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Head Injury in An Asthmatic Patient with Recent Alcohol Intake

Description of The Case

There is an inextricable and bidirectional link between alcohol and traumatic injury of the brain. There is an emerging inverse relationship between traumatic injury of the brain which can serve as a risk factor and lead to alcohol use disorder. Any bump or laceration or a penetrating brain injury defines neurological dysfunction which characterizes the traumatic injury of the brain (Weil, 2018). Zac Smyth, a 19 years old male, was brought in by ambulance after an alleged altercation when the patient’s head struck the road at 2300 hrs. The patient refused the lack of consciousness but was unable to remember all events. Zac Smyth also underwent a laceration in the back of his head after drinking alcohol at night. There were no other visible injuries. He also denies the use of drugs and states have had about 6 beers since 6 am. His breath test revealed that alcohol was taken (0.08 per cent) at 2230 hours. The patient estimates pain in occipital area to be 5 out of 10 with no analgesia taken prior to the presentation. His has a past medical history of childhood asthma and has been up to date with immunization. Additionally, his last tetanus shot was 12 months ago. Zac did not report any known allergies and was not on any medication. He has, however, reported a shortness of breath and tightness in the chest. Asthma is defined as a chronic disorder involving the respiratory system which can be characterized by various symptoms, bronchial hyper-responsiveness, and an underlying inflammation (Chaudhry & Bordoni, 2020). Asthma is fundamentally associated with the airway or the bronchial tract with its essential activity to disperse air all through the respiratory tract until it arrives at the alveoli in the lungs (Patwa & Shah, 2015). The ICF offers meanings of working and handicap, in view of the understanding that the term envelops all parts of the body's capacities, exercises and limitations to interest. Functionality is prioritised as a health component within the ICF, considering the environment both as a facilitator and as a barrier to performing activities and for participation (Piexak, 2015). Thus, disability is the result of a series of situations and conditions that include the environment, health and personal conditions. In asthmatic patients, the physiologic component varies because of irritation and diminishing the sweep of the airway. These systems altogether bring a change in the lung consistency somewhat to expand the respiratory load (Chaudhry & Bordoni, 2020).

Description and Justification of Intervention

Asthma can portray a somewhat unique clinical picture, and physicians must distinguish them (Weil, 2018). The patients of asthma can typically, however are not restricted to, wheezing, cough, shortness in breath or dyspnea which is often more amplified around evening time. There can be different triggers which increase asthma e.g. cold air, work out, and the contaminations recorded previously. (Park & Khattar, 2019). Also Zac Smyth suffered from childhood asthma. It is known that asthma has two stages, it becomes empirical to attempt to target and restrict bronchoconstriction, aggravation, and respiratory tract renovating. Since Zac Smyth is 19 year old having a very active lifestyle, thereby defining his state of bronchoconstriction with acute phases of exacerbation.

Nurses provide ambulatory support as method of intervention in the management of asthmatic patients admitted in the emergency department by providing basic airway support and bronchodilators. They manage by two strategies as priority i.e. by giving adequate ABC, loosening of tight clothes of the patient and ensuring proper airway by administering expectorants for production of cough followed by adequate oxygen support (Sinyor, 2020). From this point of view, it is perceived ICF contributes as a hypothetical structure for nursing research. It could have an impact on the medical services experts/attendants, alongside different citizenry, share duty in the arranging and improvement of innovation that comprises facilitators for exercises and the support of individuals in various life circumstances. Seeing, accordingly, that the presentation of these individuals can be improved by ecological changes, for example, physical, social and additionally attitudinal, it offers alternate points of view of an extended perspective on wellbeing: organic, individual and social (Piexak, 2015). For certain patients, risks involved could be if the improvement of incessant aggravation might be related with lasting modifications in the airway route structure—alluded to as respiratory route renovating—that are not forestalled by or completely receptive to presently accessible medicines.

Identification of Another Health Professional in The Team and Description of His/her Role

Many a times the patients in the emergency department are looked after for their immediate need e.g. head injury in case of Zac Smyth. In such cases, often the chronic disease is overlooked by the health professional if he is treated alone. A delay in the care occurs and a lot of patients are disappointed by this lack of reaction because it can lead to emergency hospitalizations. They expect thus a faster reaction, appropriate for each asthmatic patient’s particular situation. Beyond exacerbations, a proactive attitude is valued by patients. This means that the professional has a look on their asthma even if it is not the main reason for support by another professional. An additional medical attendant i.e. assistant is required to help give airway support and maintain the patency of airway as the nurse takes care of the head injury wound. The assistant is needed to pacify and clam the patient too as anxiety can also be looked upon as a major factor leading to an asthmatic attack. Asthmatic patients expect from their healthcare professional like nurses that they closely collaborate with their teammates such as their assistants. One example often mentioned is the lack of shared information between the nurses and the assistants, yet privileged partners in asthma management (Seret, 2019). Working and incapacity related with medical issue are ordered in the ICF. In this way, ICD-10 and the ICF are correlative and give a huge and more extensive perspective on human wellbeing, which may add to dynamic (Piexak, 2015).

Specification of Professionalism Characteristics

Professionalism means first characteristic of the professionals to address to the patients’ needs - for example, patients suffering from Asthma require exhaustive information such as the genesis, its underlying causes and the way it affects their lung processes. Also, they want to be informed about the symptoms to be able to recognize them, their individual trigger and how to prevent it (Seret, 2019). Another point of concern is the lack of coherence between healthcare professionals’ instructions and dosages recommended in medication leaflets. Information must be clear by the use of simple vocabulary instead of medical jargon.

Second professional characteristic is to provide patients more consulting time to approach all topics for which advice or support is requested. The professional is expected to notice if the patient wants to adopt a more passive attitude or else wants to be involved in a relationship oriented on a partnership between the two sides. For these last patients, they expect to take part in the diagnostic, co-construct the treatment plan and share the decisions.

The third professional characteristic demands the patient to be respected in his uniqueness. He should be treated as a whole and not as a diseased. Acknowledging the patients past experience also instils in them a wave of confidence in their healthcare professionals. Moreover, this quality strengthens their will to build a partnership because it opens a space to the expression of patient standpoint of asthma, individual triggers or prescribed treatment (Seret, 2019).

Description and Justification of Person-Centred/ Population-Centred Strategies

Instead of population centred/goal centred, patient centred approach in the caring of the patients suffering from chronic diseases is important such as in the case of Zac Smyth as they have been a victim of asthma since age 5, it becomes imperative for nurses to give them individual attention. This approach encourages shared control of consultation, views in managing of their health problems or focus on the consultation of the patient holistically who has personal preferences embedded in social contexts. The first strategy in patient centred approach can also be translated into a shortening of waiting time length to obtain an appointment a follow-up call from the healthcare professional after an unscheduled consultation or an emergency room visit is perceived as reassuring and the result of a real availability. Evidence suggests the second strategy to patient-centredness suggests numerous associations with their outcomes in patients, e.g. ways to activate the suffering patient than just considering their perspective have resulted consistently in good outcomes in terms of their health. This strategy is implemented when a part of the consultation is devoted to the free expression of the patient’s feelings about the illness or the treatment so that a window would be opened to the expression of fears, worries or all other questions. Some studies have criticized the patient centred approach as being superfluous with lack of grounding evidence in improving the key aims in the relationships of patient-doctor or in facilitating their participation in decision making (Burt, 2014).

In cases of asthma which is asymptomatic for years with an absence of explicit symptoms may lead to a decrease in priority of care planning for the patients and healthcare professionals. Care planning approaches vary, depending upon the current status and severity of the condition. As was in the case of Zac Smyth, care planning took a back seat all these years until now when she felt an acute exacerbation of her symptoms which prioritized her chronic condition for care planning. The most important moderator for clinical treatment for care planning is in fulfilling the patient’s needs with multimorbidity who are representative of a major part of the workload in primary care (Burt, 2014).

References for Outdoor Air Pollution and Asthma

Amador, C., Weber, C., Varacallo, M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 10, 2020. Anatomy, Thorax, Bronchial. [PMC free article] [PubMed]

Burt, J., Rick, J., Blakeman, T., Protheroe, J., Roland, M., & Bower, P. (2014). Care plans and care planning in long-term conditions: a conceptual model. Primary Health Care Research and Development15(4), 342–354. https://doi.org/10.1017/S1463423613000327

Chapman, D.G. and Irvin, C.G. (2015). Mechanisms of airway hyper-responsiveness in asthma: the past, present and yet to come. Clinical and Experimental Allergy, 45(4), 706-19. [PMC free article] [PubMed]

Chaudhry, R. and Bordoni, B. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL)Jul 31, Anatomy, Thorax, Lungs. [PMC free article] [PubMed]

D'Amato M, Vitale C, Molino A, Lanza M, D'Amato G. (2018.). Anticholinergic drugs in asthma therapy. Current Opinion in Pulmonary Medicine.23(1), 103-108. [PubMed]

Guarnieri, M., & Balmes, J. R. (2014). Outdoor air pollution and asthma. Lancet (London, England)383(9928), 1581–1592. https://doi.org/10.1016/S0140-6736(14)60617-6.

Kudo, M., Ishigatsubo, Y. and Aoki, I. (2013) Pathology of asthma. Frontiers in Microbiology, 10,4,263. [PMC free article] [PubMed]

 Maio, S., Baldacci, S., Carrozzi, L., Pistelli, F., Angino, A., Simoni, M., Sarno, G., Cerrai, S., Martini, F., Fresta, M., Silvi, P., Di, Pede, F., Guerriero, M., Viegi, G. (2016) Respiratory symptoms/diseases prevalence is still increasing: a 25-yr population study. Respiratory Medicine.,110,58-65. [PubMed]

 Froidure, A., Mouthuy, J., Durham, S. R., Chanez, P., Sibille, Y. and Pilette, C. (2016). Asthma phenotypes and IgE responses. European RespiratoryJournal, 47 (1) 304-319; DOI: 10.1183/13993003.01824-2014

Park, S.B. and Khattar, D. (2019). Tachypnea. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2019. PMID: 31082106.

Patwa, A. and Shah, A. (2015) Anatomy and physiology of respiratory system relevant to anaesthesia. Indian Journal of Anaesthesiology, 59(9):533-41. [PMC free article] [PubMed]

Piexak, D.R., Cezar-Vaz, M.R., Bonow, C.A. & Santos, S.S.C. (2015). How Nurses are Using the International Classification of Functioning, Disability and Health: An Integrative Review. Aquichan, 15(3): 351-367. DOI: 10.5294/aqui.2015.15.3.4.

Seret, J., Gooset, F., Durieux, V., Lecocq, D., & Pirson, M. (2019). What means a quality professional-patient relationship from the asthmatic patients' perspective? A narrative review of their needs and expectations. Patient Preference and Adherence13, 1951–1960. https://doi.org/10.2147/PPA.S213545

Sinyor, B. and Perez, L.C. Stat Pearls. [Internet]. Pathophysiology of asthma. Copyright © 2020, StatPearls Publishing LLC. 10 July 2020. Bookshelf ID: NBK551579PMID: 31869060.

Weil, Z. M., Corrigan, J. D., & Karelina, K. (2018). Alcohol use disorder and traumatic brain injury. Alcohol Research: Current Reviews39(2), 171–180.

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