Acute Care Across the Lifespan

Question 1

Asthma is a respiratory disorder that is mainly instigated by exposure to allergens, pollutant and person having some hidden allergies. These triggers bring about characterized inflammation and bronchospasm, upon reaction to the same. This can aggravate in patient having a build-up of mucus production, which ultimately blocks the air passages, making them more constricted for air to flow properly (Sullivan, 2016). Wheezing is classical sign observed in such patients, especially during end phases of expiration. When air passes through these constricted passages, they make a whistling sound, heard in the form of wheezing, on auscultation of lower lung spaces.

Question 2 (a)

The patient in the case study, has had multiple episodic events before. Two of the biggest complications that can be observed in this patient are, repeated visit to the healthcare facilities and permanent damage to the tissues surround lung and air passages (Russkamp, 2019). As asthma is a slow and progressive disease, upon any exposure to the allergens, it can magnify.

Question 2 (b)

The patient in the case study must have had an allergic response to the cat present in the apartment. Due to repetitive incidences of asthma, the lung passages deteriorate, eventually leading to reduced lung capacities and reduced overall functioning due to fatigue (Herman, 2016). These elements can cause permanent tissue damages in the patient, thus, reducing overall quality of life.

Question 3 (a)

Salbutamol is a primary drug choice, used as an inhaler to manage asthma. It is a long acting beta-2 receptor stimulator, which upon administration, results in relaxation of the smooth muscles (Quan, 2017). This is helpful to bring about bronchodilation in the air passages and allowing the patient to breath easily.

Question 3 (b)

Two main side effects of salbutamol observed in patients include:

1. Slow, fast or sometimes, an uneven heartbeat.

2. It is also found to make patient nervous and restless at times (Agarwal, 2018).

Question 3 (c)

Nursing consideration include the following:

1. The patient should be checked for any history of heart condition or hypersensitivity to the drug.

2. The vitals of the patient can be monitored before and after administration of the drug. This will be helpful in managing any possible side-effects from drug administration.

Question 4

The further nursing assessment that can be carried out in such cases include:

1. The drug dose modification should be done on a regular basis, so as to improve the efficacy of the drug for the patient.

2. Patient should be assessed for any other side effects such as dizziness, fatigue, lethargy.

3. Certain diagnostic tests can be helpful in determining the current clinical condition of the patient. These tests can include getting a chest x-ray done for noting the damages to the lung passages, carrying out pulmonary function tests for evaluating the lung capacities of the patient (Askari, 2016).

4. The patient can also be assessed pulmonary rehabilitation for improving respiratory strength and endurance.

Question 5

The patient was found to have a wheezing sound in her expiratory phase. With the progression of the disease of Asthma, the lung passages tend to narrow down and constrict. When the air passes through these constricted passages, it tends to make a whistling sound. This sound is heard in the form of wheezing. This is generally observed on auscultation, during the end expiration done by the patient. With a forceful exist from the narrowed lung passages, the sound magnifies and heard in the form of a wheeze or whistle (Pasterkamp, 2018).

Question 6

Asthma is usually caused by inhalation of allergens. These particles can bring about a response in the immune system as an allergic response to allergens. Lots of pets are found to trigger an allergic reaction (Del, 2017). This can overreact with the immune system and can bring about asthmatic changes.

Question 7

The three main nursing priorities in this case are as follow:

1. High blood pressure- The patient is in a hypertensive state and this is harmful for her, given her breathlessness. This can also be due to anxiety and for compensating the respiratory loss.

2. High heart rate- The patient is in tachycardia. This can also be due to underlying distress and shortness of breath. Due to shortness of breath the oxygenation to the body can be lowered. This might put an additional pressure on the patient heart and thus, reflecting signs of increased heart rate.

3. Wide spread wheezing- This can be due to wide spread bronchospasm the patient might be feeling due to allergic response of her asthma. Severe bronchospasm, leads to severe bronchoconstriction and eventually leading to difficulty in attaining normal breathing pattern. This is observed as wheezing in asthma patients.

Question 8

The two interventions that can be useful in this scenario can include:

1. Assessing the vitals of the patient- This can include assessing for respiratory rate, heart rate, blood pressure etc. With the onset of the condition the patient might experience hypoxia or hypercapnia in the initial phases of manifestation of the condition. These changes are vital from the point of monitoring the patient for respiratory failure.

2.Assessing for the breath sound- Adventitious sounds can be a vital source to assess for worsening chest condition. It can also be helpful in detecting problems like pneumonia, which is common to be observed due to chest infection. Diminishing wheezing sounds in asthma can be indicative of impeding respiratory failure in the patient (Tabata, 2018).

Question 9

Frances can be educated by the two following methods:

1. Staying away from triggers- As the patient might have developed an allergic reaction to cat exposure, she might restrain from any kind of pet for future instances. She can also be educated on avoiding rigorous exercises or activities, that might act as a trigger for her asthma.

2. Contacting emergency- The patient can also be taught to call up the emergency department at the first sign of the disease. This will help in preventing acute exacerbation episodes of asthma and will help in providing required care within the required time span (Bäuerle, 2017).

Question 10 (a)

The two signs indicating that the patient is already recovered are as follow:

1. The patient is having normal body temperature. This shows that she is not having any active infection.

2. The patient is having a clear discharge from her nose. This also indicates that the patient is not having any productive cough and sputum.

Question 10 (b)

The patient can be evaluated on the basis of blood culture. This will be helpful in indicating any underlying infection patient might be having. The patient can also be analysed for sputum analysis. This is another method which can help in identifying any underlying infection.

Question 11

The anxiety of the patient can be managed by the following methods:

1. The patient can be encouraged to stay calm. This can be done by asking the patient to take deep breaths, rather them making small talks. This will help in calming as well as restoring normal breathing pattern.

2. The patient can be transferred into loose clothing’s to promote the breathing and making it a bit ease for her (Tighe, 2019).

3. The patient can also be given an epinephrine injection. As the patient is having a probable allergic reaction to exposure. This medication can also help in lowering the impact of the condition by multiple folds.

Reference for The Microbiome and The Pathophysiology of Asthma

Agarwal, R., Dhooria, S., Sehgal, I. S., Aggarwal, A. N., Garg, M., Saikia, B., ... & Chakrabarti, A. (2018). A randomized trial of itraconazole vs prednisolone in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Chest153(3), 656-664. DOI

Askari, V. R., Alavinezhad, A., & Boskabady, M. H. (2016). The impact of “Ramadan fasting period” on total and differential white blood cells, haematological indices, inflammatory biomarker, respiratory symptoms and pulmonary function tests of healthy and asthmatic patients. Allergologia Et Immunopathologia44(4), 359-367. DOI

Bäuerle, K., Feicke, J., Scherer, W., Spörhase, U., & Bitzer, E. M. (2017). Evaluation of a standardized patient education program for inpatient asthma rehabilitation: impact on patient-reported health outcomes up to one year. Patient Education and Counseling100(5), 957-965. DOI

Del Giacco, S. R., Bakirtas, A., Bel, E., Custovic, A., Diamant, Z., Hamelmann, E., ... & Seys, S. (2017). Allergy in severe asthma. Allergy72(2), 207-220. DOI

Herman, T., Sonnenschein-Van Der Voort, A. M., De Jongste, J. C., Anessi-Maesano, I., Arshad, S. H., Barros, H., ... & Devereux, G. (2016). Early growth characteristics and the risk of reduced lung function and asthma: a meta-analysis of 25,000 children. Journal of Allergy and Clinical Immunology137(4), 1026-1035. DOI

Pasterkamp, H. (2018). The highs and lows of wheezing: a review of the most popular adventitious lung sound. Pediatric Pulmonology53(2), 243-254. DOI

Quan‐Jun, Y., Jian‐Ping, Z., Jian‐Hua, Z., Yong‐Long, H., Bo, X., Jing‐Xian, Z., ... & Cheng, G. (2017). Distinct metabolic profile of inhaled budesonide and salbutamol in asthmatic children during acute exacerbation. Basic & Clinical Pharmacology & Toxicology120(3), 303-311. DOI

Russkamp, D., Aguilar‐Pimentel, A., Alessandrini, F., Gailus‐Durner, V., Fuchs, H., Ohnmacht, C., ... & Blank, S. (2019). IL‐4 receptor α blockade prevents sensitization and alters acute and long‐lasting effects of allergen‐specific immunotherapy of murine allergic asthma. Allergy74(8), 1549-1560. DOI

Sullivan, A., Hunt, E., MacSharry, J., & Murphy, D. M. (2016). The microbiome and the pathophysiology of asthma. Respiratory Research17(1), 163. DOI

Tabata, H., Enseki, M., Nukaga, M., Hirai, K., Matsuda, S., Furuya, H., ... & Mochizuki, H. (2018). Changes in the breath sound spectrum during methacholine inhalation in children with asthma. Respirology23(2), 168-175. DOI

Tighe, D. A. (2019). Educational Guide for Patients and Families. Pocket Guide to Stress Testing, 393-406. DOI

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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