The evaluation of the patient’s condition is appropriate. I think that several aspects of your plan are very appropriate and supported by the evidence in practice. Antibiotics would not be clinically indicated at this time as well.

In review of your prescriptions, what specific symptoms will the patient take Tylenol and ibuprofen? or are you wanting them to be taken around the clock vs. PRN?

I noticed several times in your post that you referred to how physicians (or doctors) would care for a Michelle. I’m a little confused……and hoping you can provide me with some insight. What was the rationale for discussing the physician perspective? and is the standard of care different for an APRN?

I’d like to know more about how you plan to manage the patient as the treating provider.

Based on the patient’s presentation, how will you manage her in the clinic? What criteria both objective and subjective will enable you to determine if she is going home vs. to the ER?

At what point would you decide she needs a referral to a higher level of care or to a specialist?

Will there be any changes to managing her asthma at this time?

I love that you noted her BP and have a forward thinking plan to address it. The use of the BP diary is great. When will she follow up with you to discuss her diary?

How would you educate the patient that she should follow up sooner or go to the ER? What would you like her to know?

Our goal is to provide an individualized plan of care for the patient in the case study that has EBP resources to support your clinical decisions as the treating NP. I will be eager to read your reply and the additional details you add to this plan based on Michelle’s acute illness.

Discussion post supported by evidence from appropriate sources published within the last five years. Focus of journal articles represents a logical link between the article content and the case study information. In-text citations and full references are provided.