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Can you please proofread this case study for a graduate level. ( APA 7th ed for references and citation). Thank you for helping me make my assignment better. Patient Diagnosis Case Study: Asthma Complete the case study by answering the questions associated with the scenario. Scenario Nancy Smith, a 35-year-old female, presents with an asthma exacerbation. She has had asthma since she was a child for which she was hospitalized several times. Her asthma was well controlled until the past couple of years. She has been seen in urgent care a few times over the past year (most recently 4 months ago) and was given a prescription for an inhaled steroid (she never filled), albuterol inhaler, and oral steroids. She had eczema as a child and received allergy shots for many years. Her asthma symptoms flared again 2 weeks ago, and she has been using her albuterol 4 to 5 times/day. She reports that she is very short of breath when climbing stairs or when walking to the mailbox. She has had nighttime coughing spells every day during the past week and has had to prop up herself up on pillows to breathe. She indicates that she has had similar previous flares in the past. Health information: • Meds: Proair HFA, Claritin, Flonase prn. • Spirometry: o FEV1: 81% (post-bronchodilator results with 15% increase) o FVC: 88% o FEV1/FVC ratio: 82% • Pulse ox: 93% on RA Based on the scenario provided, fully inform your patient and explain their diagnosis. Use UpToDate located in the University Library to search for and locate the most current evidence-based guidelines to answer the following questions. Overall Health and Pathophysiology 1. Discuss the pathophysiology of asthma, including the 3 core defects. Relate them to Nancy’s case. 2. Explain the significance of “atopy” and “one continuous airway,” applying Nancy’s scenario. Diagnosis 3. Interpret her spirometry results by defining and analyzing each value (FEV1, FVC, FEV1/FVC ratio) individually. 4. Classify Nancy’s asthma. Which of the 4 categories (intermittent, persistent—mild, persistent or moderate, persistent—severe) does she fall under? Explain your justification. Asthma Management 5. From a pathophysiological perspective, what is the danger in Nancy overusing her rescue medication? My work start below: Scenario: Nancy Smith, 35-year-old female, presents with clinical signs of an asthma exacerbation. She stated she has had asthma since childhood and had multiple inpatient (IP) stays. Reported that her asthma was well controlled until the past couple of years, 4 months ago she has been seen at the urgent care a few times and was given a steroid inhaler prescription (never filled), albuterol inhaler, and oral steroids. Reported history of eczema during childhood and received allergy shots for many years. New episodes of Asthma flare up started 2 weeks ago per Nancy and has been using her albuterol 4 to 5 times per day. Reported coughing at nights every day during the past week and has had to prop up herself up on pillows to breathe. She indicates previous similar flares up in the past. Chief complaints: “I’ve been having trouble breathing, especially at night, and I’ve had to use my inhaler almost every day” History of Present Illness: Nancy Smith is a 35-year-old female presenting with an asthma exacerbation. She reports a worsening of asthma symptoms over the past few months, with increased shortness of breath, nighttime coughing, and decreased exercise tolerance. The symptoms have intensified in the last week, requiring propping herself up to sleep. She uses her rescue inhaler (Albuterol) to 5 times per day. Her last urgent care visit was two weeks ago. Despite having been prescribed an inhaled corticosteroid (ICS), she never filled it. Her reported symptoms are interfering with her daily life, and she is experiencing increasing anxiety over the lack of control. Past Medical History Asthma (diagnosed in childhood; hospitalized several times) • Atopic dermatitis/eczema (childhood) • Allergic rhinitis (presented from antihistamine use) Surgical History: None Social History: Lives alone, nonsmoker, no alcohol or recreational drug use reported, No know occupational or environmental exposures identified Family History: • Mother with asthma and seasonal allergies • No other significant hereditary conditions reported Medications: • Proair HFA (albuterol- frequent use (4-5x/day) • Claritin (loratadine)- PRN • Flonase (fluticasone nasal spray)- PRN • Inhaled corticosteroid (unfilled prescription) Allergies: NKA Recent labs and diagnostics: Pulmonary Function Testing (PFT) • FEV1: 81% (post-bronchodilator, with 15% improvement) • FVC: 88% • FEV1FVC Ratio: 82% Vital signs: Pulse Oximetry: 93% on room air Initial Assessment Nancy’s clinical picture is consistent with moderate persistent asthma based on symptom frequency, nocturnal awakening, rescue inhaler overuse, and partially reversible airflow obstruction (GINA,2023). Her underuse of controller therapy and overreliance on a short-acting beta agonist (SABA) increases her risk for future exacerbations (Global Initiative for Asthma [GINA],2023). Additionally, social and behavioral factors including medication nonadherence and limited support may contribute to poor asthma management. Cultural competency and education are essential to improve self-management and promote health literacy. Overall Health and Pathophysiology Asthma is a chronic inflammatory disorder characterized by airway hyperresponsiveness, airflow limitation, and remodeling (Global Initiative for Asthma [GINA],2023). The three core pathophysiology components are bronchoconstriction, airway inflammation, and mucus production contribute to intermittent episodes of wheezing, coughing, and breathlessness. There is no cure for asthma, but we can manage it. It is important that you monitor your symptoms and avoid triggers that cause an attack. In Nancy’s case, her recurrent symptoms— wheezing, dyspnea, and nighttime coughing demonstrate classic airway hyperresponsiveness and inflammation. Her spirometry confirms this although her post-bronchodilator FEV1 (81%) showed 15% improvement confirms reservable airway obstruction, a hallmark of asthma, her FEV1/FVC ratio (82%) points toward ongoing obstruction. Atopy refers to a genetic tendency to develop allergic diseases like asthma, eczema, and allergic rhinitis. Nancy’s childhood history of eczema and current asthma symptoms align with the concept of the “atopic march’ suggesting an IgE-mediated allergic component (Ober & Yao,2020). The “one continuous airway” hypothesis links upper and lower airway inflammation, explaining why poorly managed allergic rhinitis can exacerbate asthma (Licari et al.,2020). Atopy and “one continuous airway” theory support the systemic nature of allergic inflammation and its progression from skin to airway involvement. Diagnosis and classification Spirometry interpretation • FEV1 (81%): Mild Obstruction • FVC (88%): Near-normal lung volume • FEV/FVC (82%): Slightly reduced, supports obstruction • Post-bronchodilator improvement (15%): Indicates reversible airflow limitation. Confirming asthma Asthma Classification Nancy’s symptoms: Frequent nighttime awakenings, daily rescue inhaler use (45 times/day), and impaired activity point to persistent, moderate asthma. According to the GINA guidelines (2023), this classification fits Nancy’s symptoms which are: Daily symptoms, nighttime awakenings > 1 time/week, FEV1 60-80%, and some limitation in normal activity. Nancy’s falls into the category of persistent moderate. This diagnosis aligns with Nancy’s poor medication adherence and her recurrent urgent care visits. Asthma Management From a pathophysiological perspective, overuse of rescue medication such as albuterol can mask underlying inflammation, increase beta-2 receptor desensitization, and delay appropriate treatment (Vertadier et al., 2022). This overuse combined with underuse of controller medications, worsens chronic inflammation and increases the risk of severe exacerbations. Nancy’s frequent SABA use is a red flag indicating poor control and risk of future exacerbations. Nancy’s clinical presentation meets the criteria for Moderate persistent asthma, as defined by the Global Initiative for asthma (GINA,2023). Her daily symptoms, nighttime awakenings, and functional limitations indicate the need for Step 3 Therapy (GINA,2023), which includes the initiation of daily low-to-medium inhaled corticosteroid (ICS) in combination with a long-acting beta-agonist (LABA). Given her overuse of albuterol (4-5 times daily), immediate transition to a controller regimen is essential and her intermittent use of Claritin and Flonase for her allergic rhinitis likely suggest it is contributing to her asthma flares. As her NPs to manage her asthma I will use the Pender Health Promotion Model this model will help me focus on Nancy’s personal beliefs, prior behaviors, and perceived self-efficacy. Exploring why Nancy never filled her steroid inhaler prescription may reveal psychosocial, cultural, or financial factors that need to be addressed through patient education and motivational interviewing (Pender et al., 2019). I will create with Nancy a personalized care plan with green, yellow and red zones to help her recognize symptoms, implement correct medication regimen, and know when to seek medical attention. I will educate her on the difference between controller and reliever medications, appropriate inhaler technique with spacer uses if needed, and strategies to avoid triggers, such as allergens, smoke, and physical overexertion. I will also teach her the importance of monitoring her symptoms daily and encourage her to track her medication use, particularly SABA frequency, which serves as a key marker of disease control. Scheduling 6 weeks follow up visit to evaluate her symptom control, medication adherence, and possible side effects from new regimen in place. Once stable I will space up the follow-ups to every 3-6 months. Finally, due to the history of atopic dermatitis, allergic rhinitis, a referral to an allergy and immunology specialist will be appropriate for further evaluation. By promoting self-efficacy and engaging her in shared decision-making I might be able to foster lasting behavioral change. In summary 3 core components to effectively manage Nancy’s asthma care will be based on patient education, follow-ups, and therapeutic adherence. Conclusion Nancy’s case is a powerful reminder of how vital our role is in bridging the gap between evidence-based treatment and the realities of patient’s life. This case reflects a common scenario in primary care where inadequate follow-up, poor medication adherence, and social determinants intersect with chronic disease management. Using the Pender Health Promotion Model, combined with diagnoses and evidence-based guidelines. As NPs we are not just managing conditions, we are guiding people like Nancy to reclaim control over their health journeys. This case reinforces the need for holistic assessment, culturally sensitive education, and a strong provider-patient relationship bult on trust and continuity. References Global Initiative for Asthma. (2023). Global Initiative for Asthma – Global Initiative for Asthma – GINA. Global Initiative for Asthma – GINA. https://ginasthma.org Licari, A., Castagnoli, R., Brambilla, I., Marseglia, A., Tosca, M. A., Marseglia, G. L., & Ciprandi, G. (2018). Asthma Endotyping and Biomarkers in Childhood Asthma. Pediatric Allergy, Immunology, and Pulmonology, 31(2), 44-55. https://doi.org/10.1089/ped.2018.0886 Ober, C., & Yao, T.-C. (2011). The genetics of asthma and allergic disease: a 21st century perspective. Immunological Reviews, 242(1), 10-30. https://doi.org/10.1111/j.1600-065x.2011.01029.x Vertadier, N., Trzepizur, W., & Faure, S. (2022). Overuse of Short-Acting Beta-2 Agonists (SABAs) in Elite Athletes: Hypotheses to Explain It. Sports, 10(3), 36. https://doi.org/10.3390/sports10030036

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