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Complete the attached case study. Use a different color font or highlight and bullet list your
answers. This is not a group activity. All cases/questions must be completed. Submit your case
study to the link provided by the due date. Provide a source for your answers.
I. Drugs Affecting the Respiratory System Case Study
Complaint
“I need a refill for my inhaler.”
History
Rick, age 25, is being seen in your clinic for the first time. He recently moved to the area and is
establishing with you as a primary provider. His chief complaint is that he needs a refill for his
asthma inhalers and is hoping that you “know more about asthma than the last provider”
because his asthma has “never” been under control in spite of trying many different inhalers.
He has never seen an asthma specialist and has never had a written asthma treatment plan.
Rick reports having asthma “all his life,” beginning in early childhood. As a child, he remembers
being hospitalized a couple of times for asthma. He reports the mainstay of his treatment has
been to use an albuterol inhaler the past few years. He remembers using oral medicine before
but cannot remember the name. He has no other health problems except that he smokes one
pack of cigarettes per day. Upon further exploration, he reports that he used the different
inhalers for only a short time, because “they did not work.”
Assessment
Rick’s examination is normal except for soft expiratory wheezes and a loose cough. He did have
his albuterol inhaler with him, and when asked to demonstrate the use of his inhaler, he
demonstrated poor technique.
1. What would be the initial management plan? •
2. What management would occur at a follow-up visit for asthma?
3. What is the ongoing management plan for asthma?
II. Drugs Used to Treat Bacterial Infections
Complaint “I think I have a sinus infection.”
History A 24-year-old presents to urgent care with a 2 week history of cough and congestion.
They state it started out as a “normal cold” and it will not go away. They complain of a
productive cough of green mucous and green nasal discharge, with a low-grade temperature
for the past 2 days. The patient reports an intermittent frontal headache with this cold. They
are otherwise healthy, with no known drug allergies. Assessment Vital signs are stable and
temperature is 99.9°F. Tympanic membranes (TMs) are clear bilaterally, pharynx is pink with no
exudate, he has greenish postnasal drainage, turbinates are swollen and red, there is
tenderness when frontal sinuses palpated, there is no cervical adenopathy, and lungs are clear.
1. What is the plan of care for a patient with acute bacterial sinusitis?
2. What is the antibiotic of choice in a penicillin-allergic patient with sinusitis?
Case Study 3
3. What nonpharmacologic symptomatic care is recommended for acute bacterial sinusitis?
III. Drugs Used to Treat Viral, Fungal, and Protozoal Infections
Complaint “I think I have chicken pox.”
History A 23-year-old previously healthy child care worker presents to clinic with itchy rash that
has been present for approximately 18 hours. The patient states that they cared for a child with
chicken pox and is concerned the rash may be chicken pox. The patient reports a low-grade
fever, runny nose, and cough. The patient has not been vaccinated for varicella. Examination
Well appearing, hydrated young adult. Temp 100.7°F orally. Examination unremarkable except
for scattered erythematous papules and pustules consistent with varicella rash.
1. What would be the plan of care for this patient with varicella?
2. What would be the patient education for an adult taking acyclovir?
IV. Drugs Used to Treat Inflammatory Processes
Complaint “I twisted my right ankle, and it hurts when I walk.”
History Tom, a 26-year-old runner, came in to the office today complaining of constant pain in
the right ankle. While running his usual route, he accidentally stepped on a branch lying in his
path, twisting his ankle inward. He denies hearing a “pop.” He was able to walk, or limp, the
remaining quarter mile back to his home, where he immediately elevated and iced the ankle for
30 minutes. He took two acetaminophen 325 mg, showered and dressed for work, and drove to
his place of employment. He continued to experience significant pain in the ankle, which is
worse when walking. His foot became swollen. Since his job in a sporting goods store requires
that he be on his feet most of the day, he was unable to continue his normal workday, and
made a same-day appointment to be seen. He has no chronic diseases, takes no medication. He
sprained the ankle last year but was able to manage that injury at home with acetaminophen.
Assessment A 26-year-old, otherwise healthy male presents limping into the examination room,
holding his right shoe in his hand. He grimaces with partial weight-bearing of the affected foot.
He has local ecchymosis and 1+ edema over the anterolateral ligaments of the right ankle.
Capillary refill, pulses, and sensation of the foot and toes are intact. There is no lateral or
anterior instability of the joint or tendons. X-rays of the ankle and foot are negative for fracture
or dislocation. He has a grade I lateral ankle sprain
1. What would be the initial management plan for a patient with an ankle sprain?
2. What medication can be prescribed for pain?
3. What education is required for patients taking NSAIDS?
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