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• Determine appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case.

Treatment Plan:

Michelle is now coming back to the clinic with new onset flu-like symptoms. She is tachypneic, has mild SOB with exertion, an O2 saturation of 94%, and increased wheezing. She also reported being febrile at 101-102*F, a productive cough with white sputum. To further confirm her flu-like symptoms, she tested positive for Influenza A. According to the Centers for Disease Control and Prevention, treatment for Influenza antiviral drugs should ideally be started within 2 days after becoming sick, (CDC, 2021). One of the most commonly used antiviral drugs is Oseltamivir (Tamiflu)................... Continue

• Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is required. Discuss the criteria used to make your decision, how a referral is made and defend your position.

(Start) Oseltamivir (Tamiflu) 75 mg capsules

Sig: Take one capsule by mouth twice daily for 5 days Disp # 10

0 Refills

(Hooker, K. L., & Ganusov, V. V., 2021)................... Continue

• Discuss relevant education and follow up plan.

Since Michelle is being sent home, I would advise her to self-isolate in her home for at least 24 hours if possible, (Belon et al., 2021). This will help prevent the spread of the virus to her coworkers and family. It is also important to remind Michelle to keep up with her annual influenza vaccination, especially now since diagnosed with asthma................... Continue

References

Belon, L., Skidmore, P., Mehra, R., & Walter, E. (2021). Effect of a fever in viral infections — the ‘goldilocks’ phenomenon? World Journal of Clinical Cases, 9(2), 296–307. https://doi.org/10.12998/wjcc.v9.i2.296................... Continue

When would you consider PO steroids?

You are correct, instead of exempting further testing I would test her peak flow measurement to determine the severity of her exacerbation to decide her treatment plan................... Continue

Noted that a humidifier was recommended. Is this as per the GINA guidelines? Would a spacer be considered as a DME?

GINA guidelines do not specifically talk about humidifiers being the best DME for asthma patients. They only mentioned modifying humidity conditions if there were unfavorable environmental conditions such as very cold weather, low humidity, or high air pollution, (GINA, 2022)................... Continue

References

GINA. (2022). 2022 Gina Main Report - Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Retrieved from https://ginasthma.org/gina-reports/................... Continue