NRSG138 Exercise-Induced Asthma Report Sample

• Subject Code : NRSG138
• Subject Name : Nursing

Transition Into Nursing 

Introduction to Exercise-Induced Asthma

Ben, a widower, was admitted to the hospital with elevated asthma. From a pathophysiology perspective, Ben has confirmed Diabetes Mellitus. Ben was of good health until he caught a cold; he wheezed and coughed, accomplished by shortness of breath while laughing. The examination revealed that he had high levels of asthma. Asthma may result in respiratory truck disorders, which are inherently chronic. Initially, there is the presence of obstruction of the respiratory tract, then inflammation, hyper-reactivity, and remodelling of the respiratory tract. Exposure to the environmental allergen; the response is the release of antibodies IgE (Zellner et al., 2019). Orchestration of asthma occurs in two phases. The first phase is when the antibodies are initially released after exposure to environmental stimuli. According to Sinyor & Perez (2019) presence of asthma is related with the levels of IgE. The risk factors are mainly biological, given the exposure to environmental stimuli triggers the allergic reaction that ensues in the initial phase. IgE has a high affinity for basophil and mast cells. The control of inflammation, fibrosis, and hyperplasia remodelling, is done by the lymphocytes (Nhu & Aceves, 2017). Pathophysiology of the illness is dynamic but typical patients like Ben are treated as having moderate elevated asthma.

Exercise-induced Bronchospasms (EIB) refers to the constriction of airways that is triggered during or after exercise. The constant airflow obstruction or restrictions increases breathing and respiratory rates. Therefore, the diagnosis is exercise-triggered bronchoconstriction, induced by physical activities. Long-term treatment solutions involve the use of corticosteroids. Corticosteroids help in reducing the narrowing and inflammation of the bronchi tubes. Away from that, anxiety and pain management are also factors that should be looked into. The paper will adopt the Gibbs Reflective Cycle to evaluate and reflect upon the experiences of developing a comprehension of PCC.

Evaluation and Analysis of Interventions

The treatment of asthma usually depends on bronchodilators have significant benefits relative to most oral mediation given that the obstructed airways are directly influenced (Murayama & Murayama, 2019). Nursing interventions therefore will focus on prevention measures, necessarily that about limiting patient’s exposure to environmental stimuli agents that cause allergic reactions (Kuruvilla et al., 2019; Georas, Lee, & Kuruvilla, 2020). The efficacy of mesh nebulizers has been a subject of concern for many studies. Mesh nebulizers produce higher aerosol output relative to jet nebulizers. Murayama & Murayama (2018) researched on the clinical effectiveness of Salbutamol via mesh and jet nebulizers; mesh nebulizers were confirmed to be effective.

Although the two nebulizers mentioned earlier were used for the study, better efficacy could have been achieved via the usage of a vibrating mesh nebulizer, which can deliver large aerosols per usage. The time taken to inhale is considerably reduced. In this case, the administration and frequency of usage of MDI are one of the determining factors for the efficacy of mesh nebulizers. The effectiveness of Ipratropium bromide accompanied by Beta-2 agnostic work together to produce optimal output on reducing bronchoconstriction by relaxation. After ADME, Salbutamol-4’O Sulphate is produced as residue.

On contemplation and evaluation, registered nurses should focus on reducing the admiration period. Progress in medical technology equipment has culminated in design of digital nebulizers. For instance, Kesten et al. (2018) looked into the creation of Digital Breath-activated Inhaler (DBAI) and how the type of inhaler results in a reduced dosage being admitted. DBAI offers chances for monitoring the delivery of the dosage, thereby averting the problem of the discoordination of the patient.

In the long-term, the differential diagnosis for symptoms of EIB could have provided better efficacy of the interventions given that Ben has a medical history of cardiovascular diseases – diabetes Mellitus. The monitoring and usage of vital sign results could have provided more information to the nurse. The differential diagnosis of asthma will provide the prerequisites for exercise-induced laryngeal dysfunction, restrictive lung disease, anaphylaxis, and hyperventilation. The importance of warming up before exercise, as a non-pharmacological intervention, should not be overlooked (Weiler et al., 2016). The differential diagnostic approach is the best method for making sure that the patient is affected by asthma and not any other case before the initiation of treatment. In children, diseases of the upper airway are common (Chabra & Gupta, 2019).

Future research should focus on non-pharmacological methods of offering medical interventions such as therapy sessions, patient education, and awareness. The provision of the constructs, besides increasing the quality of care, resulted in cost-effective intervention methods for the patient and the hospital. Therefore, this will result in the focus of preventive measures for averting asthma rather than curative measures. The immune response is limited, and the chances of a culmination of inflammation are reduced by focusing on limiting exposure to environmental stimuli (Martin et al., 2019). For Ben, the medical intervention of using IgE proved to be effective in resistance towards external stimuli. Other pharmacological methods that were used ranged from antihistamines and antibiotics, which have long-term therapeutic utility (Sullivan et al., 2016). The swelling of the airways is corrected via admiration of corticosteroids with combinations of bronchodilators. The mucus deposit is reduced by Ipratropium bromide, while Salbutamol was utilised for limiting bronchial spasm. Ipratropium also increases bronchial dilation and activity.

Conclusion on Transition Into Nursing

To suffice, Ben was experiencing elevated asthma levels, which had made him, agitated, and with reduced speech delivery. Treatment and management usually use inhalers, although tablets medications are also available. The short-term and long-term treatment options are beta-2 agnostics and inhaled corticosteroids for treating EIB. Although mesh nebulizer is more efficient, more efficacy is obtained from DBAI but with compromising costs. Future studies in the area of asthma diagnosis should focus on differential symptoms since it is common for a compound of illness to manifest as one major disease, common with most cardiovascular comorbidities. The management of acute level exhilaration is instant reversal air obstruction. Medications for this type of asthma can range from anticholinergic to direct injection of magnesium Sulphate that leads to incensed functionality of the lungs.

Action Plans for Transition Into Nursing

Discharge planning provides the opportunity for evaluation that is necessary for PCC. Advances in this area have culminated in the development of Electronic Healthcare Records (EHR). Generally, these interventions aim at increasing medical adherence reducing probabilities of readmission (Nordmark, Zingmark, & Lindbergh, 2016). Transitional discharge that flows from inpatient to outpatient is vital for offering personalised care. In this case, the parties involved could be parents, and the victim and the provider. Informational content about every detail of the condition could be disseminated in real-time amongst the parties. Essential health care plans, in this case, will be augmented by the possibility of incorporating EHR. As such, the therapist should focus on the use of mindfulness and relaxation techniques to deal with stressor and anxiety. Anxiety, stress, and depression are comorbidities that should be averted considering that the patient has confirmed cardiovascular disease. Prognosis complications for asthma are sleep interference, heightened risk of readmission, and reduced freedom to perform demanding physical exercises.

Cognitive Behavioural Therapy (CBT) out to be scheduled will augment caregiving, medical adherence, and educational content and will improve patient confidence and monitoring (Farah et al., 2016). CBT will help Ben to deal with dysfunctional beliefs to enhance self-esteem and confidence. Importantly, CBT is one of the non-pharmacological methods to cognitive treatment which other than improving the quality of service also help in learning coping mechanism (Philip, Kannan, & Parambil, 2018). The combined use of non-pharmacological and pharmacological medical interventions will lead to patient satisfaction.

Besides, there will be an improved recuperation period (Palermo et al., 2018). Education and awareness are vital in bolstering preventive measures, given that the risk factors are analysed.

References for Transition Into Nursing

Kuruvilla, M. E., Vanijcharoenkarn, K., Shih, J. A., & Lee, F. E. H. (2019). Epidemiology and risk factors for asthma. Respiratory Medicine, 149, 16-22.

Farah, W. H., Alsawas, M., Mainou, M., Alahdab, F., Farah, M. H., Ahmed, A. T., ... & Mohammed, K. (2016). Non-pharmacological treatment of depression: a systematic review and evidence map. BMJ Evidence-Based Medicine, 21(6), 214-221.

Georas, S. N., Lee, F. E. H., & Kuruvilla, M. (2020). Scope of the Problem, Definition, and Pathophysiology. In Difficult to Treat Asthma (pp. 1-23). Humana, Cham

Kesten, S., Israel, E., Li, G., Mitchell, J., Wise, R., & Stern, T. (2018). Development of a novel digital breath-activated inhaler: Initial particle size characterization and clinical testing. Pulmonary Pharmacology & Therapeutics, 53, 27-32.

Martin, R., Zellner, M. P., Lownik, J. C., & Luker, A. J. (2019). Treatment with benign IgE reduces asthma symptomology in a mast cell-dependent manner.

Murayama, N., & Murayama, K. (2018). Comparison of the clinical efficacy of salbutamol with jet and mesh nebulizers in asthmatic children. Pulmonary Medicine, 2018.

Nhu, Q. M., & Aceves, S. S. (2017). Tissue remodeling in chronic eosinophilic esophageal inflammation: parallels in asthma and therapeutic perspectives. Frontiers in Medicine, 4, 128.

Nordmark, S., Zingmark, K., & Lindberg, I. (2016). Process evaluation of discharge planning implementation in healthcare using normalization process theory. BMC Medical Informatics and Decision Making, 16(1), 48.

Palermo, T. M., Dudeney, J., Santanelli, J. P., Carletti, A., & Zempsky, W. T. (2018). Feasibility and acceptability of internet-delivered cognitive behavioral therapy for chronic pain in adolescents with sickle cell disease and their parents. Journal of Pediatric Hematology/Oncology, 40(2), 122.

Philip, P. M., Kannan, S., & Parambil, N. A. (2018). Community-based interventions for health promotion and disease prevention in noncommunicable diseases: A narrative review. Journal of Education and Health Promotion, 7.

Sinyor, B., & Perez, L. C. (2019). Pathophysiology of Asthma. In StatPearls. Stat Pearls Publishing.

Sullivan, A., Hunt, E., MacSharry, J., & Murphy, D. M. (2016). The microbiome and the pathophysiology of asthma. Respiratory Research, 17(1), 163

Zellner, M., Lownik, J., Farrar, J., & Martin, R. (2019). Treatment with benign IgE reduces asthma symptomology in a mast cell dependent manner. In European Journal of Immunology (Vol. 49, pp. 725-725). Hoboken, NJ: Wiley.

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