Patient Scenario:  John Smith     DOB:  12/24/59

S:  HPI: Reports breathing worse past 3 days.   C/o productive cough and SOB, interrupting sleep at night.  Fever up to 101 with chills.  Has been using albertol 2

puffs 3X a day past 3 days it is not helping.  Prior to this asthma symptoms were well controlled.  Missed one day of work. No appetite.

Social: no ETOH or drug use, stopped smoking last year .

Meds:  Flovent Diskus 100 mcg Bid & albuterol 2 puffs prn      NKDA
PMH: Asthma diagnosed last year (mild persistent), tobacco abuse 30pack yr.
O:   Vitals:  T 99.9F, HR 86 BP 120/80  RR 20    RA sats 91%
Exam: pale, slightly increased resp. rate, no retractions, diminished breath sounds R   base with faint expiratory wheezing throughout, dullness on percussion R base,

FEV1 70% of  predicted with a variability 30%.

A:  Community Acquired Pnuemonia or CAP  (outpatient treatment)

P: In the critical thinking questions below you will discuss your treatment for this patient include your research and guideline references.   Answering questions

below will take you step by step thru the decision process in choosing an antibiotic and the  approach to take with his asthma medications.

Critical Thinking Questions Portion (100 pts)


1.Explain your critical thinking [reference evidence] answering each question in the format presented.
1.    What organism/s are you trying to cover?
A.    What antibiotic have you selected and why explain & include guidelines &/or research (include your references)?
B.    Explain the pharmacodynamic action of the antibiotic.
C.    Review asthma guidelines what step was patient at before his illness?
D.    Identify 5 concerns or “red flags” in the Subjective or history what the patient tells you.
E. Identify 3 concerns about the exam this is the Objective portion of the note what you observe:
F. Now that you have reviewed the history and exam what step is the patient at?
(a) Will you change asthma meds, explain?  Include dosages.
(b) Will you consider a nebulizer? Explain.  [don’t forget references]
(c) Does he need oxygen?  Explain.  [30 pts.]

2.List 3-5 instructional points you would include in educating the patient. (Note: There are probably many things you could include in your instruction but do not

exceed 5 points. Select the most important points relative to this medication and this case.  Don’t just copy and paste into this section.  Make it meaningful to this

(a)    What education will you include about the medication/s you prescribed?
(b)    What other education needs to be included that is non-pharmacological education?   [20 pts.]

3.What are the potential side effects and/or adverse drug reactions and how should they be managed?
(a) What are the most common side effects/adverse reactions can patients
Experience (do not copy and paste)? List top 5.
(b)What will your education include in those side effects that patient can
trial a treatment before calling the office or seeking medical attention.
(c)What side effects/adverse drug reactions are your worst case scenarios?
(d) If these occur, what would you want your patient to do?  [10 pts.]

4.Did you prescribe a generic or a brand/trade name?
(a) What are the generic names?  What are the brand names?
(b)Is there a generic version of these medications available?
(c)What is your rationale for prescribing or not prescribing a generic
preparations?  [2.5 pts.]

5.What is the cost of this medication?
(a)How does the cost compare brand vs generic (if available)?
(b)Is the medication as you prescribe it on the $4 lists available at Walmart,
Costco, Fred Meyers, Target, etc?  [2.5 pts.]

6.Monitoring efficacy of this medication:
(a) Specifically, when would you expect the antibiotic to work include
pharmacokinetics?  Include pharmacokinetics of inhaler.
(b)When would you want to see this patient again?
(c)At the follow up visit how will you determine efficacy:
(1) What questions will help you determine if the medications are
helping your patient?
[2]How will your exam help you determine if this medication is helping your patient?
[d]Are there lab tests or other information that you would need to gather to see if this medication is efficacious?  Are there any labs that need to be monitored with

the medication you prescribed?  [15 pts.]

7.How would this treatment change if this patient was a young female and  pregnant?
(a)   Specifically, what category in pregnancy is this antibiotic & inhaler you prescribed?
(b)How would you approach these medication with a pregnant patient?  Will  you continue or stop?  Explain.
(c) Will you prescribe another medication?   If so what category medication?
(d)What will you patient education be to this pregnant?
(c)    What evidence/guidelines/or references did you research to make your decision in this pregnant patient? Must use references specific to this patient

population.  [15 pts.]

8.    Include at least four references, including one Internet resource URL with a very brief explanation of what was used from the site.   Use MD Consult available

from our Blackboard site under “Online Data Bases.”  [5 pts.]

Must reference Asthma guidelines in addition to the 3 required.

Script Portion (10 pts):   Antibiotic and Inhaler

Download a blank prescription and complete it for this assignment.
Submit it with the critical thinking questions (below).
Save both documents on your computer with a file naming protocol:
Last Name_Scriptrespiratory_NURS524.doc
Last Name_Critical Thinking Questionsrespiratory_NURS524.doc

Seven Required Aspects:
•    Date prescription is written.
•    Name, birthdate and address of patient.
•    Inscription (name of drug and strength).
•    Subscription (quantity to be dispensed and administration aids).
•    Transcription (label instructions for patient) – dose, frequency, route of administration, duration of therapy, indications for medication.
•    Refill information.
•    Prescriber’s informations