Question 1: Poppy is a nine-year-old female who weighs 40 kilograms. She has presented to the hospital setting with the symptom of difficulty in breathing and the worsening respiratory symptoms. On admission, she was administered with nebulized Salbutamol with 6LPM of O2 and the chest X-ray shows hyperinflation of both the lungs fields. She had difficulty in speaking also as she could not speak full sentences and the voice module is also low. The data from nursing assessment states that the heart rate is 160 bpm (high heart rate), respiration rate is 42 bpm (high respiration rate), spO2 is 87% (low spO2) and RA is 92% (high RA). The blood glucose level is 9.0 mmol/L which is also abnormal and asthma is noted in the patient.
The major issue identified in the respiratory depression is of hypoxia that takes place due to the non- adequate oxygen supply to some of the body parts. In the cases of respiratory depression, there is a mismatch of V/Q which is mainly caused by the narrowing of the airways of lungs. This condition is developed in the patients when the lungs of the patient receive blood which is not carrying oxygen. This non- oxygenated blood flow causes the condition of hypoxia. There is a symptom of wheezing also in the patient that takes place because of the mucous and constriction of the lumen in the airways (Carpaij et al., 2019). The narrow airways cause the inability to expel the air and this obstructs in the way of the lumen in airways.
The patient wheezes because this expelled air is forced to be passed through the narrow airways of the lungs which makes the person wheeze. This is the main reason that wheeze is one of the most common symptoms of respiratory distress. Tachypnoea is again a health condition which is caused due to asthma and it happens when the chemoreceptors use their detection power to detect hypoxia as a result of which the respiration rate increases in the value. As a result of increased respiration rate, the patient starts to breathe faster and this has a direct impact on the increased heart rate. The nursing assessment details also states that the heart rate of the patient is high and this happens because heart gives oxygen to the entire body by pumping oxygenated blood that comes from the lungs (Sullivan, Hunt, MacSharry& Murthy, 2016).
The lungs in the patients of asthma have low levels of oxygen as a result of which the less amount of oxygen is received by the body which increases the work of the heart. The patient also has hyperinflated lungs and this is because of the condition of asthma in which there is difficulty in inhaling the air as a result of which there is increased work of breathing. The increased work of breathing is compensated by the accessory muscles as it works effectively in the inflated lungs.
The hyperinflated lungs are also characterized by extensive mucous plugging in the segmental, subsegmental bronchus and peripheral airways (Sinyor 7 Perez, 2019).
The conscious score of the patient is 14 that is the normal consciousness and this represents that the patient is conscious. The assessment of tracheal tug and low pH levels are also indicative of disturbed respiration process in the patient Poppy. The low magnesium level as indicated by the nursing assessment data reveals that the patient has narrowed airways because the good magnesium levels are a type of bronchodilator that relaxes the airways and the low magnesium levels represent inflated lungs and airways (Yamauchi & Ogasawara, 2019).
(a). Fowler's position is an effective position strategy that is used to treat patients with respiratory issues. In this position, the sitting position is achieving in the angles of 30 degrees and 90 degrees that makes the patient alleviate the symptoms and also makes them comfortable. In this position, the average oxygen saturation percentage is always the amount needed for the normal functioning of the body that has been suffering from respiratory distress (Setten, Plotnikow&Accoce, 2016). The patient is given comfort and pain-free condition by using appropriate positioning technique and this is highly effective. It helps the patient in compressing the chest that is due to gravity.
(b) The nursing intervention is to administer oxygen to the patient with the condition of asthma. The nurse will apply the intervention of titrating oxygen using a suitable accessory. The oxygen will be titrated and administered to the patient of 6L concentration. This will be done using a Hudson mask in which 6L of oxygen will be administered (Hunt, 2019). This will help the patient to decrease the work of breathing and will also improve the vital signs like heart rate and respiration rate. The advantage of using a Hudson mask is that it facilitates the delivery of a correct and limited amount of oxygen to the patient. This will help in achieving an oxygen saturation of 92% that is the standard and will also improve the condition of hypoxia by managing V/Q mismatch.
1. Salbutamol via nebulizer: This is the standard medication regime for patients with respiratory distress and is the first line of medication. It is a selective beta-2 receptor stimulant which on inhalation directly stimulates these beta- 2 receptors in the bronchial smooth muscles. This is the reason their direct stimulation makes it a good choice of bronchodilator. It stimulates adenyl cyclase and this has a major role to play in inhibiting the entry of calcium ions in the cells as the levels of cAMP increases. The release of histamines and slow-reacting substance A (SRS-A) is also inhibited that causes the relaxation of smooth muscles thus smooth breathing process is facilitated (DrugBank, 2020).
This is a suitable choice of drug for Poppy because she has respiratory distress and the nursing consideration is on the route of administration and its concentration. This is the first choice of drug in respiratory distress because it helps in alleviating the symptoms and makes breathing process easier for the patient and after its administration, the nurse will continuously monitor heart rate and respiratory rate throughout. The nursing outcome is improvement in heart rate and respiratory rate.
2. Hydrocortisone IV: An anti-inflammatory adrenocortical steroid that mainly works by reducing the irritation that is caused in airways and the lungs because of respiratory distress. It inhibits inflammation by fulfilling the requirement of high blood levels of hydrocortisone. It also decreases vasodilation and binds to the glucocorticoid receptors which results in inhibition of inflammatory transcription factors that promote anti-inflammatory genes. This is beneficial for Poppy in breathlessness (DrugBank, 2020). The nursing consideration is the route of administration and concentration and the nurse will monitor the vitals throughout. This will help Poppy in breathlessness and makes breathing process easy for her. The expected outcome is better breathing condition and relaxed breathing.
3. Ipratropium Bromide via nebulizer: This is an antagonist of the muscarinic acetylcholine receptor. In the respiratory distress, there is always an effect caused due to parasympathetic nervous system (PNS) and this ipratropium bromide is used as a bronchodilator because it inhibits the generation of bronchial secretions. The diameter of the airways is narrowed due to the release of acetylcholine into the muscles. This bronchodilator acts on the narrowed airways and increases the diameter by ceasing the acetylcholine activity in the smooth muscles of the airways (DrugBank, 2020). This medication is for relaxing breathlessness and for wheezing that takes place due to abnormal expiratory flow. The nurse will consider the route of administration of this medication and the patient will feel relaxed while breathing. The nurse will monitor the vital signs for improvement of the condition like blood pressure, respiratory rate and heart rate.
Carpaij, O. A., Burgess, J. K., Kerstjens, H. A., Nawijn, M. C., & van den Berge, M. (2019). A review on the pathophysiology of asthma remission. Pharmacology &Therapeutics, 201, 8-24.
DrugBank. (2020). Hydrocortisone. Retrieved from https://www.drugbank.ca/drugs/DB00741
DrugBank. (2020). Ipratropium. Retrieved from https://www.drugbank.ca/drugs/DB00332
DrugBank. (2020). Salbutamol. Retrieved from https://www.drugbank.ca/drugs/DB01001
Hunt, R. (2019). Acute-on-chronic respiratory failure. Challenging Concepts in Critical Care: Cases with Expert Commentary, 117.
Setten, M., Plotnikow, G. A., &Accoce, M. (2016). Prone position in patients with acute respiratory distress syndrome. RevistaBrasileiraDe TerapiaIntensiva, 28(4), 452.
Sinyor, B., & Perez, L. C. (2019). Pathophysiology Of Asthma. In StatPearls [Internet]. StatPearls Publishing.
Yamauchi, K., & Ogasawara, M. (2019). The Role of Histamine in the Pathophysiology of Asthma and the Clinical Efficacy of Antihistamines in Asthma Therapy. International Journal of Molecular Sciences, 20(7), 1733.
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