Michelle continues to work in the bakery and her asthma has been well controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is productive of white sputum. Influenza A is going around the bakery. Exam findings show a woman who appears her stated age and is alert and oriented and though calm, is having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is elevated at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.

Discussion Questions Part Two:

  1. Determine appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case. Provide your rationale with evidence.
  2. Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is required. Discuss the criteria used to make your decision, how a referral is made and defend your position.
  3. Discuss relevant education and follow up plan


According to the Global Initiative for Asthma (2021), the appropriate management of asthma exacerbations should be assessed in the primary care setting by the level of severity. For instance, the provider should begin by assessing if the patient can converse in full sentences or only words, their number of respirations, use of accessory muscles, oxygen saturation levels and peak expiratory flow (PEF) levels. Upon assessing Michelle, she returned to the office, though newly diagnosed with occupational asthma, she presents with new onset symptoms. Michelle states Influenza Type A is going around the bakery and she is presenting with +RR 24, +mild SOB with exertion, +O2 saturation of 94%, +complaints of inspiratory and expiratory wheezing +fever over the last 2 days of 101 to 102F, +cough is productive white sputum +HR 110 +Influenza type A test….Kindly click the purchase icon to purchase the full solution at $10

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