46562

1. Describe your assigned client’s situation. Why are they presenting to the clinic? What medications are they currently taking?

My client, Kia Tadesse, is a 67-year-old female diagnosed with COPD. Kia has no allergies or other medical illnesses. She is currently taking olodaterol 2.5 mcg/tiotropium 2.5 mcg (Stiotto Respimat), 2 puffs via inhalation once daily. She reports that she is strictly adherent to her medication regimen. Kia quit smoking cigarettes a year ago and doesn’t drink alcohol.

2. Despite her strict adherence to her medication, Kia presents to the clinic following a hospital discharge, where she was admitted for two days due to a COPD exacerbation. Morning labs reveal a plasma eosinophil count greater than/equal to 350 cells/uL. Physical assessment reveals bilateral expiratory wheezes on auscultation with no retractions present. The rest of the physical exam is unremarkable. Kia had one hospitalization last year and doesn’t want to continue having them after her most recent stay.

3. Discuss your personal professional assessment of the client’s situation provided in the scenario. What pharmacological treatment is necessary and why?

Kia’s recent hospitalization signals a need for a medication review. Despite being compliant, she still experienced an exacerbation like the previous year. According to the CPG, if a patient is currently taking a combination treatment that consists of a LAMA/LABA (which my client currently is), their EOS is greater than/equal to 300 cells/uL, and has had at least one hospitalization due to exacerbation, then an inhaled corticosteroid (ICS) should be added. Studies show that triple inhaled therapy of LAMA/LABA/ICS improves lung function, symptoms, and health status, and reduces exacerbations. Also, a study shows a beneficial effect on mortality in symptomatic COPD patients with a history of frequent and/or severe exacerbations (“Pocket Guide,” 2023). Kia is currently taking olodaterol 2.5 mcg/tiotropium 2.5 mcg. The ICS of choice would be budesonide (Pulmicort Flexhaler) 180 mcg/inhalation, DPI. This medication is also considered part of the glucocorticoid class. Kia will take 2 puffs via inhalation twice daily.

Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?

Additional questions I would ask Kia are: Have you made any recent changes to your normal day-to-day routine? Were you doing anything that could trigger a flare-up leading up to your current exacerbation? Would you be able to afford adding another medication to your current treatment regimen? And, due to your good compliance with care, would adding an additional medication cause any difficulty where assistance may be needed?

A follow-up appointment should be scheduled within a month to assess any physical changes found during a physical exam. During this assessment, I would look for or ask about improvement of symptoms, side effects, and address any questions and/or concerns. No routine lab testing is indicated for her current or new medication, but due to her previous elevated eosinophil (EOS) results, repeating a CBC with differential would be ideal. This can be used to see if the levels have decreased. If so, the medication change is working and could be adjusted, as ICS use is strongly correlated with eosinophil counts (“Pocket Guide,” 2023).

Patient education is always important, especially when it comes to new medications. I would educate Kia about all side effects, adverse effects that may be rare but can still occur, and when it’s necessary to call the office or go to the ER if emergent. I would assess inhaler technique and inform her to inhale slowly, holding her breath after inhalation (not too long, which can decrease oxygen). Kia should be informed that it’s important to clean the inhaler and mouthpiece regularly and rinse her mouth afterward to prevent irritation.

Reference

Pocket guide to COPD diagnosis, management, and prevention. (2023), Global Initiative for Chronic Obstructive Lung Disease, 2024 edition. https://goldcopd.org/wp-content/uploads/2024/02/POCKET-GUIDE-GOLD-2024-ver-1.2-11Jan2024_WMV.pdfOpen this document with ReadSpeaker docReader

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now