Asthma Exacerbation in Pregnancy

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Table of Contents

Case Summary
Diagnosis
Treatment Plan
Community Resources
Communication Plan
References

Case Summary

A 23-year-old female patient presents with coughing and wheezing, which she stated started about three weeks ago. She is currently 25 weeks pregnant. Her respiratory symptoms brought her to your office today.

History

She had chickenpox as a child. She had asthma as a child, diagnosed at age 8, for which she used an SABA when needed. She has not needed to use an inhaler since she was 19. She takes only her prenatal vitamins. No other acute or chronic problems. She advises you that she is up to date on all immunizations, except she has not had a flu shot (it is October).

Social

Non-smoker, no drug use. She relocated to your state two weeks ago to get away from an abusive domestic situation. She has no support network in this area and has not yet found employment. She has no medical insurance.

HPA

Non-productive cough x 3 weeks. Wheezing audible from across the room. She states it is like this all day and wakes her from sleep every night. She reports that she is fatigued even in the morning. No other complaints.

PE/ROS

The patient appears disheveled but clean. Wheezing in all lung fields. T 98, P 82 regular, R 28 no stridor. FH 130 regular. The remainder of the exam is WNL.

02 98% and FEV 70%

Diagnosis

The most likely diagnosis is asthma exacerbation based on the patient’s symptoms, medical history, and physical examination results. The patient has had asthma and has been experiencing typical signs for the past three weeks, including wheezing and an ineffective cough. She claims to be exhausted even in the morning due to the constant wheezing that can be heard from across the room. The diagnosis of asthma exacerbation is also supported by the physical examination findings of wheezing in all lung fields and decreased lung function, as demonstrated by an FEV1 of 70%. The lack of a support system and the patient’s recent move to a new area could have contributed to her asthma symptoms (Namazy & Schatz, 2021). The prenatal care provider should confirm this diagnosis at the visit the following week. Given that maternal hypoxia and fetal distress should be avoided when a patient has a history of asthma and is 25 weeks pregnant, doctors may decide to confirm this diagnosis using lung function tests. For instance, peak air flow or spirometry tests are done before and after using a bronchodilator. However, these tests are not currently recommended due to the patient’s history of asthma.

Treatment Plan

The diagnosis of asthma exacerbation is made after examining the 23-year-old female patient who has been coughing and wheezing for three weeks. The patient has a history of childhood asthma diagnosis, and she is presently exhibiting typical asthma symptoms like wheezing and a nonproductive cough. Her physical examination reveals she has reduced lung function, as indicated by an FEV1 of 70%, and wheezing in all lung fields. The patient’s recent move to a new area and lack of a support system might have exacerbated her asthma symptoms.

The doctor will suggest combining pharmaceutical and non-pharmacological interventions to treat this patient (Schatz & Namazy, 2018). On the pharmaceutical front, a short-acting beta-agonist (SABA) inhaler, like albuterol, will be recommended for use as required for symptom relief. Hence, a low-dose inhaled corticosteroid (ICS) like fluticasone will also be prescribed to reduce airway inflammation and stop further exacerbations. Therefore, a Leukotriene modifier such as montelukast will also be specified to reduce airway inflammation and eliminate further exacerbations.

In addition to pharmacological therapy, patients will receive instruction on keeping track of their symptoms and abiding by their doctor’s prescription. The doctor will also instruct the patient on avoiding or managing triggers for asthma flare-ups, like cold air, allergens, and stress. The clinician will suggest a social worker or counselor help the patient with her recent experiences of domestic abuse and lack of a support system (Namazy & Schatz, 2021). The doctor will direct the patient to a patient assistance program so she can access her medications. Last but not least, the doctor will direct the patient to a prenatal care specialist for follow-up treatment, monitoring her pregnancy and asthma, and, if possible, an influenza shot (Wu et al., 2019). The patient’s asthma must also be closely monitored throughout her pregnancy, and her care plan must be adjusted as necessary in consultation with her prenatal caregiver.

Community Resources

Several local resources could be helpful for the pregnant 23-year-old who recently moved to the area, is suffering from an asthma exacerbation, is dealing with an abusive partner, and does not have access to a support system or health insurance. Social service organizations can help with housing, food, and financial support. They might also offer assistance through case management and counseling. Community health clinics offer low-cost or free medical care to people who lack or have inadequate insurance. Additionally, they might assist with case management and health education. Community-based organizations can offer various services, including education, recreation, and employment programs. They might also help in case management and counseling.

A referral to nearby services to help this patient should also be considered. For instance, giving her information on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which offers formula and other foods after the baby is born. Some pharmaceutical companies offer patient assistance programs that offer free or inexpensive medications to people who lack insurance or have inadequate insurance. Hence, if this young woman meets the requirements, the Employment Security Commission can help her apply for unemployment benefits by providing open position listings. The public health department provides various services, such as health screenings, immunization programs, and information and resources on health-related topics. Additionally, they might offer assistance with case management and health education (Schatz & Namazy, 2018). Prenatal care providers provide prenatal checkups, prenatal testing, and childbirth education. Additionally, they might offer assistance with case management and health education.

Moreover, domestic violence shelters can offer safe housing, counseling, and support services for victims of domestic abuse in addition to these resources. For example, the Lighthouse Shelter and Heart2Heart Place offer housing and counseling to victims of domestic violence (Ventura County Rescue Mission, 2021). Women fleeing abuse can find great support in these groups, which also gives them a chance to connect with others in the neighborhood who have gone through similar things.

Communication Plan

Several clinical communication constructs would be used in an efficient communication plan to guarantee that the patient is actively participating in their treatment regimen. Tailoring teaching initiatives, tackling obstacles and worries, ensuring the patient has enough support systems, and promoting her health literacy are all tactics for an efficient communication plan (Cvietusa et al., 2019). A patient is more inclined to succeed in understanding the illness process and take an active role in their care plan if they are open-minded, participate in the learning process, are interested in managing their health care, and are willing to make necessary adjustments to enhance their overall result.

As a result, the doctor should start by expressing concern and empathy for the patient’s current situation and circumstances. It is critical to developing a positive and respectful relationship with the patient to communicate with them and engage them in their care effectively (Cvietusa et al., 2019). The doctor would encourage active listening by allowing patients to express their concerns, emotions, and expectations openly. To show that the clinician understands and values the patient’s point of view, they would listen carefully and repeat what the patient said. The doctor would also use a patient-centered approach, adapting the treatment regimen to the patient’s specific needs, preferences, and principles and involving the patient in decision-making.

The doctor would simply and concisely explain their diagnosis, available treatments, and any potential risks or side effects of the treatment. Furthermore, the patient is encouraged to ask questions and is provided with written materials or other resources to consult (Cvietusa et al., 2019). The doctor would schedule regular follow-up visits to assess the patient’s progress, address any issues or complications, and make necessary changes to the treatment regimen. The patient is also encouraged to keep in touch if they have concerns between consultations.

Furthermore, the doctor would respect the patient’s autonomy by allowing them to make decisions about their care, even if they choose not to follow the recommended course of action. The doctor would always respect and support their choices and guide them through any concerns they may have (Cvietusa et al., 2019). Hence, by employing these therapeutic communication constructs, the doctor can establish a strong rapport with the patient, encourage participation in their treatment plan, and ensure they are always informed, engaged, and respected.

References

Cvietusa, P. J., Goodrich, G. K., Shoup, J. A., Steffen, D. A., Tacinas, C., Wagner, N. M., Anderson, C. B., Ritzwoller, D. P., & Bender, B. G. (2019). Implementing Health Care Technology research into practice to improve adult asthma management. The Journal of Allergy and Clinical Immunology: In Practice, 7(3), 908–914. Web.

Namazy, J. A., & Schatz, M. (2021). Contemporary Management and treatment strategies for asthma during pregnancy. Expert Review of Respiratory Medicine, 15(9), 1149–1157. Web.

Schatz, M., & Namazy, J. (2018). Management of asthma during pregnancy: Optimizing outcomes and minimizing risk. Seminars in Respiratory and Critical Care Medicine, 39(01), 029–035. Web.

Ventura County Rescue Mission. (2021). Lighthouse Recovery Program for Women & Children. Ventura County Rescue Mission. Web.

Wu, T. D., Brigham, E. P., & McCormack, M. C. (2019). Asthma in the Primary Care Setting. Medical Clinics of North America, 103(3), 435–452. Web.

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