401211 Poppy Case Study Sample

• Subject Code : 401211
• University : Western Sydney University My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Nursing

Health Variations 4 - Acute Life Threatening Conditions

Table of Contents

Question 1 Explain the pathogenesis causing the clinical manifestations with which Poppy presents

Question 2

1. Sit Poppy in a High Fowlers position

2. Apply and titrate oxygen

Question 3 For each medication below explain

Reference List

Question 1 Explain the Pathogenesis Causing the Clinical Manifestations with Which Poppy Presents

In the case study, the 9 years old child Poppy represented signs and symptoms of acute asthma exacerbation. In past few hours, her respiratory symptoms worsened and she became unable to talk much. Vital signs showed increased RR, 42 bpm, increased HR, 160 bpm, lower oxygen saturation, 87%, along with inspiratory an expiratory wheeze. All these clinical manifestations are the result of Poppy’s acute asthma exacerbation pathogenesis.

Poppy’s medical history indicates that she was diagnosed with asthma at the age of 2. Therefore, the acute asthma exacerbation could have stimulated via any of stimuli, including “viral respiratory infection, bacterial infection, allergen exposure” or other contributing factors including airway pollutants, which causes airway inflammation. Any of these pathogen or allergen, when inhaled by Poppy, the allergen caused airflow obstruction, following inflammatory activities within the upper respiratory system (Russell and Brightling, 2017). After inhalation of the allergen, these are detected by the sensitized cells in airway cells and surrounding muscles, thereby secreting influencing inflammatory mediators, bringing neutrophil, eosinophils, promoting the inflammatory reaction and excess mucus filled in the airways and lungs. Both of these contribute in narrowing down the airways and obstructing airflow through, due to excess mucus and narrow path.

The situation makes breathing more stressful and difficult, which is reflected in Poppy’s inability to talk. It reduces oxygen saturation in blood, which is seen in reduced SPO2 of Poppy (Castillo et al., 2017). Worsened wheezing indicates airflow turbulence in the airways. Usually, wheezing is common expiratory, but in more severe condition, it is present during inspiration, indicating Poppy’s condition as severe. As the pathogenesis follows with reduced air reaching lungs and reduced oxygen in blood, body attempts to meet the normal physiological demand of oxygen by increasing respiratory and heart rate, which could help to fill lungs with more oxygen at a time, by completing more respiratory cycle. Similar signal goes to circulatory system, which stimulates heart to pump faster, so that it could circulate more blood at a time, which could meet the oxygen deficiency (Swan and Katz, 2018). These are showing the reason behind other clinical manifestations, increased HR and RR during Poppy’s worsened condition, as it became harder for her to breathe, which reduced her auscultation too.

Question 2. A. Sit Poppy in A High Fowlers Position

How does positioning a patient with acute asthma in a High Fowlers position assist to alleviate respiratory distress?

High Fowler’s position enables the nurse to position the patient, with elevated head of the bed. The upper half of patient’s body remains in 60 to 90 degree, in related to lower half of the body. This position promotes oxygenation through maximizing chest expansion and thus implemented among patients undergoing respiratory distress, like asthma in case of Poppy. As patients suffer from difficulty in breathing and shortness of breath, this position promote better oxygen flow through the upper respiratory system (Maria & Hasaini, 2019).

B. Apply and Titrate Oxygen

What oxygen delivery device will you use?

There are several options for oxygen delivery device, used for asthma patients. Considering the current health status and age of the patient, high-flow nasal cannula (HFNC) is selected.

Why did you choose this device?

HFNC is a new non-invasive ventilation therapy device, which has been evident to be well tolerated among children. Existing studies have shown that this device is safe and the method is feasible for delivering oxygen among children, with fewer adverse effects, compared to the other available devices. It is suitable for Poppy, as it enables for inspired air to be oxygenated, humidified and heated if necessary (Geng et al., 2020).

How does providing supplemental oxygen work and, how will it assist Poppy?

In case of Poppy, it is revealed that her oxygen saturation in blood has been decreased, as she is unable to inhale enough oxygen to regulate all physiological functions. As a result all organs are affected, including brain, kidney and heart. The key purpose of supplemental oxygen delivery is to improve breathing, reduce shortness of breath and improve quality of life of the patient. It will help her to breathe better and regain strength to improve oxygen saturation also (Geng et al., 2020).

Question 3 For each medication below explain 

Salbutamol via nebuliser

The mechanism of action

This is a medication from bronchodilator group, which attempts to open up lung airways and thereby improving airflow in lung. Upon being inhaled, it binds to β2 receptors in smooth muscles and activates signalling cascade, which prohibits inflammatory mediators and secretion in airways. At the same time, it causes hyperpolarization, thereby relaxing bronchial smooth muscles and dilating airways (Moore et al., 2019).

Why your patient is receiving this medication in relation to her symptoms and diagnosis?

As Poppy is having respiratory distress with breathing difficulty, diagnosed with acute asthma exacerbation; thus, it will help to dilate airways and improve her breathing.

What are the nursing considerations for this medication?

Nurses should consider appropriate dose and side effects. These include anxiety, jittery etc, which should be monitored closely.

What clinical response you expect?

It is expected that Poppy’s RR will decrease, with improved breathing pattern.

What continuing clinical observations will you need to undertake?

Continuous listening to lung sound, taking HR, BP is crucial for Poppy.

Hydrocortiso ne IV

The mechanism of action

It is a corticosteroid, which acts on different sites for hindering the pathogenesis of asthma. It increases beta-adrenergic response for relieving muscle spasm; while, reversing mucosal edema, reducing vascular permeability through vasoconstriction and hinder release of LTC4 and LTD4. Therefore, altering inflammatory response and interfering with chemotaxis, this is hindering mucus secretion (Nair et al., 2020). The its eosinopenic effect hinder cytotoxic impact of inflammatory mediators, while preventing increased airway reactivity for long-term effect by preventing late reaction.

Why your patient is receiving this medication in relation to her symptoms and diagnosis?

The patient has been diagnosed with acute asthma exacerbation, pathogenesis of which is influenced by inflammation and mucus secretion by inflammatory mediators. This medication can hinder the clinical manifestation by hindering and altering inflammatory processes.

What are the nursing considerations for this medication?

The nurse should consider patient’s history of infection, GI disease, seizure disease and some other diseases prior administration.

What clinical response you expect?

It is expected that Poppy’s disease progression would be ceased, with improved breathing and reduced wheeze.

What continuing clinical observations will you need to undertake?

Continuously taking vital signs, checking skin integrity and closely monitoring the patient is crucial.

Ipratropium Bromide via nebuliser

The mechanism of action

This medication is also used as bronchodilator, for opening up lung airways. It is an acetylcholine antagonist, which blocks muscarinic cholinergic receptors, inhibiting acetylcholine to bind. As a result, the cGMP production is reduced, causing reduced smooth muscle contraction in lung, which further helps in dilating narrowed airways in lung (Donohue et al., 2016).

Why your patient is receiving this medication in relation to her symptoms and diagnosis?

As the patient is experiencing respiratory distress with breathing difficulty, diagnosed with acute asthma exacerbation; which is mainly due to obstructed airflow in airways, it is administered to help opening airways up and improve her breathing. Usually this is administered in combination with albuterol, salbutamol in case of Poppy.

What are the nursing considerations for this medication?

Nurse should protect medication from light, use nebulizer mouthpiece, rather than face musk, while ensuring adequate hydration and temperature for reducing risk of hyperpyrexia.

What clinical response you expect?

Poppy is expected to inhale and exhale smoothly after administration, with reduced HR and reduced breathing difficulty.

What continuing clinical observations will you need to undertake?

Continuous listening to lung sound, taking viral signs and presence of adverse effect is crucial.

Reference List for Poppy Case Study

Castillo, J.R., Peters, S.P. & Busse, W.W. (2017). Asthma exacerbations: Pathogenesis, prevention, and treatment. The Journal of Allergy and Clinical Immunology: In Practice, 5(4), pp.918-927.

Donohue, J.F., Wise, R., Busse, W.W., Garfinkel, S., Zubek, V.B., Ghafouri, M., Manuel, R.C., Schlenker-Herceg, R, & Bleecker, E.R. (2016). Efficacy and safety of ipratropium bromide/albuterol compared with albuterol in patients with moderate-to-severe asthma: a randomized controlled trial. BMC Pulmonary Medicine, 16(1), 65.

Geng, W., Batu, W., You, S., Tong, Z. & He, H. (2020). High-Flow Nasal Cannula: A Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with Respiratory Failure. Canadian Respiratory Journal, 2020, 1-10.

Maria, I. and Hasaini, A. (2019). The effect of semi fowler position on the stability of breathing among asthma patients at Ratu Zalecha Hospital Martapura. In Third International Conference on Sustainable Innovation 2019–Health Science and Nursing (IcoSIHSN 2019). Atlantis Press.

Moore, L.E., Kapoor, K., Byers, B.W., Brotto, A.R., Ghods-Esfahani, D., Henry, S.L., St James, R.B. & Stickland, M.K. (2019). Acute effects of salbutamol on systemic vascular function in people with asthma. Respiratory Medicine, 155,133-140.

Nair, P., Bardin, P., Humbert, M., Murphy, K.R., Hickey, L., Garin, M., Vanlandingham, R. & Chanez, P. (2020). Efficacy of Intravenous Reslizumab in Oral Corticosteroid–Dependent Asthma. The Journal of Allergy and Clinical Immunology: In Practice, 8(2), 555-564.

Russell, R.J. & Brightling, C. (2017). Pathogenesis of asthma: implications for precision medicine. Clinical Science, 131(14),1723-1735.

Swan, J. & Katz, M.J., (2018). Asthma Patient Care. Retrieved from https://wildirismedicaleducation.com/courses/595/Asthma-Patient-Care-Wild-Iris-Medical-Education.pdf

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