NR565 ASTHMA PROTOCOL: INITIAL VISIT
Carefully read the assignment guidelines and rubric, and complete each section of the asthma protocol below.
RATIONALE
This protocol will assist in the differentiation between treatment needs for clients with asthma based on age and symptom frequency and severity, including the process for identification of clients in need of referral to pulmonology to improve asthma control. The design of the protocol for asthma encompasses these principles.
SYMPTOMS
ASTHMA
History of respiratory symptoms that vary over time with varying intensity, including:
Wheezing
Shortness of breath
Chest tightness
Cough
Triggers for exacerbation can include:
Exercise
Allergens
Season changes
Laughter
Respiratory illness
Presence of asthma phenotypes
Client responses on the Asthma Control Test (ACT) or the Asthma Control Questionnaire (ACQ)
Reduced lung function and responsiveness with medications
Reduced expiratory airflow (forced expiratory volume in one second, a.k.a. FEV1)
Variable peak expiratory flow (PEF)
PHYSICAL EXAM
Perform the following examinations:
Vital Signs (blood pressure, pulse, oxygenation, respiratory rate)
Auscultation for wheezing
Identify increased work of breathing
Identify retractions
Cardiac assessment
Lower extremities for edema and pulses
Neurological
Consult supervising physician if findings of:
Respiratory distress
LAB TESTS
Depending on severity, can include:
Arterial or venous blood gas
ph
O2
CO2
Bicarbonate
Base excess
CBC
Hemoglobin and hematocrit
WBC and eosinophils
Total or specific IgE levels
Consult supervising physician if:
Abnormal blood gas results or severe anemia
PULMONARY FUNCTION TESTS
Forced expiratory volume in one second (a.k.a. FEV1)
Peak expiratory flow (PEF)
PHARMACOLOGICAL TREATMENT
Asthma Treatment Algorithm:
To successfully treat asthma, you must be proficient in applying age-group-specific Global Initiative for Asthma (GINA) treatment recommendations. Treatment recommendations are presented as steps, with the step number indicating a level of intensity. Complete the blanks in the following table to create an algorithm for asthma care using current GINA guidelines for clients 12 years and older.
What is a “reliever”?
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What is a “controller”?
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Step
Asthma Symptom Frequency
Controller and Preferred Reliever:
Drug class and frequency as per GINA guidelines)
Controller and Alternative Reliever:
(Drug class and frequency as per GINA guidelines)
Step 1
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Drug class:
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Example Drug:
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Frequency:
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Drug class:
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Example Drug:
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Frequency:
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Step 2
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Drug class:
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Example Drug:
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Frequency:
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Step 3
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Drug class:
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Example Drug:
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Frequency:
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Drug class:
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Example Drug:
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Frequency:
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Step
4-5
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Step 4:
Drug class:
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Example Drug:
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Frequency:
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Drug class:
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Example Drug:
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Frequency:
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Step 5:
Drug class:
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Example Drug:
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Frequency:
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Refer for:
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No change.
Citation (Provide (Author, year) and not full reference): Click or tap here to enter text.
TREATMENT DIFFERENCES IN ADULTS AND CHILDREN
1st line initial pharmacological treatment in step one, track one asthmatic adult clients and no compelling contraindications/comorbidities are identified: (Choose a generic drug from the drug class you would like to prescribe as initial asthma treatment for adults).
Drug: Click or tap here to enter text.
Dose: Click or tap here to enter text.
Route: Click or tap here to enter text.
Frequency: Click or tap here to enter text.
Instructions to provide patient: Click or tap here to enter text.
Caution/Precautions: Click or tap here to enter text.
Using a source such as GoodRX, what is an estimated cost of this drug for a 30-day supply? Click or tap here to enter text.
What client education is needed for this drug?
Citation (Provide (Author, year) and not full reference): Click or tap here to enter text.
1st line initial pharmacological treatment in step one, track one pediatric clients (ages 6-11) and no compelling contraindications/comorbidities are identified: (Choose a generic drug from the drug class you would like to prescribe as initial asthma treatment for pediatric clients).
Drug: Click or tap here to enter text.
Dose: Click or tap here to enter text.
Route: Click or tap here to enter text.
Frequency: Click or tap here to enter text.
Instructions to provide patient: Click or tap here to enter text.
Caution/Precautions: Click or tap here to enter text.
Using a source such as GoodRX, what is an estimated cost of this drug for a 30-day supply? Click or tap here to enter text.
What client education is needed for this drug?
Citation (Provide (Author, year) and not full reference):
TREATMENT MONITORING
How long until a follow-up appointment should be done with the client?
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Monitoring needs for first-line medications prescribed to adults for track one, step one: (Include physical assessments, pulmonary function tests, and lab/diagnostics as applicable. If not applicable, enter N/A to show you find it not applicable.)
Physical Assessments:
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- Pulmonary Function Tests:
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- Labs:
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Citation (Provide (Author, year) and not full reference): Click or tap here to enter text.
TREATMENT FAILURE
How will you know if the treatment is not working or needs to progress?
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- What is the next step if treatment is not working or needs to progress?
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- What indicators would demonstrate the client requires a higher level of care?
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Citation (Provide (Author, year) and not full reference): Click or tap here to enter text.
References
(Three complete scholarly references as defined by the NP program are required in APA format. Please note that the textbook may be used but does not count as a scholarly source. Only clinical practice guidelines and journal articles in the last 5 years count as scholarly sources.)
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NR565 ASTHMA PROTOCOL: INITIAL VISIT
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