Assessment of Colds - Respiratory Infections

Relevant Evaluation Criteria			Scenario/Model Outcome
Information Gathering
1. Gather essential information about the patient’s symptoms, including:
a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms)			Patient complains of severe congestion and rhinorrhea for 3 days. He also has a headache and is tired.
b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s)			Symptoms appeared 3 days ago after a trip to Chicago. Congestion and headache are worse in the morning. No symptom relief has been noted.
c. description of the patient’s efforts to relieve the symptoms			Patient has tried hot showers, warm compresses, and acetaminophen 500 mg this morning for the headache.
2. Gather essential patient history information:
a. patient’s identity			John Roberts
b. patient’s age, sex, height, and weight			41 -year-old male, 5 ft 8 in, 225 lb
c. patient’s occupation		Business executive
d. patient’s dietary habits		He eats healthy, low-carbohydrate, low-fat diet when home but eats fast food when traveling.
e. patient’s sleep habits		Erratic due to frequent travel
f. concurrent medical conditions, prescription and nonprescription medications, and dietary supplements		Lisinopril 40 mg 1 tablet every day, metformin 1000 mg twice a day, Centrum multivitamin once a day, echinacea 1 tablet twice a day
g. allergies		NKA
h. history of other adverse reactions to medications		None
i. other (describe)		Patient’s temperature at the pharmacy is 100°F (37.8°C), and blood pressure is 125/80 mm Hg. His fasting blood glucose was 117 mg/dL at home.
Assessment and Triage
3. Differentiate the patient’s signs/symptoms and correctly identify the patient’s primary problem(s).		The recent onset and short duration of the patient’s congestion and lack of high fever are indicative of a cold.
4. Identify exclusions for self-treatment.		None
5. Formulate a comprehensive list of therapeutic alternatives for the primary problem to determine if triage to a medical practitioner is required, and share this information with the patient.		Options include: (1) Recommend separate OTC products for each symptom: nasal saline or decongestant (topical or systemic) for congestion; analgesic for headache; antihistamine for rhinorrhea, or because the patient has multiple symptoms, a combination product may be appropriate. (2) Recommend that John see his PCP for further evaluation and treatment. (3) Recommend self-care until John can consult his PCP. (4) Take no action.
Plan
6. Select an optimal therapeutic alternative to address the patient’s problem, taking into account patient preferences.		Self-care with a nonprescription product for congestion and headache is appropriate. Diabetes is not an exclusion for self-treatment, but the patient should check his blood glucose more frequently and see his PCP if his blood glucose becomes uncontrolled. John prefers nasal sprays.
7. Describe the recommended therapeutic approach to the patient.		For your congestion, use a topical decongestant such as oxymetazoline HCI 0.05%. Your headache is most likely related to the congestion and will resolve when the congestion does. If needed, continue to use acetaminophen 500 mg, 1-2 tablets every 4-6 hours for headache and fever. Do not take more than 8 tablets per day.
8. Explain to the patient the rationale for selecting the recommended therapeutic approach from the considered therapeutic alternatives.		Because you have diabetes, topical decongestants have less systemic absorption and, therefore, will not raise your blood pressure or blood glucose as much.
Patient Education
9. When recommending self-care with non-prescription medications and/or nondrug therapy, convey accurate information to the patient:
a. appropriate dose and frequency of administration		Use 2-3 sprays of oxymetazoline in each nostril every 10-12 hours.
b. maximum number of days the therapy should be employed		Do not use the nasal spray longer than 5 days.
c. product administration procedures		See Table Administration Guidelines for Nasal Dosage Formulations.
d. expected time to onset of relief		Nasal congestion should significantly diminish in 10 minutes, and relief should last 10-12 hours after each administration.
e. degree of relief that can be reasonably expected	Nasal congestion will be temporarily relieved but may persist for 7-14 days.
f. most common side effects	Nasal stinging or burning, sneezing, dryness
g. side effects that warrant medical intervention should they occur	Rebound congestion if oxymetazoline is used longer than 5 days; increased heart rate, blood pressure, or blood glucose
h. patient options in the event that condition worsens or persists	Your primary care provider should be consulted if congestion, headache, or fever worsens with treatment or lasts longer than 7-14 days.
i. product storage requirements j. specific nondrug measures	Store at room temperature with the cap tightly closed. Dress normally, maintain clear fluids and healthy diet, and rest as much as possible. Wash your hands frequently, and clean surfaces with antiviral products, such as Lysol, to prevent spreading your cold to others.
10. Solicit follow-up questions from patient.	Should I increase the dose of my echinacea supplement while I am sick?
11. Answer patient’s questions.	No. Increasing the dose of echinacea will not help you get well and will increase your risk of suffering unwanted adverse effects.