While working with Ms. Whitley I will be sure to do a baseline assessment to ensure which medication would be more efficient to her and her lifestyle. I will attempt to assist the patient in finding any new triggers that has been exacerbating her asthma. I will also assess how the patient is using her albuterol inhaler due to at least two thirds of patients have errors using their inhaler leading to suboptimal delivery of the medication and worse asthma control (Wu, Brigham , & McCormack , 2019). Currently the patient is prescribed a rescues medication which is short acting and providing immediate bronchodilation (Wu, Brigham , & McCormack , 2019). A low dose inhaled corticosteroid will be the next pharmacologic option. Fluticasone/salmeterol (Advair Diskus, Advair HFA) can be prepared per inhalation 50/100mcg (Rosenthal & Burchum , 2018)
I will also need an understanding on how often the patient is taking acetaminophen for her chronic pain and gain radiological images to ensure no fracture or tear. I will also go through other treatment modalities such as physical therapy, knee braces and weight management. In short term, use an NSAID such as Ibuprofen (Motrin) 800mg would be better outcome to decrease pain and inflammation in Ms. Whitney knee.
For Birth control I would ask the patient of possible family planning in the future, preference on delivery method and any previous history. Pregnancy planning is a shared decision from provider and patient. Gauging the correct birth control method for the patient will include discussions of; family planning goal, age frequency of sexual intercourse, and the individual’s capacity for adherence (Rosenthal & Burchum , 2018). Due to the patient’s young age, I would be less likely to place on long term implanted birth control option unless explicitly requested (Chacko, 2021). I believe the vaginal ring or transdermal patch would be the most reasonable for the patient. I will educate patient on using condoms to protect from STIs
I will not feel comfortable prescribing weight loss medication. I will give the patient resources on diet and exercise intervention, also check her labs to ensure there is not an underlying condition such as thyroid disorder causing weight loss challenges. It will be helpful to have a referral to a nutritionist to aid in a reduced calorie diet and eating the right foods and the right time. I will also include tips for stress management, and stimulus control.
Chacko, M. (2021, September ). Contraception: Issues Specific to Adolescents . Retrieved from UptoDate : https://www.uptodate.com/contents/contraception-issues-specific-to-adolescents?topicRef=5459&source=see_link
Rosenthal , L., & Burchum , J. (2018). Lehne’s Pharmacotherapeutics for Nurse Practitioners and Physician Assitants. St. Louis : Elsevier.
Wu, T., Brigham , E., & McCormack , M. (2019). Asthma in the Primary Care Setting. The Medical Clinics of North America, 103(3), 435-452. doi:doi.org/10.1016/j.mcna.2018.12.004
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