Reference no: EM133553621

Case Scenario 1: Jessica, a 9-year-old Caucasian girl with moderate intermittent asthma, is seen in your primary care clinic. She is using a daily inhaled corticosteroid (Flovent 44mcg, 2 puffs BID) as well as albuterol two puffs up to every four hours PRN to relieve her cough and wheeze. According to her mother, she uses about 6 doses of albuterol daily.

Question 1:

1. Do you believe this is demonstrates good control of Jessica's asthma? Why or why not?

2. What medication modifications do you recommend in this case?

3. Discuss specific patient education on the prescribed therapy.

4. What are the parameters for monitoring success of the therapy?

Case Scenario 2: A 66-year-old male presents to the urgent care clinic with a 4-day history of dry cough, progressing to rusty colored sputum, sudden onset of chills the previous evening, subjective fever, and malaise. Originally, the man thought he had a cold, but the symptoms had worsened and he "barely slept last night with all this coughing."

He denies experiencing shortness of breath but suggests he may be breathing "a little faster than normal." He relates that, on the way to the clinic, he felt some sharp right-sided chest pain after a particularly long bout of coughing. He denies any leg swelling, orthopnea, or left-sided/substernal chest pain. He also denies any gastrointestinal symptoms (no nausea, vomiting, or diarrhea). His past medical history included hypertension and hypercholesterolemia. He reported no antibiotic use in the previous three months. You do a chest x-ray confirming a diagnosis of right lower lobe pneumonia.

Question 2:

1. What is your antibiotic treatment of choice and duration? Why?

2. If this scenario were the same, except for recent antibiotic use within the last three months, how would that change your prescribed therapy and why?

3. What if this were a 6-year-old with CAP? What antibiotic, dose and duration would you choose?