Helen Year Female Question & Answer Guide (With Explanation)

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Structure your response with introduction, analysis, and conclusion.

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Original Question

Helen, a 72-year-old female patient is evaluated for fatigue and decreased exercise capacity. She has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago, and was hospitalized for her second exacerbation 1 month ago. She is a former smoker, having stopped smoking 5 years ago. Helen smoked 1 pack a day for 30 years. She has no other significant medical problems, and her medications are albuterol inhaler 2 puffs every 4 hours as needed for shortness of breath, and Advair Diskus 250/50 mcg/blister DPI one puff every 12 hours, and oxygen at 2 liters / minute via nasal cannula. Pt patient is using her albuterol inhaler at least two times a day for breathlessness. She has no known drug allergies. On physical examination, vital signs are normal. Breath sounds are decreased and there is 1+ bilateral pitting edema. Spirometry done 1 month ago showed an FEV1 of 28% predicted, the FEV1/FVC was 0.65, and blood gases measured at that time (on supplemental oxygen) showed pH 7.41, PaCO2 55 mmHg, PaO2 64 mmHg and HCO3- 32. There is no nocturnal oxygen desaturation. Chest radiograph at this time shows hyperinflation. CT scan of the chest shows homogenous distribution of emphysema. 1- What is the relevant objective and subjective assessment data from the case study? 2- What does this data indicate? What conclusions can you make? What is your preliminary diagnosis(es)? 3- Search the literature using databases, and select a clinical practice guideline (CPG) to guide your prescribing for these diagnosis(es). Which CPG did you select? (Include the reference for the CPG). Why did you select it? 4- Based on the CPG you have selected, what non-pharmacologic and pharmacologic interventions will you use for your treatment plan? How does each intervention treat the pathophysiology of the diagnosis(es)? What is the priority for each intervention (which interventions are first versus later)? 5- What are the important prescribing considerations for the pharmacologic interventions? 6- Write a prescription for each medication you would prescribe, including all elements of a prescription. 7- What outcomes would you anticipate – therapeutic effects and adverse effects? How will you evaluate for these outcomes? 8- What patient education and follow up is required for the medications you have prescribed?

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