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Acute Care Across Lifespan

Question 1

Asthma is triggered by the different factors that initiate the inflammation process and increase complication. Some of the factors that increase the chances of asthma include an environmental or genetic factor that directly leads to bronchial inflammation. The inflammation initiates the hypersensitive reactions and it leads to bronchoconstriction responses. The result of the inflammation end with oedema, increase mucus production and airways remodelling. The airways narrowing the lead to breathlessness, chest tightness and wheezing (King et al., 2018). The pathophysiology of the asthma is divided into two phases that start with the early phase that includes inhalation of the allergens followed by the late phase that includes the release of the cytokine from the mast cell (Bush, 2019).

Question 2 (a)

The psychological complication is prevalent in asthma patient and patients are stressed due to the deteriorated physical health that requires urgent attention (Fergeson et al., 2017). One of the complications that are faced by the patient is the psychological issue like stress and anxiety that is the sign of the Frances during administration.

Another complication that arises due to the major sign and symptom is the misbalance in the sleep due to discomfort that directly impacts over the mental as well as physical health (Quirt et al., 2018). Frances has also mentioned that she is facing an issue while sleeping from a couple of days and not able to maintain sleep cycle properly.

Question 2 (b)

The Sleep and asthma are kind off connected as many changes occur during the night that is the natural circadian rhythm. The individual with asthma is extra sensitive when it comes to sleep as during the night airways become slightly more inflamed followed by the decrease of the airflow. These issues increase the chances of sleeping disorder due to increase sign or symptoms at night (Li et al., 2015).

Question 3 (a)

One of the first-line therapies for asthma is salbutamol as it helps to relax your airways smooth muscle that increases the airflow. It acts as beta 2 adrenergic receptors decrease the secretion of the hypersensitivity mediators from cells that help to relax the smooth muscle. It directly stimulates the B2 receptors that activate the adenyl cyclase that help to relax the bronchial muscle and decrease airways resistance to improve breathing (Ullmann et al., 2015).

Question 3 (b)

One of the side effects that are absorbed in the patient after administration of the salbutamol is the dizziness that can increase complication thus continuous monitoring is important for the patient (Usmani et al., 2018).

Another side effect of the salbutamol is the increased heart rate that can increase the health issue for the patient. Increased heart rate is one of the major issues that can lead to further initiation of the issues (Price et al., 2018).

Question 3 (c)

The nurses should educate the patient with the information related to the medication and the patient should be aware of the side effect so that he/she can handle the situation if encounter. The nurses should also continuously monitor the patient after the administration so that the proper track of the effect of the medicine can be predicted (Scullion, 2018).

Question 4

The current condition of Frances’s indicates that she is facing issue due to asthma and it can be more complicated due to the absence of the medication. She is facing major discomfort due to shortness of breath and tightness of the chest.

The further assessment that can be used to evaluate the condition of the patient includes the use of spirometry as it helps to determine the working pattern of the lungs. It easily detects asthma by measuring the inhalation and exhalation capacity of the lung (Haynes, 2018). The fractional exhaled nitric oxide test can also be done to detect the lung inflammation that occurred due to asthma (Miskoff et al., 2019).

Question 5

The lung produces different lung sound that is directly associated with the lung condition and it helps to detect the inflammation in the lungs. One of the types of sound produced by the lungs is an adventitious sound that is referred to as the additional sound from breath sound. Wheezing that is observed in the asthma patient is a type of adventitious sound (Zimmerman & Williams, 2019). Wheezing in asthma patient result due to the localized narrowed airways that result due to the obstruction of the larynx. The sound that is associated with asthma is initiated due to the bronchoconstriction, mucosal edema, external compression and obstruction. The wheezing is observed during the expiration as during this period more severe airways narrowing occur (Shimoda et al., 2017).

Question 6

One of the major sources of an asthma attack is the allergens and if the patient encounters the allergens again he/she can get an attack that can increase complication. There are different sources of the allergens and fur animals increase the chances of attack. The major allergen associated with cats includes Fel d 1 that is present in the skin of the cats. The sebaceous and salivary glands in the fur of the cats also act as allergens for the asthma patient (Cipriani et al., 2017).

Question 7

Shortness of breath is one of the major issues that are faced by the asthma patient and it can increase the complication of the patient (Berliner et al., 2016).

High blood pressure should be addressed immediately as it is the root cause of multiple disorders and it can increase complication for the patient (Carey et al., 2018).

The enlarged cervical gland is also an issue that is faced by many patient suffering from any infection. The patient-facing issue with cervical gland should be immediately treated to reduce complication (Ramadas et al., 2017).

Question 8

Breathing exercise is the first line of contact when nurses are expected to improve the breathing issue of the patient. The different breathing exercise includes pursed-lip, belly breathing, resonant breathing and yoga (Zaccaro et al., 2018).

Hypertension can be addressed by lifestyle and dietary modification that help to improve the metabolism and maintain the blood pressure. Lifestyle modification includes increasing exercises and maintaining nutrition intake in the diet.

Question 9

The first aspect that will be covered in the educational intervention is the self-management that helps the patient to track their medicine and improve lifestyle (Boulet, 2015).

The second aspects that will be included in the educational intervention include avoidance from the allergens that will help to reduce the chances of an asthma attack (Plaza et al., 2015).

Question 10 (a)

The decrease wheezing is a sign that the patient is improving and the interventions are helpful to decrease the complication for the patient (Trevor & Chipps, 2018).

The decrease in the shortness of breath is also a sign of better health status of the asthma patient (Holgate et al., 2015).

Question 10 (b)

The pulse oximetry is the first test that will be used to evaluate the health status of the patient and chest X-ray can also be performed to analyse the lung capacity (Hashmi et al., 2020).

Question 11

Cognitive and behavioural therapy can be utilized to improve the anxiety issue of the patient. It helps to improve the thought and behaviour of the patient (Kaczkurkin & Foa, 2015).

Relaxation technique for the anxiety patient is very helpful as it helps to improve the strength and unwanted habits of the patient (Ramasamy et al., 2018).

Reference for Pathophysiological Mechanisms of Asthma

Berliner, D., Schneider, N., Welte, T., & Bauersachs, J. (2016). The differential diagnosis of dyspnea. Deutsches Arzteblatt international, 113(49), 834–845. DOI: 10.3238/arztebl.2016.0834

Boulet, L. P. (2015). Asthma education: an essential component in asthma management. European Respiratory Journal, 46(5), 1262–1264. DOI: 10.1183/13993003.01303-2015

Bush A. (2019). Pathophysiological mechanisms of asthma. Frontiers in Pediatrics, 7(68), 1-17. DOI: 10.3389/fped.2019.00068

Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and control of hypertension. Journal of the American College of Cardiology, 72(11), 1278–1293. DOI: 10.1016/j.jacc.2018.07.008

Cipriani, F., Calamelli, E., & Ricci, G. (2017). Allergen avoidance in allergic asthma. Frontiers in Pediatrics, 5(103), 1-10. DOI: 10.3389/fped.2017.00103

Fergeson, J. E., Patel, S. S., & Lockey, R. F. (2017). Acute asthma, prognosis, and treatment. Journal of Allergy and Clinical Immunology, 139(2), 438–447. DOI: 10.1016/j.jaci.2016.06.054.

Hashmi, M. F., Tariq, M., & Cataletto, M. E. (2020). Asthma. Treasure Island, United Kingdom: StatPearls Publishing.

Haynes J. M. (2018). Basic spirometry testing and interpretation for the primary care provider. Canadian journal of respiratory therapy: CJRT = Revue canadienne de la therapie respiratoire: RCTR, 54(4), 10.29390/cjrt-2018-017. DOI: 10.29390/cjrt-2018-017

Holgate, S. T., Wenzel, S., Postma, D. S., Weiss, S. T., Renz, H., & Sly, P. D. (2015). Asthma. Nature Reviews Disease Primers, 1(15025), 1-22. DOI: 10.1038/nrdp.2015.25

Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioural therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610618/

King, G. G., James, A., Harkness, L., & Wark, P. A. B. (2018). Pathophysiology of severe asthma: We’ve only just started. Respirology, 23(3), 262–271. DOI: 10.1111/resp.13251

Li, L., Xu, Z., Jin, X., Yan, C., Jiang, F., Tong, S., & Li, S. (2015) Sleep-disordered breathing and asthma: evidence from a large multicentric epidemiological study in China. Respiratory Research, 16(56), 1-10. DOI: 10.1186/s12931-015-0215-5

Miskoff, J. A., Dewan, A., & Chaudhri, M. (2019). Fractional exhaled nitric oxide testing: diagnostic utility in asthma, chronic obstructive pulmonary disease, or asthma-chronic obstructive pulmonary disease overlap syndrome. Cureus, 11(6), 1-8. DOI: 10.7759/cureus.4864

Plaza, V., Peiró, M., Torrejón, M., Fletcher, M., López-Viña, A., Ignacio, J. M., & Gich, I. (2015). A repeated short educational intervention improves asthma control and quality of life. European Respiratory Journal, 46(5), 1298–1307. DOI: 10.1183/13993003.00458-2015

Price, D. B., Gefen, E., Gopalan, G., McDonald, R., Thomas, V., Ming, S. W. Y., & Davis, E. (2018). Real-life effectiveness and safety of salbutamol Steri-Neb™ vs. Ventolin Nebules® for exacerbations in patients with COPD: Historical cohort study. PLOS ONE, 13(1), 1-18. DOI: 10.1371/journal.pone.0191404

Quirt, J., Hildebrand, K. J., Mazza, J., Noya, F., & Kim, H. (2018). Asthma. Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2), 50. DOI: 10.1186/s13223-018-0279-0

Ramadas, A. A., Jose, R., Varma, B., & Chandy, M. L. (2017). Cervical lymphadenopathy: Unwinding the hidden truth. Dental Research Journal, 14(1), 73–78. DOI: 10.4103/1735-3327.201136

Ramasamy, S., Panneerselvam, S., Govindharaj, P., Kumar, A., & Nayak, R. (2018). Progressive muscle relaxation technique on anxiety and depression among persons affected by leprosy. Journal of Exercise Rehabilitation, 14(3), 375–381. DOI: 10.12965/jer.1836158.079

Scullion J. (2018). The nurse practitioners' perspective on inhaler education in asthma and chronic obstructive pulmonary disease. Canadian Respiratory Journal, 2018, 1-9. DOI: 10.1155/2018/2525319

Shimoda, T., Obase, Y., Nagasaka, Y., Nakano, H., Ishimatsu, A., Kishikawa, R., & Iwanaga, T. (2017). Lung sound analysis helps localize airway inflammation in patients with bronchial asthma. Journal of Asthma and Allergy, 10, 99–108. DOI: 10.2147/JAA.S125938

Trevor, J. L., & Chipps, B. E. (2018). Severe asthma in primary care: identification and management. The American Journal of Medicine, 131(5), 484–491. DOI: 10.1016/j.amjmed.2017.12.034.

Ullmann, N., Caggiano, S., & Cutrera, R. (2015). Salbutamol and around. Italian Journal of Pediatrics, 41(Suppl 2), 1-2. DOI: 10.1186/1824-7288-41-S2-A74

Usmani, O.S., Biddiscombe, M.F., & Yang, S. (2018). The topical study of inhaled drug (salbutamol) delivery in idiopathic pulmonary fibrosis. Respiratory Research, 19(25), 1-10. DOI: 10.1186/s12931-018-0732-0

Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing. Frontiers in human neuroscience, 12(353), 1-16. DOI: 10.3389/fnhum.2018.00353

Zimmerman, B., & Williams, D. (2019). Lung Sounds. Treasure Island, United Kingdom: StatPearls Publishing.

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