Patho case study: Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours.

Patho case study: Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours. Guidelines: Support your responses with scholarly academic references using APA style format.
Case study 1 (3 pages)
Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours. He is accompanied by his mother, who is a good historian. She reports that her son started having symptoms of a viral upper respiratory infection 2 to 3 days ago, beginning with a runny nose, low-grade fever of 101.0 degrees F orally, and loose cough. Wheezing started on the day before the visit, so Johnathan 's mother started administering albuterol metered-dose inhaler (MDI) two puffs before bed and then two puffs at around 2 AM.

Patho case study: Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours.

The cough and wheezing appear worse today, according to the mother. He had difficulty taking deep-enough breaths to inhale this morning's dose of albuterol, even using the spacer.
Johnathan has been a patient at the clinic since birth and is up to date on his immunizations. His growth and development have been normal, and he is generally healthy except for mild intermittent asthma. This is his first asthma exacerbation of
the school year, and his mother expresses a concern about sending him to school with an inhaler.
Johnathan is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs 45 pounds (20.5 kgs.). The examination is all within normal limits except for his breath sounds. He has diffused expiratory wheezes and mild retractions. Pulse oximetry readings have been 93% of oxygen saturation.

1. What are the appropriate pharmacological therapies to be prescribed for Johnathan?
2. What information is necessary to provide to Johnathan and his mother
regarding asthma exacerbation?
3. What is an appropriate clinical assessment tool to be use with Johnathan?
4. What are the classification of asthma?
5. How would you as the NP address his mother's concern regarding providing
an inhaler at school?
6. What is an appropriate plan of care for Johnathan?
7. What is the pathophysiology of patho?

Discussion Question #1 (3 pages)
For this questions, please read the following case study and then respond to the questions noted below.
Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well.
The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done
after his MI demonstrated a preserved left ventricular ejection fraction (LVEF).
Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy. He no longer smokes and does not use alcohol or recreational
drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid.
Mr. EBR's physical examination includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema.
Distal pedal pulses are 2+ bilaterally
1. What would you add to the current treatment plan? Why?
2. Would you discontinue any of the currently prescribed medication? Why or why not?
3. How does the diagnosis stage 3 chronic kidney disease affect your choices?
4. Why is the patient prescribed more than one antihypertensive?
5. What is the benefit of the aspirin therapy in this patient?
6. What is the pathophysiology of chest pain
Discussion Question #2(2 pages)

List three classes of drugs affecting the Hematopoietic System. List the mechanism of action for each class of drug.

Choose one medication from the three classes and discuss what disorder the drug is used to treat? How often the medication is given?
What labs should get monitored while the patient is taking this medication?

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