Nursing

Patient Diagnosis Case Study: Asthma
Complete the case study by answering the questions associated with the scenario.
Scenario
Nancy Smith, a 35-year-old female, presents with an asthma exacerbation. She has had asthma since she was a child for which she was hospitalized several times. Her asthma was well controlled until the past couple of 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 received allergy shots for many years. Her asthma symptoms flared again 2 weeks ago, and she has been using her albuterol 4 to 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 herself up on pillows to breathe. She indicates that she has had similar previous flares in the past.
Health information:
• Meds: Proair HFA, Claritin, Flonase prn.
• Spirometry:
o FEV1: 61%
o FVC: 88%
o FEV1/FVC ratio: 69%
• Pulse ox: 93% on RA

Based on the scenario provided, fully inform your patient and explain their diagnosis.
Use UpToDate located in the University Library to search for and locate the most current evidence-based guidelines to answer the following questions.
Overall Health and Pathophysiology
1. Discuss the pathophysiology of asthma, including the 3 core defects.
2. Explain the significance of “atopy” and “one continuous airway,” applying Nancy’s scenario.
Diagnosis
3. Interpret her spirometry results by defining and analyzing each value (FEV1, FVC, FEV1/FVC ratio) individually.
4. Classify Nancy’s asthma. Which of the 4 categories (intermittent, persistent—mild, persistent or moderate, persistent—severe) does she fall under? Explain your justification.
Asthma Management
5. Is Nancy’s asthma being managed properly? Justify your response.
6. What is the value in performing this spirometry on Nancy when she already has a known diagnosis of asthma?
7. Discuss the patient education you would provide and how you would specifically tailor your information to Nancy to facilitate compliance and understanding.