Acute Rhinosinusitis – Case Study of Jackie 45 y.o White Female

Case Study of Jackie 45 y.o White Female

Jackie is a 45 year old white female with past medical history of controlled hypertension, controlled asthma, and eczema, She has a four day history of nasal congestion, headache, sore throat, sneezing and productive cough. She denies fever, nausea, vomiting and myalgia. She has there children who recently went back to school following a summer vacation. No one else in her household is currently presenting with similar symptoms. She calls her primary care provider\’s office requesting a medication to treat her illness. She has no known allergies, but is allergic to ragweed. Medications: Mometasone 220mcg-1 puff daily for asthma. Albuterol 90 mcg -1to2 puffsq4-6 hours as needed for shortness of breath. Lisinopril 10 mg- one tablet by mouth daily for hypertension. Oxymetazoleline hydrochloride 0.05% nasal spray-2 sprays per nostril BID x3days

Objectives:  2: Patient information describe the patient information to answer the case study questions correctly. Jackie is a 45-year-old white female with past medical history of controlled hypertension, controlled asthma, and eczema. She has a four-day history of nasal congestion, headache, sorethroat, sneezing, and productive cough. She denies fever, nausea, vomiting, and myalgias. She has three children who recently went back to school following a summer vacation. No one else in her household is currently presenting with similar symptoms. She has no known drug allergies but is allergic to ragweed. She calls her primary care provider’s office requesting a medication to treat her illness.

Which of the following is the MOST appropriate drug to recommend?

a. Oxymetazoline hydrochloride 0.05% nasal spray— 2 sprays per nostril bid until symptoms resolve.

b. Naproxen 220 mg—one tablet by mouth every 12 hours as needed until symptoms resolve.

 c. Dextromethorphan ER oral liquid—60 mg every 12 hours until symptoms resolve.

d. Amoxicillin–clavulanic acid 500 mg every 8 hours for seven day                    

2. Which of the following nonpharmacological therapies is NOT recommended?

a. Steam inhalation

b. Increased water intake

 c. Menthol lozenges

d. Saline gargle

Jackie is insistent on taking a complementary therapy to help treat her symptoms. What is the MOST appropriate recommendation?

 a. Echinacea purpurea tincture—0.75 mL

 b. Fresh garlic—3 cloves

c. Acidophilus probiotic—1 tablet daily

 d. Vitamin C—1 g

Acute Rhinosinusitis

Which of the following is the MOST appropriate drug to recommend?

a. Oxymetazoline hydrochloride 0.05% nasal spray— 2 sprays per nostril bid until symptoms resolve.

b. Naproxen 220 mg—one tablet by mouth every 12 hours as needed until symptoms resolve.

Dextromethrorphan ER oral liquid—60 mg every 12 hours until symptoms resolve.

d. Amoxicillin–clavulanic acid 500 mg every 8 hours for seven days.

The symptoms presented in the case study above infer that Jackie has acute rhinosinusitis. AR is a common upper respiratory tract infection known for presenting as a viral infection affecting the sinuses, pharynx, and larynx (Little, 2020). This results in a series of symptoms similar to those experienced during a common cold and characterized by the initial obstruction of the otitis media and upper respiratory tract. While it is possible for the symptoms to clear in cases of mild AR, consulting a primary healthcare provider is normally recommended to ensure the disease progression is tracked efficiently to prevent poor health outcomes. AR is known to incubate and manifest within a 2-week period which is why early screening is recommended to ensure patients receive much-needed medical attention. The initial treatment regimen is designed to address the irritant in the airways necessary for symptom relief.

I would recommend prescribing Dexotromethorphan ER oral liquid administered at a rate of 60 mg every 12 hours till the presenting symptoms resolve. It is an ideal choice due to its ability the reduce inflammation and the irritation of the airways which are some of the most apparent manifesting symptoms in Jackie’s case. The mechanism of action involved in the subsequent action of Dexotromethorphan ER is specifically designed to act as a cough suppressant which would ultimately reduce the intensity of upper respiratory tract irritation experienced. It, therefore, prevents the cough reflex and can also be bolstered by augmenting the treatment with bromopheramine (Ragab et al., 2020). It is also effective in preventing the action of other environmental allergens due to its anti-tussive properties and will, therefore, be ideal in preventing cough-related inflammations from manifesting.

Dexotromethorphan ER oral liquid is also an ideal choice for the patient given its low risk profile and efficiency once administered. It is also approved by the US Food and Drug Administration (FDA) in treating common upper respiratory tract infections such as AR and is easily accessible to patients since it can be prescribed for off-label use (Little, 2020). Its interaction with the mu-receptor is also a critical aspect of the drug since it exhibits anti-histamine properties necessary in preventing inflammation and irritation. Moreover, it is worth noting that Dextromethropan was an ideal choice for the patient due to its bio-availability once administered which improves the overall likelihood of the infection clearing. The success rate of this particular treatment will also rely greatly on the patient’s ability to adhere Dx 60mg every hour dosage recommended as part of the consistent medication adherence regimen.

2. Which of the following nonpharmacological therapies is NOT recommended?

a. Steam inhalation

b. Increased water intake

 c. Menthol lozenges

d. Saline gargle

The treatment regimen involved when dealing with cases of AR normally requires healthcare providers to augment pharmacological treatment options with non-pharmacological therapies in order to improve patient outcomes. Nonpharmacological therapies for AR have largely been hailed as one of the most efficient and reliable treatment options for patients seeking to exploit the benefits of non-conventional medical solutions to persistent upper respiratory tract infections (Chang, 2016). Nonpharmacological treatment options, such as saline gargle, steam inhalation, and increased water intake are frequently recommended in managing AR due to their cost-effectiveness and low-risk profile compared to available pharmacological options. They have long proven to be an effective solution to minimizing the manifestation of major AR symptoms and in pain management.

Of the four non-pharmacological treatment options listed above, I would not recommend the use of menthol lozenges in treating and managing AR. Menthol lozenges have long been used in healthcare as a solution for a sore larynx and dry coughs. However, it is worth noting that menthol lozenges are reported to have an adverse effect on patients receiving treatment for AR and are particularly known for posing a major health risk. Menthol lozenges have a high risk profile and are likely to derail Jackie’s current treatment routine and progress due to a high risk of adverse effects. According to Ragab et al., (2020), an overdose of menthol lozenges is typically associated with seizures, kidney damage, organ failure and even death. The possibility of patients experiencing each of the above-mentioned adverse effects is highly probable since individuals can easily exceed the 500 mg menthol/kilogram recommended daily intake.

Patients should also be acutely aware of the possible side effects associated with menthol lozenges. This is further compounded by the likelihood of experiencing adverse allergic reactions to menthol lozenges due to the presence of paper mint as an active chemical ingredient. Menthol-related allergic reactions manifest in the form of severe itching, rashes, blistering, redness of the skin, wheezing, and trouble breathing. It is, therefore, typically recommended to avoid menthol lozenges if diagnosed with AR since the side effects experienced may result in severe breathing complications. The possibility of an overdose is also a reality that most patients are forced to contend with which is why it is always advisable to call your primary healthcare provider in case of an adverse reaction.

Jackie is insistent on taking a complementary therapy to help treat her symptoms. What is the MOST appropriate recommendation?

 a. Echinacea purpurea tincture—0.75 mL

 b. Fresh garlic—3 cloves

c. Acidophilus probiotic—1 tablet daily

 d. Vitamin C—1 g

Complementary and alternative therapies are important elements of patient treatment incorporated with the primary aim of relieving common symptoms associated with a specified health disorder. Patients suffering from AR often end up resorting to using complementary therapies with a proven track-record as a way of avoiding the adverse side effects associated with pharmacological treatment options. The use of complementary therapies such as Echinacea purpurea is an ideal choice in this case scenario as a treatment grounded in evidence based practice (EBP) research on its therapeutic properties. Today, Echinacea purpurea tincture is known for its ability to alleviate presenting symptoms.

Echinacea purpurea tincture is also known for having a remarkable anti-inflammatory properties essential to preventing AR-related irritation. Besides, its immuno-stimulatory effects are also closely linked to an overall alleviation off upper respiratory tract infection symptoms and with no adverse effects. Preliminary results gathered during experimental trials now indicate that these properties are directly linked to the presence of secondary metabolities such as glycoproteins. caffeic derivatives, and alkamides within the plant’s chemical composition (Wagner et al., 2017). The use and application of Echinacea purpurea tincture in Jackie’s case is necessary as a complimentary therapy and will likely boost her immunological response during the entire treatment period.

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