Q.1. Explain the pathogenesis causing the clinical manifestation with which Poppy presents.
Pathogenesis of Asthma:
Asthma itself is a disorder of breathing with recurring tendency.
There are many kinds of pathogenesis of Asthma. The primary cause behind this is inflammatory disorder of airways. It may cause by different changes likewise:
Bronchoconstriction: In acute Asthma it is found the bronchial muscles contracts quickly to make the airways narrow, in the reaction to the contact of different stimulants. This facilitates acute Bronchoconstriction or the severe Asthma. It mainly happens with a IgE dependent excretions of mast cells including tryptase, leukotrienes, histamine etc. Sometime medicines like Aspirin or any anti-inflammatory drugs can also cause the disease.
Edema of Airways: Its vulnerability is more than others . Acute Asthma can be a cause of this because it becomes persistent and the inflammation becomes recurring. It limits the airflow more immensely.
Hyper responsiveness to airways: Sometime wide varieties of stimulants are available in air. For hyper responsiveness to these can be a cause of this kind of Asthma.
Remodeling of Air: Sometime changes in the structures of Airways can be a cause of this kind of Asthma
Apart of the inflammatory of airways there are also many kinds of reasons.
Low immune system: There some kind of patient whose low immune makes them prone to asthma. Reactivates to the allergic substances in the air may lead to short of breath.
Mast Cells: It has an early connection with Asthma. Sometime it causes for presence of Mast cells like Mast cell dependent drugs.
Eosinophils: It is a prominent cell causing inflammation.
Here the clinical manifestation of the child is short of breath, she was suffering from recurring respiratory problem which was getting worsened from time to time. She was unable to speak full sentence or undertake a peak flow.
2. How does positioning a patient with acute asthma in High Fowler’s position to assist to alleviate respiratory diseases?
The solution to sit in a semi-Fowler’s position, there the patient has to straighten the knees with chest held high. It is the best option to transport oxygen through the expansion of chest position. It is very much helpful for the patients who have a sudden failure of breathing (Aggarwal et
al.,2018). It is also helpful for people with lightweight and comparatively light volume people. There are mainly three types of Fowlers' position – High fowler's position, Semi Fowler's Position, low Fowler's position. All of them are helpful for the Respiratory problem (Emilsson, M., 2017).
As per our case study, the child is 9 years old and 40 kgs so she can be treated with this position. As she is too young, It would may help her. This position will be helpful in this case. As the parent of the child said that she has no history of chronic Asthma so this kind of posture will be helpful for her.
What oxygen delivery Devices will be used?
There are many kinds of Oxygen delivery devices available in the market. They are like Nasal Cannulae, Oxygen Therapy, venture mask and non-rebreather mask etc. Here as the child is not able to breathe and also in a critical condition for the oxygen need there we will choose the non-rebreather mask. This mask will provide the highest concentration of oxygen so it will ease the child for breathing.
Why the device was chosen?
The mask will fully cover the mouth and the nose and it is also connected with a reservoir bag of oxygen. Their simplex valves prevent exhaled air from entering in the Reservoir. So it is a very modern technology of oxygen control (Makhinova, 2019).
How does this device will be helpful for a poppy?
As the device will transport a great amount of oxygen to the child so it will be very much easy for her to take control over breathing (Chan et al.,2018). These kinds of masks will be helpful for us. Acute asthma has a great impact on the child's health, she got to recover soon.
Explanation of each medication
Salbutamol via Nebulizer:
Mechanism of Action: It is a fast acting adrenergic receptor agonist used for relief of Asthma. It mainly stimulates beta adrenergic receptors which previously dominant receptors in the smooth muscle of bronchial region. It leads to activation of the enzyme that forms cyclic AMP from ATP. It also increases the circular AMP which relaxes the smooth muscle of bronchial regions and also declines the resistance of airways by downgrading the intracellular concentration of Calcium. It comforts the smooth muscle from trachea to bronchioles. Increased AMP can also stimulate the excretion of Histamine, leukotreine from the mast cell of Airways. It also helps to occur less cardiovascular effects.
She is receiving this medicine because she had acute asthma attack, which causes the respiratory failures and short of breath.
The nursing consideration of this condition is to continue nebulizing for 2.5 mg bid
The response expected to be good and satisfying.
This treatment should be continued until the whole situation is under control.
In is also an anti-inflammatory medicine. It is a kind of adrenocortical steroid. It is mainly have similarities to human natural hormone cortisol produced by adrenal glands. IT has anti inflammatory action and also suppresses the response to immune. It is thought to be binding with a steroid receiver. It decrease the inflammation by stabling the leukocyte lysosomal Membrane. It also antagonizes the histamine activity.
She is having this medicine because she had inflammation.
It is dependent on the condition of severity, thus the dosages are planned. It also depends on the age and weight. Dosages are mainly 20-240mg per day in single or divided doses.
The response expected to be good.
The treatment should continue until the she will be able to move properly.
Ipratropium Bromide via Nebuliser
It is mainly important to increase the reactions to the treatments for the patients with chronic obstructive pulmonary disease. It works on anticholinergic way. It produces great bronchodilation results when it is taken in recommended dosages. It also blocks the action of Acetylcholine.
She is having this medicine as she had respiration problem.
It is to be found to be given as a dosage of 500 mcg with 3 to 4 times a day.
The response expected to be good for her breathing. Her condition is critical so breathing dosages are to be given
The treatment should be continued until the situation goes to normal.
Chan, A.H., De Simoni, A., Wileman, V., Holliday, L., Chisari, C., Newby, C.J., Taylor, S.J., Fleming, L.J., Griffiths, C.J. and Horne, R., 2018. Digital interventions to improve adherence to maintenance medication in asthma. Cochrane Database of Systematic Reviews, (5).
Aggarwal, A.N., Kumari, R. and Grover, S., 2018. Patient satisfaction with inhaled medication for asthma. Respiratory care, 63(7), pp.859-864.
Makhinova, T., Barner, J.C., Brown, C.M., Richards, K.M., Rascati, K.L., Rush, S. and Nag, A., 2019. Examination of Barriers to Medication Adherence, Asthma Management, and Control Among Community Pharmacy Patients With Asthma. Journal of Pharmacy Practice, p.0897190019840117.
Walek, S., McDonald, A. and Wolff, R., 2017. An Investigation Into the Evidence Behind Budesonide/Formoterol (Symbicort®) Usage in the Outpatient Setting as Reliever Medication for Asthma.
Emilsson, M., 2017. Treatment adherence in Asthma and Attention Deficit Hyperactivity Disorder (ADHD), Personality traits, Beliefs about medication and Illness perception (Vol. 1597). Linköping University Electronic Press.
Cheng, Q.J., Huang, S.G., Chen, Y.Z., Lin, J.T., Zhou, X., Chen, B.Y., Feng, Y.L., Ling, X., Sears, M.R. and RELIEF Asia Study investigators, 2016. Formoterol as reliever medication in asthma: a posthoc analysis of the subgroup of the RELIEF study in East Asia. BMC pulmonary medicine, 16(1), p.8.
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