JR is a 56 yo man with h/o asthma, HTN and hyperlipidemia. He presents to the ER today with h/o shortness of breath for 45 minutes at rest. He reports that he was feeling well and in his usual state of health until about an hour ago, when he smelled something burning. 20 minutes later, he began to feel short of breath and was wheezing. He tried using his albuterol inhaler without success, so he proceeded to the ER. Upon arrival, he was tachycardic, tachypneic, wheezing, using accessory muscles and hypertensive. His last admission for an asthma attack was 2 months ago. He denies a recent cold or URI and says the albuterol usually helps him when he feels an attack coming on and tends to use it on a daily basis. He generally has wheezing and shortness of breath on a daily basis. JR reports poor sleep due to waking about 2 times a week for shortness of breath. He has 2 cats, which sleep next to him on his pillow and he lives in an apartment complex. JR does not smoke, but his neighbor smokes. JR is a carpenter by occupation. He monitors his peak flow once a week at home. He reports that his peak flow generally runs about 325 L/min and his personal best is 480 L/min. His current peak flow is 175 L/min.

Medication Prior to Admission:

Albuterol MDI 2 puffs BID-QID PRN

Salmeterol Diskus 1 inhalation QID

Ipratropium bromide MDI 2 puffs QID

Lovastatin 20 mg po HS

Lisinopril 10 mg po QD

Questions:

1. Classify JR’s asthma severity and control based on signs and symptoms prior to this most recent exacerbation and visit to the ED.
2. Classify JR’s exacerbation severity based on PEF and symptoms.
3. Identify the various triggers in JR’s life that may exacerbate asthma and prevent control.
4. Which step should JR have been on prior to ER based on severity and current medications?
5. Which medications are dosed incorrectly and/or inappropriate for JR’s asthma severity?
6. Would a short-burst of oral corticosteroid be indicated at this time? If so, what dose and duration?
7. How would you assess that JR is well-controlled?
8. If JR is well-controlled, how would you step down in therapy?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). 

Scenario

“Mary  is  a  health  information  management  (HIM)  student  completing  a  clinical  practice  rotation  in  an  acute  care  hospital  in  her  community.  This  week  she  is  learning  about the release-of-information process. At the breakfast table, Mary’s mother asks her to  find  out  what  is  wrong  with  Ruth,  their  next-door  neighbor.  Ruth  has  been  admit-ted  to  the  hospital  twice  in  the  past  three  months, and Mary’s mother wants to know why.  While  processing  the  requests  for  release of information that afternoon, Mary comes  across  one  from  Ruth’s  insurance  company.  Mary  learns  that  Ruth  was  hospitalized due to physical abuse by her husband.  Mary  has  been  in  trouble  with  her  mother  recently.  She  knows  that  if  she  tells “”her  mother  this  information,  she  will  score  “big points.” She is very tempted to tell her mother the information she has learned. Later  that  same  day,  while  responding  to  another  request  for  information,  Mary  realizes  that  the  medical  record  she  is  reviewing belongs to Ron, her best friend’s fiancé.  Mary  learns  that  Ron  has  a  drug  abuse  problem  and  was  recently  diagnosed with HIV. Mary will be the maid of honor at the wedding of Ron and Patricia two months from now, and she knows that Patricia  does  not  know  about  Ron’s  problems.  Mary  becomes  worried  and  wonders whether she should tell her best friend what she has learned, because Ron’s conditions  could  affect  Patricia’s  health  and  the quality of her married life”

Questions:

“What  should  HIM  professionals  do  when  family  or  friends  ask  them  for  information about others or when they discover  things  about  people  they  know during the process of doing their work?  Does  Mary  have  the  right  to  reveal this information to others?”

“In the situation regarding Mary’s friend Patricia  and  her  fiancé  Ron,  would  Mary  be  more  justified  in  revealing  patient  information  than  in  the  situation regarding the next-door neighbor? Why or why not?”

Write 2-3 pages, each question should have one full page only, be creative and use your critical thinking, refer to the ethical decision-making matrix which is provided at the end of the chapter.

It is required to follow the APA style format, include a cover page, an introduction, and a conclusion. Use at least three quality current resources within the last five years and from medical journals.

Please review the scoring rubric before you submit your assignment.