NR 603 Week 2 Case Discussion: Pulmonary – Part 1

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Hello to all, Based upon the presenting symptoms and assessment findings given, the most likely diagnosis related to this case study would be occupational asthma or baker’s asthma. This is an active airway disease, which affects four to twenty five percent of bakers worldwide (Brittner, Peters, Frenzel, Muskin, Brettschneider, 2015). Michelle complains of shortness of breath while at work, however she has relief and no longer experiences shortness of breath once leaving work and, on the weekends, while at home. Physical exam findings showed thin, exudate to bilateral nares, boggy, pale mucosa, and wheezing noted upon inspiration and expiration. Due to wheezing and shortness of breath while at work could be due to an allergen related to an inhalation of a type of flour used at the bakery. With Michelle having exudate to both nares this would be related to an allergic rhinitis. Allergic rhinitis is an inflammation of the nasal mucosa, which is an IgE-mediated allergy causing sneezing, a stuffy nose, or a runny nose (Tanno, et al., 2016). In 2016, Michelle, had a pulmonary function test performed. There was an increase of 15% seen in her pulmonary function test post bronchodilator. The existence of airflow obstruction and a good bronchodilator response is consistent with the diagnosis of asthma. Key indicators associated with asthma include the following: recurrent difficulty in breathing or shortness of breath, recurrent wheezing or tightness in one’s chest, and a cough (worsening at night). The diagnosis of asthma requires these symptoms and demonstration of reversible airway obstruction using spirometry (Mccracken, Veeranki, Ameredes, & Calhoun, 2017). Michelle is experiencing symptoms daily, and along with this her FEV1 is >60% but less than 80%. Based upon her severity she would be considered a moderate persistent asthmatic. As a healthcare provider, to treat Michelle’s asthma, I would initially order a CBC, CMP, chest x-ray, and I would refer her to an allergist to have skin testing performed. A CBC would help to rule out infection, where as a CMP would check basic electrolytes, kidney function, and her blood glucose.

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