45 years old Hispanic male patient, who works for a constructions company, complains that two days ago while at work he experienced difficulty in breathing accompanied by coughing and short of breath. The difficulty in breathing and chest tightness increases at night when it gets cold. The patients state that he is allergic to cockroach droppings dust and grass pollen. Recently, he received a letter from management warning him of being laid off if he does not improve his work output. This has caused his stress levels to rise and in an effort to cope with the pressure of work he has indulged in frequent smoking, a habit he had quit years ago but work pressure has forced him to resume smoking. He had similar symptoms earlier in life but when he quitted smoking the symptoms disappeared. He has been using over the counter medication such as albuterol to manage the symptoms. He has not sought any medical attention for the condition since the symptoms were mild and over the counter medication cured him. However, in the last two days, the symptoms have been persistent and the usual medication has not provided any remedy.
He stated that at childhood age his mother used to buy him inhalers to use periodically during winter when he experienced any difficulty in breathing, but he did not like the idea of using inhalers since other children from the neighborhood did not use them and he did not want to appear weak. Hence, when he moved to college he stopped using inhalers since he saw it as a burden and his mother was overprotective. Apart from inhalers and over the counter drugs, his mother used to give traditional herbs which she state was a cure for his illness. He has no siblings; however, his mother told him that his father who had passed away while he was still a child had a similar condition. He stills use those herbs in his morning tea since they make it tasty. His major concerns include losing his job, not having insurance cover and not providing for his family since he is the sole breadwinner of his family.
Physical assessment findings
The patient appeared a bit distress and worried but well groomed. His temperature at the time of the visit was 97.3 and his weight was 130 pounds while the height was 67; respirations rate 24. His vision is clear and movements of the eyes are in good condition. He has congested nasal with a yellow discharge. He experienced a congested cough and his breath wheezes. Abdominal examination was normal no signs of abnormalities.
Diagnosis
Pulmonary embolism can be ruled out due to the absence of sharp chest pain, sweating, fainting and rapid breathing (Büller et al., 2013). However, the possibility of acute asthma can be considered in this case. The From the health history and physical examinations, the patient experienced frequent wheezing, short of breath and chest tightness during cold season and when exposed to allergic agents such as grass pollen (Brown et al., 2014). His condition got worse when the patient resumed smoking habit. The patient used to take inhalers to treat the illness symptoms when they appear. Currently, the patient is using traditional medicines in his tea and albuterol to control the symptoms.
Care plan
Given his age and his professional, it was necessary to put the patient on long term treatment which will help him manage his condition. The patient was put on Flonase to prevent any inflammation of respiratory truck and zafirlukast (Accolate) to manage his condition on a daily basis (Mayo Clinic, 2015). However, since the patient works in a construction company he may experience sudden asthma attack; thus, in the case of an attack he was given levalbuterol (Xopenex) and salmeterol to keep the airways open all the time (Mayo Clinic, 2015).
Teaching topics
Lifestyle changes
The patient smoke and he exposed himself to frequent dust. Thus, these two can trigger an asthma attack. According to Mitchell et al. (2012), frequent exposure to allergens, mold and irritant exacerbate asthma attack. Therefore, there is a need to reduce environmental exposure to these triggers. Hence, it is essential that the patient changes his poor lifestyle and adopt healthy life by quitting smoking. Additionally, the patient must wear a dusk mask at work and avoid dusty environs. The patient need to ensure his house is clean at all times to prevent dust and cockroach droppings (Brown et al., 2014). On the other hand, Moreira assert that there is a high correlation between asthma and weight; hence, to avoid exacerbating asthma, it is recommended that patients should check their weight (Moreira, 2013). Thus, in this scenario, the patient should check his diet and engage in mild physical exercise. This will be vital in improving his breathing patterns and lungs functionality. According to Moreira (2013), obesity has the effect of increasing the severity of asthma and allergic inflammation airway. Furthermore, the patient should seek engagement in sports and spiritual activities to keep his stress levels in check
Medication
The patient has a history of poor discipline when it comes to medication. There is a need to change this behavior. Thus, it is vital for the patient to observe drug prescription to avoid asthma attack and manage his condition. Ritz et al. (2013), observes that medication adherence has a significant impact on the management of this illness. Thus, the patient needs to take his medication seriously to avoid health complications associated with this disease.
Barriers to comprehensive care
The patient has no insurance cover and his family depends entirely on him. This can be a barrier to accessing quality care since paying medical bills straight from his pocket may not be a sustainable option for a long period. Thus, the patient may need to apply for affordable care (Obama care) which is more affordable than other private insurance covers (Cheng et al., 2013). Additionally, the patient still uses tradition medicine. This implies that the patient depends hugely in these herbs to manage his condition. This is a threat to his life in that in the case of an attack the patient may decide to use traditional medicine instead of visiting a hospital for treatment.
Reflection
The patient is under pressure from work to improve his performance. This underscores the importance of further psychology and psychiatrist treatment to help the patient to deal with his stress and how to manage pressure from family and work responsibilities. Additionally, there is the need to further check the family health history to assess the prevalence of asthma in the family. The illness has no cure, but it can be managed. The patient ought to take his medication as prescribed and avoid triggers which can cause an attack (Ritz et al., 2013). Thus, the patient needs to live a healthy life by checking his died, live in a clean environment, wear a dusk mask and manage his stress.
References
Brown, K. W., Minegishi, T., Allen, J. G., McCarthy, J. F., Spengler, J. D., & MacIntosh, D. L. (2014). Reducing patients’ exposures to asthma and allergy triggers in their homes: an evaluation of effectiveness of grades of forced air ventilation filters. Journal of Asthma, 51(6), 585-594.
Büller, H. R., Décousus, H., Grosso, M. A., Mercuri, M., Middeldorp, S., Prins, M. H., & Shi, M. (2013). Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. The New England journal of medicine, 369(15), 1406-1415.
Cheng, T., Adamides, K., Campos, S., Selbin, J., O'Leary, A., & Fuentes, R. (2013). The Obamacare Opportunity: Implementing the Affordable Care Act to Improve Health, Reduce Hardship, and Grow the Economy for All Californians.Reduce Hardship, and Grow the Economy for All Californians (August 28, 2013).
Mayo Clinic. (2015). Asthma Treatments and drugs - Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/asthma/basics/treatment/con-20026992
Mitchell, H., Cohn, R. D., Wildfire, J., Thornton, E., Kennedy, S., El-Dahr, J. M., & White, L. E. (2012). Implementation of evidence-based asthma interventions in post-Katrina New Orleans: the Head-off Environmental Asthma in Louisiana (HEAL) Study. Environmental health perspectives,120(11), 1607.
Moreira, A., Bonini, M., Garcia‐Larsen, V., Bonini, S., Del Giacco, S. R., Agache, I., & Haahtela, T. (2013). Weight loss interventions in asthma: EAACI Evidence‐Based Clinical Practice Guideline (Part I). Allergy, 68(4), 425-439.
Ritz, T., Meuret, A. E., Trueba, A. F., Fritzsche, A., & von Leupoldt, A. (2013). Psychosocial factors and behavioral medicine interventions in asthma.Journal of consulting and clinical psychology, 81(2), 231.
