Please respond to at least 2 of your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peers’ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.
Amanda’s Response:
Question #1
You are evaluating a 12-year-old child with a history of persistent asthma who was recently released from the hospital after an asthma exacerbation. He required a 3 day stay in the PICU due to respiratory distress.
An evaluation of refill history reveals his long acting control medication has not been filled for the past 4 months. How will you address this issue with the parents?
I would start the by voicing with my concern regarding the effect of the hospital stay on the family. I would inquire about the hospital admission, how the parents and child are faring since discharge, and answer any questions regarding discharge recommendations. I would begin the interaction this way to build a rapport with the parents and child. Next, I would inquire as to the parent’s and child’s understanding of his “persistent asthma”. I would attempt to identify opportunities to educate both the parents and child regarding the disease process. Then, I would review the patient’s established asthma action plan (AAP). AAPs have been shown to improve pediatric asthma outcomes (Toole, 2013). AAPs improve communication between the family, patient, school and provider (Toole, 2013). Asthma may be very costly to manage. Frequently, parents understand the treatment plan, but are unable to afford necessary medications (Valerio, Cabana, White, & Heidmann, 2006). Many Americans experience difficulty affording prescription medications and compensate by skipping doses or neglecting to fill the medication (Gellad, Huskamp, Li, Zhang, Safran, & Donohue, 2011). Discussing medication costs with patients has been shown to facilitate treatment compliance and improve outcomes (Gellad, Huskamp, Li, Zhang, Safran, & Donohue, 2011). I would ask if the reason the long acting medication was not filled is because it was too expensive. If this was the case, I could offer several options. If the patient had been well controlled on this long-acting medication in the past and samples were stocked at the clinic, I could offer samples to the family. Often pharmaceutical companies offer assistance programs to make their medication affordable to most patients. I would research this and link the family to any available programs. Another alternative solution is to change the long acting medication to something that is inexpensive, readily available, yet effective.
References
Gellad, W. F., Huskamp, H. A., Li, A., Zhang, Y., Safran, D. G., & Donohue, J. M. (2011). Use of prescription drug samples and patient assistance programs, and the role of doctor-patient communication. Journal of General Internal Medicine, 26(12), 1458-64.
Toole, K. P. (2013). Helping children gain asthma control: Bundled school-based interventions. Pediatric Nursing, 39(3), 115-24.
Valerio, M., Cabana, M. D., White, D. F., Heidmann, D. M., (2006). Understanding of asthma management*: Medicaid parents’ perspectives. Chest, 129(3), 594-601.
Eric’s Response:
- You have just finished seeing a 12-month-old boy for his well child exam. During the examination, you note a diastolic murmur on the posterior chest which you have not noted previously? What type of murmur are you concerned this child may have developed? What is your plan of care? What information will you provide the parents regarding this cardiac concern?
#2 posterior diastolic murmurs
With its location an timing I am assuming that this is most likely a Coarctation of the Aorta; it is a congenital disease of the heart that involves narrowing of the Aorta; these murmurs can only typically be heard only with severe coarctation in which development of collateral circulation is not sufficient to ensure normal flow in diastole, making it a continuous gradient systolic-diastolic (Ginghina, Nastase, Ghiorghiu, & Egher, 2012).The narrowed segment is called coarctation and it can occur anywhere in the aorta, but it is most likely to occur in the segment located just after the aortic arch; this narrowing then restricts the amount of oxygen-rich blood that is able to travel to the lower parts of the body; in the cases of more severe narrowing the more symptomatic the child/infant will be and the earlier it is typically noticed; it can be noticed in infancy but is more typically found in school aged children or adolescence; in round half of the children who present with coarctation of the aorta there is also a dysfunction of the bicuspid valve that will have two leaflets instead of the usual three (Shah, 2019).
The parents should be informed that coarctation of the aorta can cause several problems such as: forcing the left ventricle to work harder to pump blood through the narrowed aorta eventually causing failure to pump efficiently; the elevated blood pressure before the narrowing and lower after the narrowing, this can lead to headaches from too much pressure in the vessels of the head or cramps in the legs or abdomen from decreased blood flow; also the kidneys may be damaged from restricted blood flow; also the walls of the ascending aorta, aortic arch or any of the arteries in the head or arms can become weakened by the high pressure leading to increased risk for spontaneous tears which can cause stroke or uncontrollable bleeding (Shah, 2019).
Typical symptoms of coarctation of the aorta include: irritability, sweating, pale skin, heavy/rapid breathing, poor feeding, poor weight gain, cold feet/legs, diminished/absent pulses in the feet, blood pressure in the arms being significantly greater than pressure in the legs; stroke symptoms, migraines and cramps in the legs/abdomen (Shah, 2019).
Coarctation is diagnosed through identification of the murmur, history taking of symptoms and various other tests such as: chest x-rays, ECG’s, echocardiogram, cardiac catheterization or MRIs (Shah, 2019). Treatment varies on the degree of narrowing but can include: Interventional cardiac catheterization, placing a stent to open the narrowed area of the aorta; surgical repair where the narrowed area is either surgically removed or made larger with the aid of surrounding structures or a patch (Shah, 2019).
References
Ginghină, C., Năstase, O. A., Ghiorghiu, I., & Egher, L. (2012). Continuous murmur–the auscultatory expression of a variety of pathological conditions. Journal of medicine and life, 5(1), 39–46.
Shah, S. (2019, February 01). Aortic Coarctation. Retrieved from https://emedicine.medscape.com/article/150369-over…
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