treatment. We still don't know about the safety of using varenicline in conjunction with nicotine replacement therapy patches however, studies are starting to confirm that this dual therapy is well-tolerated and safe. More research is needed but the current studies are very promising (American Cancer Society, 2017, para. 13). Smoking is a
- How did the assignment help you learn to prescribe medications for asthma and COPD? Registered nurses have an incredible responsibility when they decide to advance their practice and become nurse practitioners. Advanced practice nurses are constantly scrutinized and criticized by medical doctors as we are becoming a threat to their incredibly overpaid practices, and sometimes substandard care due to the high volume of patients congesting the American healthcare system. We have proven via research and patient satisfaction surveys that we have a place in the healthcare system and we are here to stay, but it is important to practice with diligence to avoid the push back received by medical doctors always prioritizing patient safety, efficiency and cost-effectiveness. As a psychiatric nurse practitioner, I will not be prescribing drug therapy for COPD and asthma as that would be outside my scope of practice based on the chosen specialty, however, just like in previous case studies, it is important to consider drug interactions in every specialty as patients' illnesses are becoming more complex due to a variety of factors such as advances in science and healthcare. After doing research, I discovered that quite a few psychiatric drugs interact with drug therapies for COPD and asthma. Albuterol which is sold under several brand names such as Proventil HFA and Ventolin HFA can cause serious spikes in blood pressure if combined with MAOIs or tricyclic antidepressants (Woolston, 2019, para. 8). Short and long- acting muscarinic antagonists such as ipratropium have anticholinergic effects on the body therefore, they should be used with extreme caution in
patients taking antidepressants. The website rxlist recommends providers wait for 2 weeks post discontinuation of such agents before starting nebulized albuterol, ipratropium or DuoNeb (Albuterol/ipratropium combo) as this interaction can dangerously potentiate cardiovascular effects (RxList, 2018, para. 21). This
Referenc es American Cancer Society. (2017, January 12). Prescription drugs to help you quit tobacco. Retrieved from cancer/healthy/stay-away- from-tobacco/guide-quitting- smoking/prescription-drugs-to-help-you-quit- smoking RxList. (2018, September 11). DuoNeb. Retrieved from rxlist/duoneb- drug#description Woolston, C. (2019, January 1). Drug interactions. Retrieved from consumer.healthday/encyclopedia/drug-center-16/misc-drugs-news-218/drug- interactions-646388
Assignment 12.2 Shadow health D. O Connor
Course: Community Health Nursing (NUR 4636C)
University: Santa Fe College
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