The Asthmatic Athlete Case Study - Emily and Joel Case Study - Nursing Assignment Help

Assignment Task

Assignment: Comprehensive short essays based on case studies
Case study 1 - The Asthmatic athlete

Manish is a 20-year-old aspiring cricketer who has been selected to play for Victoria in next season’s Sheffield Shield tournament. Manish is also an asthma sufferer and was first diagnosed with extrinsic asthma when he was 8 years old. He has been prescribed numerous medications to manage his asthma over time including montelukast and salbutamol. He still takes salbutamol to relieve wheeziness and dyspnoea when required but is no longer prescribed montelukast as it caused adverse effects in his early teenage years. Since 16 years-of-age he has used an inhaler containing fluticasone (Flixotideâ accuhaler 250 micrograms) twice daily. After returning from cricket training one afternoon in September, Manish started to feel unwell. He was coughing a lot, felt hot and tight in the chest, and was very fatigued. He went to bed early but didn’t get a lot of sleep due to his cough. He used his inhaler containing salbutamol frequently to get some relief. Manish felt worse in the morning and noticed that he was coughing up green phlegm. He rang his coach and made an appointment to see one of the doctors at the club that afternoon. The doctor diagnosed Manish with a respiratory infection and prescribed amoxycillin; a ß-lactam antibiotic. She explained to Manish that he would feel better in a couple of days and that he must take all the tablets in the script. NB: Probable genus of causative organism Streptococcus spp. (gram +ve cocci common in bacterial respiratory infections).

Essay question
Evaluate the medications that Manish has been prescribed in his life to date. Please ensure thatyour short essay refers to Quality Use of Medicines in terms of a risk management plan for montelukast and mechanisms of antibiotic resistance. Use relevant peer-reviewed literature to support your arguments.

Case Study 2 - We want a baby Emily and Joel met each other through mutual friends and have been in a relationship for the past few years. Emily is 36 years-of-age and has been prescribed the combined oral contraceptive (COC) pill. She has taken a COC since she was 17 years-old. She is not taking any other medications continuously and is a non-smoker. Joel is 34 years-of-age and he and Emily are keen to become parents. Emily stops using the COC. After 18 months of trying to conceive, Emily and Joel visit the GP. Emily undergoes a pelvic examination and a series of diagnostic tests. Joel’s semen is analysed. Results indicated that Emily was not ovulating. Joel’s sperm count and motility were found to be within normal parameters. Emily was referred to a specialist physician. The specialist physician prescribed Emily 50 mg of clomiphene daily for 5 days. The specialist physician advised both Emily and Joel that ovulation most often occurs from 6-12 days after a course of this drug therapy and with this in mind, sexual intercourse should be timed to coincide with the expected time of ovulation. Emily and Joel were unable to conceive after this first course of drug therapy so the specialist physician increased the dose for the second course of this treatment to100 mg daily for 5 days. This cycle was repeated an additional 2 times in an attempt to induce ovulation. As clomiphene therapy was unsuccessful, the specialist physician discussed gonadotrophin therapy so that multiple eggs could be harvested for in vitro fertilisation (IVF). Emily commenced her first cycle of IVF.
Table 1: Summary of medications prescribed to EmilyMedication Dose
Medication Dose
Combined oral contraceptive pill containing both:
Ethinyloestradiol
Levonorgestrel Calendar pack containing both:
30 ?g daily
0.15 mg daily
Clomiphene citrate 50 mg daily for 5 days (1 cycle)
Clomiphene citrate 100 mg daily for 5 days (3 cycles)
Gonadotropin therapy for oocyte retrieval Follitropin alfa 150 IU via daily injections commencing day 2 of period
Cetrorelix 250 ?g via daily injections commencing
4 days after follitropin alfa injections
hCG 5,000 IU via injection (timing of administration is determined by Emily’s plasma oestrogen levels and ovarian ultrasound results)
Progesterone 90 mg vaginal gel per day commencing
2 days after oocyte retrieval
 

Essay question
Determine whether the methods for family planning in this context have been suitable. Please ensure that your short essay refers to Quality Use of Medicines with respect to IVF. Use relevant peer-reviewed literature to support your arguments.

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