NSG2ANB Bachelor Of Nursing Assignment

Concept Map:

Answer 1:

The pathophysiology of acute asthma relies upon the inflammatory symptoms and underlying interaction of the cells and their mediators in order to elicit a physiological response. The case study states that Jackson Smith was affected with acute asthma and was admitted to the emergency department on account of severe breathlessness. While noting the patient details for documentation, it was notice that the client had been suffering from asthma since childhood. Several other details were documented which included information about episodes of Dyspnea and shortness of breath. Further, it was also noted that the client had an increased heart beat which was approximately 32 beats per minute. Further, the blood pressure was also elevated and the pulse rate was approximately around 130 beats per minute which is not normal. In addition to this, it should also be mentioned that that that a deep wheezing sound was also detected. This has also been known as the process of auscultation of the lungs (Ayala et al., 2014). The physicians proceeded with an X-ray that determined an inflamed appearance of the lungs and the adjoining area. The gaseous concentration in the blood was estimated to be approximately 90% SO_2, PCO₂: 50mm HG and HCO₃ which was equivalent to be around 25mEq/L (Ayala et al., 2014). Based upon the above clinical cues, the pathogenesis of Jackson’s acute asthma could be determined.

The pathogenesis of asthma can be understood on the basis of the genetic impact and the environmental influence. In close association to the case study, it can be stated that the emergence of asthma in the client was based on the weakened immunity, respiratory infections, natural allergens, genetic and environmental components (Castro et al., 2015). The underlying defence mechanism of the disease can be explained as the process where the antigen presenting cells elicit their action by engulfing the allergens from the surrounding environment to the T cells. The inflammation factors further activate the respiratory epithelium (Chung et al., 2013). This leads to the release of thymic stromal lymphoprotein and other associated inflammatory mediators that mediate the allergic reaction. It should also be noted here that, the Dendritic cells also play an important role in presenting the allergens to the T-cells (Catro et al., 2015). The allergens are presented to the two subcategory of T-cells namely, the T-helper 2 cells and Th17 cells. The Th2 cell is responsible for the formation of immunoglobulin E from the B cells under the influence of interleukin 4 and interleukin 13 (Chung et al., 2013). Immunoglobulin E or (IGE) binds to the cell surface of the mast cells and the basophiles under the influence of interleukin 4 which has been primarily considered as the root cause for the inflammatory reaction (Chung et al., 2013). A number of reasons such as an inflammatory response generated by the neutrophils, macrophages, eosinophiles have been reported to cause bronchoconstriction of lungs, lung infect ions and acute asthma which has been the case for the client in the case study.

It can hence be stated that on account of the chronic inflammation, Jackson experienced symptoms of shortness of breath and higher respiration rate. Research studies state that on account of the presence of respiratory epithelium cells and leukocytes the pathway is blocked. On account of the presence of mediators, the inflammatory cells are recruited to the epithelium cells and this eventually infiltrates the lungs (Chung et al., 2013). Further, it should also be noted that the epithelium cells thus create a cycle for the manifestation of chronic symptoms leading to damage and obstruction in the airway that elevates the blood pressure. In addition to this, the genetic environment could also be held responsible for the manifestation of asthma in the client. The genetics involved in the production of IgE affects the dysfunctional regulation of inflammatory mediators including chemokines, cytokines and other growth factors (Gadomski & Scribani, 2014). This modification in the genetic pattern leads to the development of asthma. In the case study, Jackson had also been affected with the similar condition.

Answer 2:

In order to provide medical assistance to Jackson, the two nursing interventions that would be provided would include the pharmacological treatment and the peak flow monitoring which has been found to be effective in controlling asthma. The following paragraph would discuss the rationale behind the proposed intervention and would also use scientific evidences to back up the intervention strategies.

The case study clearly reveals that the client had been admitted to the hospital because of acute shortness of breath, hence to control the worsening condition of the client, an immediate drug must be administered to the client. It should also be critically noted here that the patient presents symptoms of progressive dyspnea that further leads to symptoms of aggressiveness and anxiety. Hence, it can be stated that the administration of corticosteroids as the primary medication can help in controlling the condition of the patient. According to research studies, it is stated that corticosteroids have the potential to decrease the peak flow variability and at the same time clear the airway obstruction. Pharmaceutical drugs such as immunomodulators and anticholinergics can also be used in order to control the condition of the patient and restore normal breathing (Griffiths & Ducharme, 2013). Research papers state that immunomodulators and anticholinergic drugs help in the prevention of asthma by disrupting the binding of the mast cells to the basophile (Garcia-Cardenas et al., 2015). This leads to the clearance of the airway passage and as a result normal breathing is restored.

The peak flow monitoring has been reported to be an efficient strategy to deal with patients suffering from acute asthma (Koch et al., 2013). Through this system, the highest airflow during the period of a forced inhalation or exhalation is recorded. Based on the recorded pattern appropriate interventions can be taken, so as to control the condition of the patient. Preventive strategies can successfully help in the improvement of congestion and breath sounds so as to effectively reduce the implication of the disease (Olson et al., 2013).

Answer 3:

Research studies state that the administration of Nebulised ipratropium bromide has been found to be effective in treating pulmonary disorders (Shan et al., 2013). On administering the drug in combination with the β2-agonists it has been reported that the airway obstruction could be effectively treated (Siddiqui et al., 2013). The drug effectively blocks the muscarinic receptors that is tightly linked to the acetylcholine receptors. This helps in relieving the COPD condition. In order to treat other symptoms such as nausea, headache and dizziness the patient would be kept under strict observation and based upon the recorded vital signs the intervention would be devised.

The pharamaceutical drug Salbutamol has been found to be effective in the treatment of asthma. The drug is inhaled in the form of aerosol and acts upon the β2-adrenoreceptors. This further elicits the effect on the smooth muscles that cover the bronchi and help in the restoration of normal breathing. It further helps in the binding of the active site of epinephrine that leads to increase in the production of cAMP that further generates release of potassium ion (Wark et al., 2013). The calcium ion concentration decreases intra cellularly and this interferes with the contraction ability of the muscles. Salbutamol has been found to be an effective drug that helps in relaxation of the muscles. It acts by binding to the β2 receptors. The impact of the applied nursing intervention would be evaluated by keeping the patient under strict observation. The positive signs of improvement in the patient will determine the level to which the intervention has been able to elicit a positive effect (Wark et al., 2013). In addition to the administration of salbutamol, the patient would also be given anti-depressants which would effectively treat the associated side-effects. The antidepressants and analgesics would effectively manage the symptoms of anxiety, head ache, body pain and muscular cramps.

Another naturally occurring drug that has been found useful in the treatment of acute asthma is IV Hydrocorticosterone 100mg. The drug has been reported to be a naturally occurring glucocorticoid that possesses excellent properties to deal with adrenocortical deficiency syndrome (Siddiqui et al., 2013). It helps in the modification of the immune response in association to a broad range of stimuli and thus enhances the metabolic effect. However, this drug has similar side-effects that has been mentioned for the other two drugs. Hence, particular attention would be paid to the condition of the patient and accordingly intervention strategies would be reformed to deal with the side-effects (Wark et al., 2013). Also the condition of the patient would be evaluated on the basis of critical observation.

References:

Holt, P. G., & Sly, P. D. (2012). Viral infections and atopy in asthma pathogenesis: new rationales for asthma prevention and treatment. Nature medicine, 18(5), 726. Retrieved from: https://www.nature.com/articles/nm.2768

Olin, J. T., & Wechsler, M. E. (2014). Asthma: pathogenesis and novel drugs for treatment. Bmj, 349, g5517. DOI:https://doi.org/10.1136/bmj.g5517

Sicherer, S. H., & Sampson, H. A. (2014). Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. Journal of Allergy and Clinical Immunology, 133(2), 291-307. DOI: https://doi.org/10.1016/j.jaci.2013.11.020

Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., … & Boulet, L. P. (2013). International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. European Respiratory Journal, erj02020-2013. Retrieved from: https://patients.thoracic.org/statements/resources/allergy-asthma/severe-asthma-full.pdf

Papadopoulos, N. G., Arakawa, H., Carlsen, K. H., Custovic, A., Gern, J., Lemanske, R., … & Zar, H. (2012). International consensus on (ICON) pediatric asthma. Allergy, 67(8), 976-997. https://doi.org/10.1111/j.1398-9995.2012.02865.x

Garcia, G., Taillé, C., Laveneziana, P., Bourdin, A., Chanez, P., & Humbert, M. (2013). Anti-interleukin-5 therapy in severe asthma. European Respiratory Review, 22(129), 251-257. DOI: 10.1183/09059180.00004013

Holgate, S. T. (2013). Mechanisms of asthma and implications for its prevention and treatment: a personal journey. Allergy, asthma & immunology research, 5(6), 343-347. DOI:  https://doi.org/10.4168/aair.2013.5.6.343

Brusselle, G. G., VanderStichele, C., Jordens, P., Deman, R., Slabbynck, H., Ringoet, V., … & Demeyere, B. (2013). Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicentre randomised double-blind placebo-controlled trial. Thorax, 68(4), 322-329. Retrieved from: https://thorax.bmj.com/content/68/4/322.short

Ayala, G. X., Gillette, C., Williams, D., Davis, S., Yeatts, K. B., Carpenter, D. M., & Sleath, B. (2014). A prospective examination of asthma symptom monitoring: provider, caregiver and pediatric patient influences on peak flow meter use. Journal of Asthma, 51(1), 84-90.DOI: https://doi.org/10.3109/02770903.2013.838255

Castro, M., Zangrilli, J., Wechsler, M. E., Bateman, E. D., Brusselle, G. G., Bardin, P., … & Korn, S. (2015). Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials. The Lancet Respiratory Medicine, 3(5), 355-366. DOI: https://doi.org/10.1016/S2213-2600(15)00042-9

Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., … & Boulet, L. P. (2013). International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. European Respiratory Journal, erj02020-2013. Retrieved from: https://patients.thoracic.org/statements/resources/allergy-asthma/severe-asthma-full.pdf

Gadomski, A. M., & Scribani, M. B. (2014). Bronchodilators for bronchiolitis. Cochrane database of systematic reviews, (6).  DOI: 10.1002/14651858.CD001266.pub4

Garcia-Cardenas, V., Armour, C., Benrimoj, S. I., Martinez-Martinez, F., Rotta, I., & Fernandez-Llimos, F. (2015). Pharmacists’ interventions on clinical asthma outcomes: a systematic review. European Respiratory Journal, ERJ-01497. DOI: 10.1183/13993003.01497-2015

Griffiths, B., & Ducharme, F. M. (2013). Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Paediatric respiratory reviews, 14(4), 234-235.DOI: https://doi.org/10.1016/j.prrv.2013.08.002

Koch, S., MacInnis, M. J., Sporer, B. C., Rupert, J. L., & Koehle, M. S. (2013). Inhaled salbutamol does not affect athletic performance in asthmatic and non-asthmatic cyclists. Br J Sports Med, bjsports-2013. DOI: https://dx.doi.org/10.1136/bjsports-2013-092706

Olsson, L. E., Jakobsson Ung, E., Swedberg, K., & Ekman, I. (2013). Efficacy of person?centred care as an intervention in controlled trials–a systematic review. Journal of clinical nursing, 22(3-4), 456-465. DOI: https://doi.org/10.1111/jocn.12039

Ritz, T., Meuret, A. E., Trueba, A. F., Fritzsche, A., & von Leupoldt, A. (2013). Psychosocial factors and behavioral medicine interventions in asthma. Journal of Consulting and Clinical psychology, 81(2), 231. Retrieved from: https://psycnet.apa.org/buy/2012-26671-001

Shan, Z., Rong, Y., Yang, W., Wang, D., Yao, P., Xie, J., & Liu, L. (2013). Intravenous and nebulized magnesium sulfate for treating acute asthma in adults and children: a systematic review and meta-analysis. Respiratory medicine, 107(3), 321-330.doi: https://doi.org/10.1016/j.rmed.2012.12.001

Siddiqui, S., Redhu, N. S., Ojo, O. O., Liu, B., Irechukwu, N., Billington, C., … & Moir, L. M. (2013). Emerging airway smooth muscle targets to treat asthma. Pulmonary pharmacology & therapeutics, 26(1), 132-144.DOI: https://doi.org/10.1016/j.pupt.2012.08.008

Wark, P. A., Tooze, M., Powell, H., & Parsons, K. (2013). Viral and bacterial infection in acute asthma and chronic obstructive pulmonary disease increases the risk of readmission. Respirology, 18(6), 996-1002.DOI: https://doi.org/10.1111/resp.12099