C. Jones is a 63-year-old female with a five-year history of type 2 diabetes and worsening symptoms of chronic asthma with dyspnea and cough. She smoked two packs of cigarettes per day for 30 years, although she has not smoked since she was diagnosed with asthma two years ago. She lives alone on a farm in rural Georgia, where she has an ample supply of oak, elm, and fruit trees as well as a large wooded area of mixed firs and other foliage nearby. She maintains several farm animals, including cattle, which provide milk and meat. She raises chickens, sheep, and goats for food and milk and to sell at the market in town. She has two dogs, both of which live in the house with her. For heat in the winter, she uses a woodburning stove and also loves to use it for cooking as often as possible. Her husband died two years ago, so she is responsible for the upkeep and maintenance of the farm; she has a farmhand, Mr. Ramirez, who works for her two to three days per week during nonharvest seasons. During harvest seasons, Mr. Ramirez works full time planting and maintaining Mrs. Jones's fields, where cotton, corn, and an assortment of vegetables are the primary crops. Mr. Ramirez arranges for migrant workers to supply labor to harvest the vegetables that she raises on the substantial farmland. For control and management of her asthma symptoms, Mrs. Jones has been on inhalers since she was diagnosed, but today she is having increased wheezing and is struggling to breathe. She is overweight, at 5'6" in height and 180 pounds. She has managed her type 2 diabetes with diet and exercise, but more recently, she has seen her blood sugars in the 200 range. Her most recent glycosylated hemoglobin test last week was 7.0% (normal is 4-6%). On physical exam, Mrs. Jones is anxious. Her blood pressure is 136/90mmHg, pulse 120 , and respiratory rate at 28 . Her lungs wheeze bilaterally. No accessory muscles are being used, and she is not cyanotic. Her lab values reveal: ABG 7.48; pO2 :58;pCO2:40;O2 sat: 90%. Her chest X-ray shows that her diaphragm is hyperinflated, and no infiltrates are seen. Mrs. Jones is treated with an albuterol and Atrovent nebulizer and is started on a course of prednisone at 40mg/day for three days, to be tapered down over two weeks. On day 2 of her prednisone, she calls to say that her blood sugar is 350 mg/dL.1. What are Mrs. Jones's risk factors for diabetes? 2. What are the triggers for asthma in her environment? 3. What actions could be taken to treat her emergently? 4. What actions could be taken for long-term effect?.

1. C. Jones is a 63-year-old female with a five-year history of type 2 diabetes and worsening
symptoms of chronic asthma with dyspnea and cough. She smoked two packs of cigarettes per
day for 30 years, although she has not smoked since she was diagnosed with asthma two years
ago. She lives alone on a farm in rural Georgia, where she has an ample supply of oak, elm, and
fruit trees as well as a large wooded area of mixed firs and other foliage nearby. She maintains
several farm animals, including cattle, which provide milk and meat. She raises chickens, sheep,
and goats for food and milk and to sell at the market in town. She has two dogs, both of which live
in the house with her. For heat in the winter, she uses a woodburning stove and also loves to use
it for cooking as often as possible. Her husband died two years ago, so she is responsible for the
upkeep and maintenance of the farm; she has a farmhand, Mr. Ramirez, who works for her two to
three days per week during nonharvest seasons. During harvest seasons, Mr. Ramirez works full
time planting and maintaining Mrs. Jones's fields, where cotton, corn, and an assortment of
vegetables are the primary crops. Mr. Ramirez arranges for migrant workers to supply labor to
harvest the vegetables that she raises on the substantial farmland. For control and management
of her asthma symptoms, Mrs. Jones has been on inhalers since she was diagnosed, but today
she is having increased wheezing and is struggling to breathe. She is overweight, at 5'6" in height
and 180 pounds. She has managed her type 2 diabetes with diet and exercise, but more recently,
she has seen her blood sugars in the 200 range. Her most recent glycosylated hemoglobin test
last week was 7.0% (normal is 4-6%). On physical exam, Mrs. Jones is anxious. Her blood
pressure is 136/90mmHg, pulse 120 , and respiratory rate at 28 . Her lungs wheeze bilaterally. No
accessory muscles are being used, and she is not cyanotic. Her lab values reveal: ABG 7.48; pO2
:58;pCO2:40;O2 sat: 90%. Her chest X-ray shows that her diaphragm is hyperinflated, and no
infiltrates are seen. Mrs. Jones is treated with an albuterol and Atrovent nebulizer and is started on
a course of prednisone at 40mg/day for three days, to be tapered down over two weeks. On day 2
of her prednisone, she calls to say that her blood sugar is 350 mg/dL.1. What are Mrs. Jones's risk
factors for diabetes? 2. What are the triggers for asthma in her environment? 3. What actions
could be taken to treat her emergently? 4. What actions could be taken for long-term effect?