Sample Assessments
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Mr. Henry Navarro, a sixty-two-year-old Hispanic male, is seeking care. In a preceding case observed, his excessive blood stress, type two diabetes, hyperlipidemia, and coronary artery disease (CAD) had been addressed. His prescribed drug redress embodies Losartan potassium/hydrochlorothiazide for blood stress, Atorvastatin for hyperlipidemia, Metformin for diabetes, and Clopidogrel and Aspirin as blood thinners to reduce the threat of stent thrombosis. This is a specialty of his persistent obstructive pulmonary sickness (COPD) and despair.
Mr. Navarro was as speedy as nowadays diagnosed with COPD and was once as soon as prescribed an albuterol inhaler. However, he continues to enjoy shortness of breath and an inexperienced cough. COPD is a chronic lung infection characterized by dyspnea, cough, and airflow obstruction by airway and alveolar abnormalities (King Han et al., 2023).
COPD is assessed in companies A, B, and E based totally on signs and symptoms and signs and symptoms and exacerbation records. Since Mr. Navarro has had hospitalizations owing to exacerbations, he falls into organization E, which includes sufferers at high risk for exacerbations (≥two in keeping with three hundred and sixty-five days or ≥1 hospitalization) (Ferguson & Make 2023).
Constant with the worldwide Initiative for Chronic Obstructive Lung infection (GOLD), sufferers with excessive COPD need to achieve dual prolonged-appearing bronchodilator remedy, combining an extended-acting β2-agonist (LABA) and a prolonged-appearing muscarinic antagonist (LAMA) (Miravitlles et al., 2022).
To beautify adherence and reduce prices, a set-dose LABA-LAMA inhaler is preferred over separate inhalers. Umeclidinium sixty-two. 5 mcg/vilanterol 25 mcg (Anoro Ellipta), taken as fast as every day, is a practical choice with minimal adverse consequences, consisting of pharyngitis, diarrhea, and extremity ache in ≤2% of patients (Medscape, n.d.).
There is a possible interaction between hydrochlorothiazide, part of his blood pressure medicine, and umeclidinium/vilanterol since both can lower potassium levels. Nevertheless, routine potassium checks may help mitigate this risk (Medscape, n.d.).
Since smoking is the main factor contributing to the development of COPD, Mr. Navarro should receive a standard smoking cessation intervention. Stopping smoking is often tricky, and individualized approaches are generally necessary, particularly regarding one’s willingness to use drugs (Rigotti, 2021).
NRT allows patients to avoid tobacco while alleviating withdrawal symptoms. It is safe for patients with cardiovascular disease and is most effective when combined with prolonged and immediate-release dosing (Rigotti, 2023).
In Mr. Navarro’s case, he should start with a nicotine patch of 21 mg placed on the skin for 6 weeks. Afterward, he is to switch to a patch of 14 mg for another 6 weeks. His dosage should be tapering, so for 2 weeks, he should apply a patch of 7 mg before complete cessation.
For more sudden premeditated urges, gum or lozenges should suffice with NRTs, such as patches or inhalators (Rigotti, 2023). Moreover, behavioral therapy is usually prescribed. Providing access to the state quitline resource can boost the chances of success in prolonged abstinence (Rigotti, 2021).
Mr. Navarro needs instruction on inhalers, physiotherapy methods, airway clearance techniques, modifiable physical activity, and respiratory exercises. Poor inhalation technique is common, particularly among older adults with some manual skill issues (GOLD, 2023). A step-back technique should be applied to confirm that inhalers are used accurately. If Mr. Navarro cannot produce a sufficient inhalation effort, then alternative components may need to be supplied.
Increased physical activity enhances the strength and endurance of the muscles used for breathing, while controlled breathing exercises help conserve energy and reduce shortness of breath. For infection control purposes, annual immunizations against influenza, pneumococcus, shingles, and COVID-19 are also recommended (GOLD, 2023).
As Mr. Navarro thoroughly assesses himself, he mentions feeling depressed due to his diminishing and lack of interest in almost every activity. Despite him denying thoughts of self-harm, he does request medicinal treatment for his depression.
A Bupropin treatment plan is most suitable, starting with 150 mg a day of Wellbutrin XL for the first three days. If there are no significant adverse effects, increase the dosage to 300mg. Bupropion is beneficial because it greatly assists in treating depression and helps in quitting smoking. Wellbutrin SR is more likely to result in severely high blood pressure, so Wellbutrin XL is the recommended choice. However, due to his hypertension, utmost care is needed while monitoring his blood pressure (Medscape, 2023).
Common symptoms include a headache and a dry mouth, agitation, weight loss, and lightheadedness (Medscape, 2023). Mr. Navarro has to understand that healing is a very slow process, and due to this, pills might take weeks to start working; regardless, he cannot quit them the moment he starts seeing the slightest change. In addition, he must be referred to a therapist or psychiatrist to get the correct diagnosis and treatment.
The use case summary illustrates the necessity of tailored treatment for COPD as well as depression challenges. Mr. Navarro’s care plan should focus on optimizing pharmacologic remedies, ensuring adherence, and imposing smoking cessation strategies.
Ferguson, G. T., & Make, B. (2023). sturdy COPD: initial pharmacologic management. UpToDate. Retrieved July sixteen, 2023.
Global Initiative for Chronic Obstructive Lung Sickness (GOLD). (2023). international method for preventing, assessing, and managing COPD: 2023 record.
King Han, M., Dransfield, M. T., & Martinez, F. J. (2023). continual obstructive pulmonary disease: evaluation and staging. UpToDate.
Medscape. (2023). Bupropion (Wellbutrin XL).
Medscape. (n.d.). Umeclidinium bromide/vilanterol inhaled (Anoro Ellipta).
Miravitlles, M., Kawayama, T., & Dreher, M. (2022). LABA/LAMA as first-line therapy for COPD: A precis of the proof. Mag of clinical remedy.
Rigotti, N. A. (2021). Evaluation of smoking cessation manipulation in adults. UpToDate.
Rigotti, N. A. (2023). Pharmacotherapy for smoking cessation in adults. UpToDate.
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