Introduction
The patient is a 23-year-old pregnant woman. She has had symptoms, including cough and wheezing, for more than three weeks. She is 25 weeks pregnant and was relocated due to experiencing domestic violence. She had a prenatal visit a month ago in another state, but this visit was specifically about her pregnancy, and her next visit is scheduled for the following week. Nevertheless, these rough symptoms require immediate attention, as the patient reported having fatigue due to the inability to rest because of the cough.
Diagnosis and Rationale
Based on the patient’s medical history, she had asthma, but the symptoms of asthma were cured, and since then, the patient has observed no symptoms of asthma. Presently, she takes supplements for pregnancy, including vitamins, but no medication for asthma, as there were no signs of it. Additionally, the patient did not report any other health concerns or chronic diseases. The woman does not smoke or drink alcohol. However, she has no support network or medical insurance; she has no job, so her financial situation is dissatisfying. The patient’s clinical examination revealed wheezing and a high temperature; all other data are within normal limits.
Based on the medical history and further examination, the probable diagnosis is the return of asthma. The patient has a history of this disease and presents with asthma-related symptoms, including coughing and wheezing. These symptoms have persisted for three weeks, so the possibility of asthma is extremely high. Additionally, the patient’s social background plays a significant role in disease recurrence. Even though the 19-year-old patient did not use the inhaler, it can be explained by achieving great control over asthma due to positive environmental factors. However, it was reported that the patient experienced domestic violence and was made to move from that place, which could trigger asthma.
The patient’s social and medical history strongly emphasizes a return of asthma. The physical examination, along with wheezing, supports the diagnosis. In addition, the patient’s background was considered, as stress, fear, pain, and intense emotions can significantly influence the return of the illness. Lastly, a woman is pregnant, which can also trigger present organism disease because of stress, concerns, and the presence of two organisms in one. Hence, the probable diagnosis based on the symptoms and medical and social background is an asthma exacerbation.
Treatment
Pharmacological
The treatment plan will consist of two parts: the first is pharmacological treatment. Firstly, previously used treatments can be repeated. The short-acting beta-agonist primarily relieves asthma symptoms and reduces overall disease burden (Fletcher et al., 2022). In this prescription, the patient is advised to use the inhaler immediately to relieve wheezing and reduce coughing. Secondly, asthma management is recommended, including short-acting beta-agonists and inhaled corticosteroids (Sharma et al., 2023). The medication is considered safe for use during pregnancy and is endorsed by the Global Initiative for Asthma (GINA) guidelines (2021). Lastly, the patient is recommended to start taking inhaled medicine. These medications will help reduce inflammation and prevent the disease from further developing (Fletcher et al., 2022). In addition, this treatment is non-harmful during pregnancy, so it would be safe for the woman to take these supplements and not harm the child. Therefore, one possible treatment option is pharmacological, involving prescribing a short-acting beta-agonist and relevant supplements. Still, patients’ pregnancy should be considered, so non-harmful for the child supplements should be used.
Non-Pharmacological
Additionally, non-pharmacological treatment, considering environmental factors and stress triggers, should be implemented. It was reported that the patient is a non-smoker and did not take drugs, so the influence of environmental factors is already decreased. However, the patient should be informed about the harmful effects of smoking, alcohol, drugs, and other relevant factors on her health and that of her child, and the way to reduce their impact. The patient experienced domestic violence, which could trigger the disease, so the woman should learn how to cope with stress, including doing the activity that brings her joy. Additionally, women should be encouraged to integrate into their local community and seek help there. Another intervention that can be offered is practicing breathing exercises, which can help improve lung function. Lastly, the patient should use a humidifier to keep the air moist, which can help reduce coughing. Thus, non-pharmacological treatment can be helpful to implement with pharmacological treatment to reduce the negative impact of environmental factors, including the patient’s social background and experience of domestic violence; stress relief techniques should be used.
Community Resources Available
The patient reported having no medical insurance, so she faces insecurity about her well-being, and community resources are needed. In the state of Illinois, the first community resource available is the program, FamilyCare/All Kids Assist, introduced by the Illinois Department of Healthcare and Family Services. The program ensures that both low-income and uninsured children under 18, as well as their caregivers or parents, receive medical care (HFS, n.d.). Another vital program in Illinois is the Special Supplemental Nutrition Program for Women, Infants, and Children, which provides supplemental foods, healthcare services, and nutrition education to women and their children under age 5 (USDA, n.d.). The last helpful community resource is the Asthma and Allergy Foundation of America, which offers educational programs for those diagnosed with asthma (AAFA, n.d.). With the help of such resources, it will be possible not only to access proper treatment but also to educate oneself on how to live with the diagnosis.
Therapeutic Communication Planning
Another crucial aspect to consider is the communication plan, which can ensure the patient is actively engaged in the treatment process. Choosing the most appropriate treatment methods can help the woman feel more comfortable with them. The Global Strategy for Asthma national standards state that healthcare providers should focus on educating patients on poorly controlled asthma and its repercussions (Popa et al., 2021).
Firstly, nurses should practice active listening, which involves asking open-ended questions and understanding patients’ concerns and perspectives (Robinson & Woo, 2019). Additionally, it is essential to consider therapeutic concepts such as empathy (Robinson & Woo, 2019). When healthcare professionals show empathy, patients are more likely to trust them.
Furthermore, educating patients is a crucial component of the communication plan (Robinson & Woo, 2019). In this case, educating the patient about her respiratory symptoms and medication, as well as the condition’s impact on both the mother’s and the fetus’s health, is crucial. Finally, collaboration is another therapeutic concept in the communication plan that helps ensure the patient is involved in the decision-making process.
Conclusion
To sum up, the woman is observed to have the return of her previous disease – asthma. Harmful environmental factors, depression, and stress can explain this. In addition, the woman is pregnant, which also contributes to stress, as she experienced domestic violence. In this case, medical intervention is highly recommended. The previous treatment, which aims to relieve symptoms without harming the child, should be considered. In addition, medical examination and appropriate medication are needed, but the patient’s pregnancy should be considered to avoid harming the child and increasing the patient’s stress level.
Reference
AAFA. (n.d.). Programs. The Asthma and Allergy Foundation of America.
GINA. (2021). What’s new in GINA 2021? Global Initiative for Asthma.
Fletcher, M., van der Molen, T., Lenney, W., Boucot, I., Aggarwal, B., & Pizzichini, E. (2022). Primary care management of asthma exacerbations or attacks: impact of the COVID-19 pandemic. Advances in therapy, 39(4), 1457-1473.
HFS. (n.d.). Medical programs. Illinois Department of Healthcare and Family Services.
Popa, M., Peltecu, G., Gica, N., Ciobanu, A. M., Botezatu, R., Gica, C., Steriade, A., & Panaitescu, A. M. (2021). Asthma in pregnancy. Review of current literature and recommendations. Maedica, 16(1), 80–87.
Robinson, M. V., & Woo, T. M. (2019). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.). F.A. Davis Company.
Sharma, S., Hashmi, M. F., & Chakraborty, R. K. (2023). Asthma medications. National Library of Medicine.
USDA. (n.d.). Special supplemental nutrition program for women, infants, and children (WIC). U.S. Department of Agriculture.