Acute Care Across Lifespan - Question 1

Asthma is complex and involves airway inflammation, narrowing or obstruction of airway, and bronchial hyper responsiveness of the bronchi. The narrowing occurs because of constriction of bronchial smooth muscles in response to irritants or allergens. The severe bronchoconstriction happens because of allergens which are caused by the mediators (tryptase, leukotrienes and prostaglandins) released from the mast cells and these are IgE-dependent (Yamauchi & Ogasawara, 2019).

There is over production of mucus in the bronchi to remove allergen from the body. The allergen causes mast cells in the tissues of the bronchi to rupture and secrete prostaglandin and histamine. Consequently, mucosa of the bronchi becomes enlarged and inflated. Bronchial hyper responsiveness is an exaggerated response to stimuli, leading to excessive bronchial narrowing (Mims, 2015, September).

Acute Care Across Lifespan - Question 2a

  • Airway remodeling
  • Medication side-effects

Commonly used Salbutamol has been found to have some side-effects (Siddique, & Diwakar, 2018).

Acute Care Across Lifespan - Question 2b

Airway remodeling

Asthma can cause airway remodeling in some people. It can cause permanent changes in structural cells and tissues of airway. It includes change in cellular and extracellular matrix, epithelial cell apoptosis, loss of ciliated cells, goblet cell hyperplasia, softening in the bronchial cartilage, abundance of blood vessels and increase in number of smooth muscle cells. These structural changes can lead to decreased lung function, prolonged coughing, stiffening of airway wall, amplified mucus production and more blood flow in the airway (Fehrenbach, Wagner & Wegmann, 2017).

Acute Care Across Lifespan - Question 3a

Salbutamol is used in the treatment of mild to severe asthma. Salbutamol stimulate Beta-2 adrenergic receptors present in bronchial smooth muscles (Neame, et al 2015).

Salbutamol promotes the synthesis of cyclic adenosine monophosphate(cAMP). This Camp promotes the increased binding of calcium ions to the cellular membrane. It leads to reduced calcium concentration which causes the dilation of bronchial smooth muscles (Andrzejowski, & Carroll, 2016).

Acute Care Across Lifespan - Question 3b

Side effects of salbutamol are light-headedness, migraine and high-blood pressure (Siddique, & Diwakar, 2018).

Acute Care Across Lifespan - Question 3c

Following are the nursing responsibilities with regards to two of the medication side-effects.

The structure of Beta2-adrenergic receptor agonists is resembling the structure of hormones which plays an important role in the cardiovascular system. It includes rising of the cardiac contractility, the pressure of the pulse and heart rate (Feitoza, et al 2017). Careful monitoring is required by the nurses. This is because with the increased heart rate there can be cardiac arrhythmia, decrease in cardiac output, pulmonary oedema and myocardial ischemia. Beta-2 agonist dilators for bronchi are made in such a way that they can attach selectively to β2-receptors present in the lungs. However, it can sometimes get bonded to sympathetic receptors in other organs when high dosage of this drug is given leading to side effects.

Hypokalemia is a potentially serious side effect of salbutamol (Lorensia, et al 2016). It causes depletion of serum potassium. It can be treated by taking oral potassium supplements or in some cases intravenously.

Acute Care Across Lifespan - Question 4

Nursing assessments have to be carried in this case. Francis has fever and enlarged cervical glands. These glands are lymph nodes which are swollen due to allergies or sinusitis and these trigger the asthma attacks (Kiboneka, & Kibuule, 2020). Additionally, she had fever therefore, assessments have to be carried out for diagnosing the infections. Infections can trigger the asthma attack (Hewitt, et al 2016). Assessment has to be done for the respiratory rate, rhythm and depth. Allergy testing and x-ray imaging can also be done.

Acute Care Across Lifespan - Question 5

Wheezing is a musical high-pitched sound that is produced due to turbulence in the airflow (Silva-Estrada, et al 2018). This sound is produced due to the vibrations in the narrowed airway walls which is caused by the reduced velocity of the air flow. The characteristic of this sound is inclusive of its amplitude and pitch. The pitch shows the stiffness, longitudinal tension and thickness of the airway. This also points out at the severity of air passage obstruction. The extent of bronchial obstruction is found to be proportional with the number of air passages that are producing wheezing sound (Patel, Mirabile, & Sharma, 2020).

Acute Care Across Lifespan - Question 6

The fur of cats can act allergens for the patients who have respiratory illness like the asthma patients. Cats are persistent sources of indoor allergens (Ownby, & Johnson, 2016).

Acute Care Across Lifespan - Question 7

Three of the priorities for Francis are the risk of an impending respiratory failure, infection and hypoxemia. The lymph nodes of the patients are moderately enlarged which is pointing at the infection and because of infection there is fever condition. Further, the wheezing also points at the narrowing of the passage and of an impending respiratory distress (Patel, Mirabile, & Sharma, 2020). The patient may require ventilators for breathing easily (Fergeson, Patel, & Lockey, 2017).

Hypoxima can occur as the patient is unable to breathe in oxygen. With this there is less volume of oxygen in the lungs and this leads to reduced oxygen concentration in the blood (Deana, et al 2019).

Acute Care Across Lifespan - Question 8

Nursing interventions for wheezing and hypoxemia.

Nurse has to assess the respiratory rate, rhythm and depth. There can be changes in the respiratory rhythm and rate which is an early indication of impending distress of the respiratory system. Assessment has to be done for the abnormal breath sounds of wheezing as these occur due to bronchospasm (Anderson, et al 2016). Wheezing may be associated with pneumonia (Rhim, et al 2019).

Arterial blood gases have to be monitored as there can be hypoxemia and this leads to elevated respiratory depth and rate and carbon dioxide is blown out. There may be pending respiratory failure and hence may require mechanical ventilation (Sekiguchi, et al 2019). Bronchodilators have to be given. Corticosteroids like Budesonide can be given for reducing the inflammation of the airways and reduce the mucus made by the bronchial tubes.

Acute Care Across Lifespan - Question 9

Two strategies for education an asthma patient are as follows:

The nurses must explain asthma and help the patient recognize the symptoms. The possible allergies and other factors which can lead to asthma attack must also be explained (Evans-Agnew, & Cooper, 2016). 

The medications which can be given for immediate relief must be made known to the patient. Side-effects of the medications also have to be told to the patients. Proper use of multiple inhalers has to be taught to the patient as these require different techniques (Scullion, 2018).

Acute Care Across Lifespan - Question 10a

Bronchodilators improve breathing and cessation of wheezing sound (Pollock, et al 2017).

Acute Care Across Lifespan - Question 10b

The respiratory rate, rhythm and depth will be evaluated for ascertaining the effectiveness of the medications. This will ensure that the patient has normal breathing. A chest X ray can be obtained for ascertaining that the airway passage is clear and the mucus has been removed by the medications (Patel, Mirabile, & Sharma, 2020). These two signs will ensure that the patient is having normal breathing and this will help in restoring the reduced oxygen level in body as well.

Acute Care Across Lifespan - Question 11

The nurse must address the Francis’ anxiety. For dealing with this patient, the nurse must use empathetic communication so that she feels relaxed (Meng, 2017). This will also help her in taking bronchodilators effectively. A quiet environment can be provided for managing the anxiety as it helps in relaxation the anxious patient (Gutiérrez, & Rodríguez, 2020). Soft music can be accompanied. By maintaining calmness there is reduction in oxygen consumption and the body’s work for breathing.

Nurse should stay with her and encourage slow and deep breathing. Muscle relaxation technique like pursed lips and diaphragmatic breathing should be encouraged (Mendes, et al 2019). Imagery and repetitive phrase such as ‘relax and let go’ must be used for helping the patient come over the anxiety state (Saha, et al March, 2015). Relaxation techniques are effective methods for overcoming anxiety.

References for The Immunology of Asthma

Anderson, H. M., Lemanske Jr, R. F., Evans, M. D., Gangnon, R. E., Pappas, T., Grindle, K., ... & Jackson, D. J. (2016). Assessment of wheezing frequency and viral etiology on childhood and adolescent asthma risk. J Allergy Clin Immunol, 139(2), 692-694.

Andrzejowski, P., & Carroll, W. (2016). Salbutamol in paediatrics: pharmacology, prescribing and controversies. Archives of Disease in Childhood-Education and Practice101(4), 194-197.

Deana, C., Conangla, L., Vetrugno, L., Saltarini, M., Buttera, S., Bove, T., ... & De Monte, A. (2019). Persistent hypoxemia after an asthma attack. The ultrasound journal11(1), 6.

Evans-Agnew, R., & Cooper, C. (2016). Asthma education: Five key messages. Nursing made Incredibly Easy14(4), 22-30.

Fehrenbach, H., Wagner, C., & Wegmann, M. (2017). Airway remodeling in asthma: what really matters. Cell and tissue research367(3), 551-569.

Feitoza, M. D. S., Melo, J. R. D., Medeiros, W. M., Cucato, G. G., Stelmach, R., Cukier, A., ... & Mendes, F. A. R. (2017). Effect of salbutamol on the cardiovascular response in healthy subjects at rest, during physical exercise, and in recovery phase: a randomized, double-blind, crossover study. Motriz: Revista de Educação Física23(3).

Fergeson, J. E., Patel, S. S., & Lockey, R. F. (2017). Acute asthma, prognosis, and treatment. Journal of Allergy and Clinical immunology139(2), 438-447.

Garagorri-Gutiérrez, D., & Leirós-Rodríguez, R. (2020). Effects of physiotherapy treatment in patients with bronchial asthma: A systematic review. Physiotherapy Theory and Practice, 1-11.

Hewitt, R., Farne, H., Ritchie, A., Luke, E., Johnston, S. L., & Mallia, P. (2016). The role of viral infections in exacerbations of chronic obstructive pulmonary disease and asthma. Therapeutic advances in respiratory disease10(2), 158-174.

Kiboneka, A., & Kibuule, D. (2020). The Immunology of Asthma. EC Paediatrics9, 01-12. Retrieved from https://www.ecronicon.com/ecpe/pdf/the-immunology-of-asthma.pdf

Lorensia, A., Ikawati, Z., Andayani, T. M., Maranatha, D., & Wahjudi, M. (2016). Comparison of electrolyte disturbance of using intravenous aminophylline versus nebulization salbutamol for exacerbation asthma in Surabaya, Indonesia. International Journal of Pharmaceutical and Clinical Research8(4), 221-228.

Mendes, L. P., Moraes, K. S., Hoffman, M., Vieira, D. S., Ribeiro-Samora, G. A., Lage, S. M., ... & Parreira, V. F. (2019). Effects of diaphragmatic breathing with and without pursed-lips breathing in subjects with COPD. Respiratory care64(2), 136-144.

Meng, Y. (2017). Alleviating Anxiety of Asthmatic Children: Engaging Design into Cognitive Behavior Therapy (Doctoral dissertation, University of Cincinnati).

Mims, J. W. (2015, September). Asthma: definitions and pathophysiology. In International forum of allergy & rhinology (Vol. 5, No. S1, pp. S2-S6).

Neame, M., Aragon, O., Fernandes, R. M., & Sinha, I. (2015). Salbutamol or aminophylline for acute severe asthma: how to choose which one, when and why?. Archives of Disease in Childhood-Education and Practice100(4), 215-222.

Ownby, D. R., & Johnson, C. C. (2016). Dogs, cats, and asthma: Will we ever really know the true risks and benefits?. Journal of Allergy and Clinical Immunology138(6), 1591.

Patel, P. H., Mirabile, V. S., & Sharma, S. (2020). Wheezing. In StatPearls [Internet]. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482454/

Pollock, M., Sinha, I. P., Hartling, L., Rowe, B. H., Schreiber, S., & Fernandes, R. M. (2017). Inhaled short‐acting bronchodilators for managing emergency childhood asthma: an overview of reviews. Allergy72(2), 183-200.

Rhim, J. W., Kang, H. M., Yang, E. A., & Lee, K. Y. (2019). Epidemiological relationship between Mycoplasma pneumoniae pneumonia and recurrent wheezing episode in children: an observational study at a single hospital in Korea. BMJ open9(4), e026461.

Saha, S., Dey, D., Bhattacharyya, I. M., & Das, A. (2015, March). An investigation on biofeedback analysis and psychosomatic applications. In 2015 International Conference on Recent Developments in Control, Automation and Power Engineering (RDCAPE) (pp. 38-43). IEEE.

Scullion, J. (2018). The nurse practitioners’ perspective on inhaler education in asthma and chronic obstructive pulmonary disease. Canadian Respiratory Journal2018. https://doi.org/10.1155/2018/2525319

Sekiguchi, H., Kondo, Y., Fukuda, T., Hanashiro, K., Baba, M., Sato, Y., ... & Matumoto, T. (2019). Noninvasive positive pressure ventilation for treating acute asthmatic attacks in three pregnant women with dyspnea and hypoxemia. Clinical Case Reports7(5), 881.

Siddique, F., & Diwakar, G. V. (2018). Assessment of Asthmatic Patients Treated with Salbutamol: A Hospital Based Study. Journal of Advanced Medical and Dental Sciences Research6(4), 20-22.

Silva-Estrada, J., Reyna-Figueroa, J., Wakida-Kusonoki, G., Limón-Rojas, A., & Campos-Romero, F. (2018). Wheezing Disorders in Childhood. Clinical Case Reports International-Respiratory Medicine2(2)..

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 sciences20(7), 1733.

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