prescribing and assessing for a asthmatic patient at gp practice

 

 

 

 

 

PRESCRIBING AND ASSESSING FOR ASTHMATIC PATIENT AT GP PRACTICE

 

 

Name

 

 

 

Course

Professor’s Name

Institution

City/State

Date

 

 

 

Prescribing and Assessing For Asthmatic Adult at GP Practice

 

Background Information

Paige J is a joyous mother of three. She is from the Hispanic ethnic group who works as a receptionist at a five-star hotel. Paige J has a huge passion for cats, and she was diagnosed with asthma in the last five years.

Paige J claims that what triggers her Asthma is the exposure to dust, pollen, and animals like dogs and cats, which she likes spending time with when at home. When Paige spends some minutes or hours with her cat, for example, she ends up waking up at the night hours with terrible Asthma and tightness of the chest. She does not talk during asthma attacks because talking makes her struggle a lot. She uses mostly her rescue inhaler, and just in case she does not have it, she tries to get some fresh air or drink some chocolate. She also has prescribed medicine, which she uses in case of an attack. Her attacks happen during the night. Paige denies being a smoker. Her asthma is classified as mild persisted, where the symptoms can reveal themselves twice in a week, but not more than one is a day. Paige J has been referred to me as a general practitioner because I have a good past medical history of treating patients with asthma.

Past Medical history

Paige J Asthma manifested itself in the last five years. She has been using an inhaler in case of attacks. Most of her attacks happen during the night.  She has been using inhaled corticosteroids (Qnasi, Qvar). She also medicated with long-acting beta-agonists serevent. She has never used allergy medications

Subjective Information

Wheezing-high pitched whistling sound when breathing out, airway obstruction syndrome, she experienced panic fear, and she had fatigue signs. After an asthma attack, she is not able to work the following day and do her daily chores. She cannot do tasks that her demanding, and she has added significant weight.

Paige J complains that she has been to many health Centres, and she has not got any significant help, which has increased her psychological problems like stress, anxiety with some point of depression. Paige J also complains that the medication, which she has been using (with long-acting beta-agonists Serevent), has not helped despite spending large amounts on the drugs.

Objective Information

More tests were needed to measure Paige lung function to find out how air moved in and out during breathing. The spirometry test was 69%. The normal range should be more than 80% Paige reacted to methacholine in the first lung function test. The nitric oxide test indicated 50 parts per billion. A normal range should be 25-30 parts per billion. Sputum eosinophils were at 5%. The normal range should be 3%.  From observation, she had hives and itchy skin. Her skin was a bit swollen. From the result, Paige had mild intermittent asthma.

Assessment – Medicines Optimization

The drug-related problems (DRPs) identified in this case were:

  1. The Qvar inhaled corticosteroids made Paige have stomach upsets, stuffy nose, sore throat nausea at some times. The long-acting beta-agonists (Serevent) have little impact on Paige.
  2. There was a need to pre-describe both Qvar inhaled corticosteroids and the long-acting beta-agonists (Serevent).

Change of medicine was needed and the immediate start of allergic medication. I prescribed her Ipratropium (Atrovent) medicine, which acts quickly to immediately relax airways and make it easier to breathe. For long-term medication, I prescribe Paige J the flunisolide inhaled corticosteroids, which have reduced the risk of side effects when used for a very long time. For her allergy medication, I prescribed her allergy shots immunotherapy,  which is very best in reducing the immune system reaction to dust, cats and pollen allergens. The only side effect of allergy shots is swelling at the point of injection. The allergy shots are outstanding in treating allergies, and they consequently prevent the development of new allergies. Paige J had no problems adhering to the medication instructions. The previous medication had been inappropriately prescribed to Paige since it was not helping her.  This was because Qvar inhaled corticosteroids, and Serevent long-acting beta-agonists both solve a similar problem and used together; the result interaction can lead to reduced absorption of either the drugs.

Appraisal

Ipratropium (Atrovent) medicine

Henderson (2017) does a research on 66 asthmatic patients indicated that Ipratropium bromide Atrovent had pharmacology effects leading to a high degree of activity and a specific bronchoselectivity if administered intravenously. Evidence indicates that it is the best for routine administration with small doses, which lead to the opening of airways without resulting in anticholinergic side effects. The pharmacology properties of this drug are that it “blocks the muscarinic cholinergic receptor in the smooth muscles of the bronchi in the lungs.”  This medicine would work for Paige to improve her lung function, which had a Spirometry test which very low than normal. Patients with other co-morbidities like diabetes can use this medication.

Flunisolide inhaled corticosteroids

Evidence indicates that flunisolide is very useful in preventing, controlling asthma symptoms especially the wheezing, and the shortness of breath, which results from asthma (Choby & Lee, 2015). The drug works closely with lungs making breathing easier. “American Academy of Allergy Asthma & Immunology” (AAAAI) has a set guide for the use of this drug. The pharmacological properties of Flunisolide are that it undergoes very quick and intensive first-pass metabolism (Watts et al. 2019).

Allergy shots immunotherapy

Evidence-based studies indicate that allergy shots were effective for treating all year round and indoor allergies (Schroer & Aalberse, 2018). AAAAI has set out the guidelines used for this medication.

Plan

I recommended Paige to stop using her previous medication immediately once she begins using the new prescribed drugs. I also recommend that she should have more air conditioners in her house. I also recommended that she should avoid her cat even though she has a huge passion for cats. The change in asthma symptoms has to monitor closely in the first month and medicine adherence. I agreed with Paige J to have weekly visits at her home as one way to follow up. Phone calls would also be used to determine her progress.

Paige was happy with this treatment plan, especially the idea of treating her allergic conditions, which she never thought was a significant issue that needed medication. This treatment plan was much more than she expected. I kept Paige’s medical chart for a future treatment plan. We agreed that she should call me whenever she had any questions or issue regarding her asthmatic condition. Paige did not have team-based care since she did not have comorbidities related to her asthma.

 

 

Reference List

Choby, G. W., & Lee, S., 2015. Pharmacotherapy for the treatment of asthma: current treatment options and future directions. In International forum of allergy & rhinology (Vol. 5, No. S1, pp. S35-S40).

Henderson, L. 2017. Prehospital use of ipratropium bromide paired with salbutamol as treatment for shortness of breath. [Online] https://emspep.cdha.nshealth.ca/ProtocolImages/LHenderson%20CAT.pdf. Accessed 28 October 2019

Schroer, B. and Aalberse, R.C., 2018. Clinical Allergy at the Interface of Sticky Dust Particles and Crystal-Clear Proteins. The Journal of Allergy and Clinical Immunology: In Practice6(6), pp.1866-1868.

prescribing and assessing for a asthmatic patient at gp practice

 

 

 

 

 

PRESCRIBING AND ASSESSING FOR ASTHMATIC CHILD AT GP PRACTICE

 

 

Student’s Name

 

 

 

Course

Professor’s Name

Institution

State/Course

Date

 

 

 

 

 

Prescribing and Assessing For Asthmatic Child at GP Practice

Background Information

Biodata

Name: James Smith

Age: 5 ½ years

Sex: Male

Ethnicity: Black African

Residence: St. Louis Missouri

Next of Kin: Mary Smith

Relationship with next of kin: Mother

Next of kin cellphone: 0723310923

Subjective Information

Presenting Complains

The patient presented with difficulty in breathing, wheezing, sweating, and lethargy, which had begun in the morning (5 hours before seeking care).

History of Presenting Complain

The patient was well until the morning when he developed the above complaints. He woke up and took breakfast, which comprised an egg, banana and white tea.  Later he visited construction site for a residence the family is building.  He visited the stores to pick a material for one of the construction workers.  After approximately 30 minutes, he returned to the house to bath since they had planned a trip to visit his father at work.  The developed labored breathing on the way out, but her mother opted to continue with the journey and visit a hospital later. However, wheezing worsened, she had to stop the journey and seek a nearby hospital.

Past Medical-Surgical History

The patient has had one episode of asthmatic attack at the age of 2 years, but it resolved within a year of medication. No other chronic illness or allergy has been noted. He has never been operated.

Social History

He is a third born in a family of five. He is in grade KG. His performance in school is impressive; he is playful and active class representative.  He lives with his mother. The other siblings are in boarding schools.

Objective Information

Observation of Vital Signs

Temperature: 37.4Oc (36.2 Oc -37.2 Oc, Pulse rate 83 beats/min (60-110, Respiratory rate 30(20-40) beats/min, Blood pressure 127/67 mmHg.

Focused Assessment

Generally, the patient was ambulating, conscious but strained to walk fast. No abnormalities were noted on the skin. The head and neck showed nothing significant. However, there was labored breathing. Auscultation of the chest showed wheezing on expiration. The abdominal muscles were involved in expiration of air.  Extremities were normal, although there was a tinge of cyanosis on the lower extremities.  Oxygen saturation on the upper extremities was averagely 89.0C.

Diagnosis

The history presented as well as physical assessment findings were indicative of respiratory tract problems associated with narrowing of airways.  Such conditions included Asthma, pneumonia, and bronchiolitis.  Additional tests were conducted to include an X-ray to rule out pneumonia. The test was negative for pneumonia. Exhaled Nitric Oxide test shows 23 parts per billion confirming inflammation of the airway. The acute nature of the condition leads to a conclusion of Asthmatic Attack diagnosis.

Pathophysiology

An asthmatic attack occurs when an allergen activates inflammatory response in the body thus causing inflammation, swelling and accumulation of fluid along the airways. The airways are narrowed by the accumulated fluid and inflammation, necessitating forceful breathing out (expiration), which ought to be effortless in normal circumstances.  This impairs gaseous exchange at the alveoli leading to reduced oxygen saturation in blood and tissues, which is responsible for myalgia and lethargy. If no intervention is done, asthma associated inflammation leads to loss of lung function with time leading to development of comorbidities such as Congestive Pulmonary Disease and bronchiectasis.  Public health considerations involve removal of allergens from the environment to minimize risks of Asthmatic attack (Holgate, 2011; Morris, 2019).

Assessment

The identified problem was that the patient was not fully informed asthmatic attacks could re-occur in the future. This was the second time the patient was treated for Asthma.  One of the critical approaches to management of Asthma is avoidance of the allergen. But the patient, in this case, believed they were healed and never anticipated another episode of attack would occur with another exposure.  A visit to the construction store, which often is dusty and houses cement among other items was the potential source of the allergen that leads to development of Asthma.  Besides, there was inappropriate prescribing and monitoring of patients. Patients diagnosed with Asthma are required to keep inhaler medications and to be conversant with asthma symptoms. This is meant to ensure they can assess emergency care wherever the condition happens.  In this case, they lacked the expertise as well as the drugs to manage the situation at home.

Option Appraisal

Evidence

Guidelines for the management of Asthma require a systematic approach to ensure quality care and effective management. The first approach is correct diagnosis of Asthma patients and identification of allergens.  The second step is management of the acute phase with medications that reduce inflammation of the airway as well as reduce secretions on the airway. The third step is education of the patient to improve their knowledge on the causes, pathophysiology, management, and prevention of Asthma.  Lastly is removal of the allergen and educating the patient on identification and avoidance of the allergen (Global Initiative for Asthma, 2019; Morris, 2019).

Concordance

The development of concordance relationship with the client begins on clear education of the problem they are suffering from and developing an open connection on the nature of the condition and how it can be managed and/or prevented. Besides, establishing an agreement for regular clinic visits to provide follow up and encourage regular discussion would improve the relationship. I will promote self-care by educating the client to have an inhaler medication in the house for use during such episodes. Besides, I will share hospital contact information to enable client seek help from home by way of phone consultation.

Pharmacoeconomics

There are no cheaper drugs for managing Asthma. However, it is necessary to ensure the child has an insurance cover. Secondly, prevention of allergen is the best approach to minimize costs associated with Asthma attack. Moreover, self-medication with inhaler medications can reduce hospital consultation costs

Clinical Governance

Quality management of Asthma requires identification of the allergen, treatment of attacks, and development of approaches to enable the client avoid allergens. This ought to have been emphasized. Besides, self-treatment is necessary in this case because asthmatic attacks can occur anywhere, anytime (Global Initiative for Asthma, 2019).

Legal Aspects

The legal aspects involved in the case was the treatment of a minor. Besides, inhaler drugs were prescribed for use at home. The drug would be administered by the patient’s guardian.

Ethical Aspects

Ethical aspects included respecting the patient’s right to full information regarding their treatment and condition.  In this case, educating the patient to prevent future attacks was a vital component of the care. It would improve wellbeing of the patient and reduce healthcare costs for the patient.

Plan

Recommendations

I recommend that the management of Asthmatic patients to be broadened to include more education on prevention of non-allergens. I recommend that Asthmatic patients should be allowed to consult from their homes to manage acute episodes because transfer to hospital consumes more time.  The patient follows up after the first episode of attack is necessary. A bi-annual visit to the clinic, even in the absence of asthma signs and symptoms is essential to allow evaluation of client progress and knowledge of the condition.

Communication

We agreed with the client to continue with a follow-up clinic the following week.  I kept records of the history and physical assessment that was done, cardex and a clinic appointment copy.  Moreover, records of the treatment sheet and prescribed drugs were kept. To ensure seamless communication with the previous hospital, the patient was given a discharge summary to indicate what was done in our hospital. This would provide if he visits the next hospital, there would be clarity on what was done in another hospital. Besides, the patient was encouraged to bring discharge summary from the other hospital in the follow-up clinic.

 

 

References List

Global Initiative for Asthma, 2019. Global strategy for asthma management and prevention. [Online] URL https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf. Accessed 27 October 2019.

Holgate, S.T., 2011. Pathophysiology of asthma: What has our current understanding taught us about new therapeutic approaches? Journal of Allergy and Clinical Immunology 128, 495–505. https://doi.org/10.1016/j.jaci.2011.06.052

Morris, M.J., 2019. Asthma guidelines: Guidelines Summary, classification guidelines, management guidelines. Medscape. [Online] https://emedicine.medscape.com/article/296301-guidelines. Accessed 27 October 2019.

 

prescribing and assessing for a asthmatic patient at gp practice

 

 

 

PRESCRIBING AND ASSESSING FOR ASTHMATIC PATIENTS AT GP PRACTICE

 

 

Student’s Name

 

 

 

Professor’s Name

Course

Institution

State/City

Date

 

 

Prescribing and Assessing for Asthmatic Patients at GP Practice

Reflective of a Child Suffering from Asthma

Assessing and managing asthma among children is a challenging task since incorrect assessment is common, which later affects the quality of life of a child. Thus, reflecting on the entire process of diagnosing and prescribing medication to an asthmatic kid is a significant practice for a caregiver. The reflective process will be facilitated by the use of the Gibbs Reflective Cycle. The adoption of this reflective model is essential in enabling one to think systematically concerning an experience one had during a particular situation or event.

Description

Smith, a five and half-year-old boy, was brought to the hospital by his mother after he experienced difficulty in breathing, wheezing, lethargy, and sweating, which had started five hours before seeking medical attention. This necessitated my team and I to carry physical and diagnostic tests meant to identify the cause of these conditions. My workmate, Jenner, took physical assessment by measuring his blood pressure, body temperature, and pulse rate. I also observed his breathing patterns by observing the movement of his ribs and neck during breathing and any abnormalities on the skin during breathing. These were the first essential indicators that one would check when assessing whether one is suffering from asthma or not.

Feelings

Initially, I felt nervous when Smith was brought to us because of the tension and shock of his mother. However, after getting the facts of the case, I felt confident because I had handled several others before. This enabled me to engage Smith in a conversation and practices meant to assess his condition (Ortiz-Alvarez et al., 2012). Being sure of what I was doing prompted me to coordinate my team members in attending to Smith. I also managed to calm Smith’s teacher down by assuring her that the condition was not severe. Successful diagnostic tests and assessments confirmed to us that Smith was suffering from an asthmatic attack. I felt happy after I realised the cause of the attack and that Smith had suffered from an asthmatic attack at the age of 2 years. Looking back at the situation encourages me to first get the facts of the case and carrying basic diagnostic assessments. My workmates were as well excited when we learned that Smith was suffering from mild asthmatic attacks. The coordination and role-taking of my two coworkers facilitated this diagnosis, which was a win for us all. Consequentially, the event reinforced our cooperation and instant response to emergency cases.

Evaluation

The entire experience was successful because the diagnostic results were positive. This follows the success of the physical assessment done on Smith. However, the initial encounter with the situation was not pleasing. The tension and anxiety of Smith’s mother, as well as Smith’s worsening condition got us freaked and confused. This got us panicking before we composed ourselves and took the initial assessments. I played a crucial role in conducting diagnostic tests meant to identify the causative problem leading to the respiratory tract problem resulting in the narrowing of the airways. My other coworkers also had significant input in identifying carrying Smith’s physical assessment and determining the pathophysiology of the condition.

Analysis

The event served a crucial role in shaping my future response to the children suffering from asthma. I learned that it is imperative for one to first collect the history presenting the complaint, as well as the patient’s social and medical history. This information should be gathered from an informed individual or the patient himself. Besides, I discovered that having the parent in control and assuring them that the situation is under control is paramount to avoiding further confusion during the treatment process. Teamwork also proved to be a significant aspect that one should utilise during emergency cases. Thus, effective coordination of a team is essential to instant response of an emergency in healthcare.

Conclusion

In a similar event in future, I would engage myself in a similar practice to obtain such positive results. I also learned that asthma attack could occur once a person is in contact with his allergens regardless of the period that one has stayed without the seizures. I also discovered that teamwork is an imperative practice in health care for an effective response to urgent situations. In future, I would do the same thing to achieve a positive outcome.

Action Plan

In a similar future case, I will ensure that the patient is calm as well as other parties involved so that I can get the facts of the case right. Such a move will allow me to gather all relevant facts about the conditions suffered by a patient. As a result, I will learn ways of calming and reducing the stress of the patient and those involved in the event. I will also learn about leadership skills so that I can efficiently manage and coordinate my coworkers.

Reflective of an Adult Suffering from Asthma

Aesthetics

After engaging with Paige, I aimed at measuring her lung function by assessing the way air moved in and out while breathing. I achieved this goal by conducting a spirometry test and nitric oxide test (Mayo Clinic Staff 2018). As a result, I learned that Paige was suffering from mild intermittent asthma. However, I discovered that Paige was not using an allergy medication. Thus, I prescribed new medicines to Paige since the current ones were not impactful to her condition. Paige was comfortable with this recommendation since her current medications were not aiding her

Personal

I felt confident and comfortable attending to Paige since she was a referral patient following my expertise in dealing with and treating asthmatic patients. I efficiently conducted tests showing the state of Paige’s asthma condition. The evaluation was successful because I relied on Paige’s knowledge of her health condition and her experience in other medical centres that have attended to her condition. I knew that lack of allergic medications to aid her in reducing her immune system reaction to the dust and pollen allergens.

Ethics

            I conducted all required diagnostic tests to ensure that my treatment procedure improves Paige’s health condition. This is because my goal was to do good by prescribing the effective medications that will not harm my patient but aid her in recovering from her ailing conditions. Nevertheless, I engaged in an incongruent way by prescribing new medication to Paige without explaining to her the adverse effects of the new prescription. I did not inform Paige that she will get swellings after injecting herself.

Empirics

Paige’s medical history clearly revealed that she has been asthmatic since her childhood. Besides, her current symptoms conformed to those of an asthmatic patient. Wheezing at high pitch sounds and airway obstruction syndrome are among the critical signs of asthmatic patients. Besides, she has been experiencing asthmatic attacks after encountering with her allergens, yet she did not have a medication to aid her immune system in responding to the allergens.

Reflexivity

Both patients, Smith and Paige, exhibited similar symptoms only that the severity of their signs was different. Besides, wheezing sounds while breathing out and difficulty in breathing was common between the two patients. The experience I have amassed in both situations will enable me to handle such cases in future more comfortable and professional. In future, I will ensure that I assess the entire health conditions of a patient before settling on one condition. This will enable me to rule out other potential conditions with similar symptoms. Likewise, I will evaluate the triggering factors that have resulted in the deterioration of the health conditions of a patient like Piage who had her condition under medical control. I will also involve patients in every treatment decision to ensure that my patients are aware of therapeutic adjustments made during treatment. The impact of these alternative actions is that only the right illness will be treated. Besides, I will engage my patients in an educative session meant to inform them about the causes, management, and prevention of their health condition.

This experience has been impactful by enlightening me on ways of approaching a situation from a diverse angle. I have discovered the essence of teamwork and patients’ input in their treatment process. As a result, I will support my fellow workmates as a way of facilitating the treatment process. Consequently, in the future, I will take a leadership-learning course meant to aid me in managing and coordinating my team. By taking this course, I will focus on improving my communication, management, and leadership skills required to solve uncertainty in the workplace and enhance collaboration among workers.

 

 

Reference List

Mayo Clinic Staff.  2018. Asthma: Steps in testing and diagnosis. Mayoclinic. [Online] https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma/art-20045198. Accessed 27 October 2019.

Ortiz-Alvarez, O., Mikrogianakis, A., Canadian Paediatric Society and Acute Care Committee, 2012. Managing the paediatric patient with an acute asthma exacerbation. Paediatrics & Child Health17(5), pp.251-255.

prescribing and assessing for a asthmatic patient at gp practice

 

 

 

PRESCRIBING AND ASSESSING FOR ASTHMATIC PATIENTS AT GP PRACTICE

 

 

Student’s Name

 

 

 

Professor’s Name

Course

Institution

State/City

Date

 

 

Prescribing and Assessing for Asthmatic Patients at GP Practice

Reflective of a Child Suffering from Asthma

Assessing and managing asthma among children is a challenging task since incorrect assessment is common, which later affects the quality of life of a child. Thus, reflecting on the entire process of diagnosing and prescribing medication to an asthmatic kid is a significant practice for a caregiver. The reflective process will be facilitated by the use of the Gibbs Reflective Cycle. The adoption of this reflective model is essential in enabling one to think systematically concerning an experience one had during a particular situation or event.

Description

Smith, a five and half-year-old boy, was brought to the hospital by his mother after he experienced difficulty in breathing, wheezing, lethargy, and sweating, which had started five hours before seeking medical attention. This necessitated my team and I to carry physical and diagnostic tests meant to identify the cause of these conditions. My workmate, Jenner, took physical assessment by measuring his blood pressure, body temperature, and pulse rate. I also observed his breathing patterns by observing the movement of his ribs and neck during breathing and any abnormalities on the skin during breathing. These were the first essential indicators that one would check when assessing whether one is suffering from asthma or not.

Feelings

Initially, I felt nervous when Smith was brought to us because of the tension and shock of his mother. However, after getting the facts of the case, I felt confident because I had handled several others before. This enabled me to engage Smith in a conversation and practices meant to assess his condition (Ortiz-Alvarez et al., 2012). Being sure of what I was doing prompted me to coordinate my team members in attending to Smith. I also managed to calm Smith’s teacher down by assuring her that the condition was not severe. Successful diagnostic tests and assessments confirmed to us that Smith was suffering from an asthmatic attack. I felt happy after I realised the cause of the attack and that Smith had suffered from an asthmatic attack at the age of 2 years. Looking back at the situation encourages me to first get the facts of the case and carrying basic diagnostic assessments. My workmates were as well excited when we learned that Smith was suffering from mild asthmatic attacks. The coordination and role-taking of my two coworkers facilitated this diagnosis, which was a win for us all. Consequentially, the event reinforced our cooperation and instant response to emergency cases.

Evaluation

The entire experience was successful because the diagnostic results were positive. This follows the success of the physical assessment done on Smith. However, the initial encounter with the situation was not pleasing. The tension and anxiety of Smith’s mother, as well as Smith’s worsening condition got us freaked and confused. This got us panicking before we composed ourselves and took the initial assessments. I played a crucial role in conducting diagnostic tests meant to identify the causative problem leading to the respiratory tract problem resulting in the narrowing of the airways. My other coworkers also had significant input in identifying carrying Smith’s physical assessment and determining the pathophysiology of the condition.

Analysis

The event served a crucial role in shaping my future response to the children suffering from asthma. I learned that it is imperative for one to first collect the history presenting the complaint, as well as the patient’s social and medical history. This information should be gathered from an informed individual or the patient himself. Besides, I discovered that having the parent in control and assuring them that the situation is under control is paramount to avoiding further confusion during the treatment process. Teamwork also proved to be a significant aspect that one should utilise during emergency cases. Thus, effective coordination of a team is essential to instant response of an emergency in healthcare.

Conclusion

In a similar event in future, I would engage myself in a similar practice to obtain such positive results. I also learned that asthma attack could occur once a person is in contact with his allergens regardless of the period that one has stayed without the seizures. I also discovered that teamwork is an imperative practice in health care for an effective response to urgent situations. In future, I would do the same thing to achieve a positive outcome.

Action Plan

In a similar future case, I will ensure that the patient is calm as well as other parties involved so that I can get the facts of the case right. Such a move will allow me to gather all relevant facts about the conditions suffered by a patient. As a result, I will learn ways of calming and reducing the stress of the patient and those involved in the event. I will also learn about leadership skills so that I can efficiently manage and coordinate my coworkers.

Reflective of an Adult Suffering from Asthma

Aesthetics

After engaging with Paige, I aimed at measuring her lung function by assessing the way air moved in and out while breathing. I achieved this goal by conducting a spirometry test and nitric oxide test (Mayo Clinic Staff 2018). As a result, I learned that Paige was suffering from mild intermittent asthma. However, I discovered that Paige was not using an allergy medication. Thus, I prescribed new medicines to Paige since the current ones were not impactful to her condition. Paige was comfortable with this recommendation since her current medications were not aiding her

Personal

I felt confident and comfortable attending to Paige since she was a referral patient following my expertise in dealing with and treating asthmatic patients. I efficiently conducted tests showing the state of Paige’s asthma condition. The evaluation was successful because I relied on Paige’s knowledge of her health condition and her experience in other medical centres that have attended to her condition. I knew that lack of allergic medications to aid her in reducing her immune system reaction to the dust and pollen allergens.

Ethics

            I conducted all required diagnostic tests to ensure that my treatment procedure improves Paige’s health condition. This is because my goal was to do good by prescribing the effective medications that will not harm my patient but aid her in recovering from her ailing conditions. Nevertheless, I engaged in an incongruent way by prescribing new medication to Paige without explaining to her the adverse effects of the new prescription. I did not inform Paige that she will get swellings after injecting herself.

Empirics

Paige’s medical history clearly revealed that she has been asthmatic since her childhood. Besides, her current symptoms conformed to those of an asthmatic patient. Wheezing at high pitch sounds and airway obstruction syndrome are among the critical signs of asthmatic patients. Besides, she has been experiencing asthmatic attacks after encountering with her allergens, yet she did not have a medication to aid her immune system in responding to the allergens.

Reflexivity

Both patients, Smith and Paige, exhibited similar symptoms only that the severity of their signs was different. Besides, wheezing sounds while breathing out and difficulty in breathing was common between the two patients. The experience I have amassed in both situations will enable me to handle such cases in future more comfortable and professional. In future, I will ensure that I assess the entire health conditions of a patient before settling on one condition. This will enable me to rule out other potential conditions with similar symptoms. Likewise, I will evaluate the triggering factors that have resulted in the deterioration of the health conditions of a patient like Piage who had her condition under medical control. I will also involve patients in every treatment decision to ensure that my patients are aware of therapeutic adjustments made during treatment. The impact of these alternative actions is that only the right illness will be treated. Besides, I will engage my patients in an educative session meant to inform them about the causes, management, and prevention of their health condition.

This experience has been impactful by enlightening me on ways of approaching a situation from a diverse angle. I have discovered the essence of teamwork and patients’ input in their treatment process. As a result, I will support my fellow workmates as a way of facilitating the treatment process. Consequently, in the future, I will take a leadership-learning course meant to aid me in managing and coordinating my team. By taking this course, I will focus on improving my communication, management, and leadership skills required to solve uncertainty in the workplace and enhance collaboration among workers.

 

 

Reference List

Mayo Clinic Staff.  2018. Asthma: Steps in testing and diagnosis. Mayoclinic. [Online] https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma/art-20045198. Accessed 27 October 2019.

Ortiz-Alvarez, O., Mikrogianakis, A., Canadian Paediatric Society and Acute Care Committee, 2012. Managing the paediatric patient with an acute asthma exacerbation. Paediatrics & Child Health17(5), pp.251-255.

prescribing and assessing for a asthmatic patient at gp practice

 

 

 

PRESCRIBING AND ASSESSING FOR ASTHMATIC PATIENTS AT GP PRACTICE

 

 

Student’s Name

 

 

 

Professor’s Name

Course

Institution

State/City

Date

 

 

Prescribing and Assessing for Asthmatic Patients at GP Practice

Reflective of a Child Suffering from Asthma

Assessing and managing asthma among children is a challenging task since incorrect assessment affects the quality of life of a child. Thus, reflecting on the entire process of diagnosing and prescribing medication to an asthmatic kid is a significant practice for a caregiver. The reflective process will be facilitated by the use of the Gibbs Reflective Cycle. The adoption of this reflective model is essential in enabling one to think systematically concerning an experience one had during a particular situation or event.

Description

Ralph, a 12-year-old boy, was brought to the hospital on an afternoon by his teacher after he experienced difficulty in breathing and chest pains. Ralph’s chest was also cold at the arrival time in the hospital. This necessitated my team and I to carry diagnostic tests meant to assess whether Ralph was suffering from asthma. I went ahead to ask Ralph whether he was still feeling chest pain. I also observed his breathing patterns by observing the movement of his ribs and neck during breathing. My workmate, Jenner, was also keen listening to the sounds made by Ralph when breathing. These were the first important indicators that one would check when assessing whether one is suffering from asthma or not.

Feelings

Initially, I felt nervous when Ralph was brought to us because of the tension and shock of his teacher. However, after getting the facts of the case, I felt confident because I had handled several others before. This enabled me to engage Ralph in a conversation and practices meant to assess his condition (Ortiz-Alvarez et al., 2012). Being sure of what I was doing prompted me to coordinate my team members in attending to Ralph. I also managed to calm Ralph’s teacher down by assuring him that the condition was not severe. After carrying out successful diagnostic tests and assessments on Ralph, I felt happy that Ralph was suffering from mild asthma. Looking back at the situation encourages me to first identify the condition that a patient is suffering from and get everything in control. My workmates were as well excited when we learned that Ralph was suffering from mild asthmatic attacks. The coordination and role-taking of my two coworkers facilitated this diagnosis, which was a win for us all. Consequentially, the event reinforced our cooperation and instant response to emergency cases.

Evaluation

The entire experience was successful because the diagnostic results were positive. After realizing that Ralph was suffering from mild asthma, he was given a dose of inhaled corticosteroids (ICS) that assisted him to breathe appropriately and eased his chest pain (Suh et al., 2017). However, the initial encounter with the situation was not pleasing. The tension and anxiety of Ralph’s teacher, as well as Ralph’s condition, freaked and confused us. This got us panicking before we composed ourselves and took the initial assessments. I played a crucial role in conducting physical examination and assessing symptoms of asthma exhibited by Ralph. I engaged him in a conversation after observing the movement of his ribs and neck when breathing. My other coworkers also had significant input in identifying cold in Ralph’s chest and listening to the whistling sound when breathing.

Analysis

The event served a crucial role in shaping my future response to the children suffering from asthma. I learned that it is imperative for one to remain calm when nervous about a situation. Besides, I discovered that having the parents or teachers in control and assuring them that the situation is under control is paramount to avoiding further confusion during the treatment process. Teamwork also proved to be a significant aspect that one should utilize during emergency cases. Thus, effective coordination of a team is essential to instant response of an emergency in healthcare.

Conclusion

In a similar event, I would have sought the patient’s historical information about his current problem. I would have asked his parents to come and have a brief discussion with me to ensure that they respond effectively to the situation in the future. I learned that teamwork is an imperative practice in health care for an effective response to urgent situations. In future, I would do the same thing to achieve a positive outcome.

Action Plan

In a similar future case, I will ensure that the patient is calm as well as other parties involved so that I can get the facts of the case right. Such a move will allow me to gather all relevant facts about the conditions suffered by a patient. As a result, I will learn ways of calming and reducing the stress of those involved in the event. I will also learn about leadership skills so that I can efficiently manage and coordinate my coworkers.

Reflective of an Adult Suffering from Asthma

I encountered with Joy, a 23-year-old woman suffering from asthma since her childhood. Her best peak flow has always been 650l/min. Joy came to the hospital after experiencing persistent coughing over the past two days, which has necessitated her to use a salbutamol inhaler several times a day that it is prescribed.

Aesthetics

After engaging with Joy, I aimed at getting her medical history, symptoms, and carrying physical tests regarding asthma. I achieved these goals by inquiring the medical history of the patient and examining her throat, nose, and upper airways. I also used stethoscope to listen to her breathing. As a result, I learned that Joy was experiencing recurrent wheezing, chest tightness, and difficulty breathing which would worsen during the night. Joy was okay with these results, as she confirmed that she had experienced most of them over the past few days.

Personal

I felt confident and comfortable carrying out this assessment as I was conversant with such patients. I efficiently assessed the significant indicators of a severe asthma attack. The evaluation was successful because I relied on Joy’s knowledge of her health condition in answering diagnosing her case. The severity of her condition prompted me to carry additional tests such as a chest X-ray and blood tests to ensure that her current health is because of asthma.

Ethics

            I conducted all required diagnostic tests to ensure that my treatment improves Joy’s health condition. This is because my goal was to do good by prescribing the effective medications that will not harm patients but aid them in recovering from their ailing conditions. Nevertheless, I engaged in an incongruent way by persuading Joy to take further tests different from those of asthma. Although Joy and I knew that she was asthmatic, I coerced her to take chest x-rays and blood tests to affirm that her current condition was because of asthma.

Empirics

Joy’s medical history clearly revealed that she has been asthmatic since her childhood. Besides, her current symptoms conformed to those of an asthmatic patient. Chest pain and difficulty in breathing are among the critical signs of asthmatic patients (Mayo Clinic Staff, 2018). Further, the peak flow of a typical patient should range from 400 to 600l/min, while that of Joy was 650l/min.

Reflexivity

Both patients, Ralph and Joy, exhibited similar symptoms only that the severity of their signs was different. Ralph was suffering from slight asthma, while Joy was suffering from server one. Besides, chest pains and difficulty in breathing was common between the two patients. The experience I have amassed in both situations will enable me to handle such a situation in future more comfortable. In future, I will ensure that I assess the entire health conditions of a patient before settling on one condition. This will enable me to rule out other potential conditions with similar symptoms. Likewise, I will evaluate the triggering factors that have resulted in the deterioration of the health conditions of a patient like Joy who had her condition under medical control. I would also avoid coercing patients to take tests unwillingly. The impact of these alternative actions is that only the right illness will be treated. Besides, I will advise my clients accordingly on the dos and don’ts that will assist them control the health conditions.

This experience has been impactful by enlightening me on ways of approaching a situation from a diverse angle. I have discovered the essence of teamwork and patients’ input in their treatment process. As a result, I will support my fellow workmates as a way of facilitating the treatment process. Consequently, in the future, I will take a leadership-learning course meant to aid me in managing and coordinating my team. By taking this course, I will focus on improving my communication, management, and leadership skills required to solve uncertainty in workplace and enhance collaboration among workers.

 

 

Reference List

Mayo Clinic Staff.  2018. Asthma: Steps in testing and diagnosis. Mayoclinic. [Online] https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma/art-20045198. Accessed 27 October 2019.

Ortiz-Alvarez, O., Mikrogianakis, A., Canadian Paediatric Society and Acute Care Committee, 2012. Managing the paediatric patient with an acute asthma exacerbation. Paediatrics & Child Health17(5), pp.251-255.

Suh, D.I., Yang, H.J., Kim, B.S., Shin, Y.H., Lee, S.Y., Park, G., Kim, W.K., Kim, H.B., Baek, H., Kim, J.K. and Kim, J.T., 2017. Asthma severity and the controller prescription in children at 12 tertiary hospitals. Allergy, Asthma & Immunology Research9(1), pp.52-60.

learning in practice diary

Learning in practice diary

Name

Instructor

Course

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diary 1 I focused on these four themes and their below competencies

Description

I undertook the practice in a general practice place in a community based hospital in a local community. The shortage of physicians in the community informed my decision to offer my support in this health center. A general practitioner, with the help of other original health workers supervised my learning. Among other people present were the senior nurses, pharmacist, and doctors who worked at the health center. These people contributed mostly to my practice at the health center as they offered me the leeway to exercise extreme professionalism with my patients.

My area of scope is asthma, among other allergic illnesses. Primarily, I saw patients with asthma, but like mentioned, our group also attended to other patients such as eczema, diabetes, and heart failure. Overall, the interaction with these patients helped introduce me to the medical practice. Besides, the involvement with diverse types of patients enhanced my overall experience in handling different types of friends.

Contribution 

Primly, my role was to assess the patient’s conditions such as clinical assessments, interpretation of patient records to enhance patients’ management. Among other assessment activities involved confirming the diagnosis of various patients to improve precision in treatment. General tasked involved obtaining the patient’s records and providing them when needed. This practice enhanced the overall efficiency of the healthcare system. Another activity that was involved in included monitoring and review of the clients’ commitment to the treatment by giving the client clear, accessible, and understandable information concerning the medicines. This enables the client to maintain the treatment schedule.

Working in this center was challenging but helped integrate in my profession. I received feedback from patients most in my area of scope. In most cases, patients tipped me for my exemplary. Notwithstanding, I also received feedback from colleagues that denoted my propensity to diversity in their midst. In general, I created a tremendous impact on both my colleagues’ patients. Consequently, this enhanced my work diversity.

Learning 

During this time at the center, I learned adequate patient care as well as patient record keeping. In practice, patient record keeping is essential in promoting work efficiency in the healthcare system. Besides, meeting different people in different environments enhanced my thinking; I have been able to acquire integrative abilities that enabled me to consider other races equally.

Clinical decision-making is essential for the success of a therapeutic process. In that case, I indulged my supervisors in the discussion of various decision-making processes. Mainly, clinical decisions are critical as they directly influence the outcome of the entire treatment process as well as the professionalism of the health practitioner. The first discussion was aimed at understanding the outcome of various decisions and how they relate to ethical considerations in medicine. The second discussion involved dilemmatic choices that put the life of the patient in jeopardy; this was meant to assess the basic options the practitioner has in such conditions. Overall, proper decision-making promotes efficiency in the healthcare organization.

Action plan

Hitherto, I have acquired the necessary background about my course. However, I feel there is a need to engage in thorough training to help me understand the profession better. Essential areas to be covered in my remaining hours involve (1) patient care, (2) precision and (3) management. Up to now, I am not able to offer holistic patient management without help from a senior practitioner. In my forthcoming hours, I intend to acquire more patient management skills. Precision is essential in healthcare; this pertains to diagnosis prescription and overall patient care. Finally, adequate management skills are essential in ensuring that patients under my care receive proper healthcare management. Further, this learning outcome enables me to acquire superior organization management, which inadvertently promotes my overall professional performance.

Diary entry twotwo then focused on these fourfour themes and competence 

While in the midway of my practice hours, my study focused on the the identification of options. Here my significant concerns on assessing the risks a patient has during treatment, especially on using different treatment methods. For example, the consideration of both pharmacological and non-pharmacological treatment as modified treatment methods were are options in treatment. A good practitioner should be able to utilize these options to offers better healthcare to the patients.

To enhance efficiency in treatment management, it is essential for the practitioner to exercise adequate decision-making process. Through the theme of shared decision-making, the session aimed at promoting partnership between the patient and the caregivers. In the same meeting, my supervisors took me through a comprehensive learning process of identifying various, diverse values, beliefs, and expectations of the outcome of different healthcare approaches. My prime goal in this category was to understand the multiple perceptions of the patients on different treatment methods. This helps in the provision of a non- bias illness management options.

With prescription as a major theme of the session, the learning outcome was aimed at integrating an up-to-date awareness of different impacts of various clinical outcomes. Prescription as crucial medical practice, the session was accompanied with deep precision. In this case, it is essential to understand the adverse effects of various medical treatments and ways of avoiding them. Since the practice involves significant precision, a practitioner needed to pay attention to the generic medicines and their safety measures. Overall, the idea of the learning was to understand the potential opportunity of misuse of drugs. The sessions acted as an opener to my professional career as a medic.

Description

I undertook my learning practice in a private hospital under the supervisor of a senior pharmacist. In the area, the area of the supervisor depended majorly on the specific aim of the various learning outcomes. For example, during the prescription session, the pharmacist helped understand the general principles of prescription. The detailed and comprehensive learning process enabled me to understand various outcomes of clinical and medical orders. Among the present were nurses, doctors, and other subordinate physicians who offered me supports through the learning session.

During this time, I was not exposed to real patients as the supervisor presented me to various disease case files. Through these case files, I was able to train on offering a prescription to actual patients.

Contribution

I worked closely with my supervisor to offer a prescription to the patient. Even though I had no actual encounter with patients, my trainer availed case medical patient files, which I help her fill as well as provide a prescription. The rigorous training process led to significant experience in handling various patients.

Learning 

Missioned towards understanding various options and decision making, I have acquired different skillset about medicine use. Besides pharmacological knowledge, I have gained various clinical approaches and patient management. In particular, in the identification of options, I have learned the experience of handling multiple circumstances. Unlike the institutive concepts, I am aware of the diversity among the patients with respect to values, belief, and expectations as learned in the theme of shared decision making. Overall, identification options help the practitioner to weigh options before arriving at the best. On the other hand, share the decision-making concept helps the practitioner to operate in a diversified environment. Finally, prescription uses the above ideas to foster precision in care provision; these are the outcomes of the high sessions.

Actin plan 

Still, I have not gained enough experience in prescription. It crucial to gain adequate expertise to enable me to provide the safe and flawless prescriptions to the patients. Therefore, I intend to divulge in intensive prescription learning; this will enhance my ability to work independently. Moreover, to become a complete medical prescriber, it is essential to attain a high level of precision (Kiberstis, 2009). Therefore I desire to enhance my abilities in the same line.

Diary entry 3

Last diary Description

I undertook my learning practice at a public community healthcare center under the supervision of a pharmacist among other health care professionals such as practicing nurses and doctors. This medical personnel’s enhanced my learning process as they speeded my understanding of various aspects of the study. The senior pharmacist oversaw all my activities with the help of the other health professionals.

While in my advanced stages of prescription lessons, I was subjected to actual patients to enable me, advance my previous learning. For the first time, I got to interact with the patient in my area of scope. During the last sessions, I was subjected to quasi on no-existent patients for purposes of the study. However, the subsequent meeting enabled me to have a face-to-face interaction with the client in my area.

Contribution 

With an overriding theme of prescription, I was able to observe different causes of medication errors and different means of detection. Besides, my supervisor took me through alternative ways of prescribing medications such as online or remote media and the various steps taken to minimize the associated risks.

I engaged in a prescription task where I got involved the prescription team to ensure continuity of safe care across the system. Among other necessary process, I undertook included, undertaking of clinical assessment by taking appropriate diagnosis with adequate consideration of both legal, social, and ethical clinical aspects. Another undertaking included recognizing the unique implications during the development of anatomical and physiological diversity among neonate, young people, and children

Learning

As premised by the main themes; adequate prescription knowledge improves medical prescription and promotes professionalism. Among other learning outcomes, these sessions helped me acquire the in-depth implication of the application of precision in medicine prescription (Kiberstis, 2009). During the session of learning to prescribe professionally, I was able to acquire confidence and acceptance of personal responsibility. This follows the fact that a practitioner should be able to accept their responsibilities in their line of work. Besides, learning to improve prescribing enabled me to understand the importance of keeping an up-to-date concerns on emerging issues with particular medications such as resistance.

Focused towards promoting precision and professionalism in the medical unit in the section patient medication the discussion endeavored on developing an efficient and effective process of prescribing medicines. Like in most cases, clinical decisions significantly impact the practitioner’s prescription approaches. The supervisor advised me to apply the conventional methods to solve difficult situations that may arise during medication.

Undoubtedly, I am thrilled to transition to my new role. However, I am aware of the unsettling demands of the job. Therefore, I have put the necessary mechanisms to helps me develop through the career ladder. The feeling is enormously exiting consequently, I cannot wait to start.

Action plan  

Up to this point, I have gathered enough experience to the practice. The last session has been able to shape my thinking process concerning my scope as well as the medication process. With this general knowledge of medication, I can apply the learning experiences to navigate daily clinical duties. The comprehensive sessions have offered adequate expertise in the various medical field.

However, there is still room for more learning. In particular, it is essential to attend various clinical seminars to gain more knowledge of different approaches to contemporary practice change. Besides, the rapidly changing technology requires medical practitioners to blend into the new systems. Having completed my hours, I can pride over the exemplary experiences gained from the sessions. These experiences will enable me to move towards becoming a prolific prescriber.

The upcoming steps to becoming an excellent prescriber include reading and reviewing different cases. From these cases, I will able to determine different options in medication. Besides, honing my prescribing abilities will help me improve my professionalism. The application of these steps, among other logical techniques, will promote my medical practice prowess.

I am looking forward to building an excellent profession.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Kiberstis, P. (2009). BIOMEDICINE: Precision Prescription. Science323(5916), 855a-855a. doi: 10.1126/science.323.5916.855a

 

 

learning in practice diary

Diary 1 I focused on these 4 themes and their below competencies

Description

I undertook the practice in a general practice place in a community based-hospital in a local community. The dearth of physicians in the community informed my decision to offer my support in this health center. A general practitioner with the help of other original health workers supervised my learning. Among other people present were the senior nurses, pharmacist and doctors who worked at the health center. These people contributed largely to my practice at the health center as they offered me the leeway to exercise extreme professionalism with my patients.

My area of scope is asthma among other allergic illness. Primarily, I saw patients with asthma but like mentioned our group also attended to other patients such as eczema, diabetes and heart failure. Overall, the interaction with these patients helped introduce me into the medical practice. In addition, the involvement with diverse types of patients enhanced my overall experience in handling different type of friends.

Contribution

Primly, my role was to assess the patient’s conditions such as clinical assessments, interpretation of patient records to enhance patients’ management. Among other assessment activities involved confirming the diagnosis of various patients to enhance precision in treatment. General tasked involved obtaining the patients records and providing them when needed. This practice enhanced the overall efficiency of the healthcare system. Another activity that was involved in included monitoring and review of the clients’ commitment to the treatment by giving the client clear, accessible and understandable information concerning the medicines. This enables the client to maintain the treatment schedule.

Working in this center was challenging but helped integrate in my profession. I received feedbacks from patients most in my area of scope. In most cases, patients tipped me for my exemplary. Notwithstanding, I also received feedbacks from colleagues that denoted my propensity to diversity in their midst. In general, I created tremendous impact on both my colleagues’ patients. Consequently, this enhanced my work diversity.

Learning

During this time at the center, I learned adequate patient care as well as patient record keeping. In practice, patient record keeping is important in promoting work efficiency in healthcare system. In addition, meeting different people in with different environment enhanced my thinking; I have been able to acquire integrative abilities that enabled me to consider other races equally.

Clinical decision-making is important for the success of a medical process. In that case, I indulged my supervisors in the discussion of various decision-making processes. Mainly, clinical decisions are critical as they directly influence the outcome of the entire treatment process as well as the professionalism of the health practitioner. First discussion was aimed at understanding the outcome of various decisions and how they relate to ethical considerations in medicine. Second discussion involved dilemmatic decisions that put the life of the patient in jeopardy; this was meant to assess the basic options the practitioner has in such conditions. Overall, proper decision-making promotes efficiency in the healthcare organization.

Action plan

Hitherto, I have acquired the basic background pertaining to my course, however I feel there is need to engage in thorough training to help me understand the profession better. Important areas to be covered in my remaining hours involve (1) patient care (2) precision and (3) management. Up to now, I am not able to offers holistic patient management without help from a senior practitioner. In my forthcoming hours, I intend to acquire more patient management skills. Precision is important in healthcare; this pertains to diagnosis prescription and overall patient care. Finally, adequate management skills are important in ensuring that patients under my care receive adequate healthcare management. Further, this learning outcome enables me to acquire superior organization management which inadvertently promotes my overall professional performance.

Diary entry 2 then focused on these 4 themes and competence

While in the midway of my practice hours, my study focused on identification of options. Here my major concerns on assessing the risks a patient has during treatment especially on using different treatment methods. For example, the consideration both pharmacological and non-pharmacological treatment as modified treatment methods were are options in treatment. A good practitioner should be able to utilize these options to offers better healthcare to the patients.

To enhance efficiency in treatment management, it is essential for the practitioner to exercise adequate decision-making process. Through the theme of shared decision-making the session aimed at promoting partnership between the patient and the caregivers. In the same session, my supervisors took me through a comprehensive learning process of identifying various, diverse values, beliefs and expectations of the outcome of various healthcare approaches. My prime goal in this category was to understand the various perceptions of the patients on various treatment methods. This helps in the provision of a non- bias illness management options.

With prescription as major theme of the session, the learning outcome was aimed at integrating an up-to date awareness of different impacts of various clinical outcomes. Prescription as crucial medical practice, the session was accompanied with deep precision. In the case, it is important to understand the adverse effects of various medical treatments and ways of avoiding them. Since the practice involves significant precision, a practitioner needed to pay attention on the generic medicines and there safety measures. Overall, the idea of the learning was to understand the potential opportunity of misuse of medicines. The sessions acted as an opener to my professional career as a medic.

Description

I undertook my learning practice in a private hospital under the supervisor of a senior pharmacist. In the area the area of the supervisor depended majorly on the specific aim of the various learning outcomes. For example during the prescription session, the pharmacist helped understand the general principles of prescription. The detailed and comprehensive learning process enabled me to understand various outcomes of clinical and medical prescriptions. Among present were nurses, doctors and other subordinate physicians who offered  me supports through the learning session.

During this time, I was not exposes to real patients as the supervisor exposed me to various disease case files. Through these case files, I was able to train on offering prescription to actual patients.

Contribution

I worked closely with my supervisor to offer prescription to patient. Even though I had no actual encounter with patients my trainer availed case medical patient files which I help her fill as well as provide prescription. The rigorous training process led to significant experience in handling various patients.

Learning

Missioned towards understanding various options and decision making, I have acquired different skillset pertaining to medicine use. Besides the pharmacological knowledge, I have gained various clinical approaches and patient management. In particular, in the identification of options, I have gained the experience of handling various circumstances. Unlike the institutive concepts, I am cognizant of the diversity among the patients in respect to values, belief and expectation as learned in the theme of shared decision making. Overall, identification options help the practitioner to weigh options before arriving to the best. On the other hand, share decision-making concept helps the practitioner to operate in a diversified environment. Finally, prescription uses the above concepts to foster precision in care provision; these are the outcomes of the above sessions.

Actin plan

Still, i have not gained enough experience in prescription. it crucial to gain adequate experience to enable me provide safe and flawless prescription to the patients. Therefore, I intend to divulge in intensive prescription learning; this will enhance my ability to work independently. Moreover, with an aim to become a complete medical prescriber, it is essential to attain high level of precision, therefore it is my desire to enhance my abilities in the same line.

Diary entry 3

Last diary Description

I undertook my learning practice at a public community healthcare center under the supervision of a pharmacist among other health care professional such as practicing nurses and doctors. These medical personnel’s enhanced my learning process as they speeded my understanding of various aspects of study. The senior pharmacist oversaw all my activities with the help of the other health professional.

While in my advanced stages of prescription lessons, I was subjected to actual patients to enable me, advance my previous learning. For the first time, I got to interact with patient in my area of scope. In the previous sessions, I was subjected to quasi on no-existent patients for purposes of study, however the subsequent session enabled me to have a face-to face interaction with client in my area.

Contribution

With an overriding theme of prescription, I was able to observe different causes of medication errors and different means of detection. In addition, my supervisor took me through alternative ways of prescribing medications such as online or remote media and the various steps taken to minimize the associated risks.

I engaged in a prescription task where I got involved prescription team to ensure continuity of safe care across the system. Among other important process I undertook included, undertaking of clinical assessment by taking appropriate diagnosis with adequate consideration of both legal, social and ethical clinical aspects. Another undertaking included recognizing the unique implications during the development of anatomical and physiological diversity among neonate, young people and children

Learning

As premised by the main themes; adequate prescription knowledge improves medical prescription and promotes professionalism. Among other learning outcomes, these sessions helped me acquire the in-depth implication of the application of precision in medicine prescription. During the session of learning to prescribe professionally, I was able to acquire confidence and acceptance of personal responsibility. This follows the fact that a practitioner should be able to accept their responsibilities in their line of work. In addition, learning to improve prescribing enabled me to understand the importance of keeping an up-to date concerns on emerging issues with certain medicine such as resistance.

Focused towards promoting precision and professionalism in the medical unit in the section patient medication, the discussion endeavored on developing efficient and effective process of prescribing medicines. Like in most cases, clinical decisions greatly impact on the practitioners prescription approaches. The supervisor advised me to apply the conventional approaches to solve difficult situations that may arise during medication.

Undoubtedly, I am thrilled to transition to my new role. However, I am aware of the unsettling demands of the job, therefore, I have put the necessary mechanisms to helps me develop through the career ladder. The feeling is enormously exiting therefore, I cannot wait to start.

Action plan  

Up to this point, I have gathered enough experience to practice. The last session has been able to shape my thinking process concerning my scope as well as medication process. With this general knowledge of medication, I can apply the learning experiences to navigate the daily clinical duties. The comprehensive sessions has offered adequate experience in various medical field.

However, I there is still room for more learning. In particular, it is essential to attend various clinical seminars to gain more knowledge on different approaches to contemporary practice change. In addition, the rapidly changing technology requires medical practitioners to blend into the new systems. Having completed my hours, I can pride over the exemplary experiences gained from the sessions. These experiences will enable me to move towards becoming a prolific prescriber.

The upcoming steps to becoming an excellent prescriber include reading and reviewing different cases. From these cases, I will able to determine different options in medication In addition, honing my prescribing abilities will help me improve my professionalism. The application of these steps among other logical techniques will promote my medical practice prowess. I am looking forward to building an excellent profession.

 

 

 

 

 

 

 

 

prescribing and assessing for a asthmatic Child in primary care

Background:

BIODATA

Name: James Smith

Age: 5 ½ years

Sex: Male

Ethnicity: Black African

Residence: St. Louis Missouri

Next of Kin: Mary Smith

Relationship with next of kin: Mother

Next of kin cellphone: 0723310923

PRESENTING COMPLAINS:

Patient presented with difficulty in breathing, wheezing, sweating and lethargy which had begun in the morning (5 hours before seeking care).

HISTORY OF PRESENTING COMPLAIN:

Patient was well until the morning when he developed the above complains. He woke up and took breakfast which comprised an egg, banana and white tea.  Later he visited construction site for a residence the family is building.  He visited the stores to pick a material for one of the construction workers.  After approximately 30 minutes, he returned to the house to bath since they had planned a trip to visit his Father at work.  The developed labored breathing on the way out but her mother opted to continue with the journey and visit a hospital later. However, wheezing worsened she had to stop the journey and seek a nearby hospital.

PAST MEDICAL SURGICAL HISTORY

Patient has had one episode of asthmatic attack at the age of 2 years but it resolved within a year of medication. No other chronic illness, or allergy has been noted. He has never been operated. 

SOCIAL HISTORY

He is a third born in a family of five. He is in grade KG. His performance in school is impressive, he is playful and active class representative.  He lives with his mother. The other siblings are in boarding schools.

 

Physical Assessment:

OBSERVATION OF VITAL SIGNS

Temperature: 37.4Oc (36.2 Oc -37.2 Oc, Pulse rate 83 beats/min (60-110, Respiratory rate 30(20-40) beats/min, Blood pressure 127/67 mmHG. 

Focused Assessment:

Generally, the patient was ambulating, conscious but strained to walk fast. No abnormalities were noted on the skin. Head and neck showed nothing significant. However, there was labored breathing. Auscultation of the chest showed wheezing on expiration. The abdominal muscles were involved in expiration of air.  Extremities were normal although there was a tinge of cyanosis on the lower extremities.  Oxygen saturation on the upper extremities was averagely 89.0C. 

 

DIAGNOSIS

The history presented as well as physical assessment findings were indicative of respiratory tract problem associated with narrowing of airways.  Such conditions included Asthma, pneumonia and bronchiolitis.  Additional tests were conducted to include an X-ray to rule our pneumonia. The test was negative for pneumonia. Exhaled Nitric Oxide test shows 23 parts per billion confirming inflammation of the airway. The acute nature of the condition lead to conclusion of Asthmatic Attack diagnosis. 

 

PATHOSPHYSIOLOGY

Asthmatic attack occurs when an allergen activates inflammatory response in the body thus causing inflammation, swelling and accumulation of fluid along the airways. The airways are narrowed by the accumulated fluid and inflammation, necessitating a forceful breathing out (expiration) which ought to be an effortless in normal circumstances.  This impairs gaseous exchange at the alveoli leading to reduced oxygen saturation in blood and tissues, which is responsible for myalgia and lethargy.

If no intervention is done, the asthma associated inflammation leads to loss of lung function with time leading to development of comorbidities such as Congestive Pulmonary Disease and bronchiectasis.  Public health considerations involve removal of allergens from the environment in order to minimize risks of Asthmatic attack. 

ASSESSMENT

The identified problem was that the patient was not fully informed asthmatic attacks could re-occur in future. This was the second time the patient was treated for Asthma.  One of the key approaches to management of Asthma is avoidance of the allergen. But the patient in this case believed they were healed and never anticipated another episode of attack would occur with another exposure.  A visit to the construction store, which often is dusty and houses cement among other items was the potential source of the allergen that lead to development of Asthma.  Besides, there was inappropriate prescribing and monitoring of patients. Patients diagnosed with Asthma are required to keep inhaler medications and to be conversant with asthma symptoms. This is meant to ensure they can assess emergency care wherever the condition happens.  In this case, they lacked the know-how as well as the drugs to manage the situation at home. 

 

EVIDENCE

Guidelines for management of Asthma require a systematic approach to ensure quality care and effective management. The first approach is correct diagnosis of Asthma patients and identification of allergens.  The second step is management of the acute phase with medications that reduce inflammation of the airway as well as reduce secretions on the airway. The third step is education of the patient to improve their knowledge on the causes, pathophysiology, management and prevention of Asthma.  Lastly is removal of the allergen and educating the patient on identification and avoidance of the allergen. 

 

CONCORDANCE

Development of concordance relationship with the client begins on clear education of the problem they are suffering from and developing an open relationship on the nature of the condition and how it can be managed and/or prevented. Besides, establishing an agreement for regular clinic visits to provide follow up and encourage regular discussion would improve the relationship. I will encourage self care by educating the client to have an inhaler medication in the house for use during such episodes. Besides, I will share hospital contact information to enable client seek help from home by way of phone consultation.

PHARMACOECONOMICS

There are no cheaper drugs for managing Asthma. However, it is necessary to ensure the child has an insurance cover. Secondly, prevention of allergen is the best approach to minimize costs associated with Asthma attack. Moreover, self-medication with inhaler medications can reduce hospital consultation costs

CLINICAL GOVERNANCE

 

LEGAL ASPECTS

 

ETHICAL ASPECTS

 

RECOMMENDATIONS

I recommend that management of Asthmatic patients to be broadened to include more education on prevention of non-allergens. I recommend that Asthmatic patients should be allowed to consult from their homes to manage acute episodes because transfer to hospital consumes more time.  Patient follow up after the first episode of attack is necessary. A bi-annual visit to the clinic even in the absence of asthma signs and symptoms is necessary to allow evaluation of client progress and knowledge of the condition.

 

Communication

We agreed with the client to continue with a follow up clinic  the following week.  I kept records of the

 

prescribing and assessing for a asthmatic Child in primary care

 

 

 

 

 

 

 

 

CLINICAL REFLECTION

 

BY

 

Name

 

 

 

 

 

Class

Professor

College

 

 

 

Date

 

 

 

 

 

Background:

BIODATA

Name: James Smith

Age: 5 ½ years

Sex: Male

Ethnicity: Black African

Residence: St. Louis Missouri

Next of Kin: Mary Smith

Relationship with next of kin: Mother

Next of kin cellphone: 0723310923

PRESENTING COMPLAINS:

Patient presented with difficulty in breathing, wheezing, sweating and lethargy which had begun in the morning (5 hours before seeking care).

HISTORY OF PRESENTING COMPLAIN:

Patient was well until the morning when he developed the above complains. He woke up and took breakfast which comprised an egg, banana and white tea.  Later he visited construction site for a residence the family is building.  He visited the stores to pick a material for one of the construction workers.  After approximately 30 minutes, he returned to the house to bath since they had planned a trip to visit his Father at work.  The developed labored breathing on the way out but her mother opted to continue with the journey and visit a hospital later. However, wheezing worsened she had to stop the journey and seek a nearby hospital.

PAST MEDICAL SURGICAL HISTORY

Patient has had one episode of asthmatic attack at the age of 2 years but it resolved within a year of medication. No other chronic illness, or allergy has been noted. He has never been operated.

SOCIAL HISTORY

He is a third born in a family of five. He is in grade KG. His performance in school is impressive, he is playful and active class representative.  He lives with his mother. The other siblings are in boarding schools.

 

Physical Assessment:

OBSERVATION OF VITAL SIGNS

Temperature: 37.4Oc (36.2 Oc -37.2 Oc, Pulse rate 83 beats/min (60-110, Respiratory rate 30(20-40) beats/min, Blood pressure 127/67 mmHG.

FOCUSED ASSESSMENT:

Generally, the patient was ambulating, conscious but strained to walk fast. No abnormalities were noted on the skin. Head and neck showed nothing significant. However, there was labored breathing. Auscultation of the chest showed wheezing on expiration. The abdominal muscles were involved in expiration of air.  Extremities were normal although there was a tinge of cyanosis on the lower extremities.  Oxygen saturation on the upper extremities was averagely 89.0C.

 

DIAGNOSIS

The history presented as well as physical assessment findings were indicative of respiratory tract problem associated with narrowing of airways.  Such conditions included Asthma, pneumonia and bronchiolitis.  Additional tests were conducted to include an X-ray to rule our pneumonia. The test was negative for pneumonia. Exhaled Nitric Oxide test shows 23 parts per billion confirming inflammation of the airway. The acute nature of the condition lead to conclusion of Asthmatic Attack diagnosis.

 

PATHOSPHYSIOLOGY

Asthmatic attack occurs when an allergen activates inflammatory response in the body thus causing inflammation, swelling and accumulation of fluid along the airways. The airways are narrowed by the accumulated fluid and inflammation, necessitating a forceful breathing out (expiration) which ought to be an effortless in normal circumstances.  This impairs gaseous exchange at the alveoli leading to reduced oxygen saturation in blood and tissues, which is responsible for myalgia and lethargy. If no intervention is done, the asthma associated inflammation leads to loss of lung function with time leading to development of comorbidities such as Congestive Pulmonary Disease and bronchiectasis.  Public health considerations involve removal of allergens from the environment in order to minimize risks of Asthmatic attack (Holgate, 2011; Morris, 2019).

ASSESSMENT

The identified problem was that the patient was not fully informed asthmatic attacks could re-occur in future. This was the second time the patient was treated for Asthma.  One of the key approaches to management of Asthma is avoidance of the allergen. But the patient in this case believed they were healed and never anticipated another episode of attack would occur with another exposure.  A visit to the construction store, which often is dusty and houses cement among other items was the potential source of the allergen that lead to development of Asthma.  Besides, there was inappropriate prescribing and monitoring of patients. Patients diagnosed with Asthma are required to keep inhaler medications and to be conversant with asthma symptoms. This is meant to ensure they can assess emergency care wherever the condition happens.  In this case, they lacked the know-how as well as the drugs to manage the situation at home.

 

EVIDENCE

Guidelines for management of Asthma require a systematic approach to ensure quality care and effective management. The first approach is correct diagnosis of Asthma patients and identification of allergens.  The second step is management of the acute phase with medications that reduce inflammation of the airway as well as reduce secretions on the airway. The third step is education of the patient to improve their knowledge on the causes, pathophysiology, management and prevention of Asthma.  Lastly is removal of the allergen and educating the patient on identification and avoidance of the allergen (Global Initiative for Asthma, 2019; Morris, 2019).

 

CONCORDANCE

Development of concordance relationship with the client begins on clear education of the problem they are suffering from and developing an open relationship on the nature of the condition and how it can be managed and/or prevented. Besides, establishing an agreement for regular clinic visits to provide follow up and encourage regular discussion would improve the relationship. I will encourage self care by educating the client to have an inhaler medication in the house for use during such episodes. Besides, I will share hospital contact information to enable client seek help from home by way of phone consultation.

PHARMACOECONOMICS

There are no cheaper drugs for managing Asthma. However, it is necessary to ensure the child has an insurance cover. Secondly, prevention of allergen is the best approach to minimize costs associated with Asthma attack. Moreover, self-medication with inhaler medications can reduce hospital consultation costs

CLINICAL GOVERNANCE

Quality management of Asthma requires identification of the allergen, treatment of attacks and development of approaches to enable the client avoid allergens. This ought to have been emphasized. Besides, self-treatment is necessary in this case because asthmatic attacks can occur anywhere, anytime (Global Initiative for Asthma, 2019).

 

LEGAL ASPECTS

The legal aspects involved in the case was treatment of a minor. Besides, inhaler drugs were prescribed for use at home. The drug would be administered by the patient guardian.

 

ETHICAL ASPECTS

Ethical aspects included respecting the patient right to full information regarding their treatment and condition.  In this case, educating the patient to prevent future attacks was a key component of the care. It would improve wellbeing of the patient and reduce healthcare costs for the patient.

 

RECOMMENDATIONS

I recommend that management of Asthmatic patients to be broadened to include more education on prevention of non-allergens. I recommend that Asthmatic patients should be allowed to consult from their homes to manage acute episodes because transfer to hospital consumes more time.  Patient follow up after the first episode of attack is necessary. A bi-annual visit to the clinic even in the absence of asthma signs and symptoms is necessary to allow evaluation of client progress and knowledge of the condition.

 

Communication

We agreed with the client to continue with a follow up clinic the following week.  I kept records of the history and physical assessment that was done, cardex and a c clinic appointment copy.  Moreover, records of the treatment sheet and prescribed drugs were kept. To ensure a seamless communication with the previous hospital, the patient was given a discharge summary to indicate what was done in our hospital. This would ensure if he visits the next hospital, there would be clarity on what was done in another hospital. Besides, the patient was encouraged to bring discharge summary from the other hospital in the follow up clinic.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Global Initiative for Asthma, 2019. Global Strategy for Asthma Management and Prevention (2019 update) [WWW Document]. URL https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf (accessed 10.27.19).

Holgate, S.T., 2011. Pathophysiology of asthma: What has our current understanding taught us about new therapeutic approaches? Journal of Allergy and Clinical Immunology 128, 495–505. https://doi.org/10.1016/j.jaci.2011.06.052

Morris, M.J., 2019. Asthma Guidelines: Guidelines Summary, Classification Guidelines, Management Guidelines.

 

prescribing and assessing for a asthmatic patient at gp practice

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRESCRIBING AND ASSESSING FOR ASTHMATIC PATIENT AT GP PRACTICE

 

 

Name

 

 

 

Healthcare and Nursing

Professor

Institution’

Date

 

 

 

 

 

 

 

  1. Background

 

Paige J is a joyous mother of three. She is from the Hispanic ethnic group who works as a receptionist at a five-star hotel. Paige J has a huge passion for cats and she was diagnosed with asthma in the last five years.

Paige J claims that what triggers her Asthma is the exposure to dust, pollen, and animals like dogs and cats which she likes spending time with when at home. When Paige spends some minutes or hours with her cat for example, she ends up waking up at the night hours with terrible Asthma and tightness of  the chest. She does not talk during asthma attacks because talking makes her struggle a lot. She uses mostly her rescue inhaler and just in case she does not have it, she tries to get some fresh air or drink some chocolate. She also has prescribed medicine which she uses in case of attack. Her attacks happen during the night. Paige denies being a smoker. Her asthma is classified as mild persisted where the symptoms can reveal themselves twice in a week but not more than one is a day.

Paige J has been referred to me as a general practitioner because I have a good past medical history of treating patients with asthma.

  • Past Medical history

Paige J Asthma manifested itself in the last five years. She has been using an inhaler in case of attacks. Most of her attacks happen during the night.  She has been using inhaled corticosteroids (Qnasi, Qvar). She also medicated with long-acting beta-agonists serevent. She has never used allergy medications

 

 

  1. Subjective information was obtained from Paige J

Wheezing-high pitched whistling sound when breathing out, airway obstruction syndrome, she experienced panic fear and she had fatigue signs. After an asthma attack, she is not able to work the following day and do her daily chores. She cannot do tasks that her demanding and she has added significant weight.

Paige J complains that she has been to many health Centres and she has not got any significant help which has increased her psychological problems like stress, anxiety with some point of depression. Paige J also complains that the medication which she has been using (with long-acting beta-agonists Serevent) has not helped despite spending large amounts on the drugs.

  1. Objective

More tests were needed to measure Paige lung function to find out how air moved in and out during breathing. The spirometry test was 69%. The normal range should be more than 80% Paige reacted to methacholine in the first lung function test. The nitric oxide test indicated 50 parts per billion. A normal range should be 25-30 parts per billion. Sputum eosinophils were at 5%. The normal range should be 3%.  From observation, she had hives and itchy skin. Her skin was a bit swollen. From the result, Paige had mild intermittent asthma.

  1. Assessment – Medicines Optimization.

What drug-related problems (DRPs) were identified e.g.:

The  Qvar inhaled corticosteroids made Paige have stomach upsets, stuffy nose, sore throat nausea at some times. The long-acting beta-agonists (Serevent) have little impact on Paige.

There was a need to pre-describe both Qvar inhaled corticosteroids and the long-acting beta-agonists (Serevent). Change of medicine was needed and the immediate start of allergic medication. I prescribed her Ipratropium (Atrovent) medicine which acts quickly to immediately relax airways and make it easier to breathe. For long term medication, I prescribe Paige J the flunisolide inhaled corticosteroids which have reduced the risk of side effects when used for a very long time. For her allergy medication, I prescribed her allergy shots immunotherapy which is very best in reducing the immune system reaction to dust, cats and pollen allergens. The only side effect of allergy shots is swelling at the point of injection. The allergy shots are extremely good in treating allergies and they consequently prevent the development of new allergies. Paige J had no problems adhering to the medication instructions. The previous medication had been inappropriately prescribed to Paige since it was not helping her.  This was because Qvar inhaled corticosteroids and Serevent long-acting beta-agonists both solve a similar problem and used together, the result interaction can lead to reduced absorption of either the drugs.

 

  1. Appraisal

Ipratropium (Atrovent) medicine

Research done by Henderson, (2017) np on 66 asthmatic patients indicated that Ipratropium bromide Atrovent had pharmacology effects leading to a high degree of activity and a specific bronchoselectivity if administered intravenously. Evidence indicates that it is the best for routine administration with small doses which lead to the opening of airways without resulting in anticholinergic side effects. The pharmacology properties of this drug are that it “blocks the muscarinic cholinergic receptor in the smooth muscles of the bronchi in the lungs.”  This medicine would work for Paige to improve her lung function which had a Spirometry test which very low than normal. This medication can be used by patients with other co-morbidities like diabetes.

Flunisolide inhaled corticosteroids

Evidence indicates that flunisolide is very effective in preventing and controlling asthma symptoms especially the wheezing and the shortness of breath which results from asthma (Choby, & Lee, 2015 pp. S35-S40). The drug works closely with the lungs making breathing easier. “American Academy of Allergy Asthma & Immunology” (AAAAI) has a set guide for the use of this drug. The pharmacological properties of Flunisolide are that it undergoes very quick and intensive first-pass metabolism (Watts, et.al 2019. p.294).

Allergy shots immunotherapy

Evidence-based studies indicate that allergy shots were effective for treating all year round and indoor allergies (Schroer, B. and Aalberse, R.C., 2018. 1866-1868). AAAAI has set out the guidelines used for this medication.

 

  1. Plan

I recommended Paige to stop using her previous medication immediately once she begins using the new prescribed drugs. I also recommend that she should have more air conditioners in her house. I also recommended that she should avoid her cat even though she has a huge passion for cats. The change in asthma symptoms has to monitor closely in the first month and medicine adherence. I agreed with Paige J to have weekly visits at her home as one way to follow up. Phone calls would also be used to determine her progress.

Paige was happy with this treatment plan especially the idea of treating her allergic conditions which she never thought was a major issue that needed medication. This treatment plan was much more than she expected. I kept Paige’s medical chart for a future treatment plan. We agreed that whenever she had any questions and any help, feel free to call me. Paige did not have team-based care since she did not have comorbidities related to her asthma.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Choby, G. W., & Lee, S. (2015, September). Pharmacotherapy for the treatment of asthma: current treatment options and future directions. In International forum of allergy & rhinology (Vol. 5, No. S1, pp. S35-S40).

Henderson, L. (2017). Prehospital use of ipratropium bromide paired with salbutamol as treatment for shortness of breath.

Schroer, B. and Aalberse, R.C., 2018. Clinical Allergy at the Interface of Sticky Dust Particles and Crystal-Clear Proteins. The Journal of Allergy and Clinical Immunology: In Practice6(6), pp.1866-1868.