NR 603 Week 2 Part 1: Case Discussion Reflection

Case Summary:Michelle’s main complaint is shortness of breath (SOB) that occurs specifically while she is at work, with noticeable relief when she is away from the workplace, particularly on weekends when she is at home. This pattern strongly suggests an occupational trigger.

The physical exam further supports this diagnosis, revealing thin exudate in both nares, boggy and pale mucosa, along with wheezing noted on both inspiration and expiration. These findings are indicative of an allergic response, likely triggered by airborne allergens at her workplace, such as flour dust, which is a well-known cause of baker’s asthma.

Michelle’s history of allergic rhinitis, characterized by the inflammation of the nasal mucosa, further contributes to the likelihood of an IgE-mediated allergic response. Common symptoms of allergic rhinitis include sneezing, nasal congestion, and a runny nose, which Michelle has likely experienced, as evidenced by the nasal exudate and mucosal changes observed during her physical exam (Tanno et al., 2016).

In 2016, Michelle underwent a pulmonary function test (PFT) which demonstrated a 15% improvement post-bronchodilator. This significant increase in lung function post-bronchodilator is a hallmark of asthma, confirming the diagnosis. Key indicators of asthma include recurrent episodes of SOB, wheezing, chest tightness, and coughing, particularly at night. For a definitive asthma diagnosis, these symptoms must be present along with evidence of reversible airway obstruction, which was demonstrated in Michelle’s PFT results.

Given the evidence, Michelle’s symptoms and diagnostic findings are consistent with occupational asthma, likely exacerbated by her exposure to flour or other allergens in the bakery where she works. Management of her condition will require both medical intervention to control her asthma and potentially modifying her work environment or role to reduce her exposure to the triggering allergens.

References:

• Brittner, C., Peters, U., Frenzel, D., Muskin, S., Brettschneider, R. (2015). Occupational asthma: A baker’s risk. Journal of Occupational Health, 57(4), 365-373.
• Tanno, L. K., Calderon, M. A., Demoly, P., Casale, T., Lockey, R. F., Canonica, G. W., & Rosario, N. (2016). Revisiting allergic rhinitis management. Allergy, 71(1), 137-141.

This reflection highlights the importance of recognizing occupational triggers in respiratory conditions and the role of thorough clinical assessment and diagnostic testing in managing such cases effectively.

Best regards, [Your Name]