Nancy Chen is a 32 year old woman who is in good health except for her current problem. She has come to the urgent care center because of a stuffy nose; red, itchy eyes; and a slightly sore throat. She takes daily calcium supplements but no other medications. She is 5 ft. 6 in tall and weighs 67 kg (148 lbs.).
Nancy is a fourth-grade teacher at a local elementary school and is worried about being able to finish her end of school term activities with the symptoms of a lingering “cold”. Her vital signs are as follows: temperature, 37.4C (99.4F); pulse, 102 beats/min; respirations, 12 breaths/min; blood pressure, 148/88 mmHg; oxygen saturation, 98%.
After taking her vital signs, Nancy tells the nurse practitioners that her mother-in-law bought her a Neo-Synephrine nasal spray about 10 days ago. it helped, but she tells the nurse that it ran out yesterday and now her nose is even stuffier than before. She has been taking Tylenol but stopped using that, too, because she does not feel like she has a fever and it was not helping much anyway. Nancy says, “I went to the drug store after school and did not stay. I felt so miserable that I could not even figure out what medicine does what and I just wanted to get home. I need some rest so I can take care of my girls, do a good job for my students, and get my report cards done.” The nurse practitioner observes that Nancy has a cough, runny nose, and inflamed eyes, which she occasionally rubs during the conversation.
If Nancy has no history of heart disease or HTN and takes no medicines to treat those conditions, what do you think might be the cause of her elevated blood pressure and heart rate?
Nancy gave her two daughters a golden retriever puppy a few weeks ago. How does this information add to your assessment findings and patient teaching?
The nurse practitioner diagnosis Nancy with probable allergic rhinitis and prescribes intranasal fluticasone (Flonase). In addition, the nurse practitioners suggests getting two OTC cough suppressants, one with the main ingredient dextromethorphan and the other one with the main ingredient diphenhydramine. What do you tell Nancy is the reason she is being prescribed each one?
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