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Select one of the two questions from the discussion questions listed below. By Week 4, Day 3, respond to the selected discussion question and submit your response to this Discussion Area.

Be sure to respond to the question using the lessons and vocabulary found in the reading. Justify your answers using examples and reasoning. Support your answers with examples and research and cite your research using APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ posts. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.

Discussion Question 1

SE is a twenty-two-year-old Caucasian woman who was diagnosed with asthma at age seven. According to her medical record, she has “”mild persistent”” asthma. Today, she reports that she has been using her albuterol metered-dose inhaler (MDI) approximately three to four days per week over the last two months. Over the past week, she admits to using albuterol once daily. She has been awakened by a cough three nights during the last month. She states she especially becomes short of breath when she exercises. However, she also admits that the shortness of breath is not always brought on by exercise. She also has a fluticasone MDI, which she uses “”most days of the week.”” She has been hospitalized twice in the last year for poorly controlled asthma and has been to the emergency department (ED) three times in the last six months for the same problem. Her lab work is all within normal limits, with the exception of a positive human chorionic gonadotropin (HCG). Answer the following questions:

• What information in the case study suggests that her asthma is not well controlled?
• What factors could possibly lead to this?
• How would you classify the symptoms based upon the National Institutes of Health (NIH) guidelines?
• With the recognition that she is pregnant, how would you alter her treatment for asthma?

Support your responses with guidelines, including the NIH guidelines, for management of asthma during pregnancy. Use other peer-reviewed articles as needed to support specific aspects of your plan.

Discussion Question 2

TJ is a fifty-five-year-old police officer who presents to the clinic with complaints of epigastric pain for two weeks. He has been taking over-the-counter (OTC) Zantac without relief. He was diagnosed about a year ago with a bleeding ulcer, and he expresses concerns that the current symptoms remind him of that event. At that time, he was given “”multiple prescriptions”” for his stomach, but he did not complete the course of therapy because he began to feel better. He also has osteoarthritis in his wrists and hips, for which he takes OTC NSAIDs. He smokes one to two packs per week and drinks an average of one alcoholic beverage daily. His vital signs and blood work are all within normal limits. Answer the following questions:

• What additional testing would you suggest at this point?
• Describe any and all variables that could be contributing to his symptoms.
• What alterations would you suggest in his treatment? Be sure to consider additional diagnoses and whether prophylaxis would be appropriate for NSAID-induced ulcers.

Support your responses with guidelines you locate in the literature and peer-reviewed articles as needed to support your ideas.

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