NR 603 Week 2 Case Study Primary Diagnosis: Pulmonary

1. What is your primary diagnosis for Michelle given the pattern of occurrence of symptoms, exam results, and recent history? Include the rationale and a reference for your diagnoses. 2. What is your first-line treatment plan for Michelle including medications, labs, education, referrals, and follow-up? Identify the drug class of each medication you prescribe and exactly what symptom it is targeted to address. 3. Address Michelle's request for an antibiotic Dr. Deering and class, Primary Diagnosis: Based on the presenting symptoms and assessment findings within this case study, the primary diagnosis for Michelle is occupational asthma. Occupational asthma (OA), or work-related asthma (WRA), is the most common occupational lung disease in the United States (Global Initiative for Asthma [GINA], 2019). OA results from exposure to a stimulus, such as dust, grain, flour, latex, insects, and mold, found in the workplace environment (Jolly et al., 2015). Exposure to these types of allergens causes symptoms of asthma, including coughing, wheezing, chest tightness, and shortness of breath (Dao & Bernstein, 2018). Nasal congestion and eye irritation can also occur as a result of OA. In this case study, Michelle presents with shortness of breath while she is at work. When she is not at work, she has relief and no longer experiences difficulty breathing. Even on weekends when she is at home, she denies respiratory symptoms. Individuals diagnosed with OA tend to have more symptomatic days and exacerbations of asthma symptoms while they are exposed daily to a particular allergen in the workplace. Since Michelle has a history of seasonal allergies, she is at an increased risk of developing occupational asthma. One of the main risk factors for occupational asthma is atopy, which is characterized by a sensitivity to allergens (Dao & Bernstein, 2018). Therefore, individuals with atopy often have seasonal allergies, allergic skin rashes, and food allergies. In this case study, Michelle has a history of seasonal allergies and has seen an allergy specialist.