26 Sep Case Study 2: Cardio and Pulmonary 1. Nancy, a 35-
Case Study 2: Cardio and Pulmonary 1. Nancy, a 35-year-old female, presents with an asthma exacerbation. She has had asthma since she was a child and was hospitalized several times as a child but her asthma was well controlled until the past couple years. She has been seen in urgent care a few times over the past year (most recently 4 months ago) and was given a prescription for an inhaled steroid (she never filled), albuterol inhaler, and oral steroids. She had eczema as a child and also received allergy shots for many years. Her asthma symptoms flared again 2 weeks ago and she has been using her albuterol 4–5 times/day. She reports that she is very short of breath when climbing stairs or when walking to the mailbox. She has had nighttime coughing spells every day during the past week and has had to prop up on pillows to breathe. She indicates that she has had similar previous flares in the past and she “just wants more albuterol and steroid pills.” Meds: Proair HFA, Claritin, Flonase prn. Spirometry: FEV1: 61% FVC: 88% FEV1/FVC ratio: 69% Pulse ox: 93% on RA a. Classify Nancy’s asthma using (and citing) the most current EBP guidelines. Which of the four categories (intermittent, persistent – mild, persistent – moderate, persistent – severe) does she fall under? Explain your justification. b. Is Nancy’s asthma being managed properly? Explain your answer. c. Would you refill her albuterol inhaler and steroid pill prescriptions as she requested? d. Incorporate the pathophysiology of the three core defects of asthma into your discussion for all of these questions. e. What is the value in performing this spirometry on Nancy when she already has a known diagnosis of asthma? f. Interpret her spirometry by defining and analyzing each indice (FEV1, FVC, FEV1/FVC ratio) individually. g. Explain the significance of “atopy” and “one continuous airway” applying Nancy’s scenario. 2. Harry, a 42-year-old Caucasian male, presented with a BP of 172/104 three weeks ago and was placed on lisinopril/hctz 20/12.5 – 1 tablet daily. He returned today and his BP is 148/88. He complains of a persistent, dry, hacky cough that is annoying him significantly. a. Explain the pathophysiology of his cough and lisinopril. How would you address this? b. Explain the location within the RAAS and the mechanism of action for lowering blood pressure for each of the following four antihypertensive drug classes: renin inhibitor, ACE, ARB, and aldosterone inhibitor. A brief paragraph for each will suffice. c. Discuss how the RAAS impacts African-Americans differently than other ethnicities. According to the EBP guidelines, which two drug classes are used specifically in the treatment of African-Americans for hypertension? 3. Harry was also started on atorvastatin 40mg three weeks ago and complains of severe weakness and muscle pain in his legs and shoulders. His urine is “tea colored.” His CK (creatine kinase) is 2,000. a. Identify Harry’s diagnosis and explain his weakness, muscle pain in legs and shoulders, elevated CK, and tea-colored urine from a pathophysiological perspective. b. Explain from a pathophysiological perspective the difference in mechanism of action between a hydrophilic and lipophilic statin as they relate to myalgias. As an FNP, how does this knowledge help you? Give two examples of hydrophilic and lipophilic statins.
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