401211 Poppy Health Variations Case Study Sample

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

Acute Life Threatening Conditions - Question 1

Explain the pathogenesis causing the clinical manifestations with which Poppy presents.

 In asthma, the airways contract which causes breathing tubes to narrow. This contraction of airways leads to ventilation perfusion imbalance, lung hyperinflation, and increased work of breathing that may lead to ventilatory muscle fatigue [1]. This is confirmed by respiratory function tests, wheezing in both lungs, inability to speak in full sentences. Further supported by chest X rays of the patient showing hyperinflation in both the lungs. The airflow limitation and bronchial inflammation can lead to inspiratory and expiratory wheezing and patient’s in ability to speak full sentences[2].

Acute Life Threatening Conditions - Question 2

Nursing Strategies

1. 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?

When poppy is made to sit in High Fowler position, it is the position where the poppy’s upper half body is between 60 to 90 degrees in relation to lower half of the body. Positional strategies have been widely used to improve oxygenation of patients with acute respiratory distress syndrome (ARDS).The practice of making the patient sit in the prone position is reinforced by a strong physiological basis and has a noteworthy improvement of the oxygenation status in many ARDS patients.^[3]

2. Apply and titrate oxygen

• What oxygen delivery device will you use?
• Why did you choose this device?
• How does providing supplemental oxygen work and, how will it assist Poppy?

As the patient is presented with SpO2 87%< 92%,she must be urgently treated with oxygen delivery[4]. The device that can be used is Nasal high Flow (NHF)[5]. Nasal High Flow is used in paediatric asthmatics in eds[6]. NHF helps in distributing humidified and heated gas at a rate better than inspiratory flow[7]. Further the NHF will help in reducing anatomical dead space by flushing the nasopharyngeal cavity and also by improving CO2 clearance. It will also provides a certain level of positive end-expiratory pressure (PEEP), between 2 and 7 cm H2O, depending on the flow rate used that may help in reduce resistance⁷.

Acute Life Threatening Conditions - Question 3

For each medication below explain

Salbutamol via nebuliser

Hydrocortisone IV

Ipratropium Bromide via nebuliser

1. Salbutamol via nebuliser

The mechanism of action: Salbutamol via nebuliser is used for the treatment of acute severe asthma. Salbutamol is generally delivered through the inhaled route like nebuliser in this case especially for children[8]. It acts by selectivity allowing bronchodilation of beta-2 receptors on bronchial smooth muscle without significant tachycardia linked with activation of beta-1 receptors on cardiac muscle.

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

As the patient is presented with inability to speak sentences, both inspiratory and expiratory wheezing along with HR 160bpm. Salbutamol via nebuliser will help in opening up the bronchial airways.

What are the nursing considerations for this medication?

• For this case, the dosage should be minimal as drug tolerance may develop after prolonged use.
• Due to high risk of cardiac effects, keep beta-adrenergic blocker (atenolol, should be on standby.
• Formulate solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL normal saline; deliver over 5–15 minutes by nebulization.

What clinical response you expect?

As salbutamol will lead to wider open airways. It will help in relieving cough, shortness of breath and both inspiratory and expiratory wheezing.

What continuing clinical observations will you need to undertake?

After administering the drug, poppy may feel drowsiness, dizziness, fatigue, headache, nausea, vomiting, change in taste; rapid heart rate, anxiety, sweating, flushing, insomnia.

2. Hydrocortisone IV

The mechanism of action: Administering Hydrocortisone IV will help the patient by improving its respiratory functions[9] by reducing inflammation. It will help in enhancing beta-adrenergic response to relieve the muscle spasm. They also act by reversing the mucosal odema, decreasing vascular permeability by vasoconstriction. Also systemic administration of hydrocortisone will lead to less relapses of the attack.⁹

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

The systematic administration of hydrocortisone will help poppy in relieving symptoms like wheezing, shortness of breath. Also, this administration will reduce the risk of relapse at discharge from emergency department[10].

What are the nursing considerations for this medication?

• Hydrocortisone injection should be given over a period of 30 seconds.
• For Children having Hydrocortisone, there growth should be regularly monitored.

What clinical response you expect?

Though Hydrocortisone will not have direct effect on bronchial activity. It act by inhibiting late phase reactions. Thus by blocking late reaction they prevent increased airways reactivity.

What continuing clinical observations will you need to undertake?

For poppy patient who is child of 9 years. One needs to monitor the height and weight at regular intervals.

3. Ipratropium Bromide via nebuliser

The mechanism of action.

Ipratropium Bromide via nebuliser act as bronchodilator by causing muscle to relax and airways to dilate. During asthma attack cholinergic nerves leads to narrowing of lungs.

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

As the patient is presented with worsening respiratory symptoms and is unable to take peak flow. Administering Ipratropium Bromide will help enlarging nasal and bronchial airways passage. Thus, relieving the patient from these symptoms.

What are the nursing considerations for this medication?

keeping a close watch on various respiratory parameters

What clinical response you expect?

After administration of Ipratropium Bromide will help in relieving symptoms like inspiratory and expiratory wheezing and shortness of Breath.

What continuing clinical observations will you need to undertake?

After administering the drug, poppy may feel headache, dry mouth, constipation, throat irritation, gastrointestinal disorders.

References for Acute Life Threatening Conditions

Alangari A. A. (2014). Corticosteroids in the treatment of acute asthma. Annals of thoracic medicine, 9(4), 187–192. https://doi.org/10.4103/1817-1737.140120

Baudin, F., Buisson, A., Vanel, B., Massenavette, B., Pouyau, R., & Javouhey, E. (2017). Nasal high flow in management of children with status asthmaticus: a retrospective observational study. Annals of intensive care, 7(1), 55. https://doi.org/10.1186/s13613-017-0278-1

Kirkland SW, Vandermeer B, Campbell S et al. Evaluating the effectiveness of systemic corticosteroids to mitigate relapse in children assessed and treated for acute asthma: A network meta-analysis. J Asthma 2018: 1-12.

Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in microbiology, 4, 263. https://doi.org/10.3389/fmicb.2013.00263

Milési C, Boubal M, Jacquot A, Baleine J, Durand S, Odena MP, et al. High-flow nasal cannula: recommendations for daily practice in pediatrics. Ann Intensive Care. 2014;4:29. doi: 10.1186/s13613-014-0029-5. 

Milési C, Essouri S, Pouyau R, Liet J-M, Afanetti M, Portefaix A, et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study) Intensive Care Med. 2017;43:209–216. doi: 10.1007/s00134-016-4617-8.

Ortiz-Alvarez, O., Mikrogianakis, A., & Canadian Paediatric Society, Acute Care Committee (2012). Managing the paediatric patient with an acute asthma exacerbation. Paediatrics & child health, 17(5), 251–262. https://doi.org/10.1093/pch/17.5.251

Papiris, S., Kotanidou, A., Malagari, K., & Roussos, C. (2002). Clinical review: severe asthma. Critical care (London, England), 6(1), 30–44. https://doi.org/10.1186/cc1451

Richard, J. C., & Lefebvre, J. C. (2011). Positioning of patients with acute respiratory distress syndrome: combining prone and upright makes sense. Critical care (London, England), 15(6), 1019.

Ullmann, N., Caggiano, S., & Cutrera, R. (2015). Salbutamol and around. Italian Journal of Pediatrics, 41(Suppl 2), A74. https://doi.org/10.1186/1824-7288-41-S2-A74

[1] Papiris, S., Kotanidou, A., Malagari, K., & Roussos, C. (2002). Clinical review: severe asthma. Critical care (London, England), 6(1), 30–44. https://doi.org/10.1186/cc1451

[2] Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in microbiology, 4, 263. https://doi.org/10.3389/fmicb.2013.00263

[3] Richard, J. C., & Lefebvre, J. C. (2011). Positioning of patients with acute respiratory distress syndrome: combining prone and upright makes sense. Critical care (London, England), 15(6), 1019.

[4] Ortiz-Alvarez, O., Mikrogianakis, A., & Canadian Paediatric Society, Acute Care Committee (2012). Managing the paediatric patient with an acute asthma exacerbation. Paediatrics & child health, 17(5), 251–262. https://doi.org/10.1093/pch/17.5.251

[5] Baudin, F., Buisson, A., Vanel, B., Massenavette, B., Pouyau, R., & Javouhey, E. (2017). Nasal high flow in management of children with status asthmaticus: a retrospective observational study. Annals of intensive care, 7(1), 55. https://doi.org/10.1186/s13613-017-0278-1

[6] Milési C, Essouri S, Pouyau R, Liet J-M, Afanetti M, Portefaix A, et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study) Intensive Care Med. 2017;43:209–216. doi: 10.1007/s00134-016-4617-8.

[7] Milési C, Boubal M, Jacquot A, Baleine J, Durand S, Odena MP, et al. High-flow nasal cannula: recommendations for daily practice in pediatrics. Ann Intensive Care. 2014;4:29. doi: 10.1186/s13613-014-0029-5. 

[8] Ullmann, N., Caggiano, S., & Cutrera, R. (2015). Salbutamol and around. Italian Journal of Pediatrics, 41(Suppl 2), A74. https://doi.org/10.1186/1824-7288-41-S2-A74

[9] Alangari A. A. (2014). Corticosteroids in the treatment of acute asthma. Annals of thoracic medicine, 9(4), 187–192. https://doi.org/10.4103/1817-1737.140120

[10] Kirkland SW, Vandermeer B, Campbell S et al. Evaluating the effectiveness of systemic corticosteroids to mitigate relapse in children assessed and treated for acute asthma: A network meta-analysis. J Asthma 2018: 1-12.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help