Asthma in General Practice

Introduction

This essay will give a critical analysis of a minor illness case study; a patient presenting with asthma. Within the essay, I will give a brief description of the consultation, examination and development of a treatment plan process for the case study patient within the general practice care setting. The case study involves John, a 32-year-old industrial engineer who visited the clinic with complaints of short breath, coughing, and chest tightness. As a general practice nurse (GP), I implemented various approaches to effective communication during my consultation with John. This was part of my effort to ensure that I gather as much material information as possible to help in effective disease diagnosis.

History Taking

After inviting John into the consultation room, I created an environment for an effective history taking. I did this by first introducing myself and letting John introduce himself – to create a good rapport (Mueter et al, 2015). Besides, as recommended by Stevens et al (2019), I developed criteria for probing and asking him questions through open-ended and closed questions. Particularly, open-ended was meant to let John thoroughly explain his responses to my questions while probing was meant to create a deeper exchange of information for clarity. According to Norouzinia et al (2016), such a strategy enables the practitioner to avoid making assumptions about the patient’s condition but rather develop essential information based on the patient’s accounts. Furthermore, I endeavoured to actively listen to John as he responded to my questions. For instance, I gave him both verbal and non-verbal feedback by nodding my head and agreeing to some of the information (Mueter et al, 2015). Furthermore, I probed and asked more questions on the information he gave, and this helped in gathering more in-depth information to help with diagnosis (Moore et al, 2018). Another aspect of my consideration was the patients’ social history and how it influenced his presenting conditions, which I fund that John is a non-smoker. Appendix A illustrates full patient history data including his social history.

Physical Examination

After taking the general history of the patient, noticed that John’s family had no history of asthma, and so I proceeded with the diagnosis based on the information he could give me. For this reason, I took his physical history after gaining his consent for the same. According to Kangasniemi et al (2015), the ethical and legal procedures of clinical practice stipulates that the clinician must gain consent before conducting any type of treatment, before delivering and form of personal care, or before conducting a physical examination. Essentially, patient consent is considered important because the patients have a right to determine anything that happens on their body, which is an essential element of good practice (Kangasniemi et al, 2015).

Meanwhile, my physical examination was aimed at achieving the correct diagnosis by examining the following details: whether there were any present symptoms of airflow obstruction, whether the airflow symptoms could be reversible, and whether there were alternative diagnoses that could be excluded.

My physical examination involved ear examination, spirometry performance, chest auscultation and peak flow, blood pressure, respiratory rate, body temperature, Heart Rate, peripheral oxigene saturation. Ideally, chest auscultation involved listening to John’s breath sounds in the chest, using a stethoscope to identify any changes of the breath sounds caused by a change in the lungs or surrounding tissue changes (O’Bryne & Meiza, 2018). I also performed an ear examination to identify any chronic fluids or signs of infection. Perhaps the most important physical examination I performed on John was to test his lung function through spirometry, which essentially would help in confirming the presence of asthma (Kondo & Tamaoki, 2018). To conduct this examination, according to O’Bryne & Meiza (2018), I gently asked John to breathe into a device connected to the spirometer, to measure the amount of air he could breathe in and out, as well as his rate of airflow. This test was combined with a test of John’s peak flow, which essentially measured the extent to which John could force air out of his lungs (Arkawa et al 2017).

The signs and symptoms of breathing difficulties could also be as a result of chronic obstructive pulmonary disease (COPD). According to Kondo & Tamaoki (2018), COPD is an inflammatory lung infection that causes lung airflow obstruction. John, as an industrial engineer, is often exposed to particulate matter and toxic gases, causing me to suspect that he could be having an COPD. However, to differentiate asthma from COPD and other causes of airflow destruction, I performed a differential diagnosis – the reversibility test, which surpassed the recommended ≥400 mL in FEV1 post-bronchodilator (i.e., 500 mL in FEV1 post-bronchodilator). Ultimately, as illustrated in Appendix B, the physical examination, especially the spirometry with reversibility test led me to suspect that John had mild asthma.

Treatment Plan

The treatment plan I developed for John involved both pharmacological and non-pharmacological approaches. For non-pharmacological approaches, I advised John not to let anyone smoke next to him since he is not a smoker, particularly because the cigarette is an irritant (Reddel et al, 2015). Besides, I asked John to avoid dust by using protective gears when working within a dusty environment. Part of the advice I gave to him also involved avoiding other triggers such as pollens, as well as indoor irritants such as scented candles, deodorants or mothballs (Israel & Reddel, 2017).

On the other hand, John’s pharmacological management of asthma involved the use of salbutamol inhaler used together with a spacer. According to O’Bryne & Meiza (2018), salbutamol is useful in relieving asthma symptoms of breathlessness, wheezing and coughing, and acts by relaxing the muscles of the airways that lead into the lungs thereby enabling the user to easily breathe. The spacer makes it easier to use the salbutamol inhaler by holding the medication until the medication is getting into the lungs (Israel & Reddel, 2017). All in all, I discussed with John red flags related to his symptoms, in particularly 60% peak flow drop and 80% peak flow drop. I provided john with a peak flow meter and a diary so he could test at home, morning and evening and keep records. I arranged a follow-up appointment for Johan, the following day with one of my GP colleagues as recommended by Reddel et al (2015).

Conclusion

The most interesting thing I have learned from my interaction with John is that effective communication with the patient is the most important aspect of patient consultation. Adopting effective communication strategies such as active listening enabled me to interact with John in a manner that made him open up and provide information that was vital for his diagnosis. A possible implication of this new realization is that effective communication can allow a proper exchange between a patient and the clinician so that the situation is viewed from both the patient and the clinician’s practitioner. This realization is valuable for it will change how I approach every consultation session with my patients because getting the best information from them is one of the elements of a proper diagnosis.

References

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