Peer Responses:

    Length: A minimum of 150 words per post, not including references
    Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
    Citations need to be within 5 (Five)  years
    Context: Nursing in the USA

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Ms. Whitley is a 26 year old female. She has a history of asthma since grade school, for the last 3 months she has had to use her Albuterol inhaler 3-4 times per week, sometimes at night. She states she has chronic knee pain from playing soccer in high school, no surgeries, takes Acetaminophen as needed. She also asks about starting a birth control method, currently using condoms. She asks what you think about medication to help with weight loss since she would like to drop the 20 lbs she gained in college.

1. Ms. Whitley scores mild on the Asthma Severity Scale, therefore she will be started on Step 2 on the Stepwise Approach to managing asthma. This includes a low dose IGC and a SABA. For the low dose IGC, I will choose budesonide (pulmicort flexhaler) DPI 180mcg/inhalation, 2 puffs in the morning and 2 puffs in the evening. I will keep her on her albuterol (pro-air) inhaler to be used PRN for shortness of breath. I will also add in a leukotrine modifier called montelukast (singulair), for prophylaxis and maintenance therapy of asthma. The dose would be 10mg tablet once daily in the evening. I would educate the patient on the importance of taking her maintenance medications as prescribed and to only use the SABA for breakthrough SOB.

2. For Ms. Whitleys chronic knee pain, I would assess her pain level and inquire about how often she is taking the acetaminophen and how much, and is it working for her. If it is not sufficient in managing her pain, I would suggest the use of naproxen (alleve), 250-500mg every 12 hours. Naproxen is a non-steroidal anti-inflammatory medication which works by reducing hormones that cause inflammation and pain in the body. I would educate the patient about the risk for peptic ulcers, gastric distress and gastric bleeding as side effects of the NSAIDS and to report these symptoms to her provider ASAP. I would also advise her to use heat or ice therapy for flare-ups.

3. As far as starting a birth control method, I would have to ask Ms. Whitley what her family planning goals are. I would educate her on the many different avenues of birth control that is available. Some examples are oral contraceptives, subdermal etonogestrel implants, vaginal contraceptive rings, depot shots, and IUDs. I would advise her to review each option and then make an informed decision on how she would like to proceed. If she chooses a long-term method of birth control, I would advise her to go with a subdermal system (Nexplanon) which is a small rod that contains synthetic progestin that is implanted subdermally in the groove between the bicep and tricep in the non-dominant arm(Burcham & Rosenthal, 2019, p. 763). This type of birth control lasts for three years. The other type of long-term birth control that I would recommend is an IUD. There is Paragard which has copper T 380A, and can remain in place for 10 years. Then there is the Mirena, which contains levonorgestrel, and can be left in place for 5 years. I would teach the patient that she may have irregular bleeding or amenorrhea with the use of Nexplanon and cramping and irregular bleeding with the IUD.

4. Ms. Whitley asked about medication to help her lose the 20lbs she gained in college. I would advise her that medication are only used as an adjunct therapy with diet and exercise, but only for people who have an elevated health risk and only after a 6 month trial of diet and exercise has failed (Burcham & Rosenthal, 2019, p. 1009). If the patient were to meet the criteria for weight loss medication, I would choose a short course of phentermine (Adipex) at 37.5mg daily. This drug is a sympathomimetic amines medication and work by suppressing the appetite. I would advise the patient about the side effects of tachycardia, hypertension, and anginal pain.
References
Burcham, J. R., & Rosenthal, L. D. (2019). Pharmacology for nursing care (10th ed.). St. Louis, MO: Elsevier.