As recorded in her medical history, the patient in discussion has experienced asthma. This is important as it enables a practitioner to identify one of the potential causes of her symptoms. She claims that she has been coughing and wheezing since three weeks ago. These are indicators of various illnesses, including pneumonia and influenza. This paper aims to diagnose the patient’s condition and offer treatment options.
Diagnosis
My diagnosis is that she is experiencing asthmatic symptoms, which might have been triggered by hormonal changes or stress as she is pregnant. According to Nadolpho (2012), there is proof that some hormones can trigger asthma, for example, progesterone and estrogen. Nadolpho (2012) further claims that this is due to their ability to increase inflammation in the body, which affects the air paths. Additionally, it is recorded that she has not had a flu shot yet. Even though this could have led to issues such as influenza and pneumonia, the evidence is insufficient (Nadolpho, 2012). Using the symptoms only, one can argue that wheezing is mostly seen more in individuals with asthma than in influenza and pneumonia.
Pharmacological Intervention
For pharmacologics, I am prescribing medications use of inhalers and oral drugs safe for pregnant women, for example, glucocorticoids. Therefore, prescribing medications and methods that are safe for her condition should be a priority (Ahmed & Turner, 2019). Glucocorticoids can be utilized in this situation to treat asthmatic symptoms. Experience from the use by pregnant women shows that they are safe for not only the mother but for the child as well (Akar-Ghibril et al., 2020). They consist of pills such as inhaled drugs, for example, budesonide, fluticasone, beclomethasone, and prednisone. Many inhalers combine a glucocorticoid with a long-acting bronchodilator (Akar-Ghibril et al., 2020). It may be essential to modify the type and dose of medication to compensate for the alterations in the female’s metabolism and the severity of her health condition.
Pharmacodynamics and Pharmacokinetics of Glucocorticoids
The impact of glucocorticoids is mediated by genomic as well as nongenomic mechanisms. According to Akar-Ghibril et al. (2020), the former consists of activation of the cytosolic glucocorticoid receptor that causes suppression of manufacture of inflammatory enzymes and chemokines. The pharmacokinetics consisting of distribution, absorption, and elimination, are key determinants of the duration or magnitude of action. According to Akar-Ghibril et al. (2020), the above-mentioned factors control dosage. Similar to other steroid hormones, glucocorticoids access the cognate intracellular receptors by passive diffusion via the plasma membrane (Akar-Ghibril et al., 2020). From there, they are bound to a particular plasma transport called transcortin. It is important to note that the majority of it is eventually excreted in urine (Akar-Ghibril et al., 2020). Glucocorticoids should be consumed with care as excessive dosage can result in abnormalities of placental and fetal growth in pregnant women.
Non-pharmacological Intervention
For non-pharmacological intervention, I am recommending massage, which has several benefits; including helping alleviate the risk of developing severe asthma. When the respiratory system is affected, the rib cage’s tightness increases, the lung capacity becomes shallow, and the nervous and muscular systems have difficulty relaxing. According to Asthma for Health Professionals (2022), massage allows the muscles to be stretched and release tension, which decreases lung congestion. In addition, it generates heat to increase body temperature and rate of respiration.
Exercise
Apart from massage, I am recommending exercise but with caution. Despite regular physical activity being identified as one of the methods to reduce the effect of asthmatic symptoms, some exercises can lead to a worse asthma condition. According to National Heart, Lung, and Blood Institute, National Institutes of Health (2017), the key will be to perform jogging exercise once daily for twenty minutes. They can work by making the lungs stronger without the risk of inflammation. The more someone engages in physical activities, the more their lungs become used to consuming oxygen.
As a nurse practitioner, experience in the field suggests that the exercises reduce symptoms as they increase endurance. According to National Heart, Lung, and Blood Institute, National Institutes of Health (2017), over a period, exercising helps the air paths to establish tolerance to physical activities. This allows someone to be less tired than before when engaging in normal activities such as using the stairs or running. Exercise will improve cardiovascular fitness, which is the overall conditioning of the heart, and better the blood and oxygen flow.
Meditation
I am recommending that the patient embraces meditation and chiropractic adjustments. On the one hand, results from personal trials show that meditation may be useful in minimizing stress. Among asthma patients, it can improve life quality (Ahmed & Turner, 2019). On the other hand, the condition in discussion results in airway constriction and inflammation, leading to breathing difficulty. Gentle adjustments will allow appropriate nerve communication that will guarantee the entire body is working at optimal health levels. This will provide as well better immune responses in her to help combat the symptoms any time they arise.
Communication Plan
Communication is an important tool that guarantees the patient understands the instructions given by nurse practitioner. It is essential to ascertain verbal as well as nonverbal information concerning the condition and approach them. An NP can determine the emotional state through eye tracking (Ahmed & Turner, 2019). It helps to develop a communication culture and engage the individual during recovery. For instance, for the patient in discussion, to ensure that she takes her medication seriously, it would be essential to consider developing a channel through which she will feel comfortable speaking about any emerging issues as she continues with the prescription.
During this process, it will be important to ask her whether or not she understands the instructions I give and allow her to demonstrate one of the suggested or recommended actions. For example, in case the goal is performing a breathing exercise, she could illustrate that to enable the practitioner to identify if she needs more education on that or not (Ahmed & Turner, 2019). Apart from that, there is the issue of medication, whereby it would be beneficial if she could show that she comprehends how much she needs to consume daily. A simple questionnaire can help the nurse practitioner to determine the length of her understanding.
Local Resources to Address
In addition to interventions, there are issues that one must address, including housing, medical insurance, and counseling. In the city of Chicago, there is an establishment named Home for New Moms. It offers parenting, child development initiatives, and career readiness for young mothers. Additionally, the patient can access instant and temporary coverage from Medicaid Presumptive Eligibility program in Illinois, if she meets certain income requirements. Lastly, for counseling, she can get support from Caris Pregnancy Counseling and Resources in Chicago. All these facilities are found within the state of Illinois which makes it easier for her to access.
Conclusion
The paper includes a diagnosis of the patient’s asthmatic condition and treatment using glucocorticoids and non-pharmacological ways such as massage and meditation. From the symptoms, it is obvious that she is experiencing asthma which might have been triggered by hormonal changes as she is pregnant. The interventions suggested have considered her state and thus, recommend methods that are safe for her and the baby. It is important for a pregnant female to constantly seek medical attention to ensure her safety and that of the unborn child.
References
Ahmed, H., & Turner, S. (2019). Severe asthma in children—a review of definitions, epidemiology, and treatment options in 2019.Pediatric Pulmonology, 54(6), 778–787. Web.
Akar-Ghibril, N., Casale, T., Custovic, A., & Phipatanakul, W. (2020). Allergic endotypes and phenotypes of asthma.The Journal of Allergy and Clinical Immunology: In Practice, 8(2), 429-440. Web.
Asthma for health professionals. (2022). Asthma for Health Professionals | NHLBI, NIH. www.nhlbi.nih.gov. Web.
Nadolpho. (2012). Pregnancy and Asthma. ACAAI Public Website. Web.
National heart, lung, and blood institute, national institutes of health. (2017). Guidelines from the National Asthma Education and Prevention Program. Web.