Acute Severe Asthma Concept Map

This assignment focuses on creating a concept map to illustrate the complexities of acute severe asthma. Students are expected to demonstrate their understanding of the interplay between host factors, environmental triggers, clinical manifestations, and management strategies for this life-threatening condition. The assignment emphasizes the importance of visual learning tools in healthcare education.

Concept Map

Table of Contents
INTRODUCTION...........................................................................................................................1
TASK ..............................................................................................................................................1
Pathophysiology...............................................................................................................................1
Case Study.......................................................................................................................................3
Q1:..........................................................................................................................................3
Q2:..........................................................................................................................................4
Q3: .........................................................................................................................................5
a.) ..................................................................................................................................5
b.) .................................................................................................................................6
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
Concept Map refers to the diagram that shows suggested relationships among concepts. It
begins with the main concept or idea and then branch out to demonstrate how that idea can be
fragmented into specific topics. This assignment is based on Acute Severe Asthma which is
formerly called as status asthmaticus. It is an acute asthma exacerbation which can result in
hypercarbia, hypoxemia and secondary respiratory failure (Status Asthmaticus, 2018). Jackson
Smith is an 18 year old boy who is suffering from acute severe asthma. In this report, a concept
map of disease is developed and pathogenesis causing clinical manifestations is defined. Some
nursing strategies to manage patients with asthma, action mechanism of drugs and its nursing
implications are defined in this project.
TASK
Pathophysiology
Disease: Acute Severe Asthma
Causes
 Come in contact with asthma triggers or allergic things.
 Avoiding use of peak flow meter
 Do not intake asthma medications timely
 Viral infection
Pathogenesis
 Endobronchial biopsy tissue and bronchoalveolar lavage (BAL) fluid is examined.
 More number of neutrophils are seen in BAL fluid with increased levels of eosinophils in
initial 48 hours but seem to fall rapidly in response to corticosteroid therapy.
 BAL fluid contained increased level of pro inflammatory mediators interleukin IL-6,
(IL)-1β and TNF‐α (tumour necrosis factor).
 T cell activation with increased T cell makers and Oxidant stress.
 Increase in oxygen free radical production that overwhelms host antioxidant defence.
Clinical Manifestations
 Severe dyspnoea
 Inability to speak sentences in one breath
 SpO2 90%, on room air
 Respiratory rate of 32 breaths/minute
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 Pulse rate of 130 beats/minute
 BP 150/85 mm Hg
 Auscultation of lungs identifies diminished breath sounds and widespread wheeze
Diagnosis
 Complete history of patient.
 Hyper inflated lung fields.
 Chest X-ray
Treatment
 High doses of inhaled bronchodilators, like levalbuterol or albuterol to open up airways.
 Ipratroprium bromide, other type of bronchodilator distinct than albuterol
 Oral, inhaled or injected corticosteroids to reduce inflammation
 Temporary ventilation support
 An epinephrine shot
 Oxygen is given to maintain Spo2 greater than 90%
Course of Disease
 Drugs are given to patient like Nebulised Salbutamol, Nebulised Ipratropium bromide
(4/24) and IV Hydrocortisone 100mg Ventilator support is given to patient
Complications:
 partial or full lung collapse
 pneumonia
 Airleak
 Atelectasis (mucous plugging)
 Myocardial infarction
 Electrolyte disorders (salbutamol)
 Myopathy & rhabdomyolysis
 Anoxic brain injury
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 Lactic acidosis (cell injury)
Prognosis
 Acute severe asthma prognosis is impacted by factors like severity of asthma and age.
 One in 250 people is likely to die who is suffering from acute severe asthma.
Prevention
 Ensure intake of asthma medication as prescribed
 Avoid triggers (like dust, chemicals or pollen)
 Avoid allergic food
 Use peak flow meter several times.
 Take regular check up from medical professional
Case Study
Q1:
Pathogenesis of a disease refers to biological mechanism that leads an individual to
diseased state. It is also defined as origin and development of disease whether it is recurrent,
chronic or acute. Jackson Smith is a 18 year old male boy who is admitted to emergency
department due to severe breathlessness. He has diagnosed with acute severe asthma with
clinical manifestations like inability to speak sentences clearly in one breath, high pulse rate,
high blood pressure, respiratory rate of 32 breaths per minute and auscultation of lungs.
Pathogenesis causing these clinical manifestations includes various factors (El-Hattab and et. al.,
2015). The expression of acute severe asthma is complex, interactive procedure that rely on
interplay between two main factors, i.e., environmental exposures and host factors that occur at
the time in development of immune system.
Host factors:
Innate immunity: A appreciable interest in role of adaptive and innate immune responses
are there associated with regulation and inflammation development. Specifically, it emphasise on
imbalance between cytokine profiles Th1 and Th2 which causes allergic diseases liken acute
severe asthma. In asthma, airway inflammation may depict loss of normal balance among the
opposing variants of Th lymphocytes (Antonucci and et. al., 2014). Cytokine balance various
factors like alteration in type or number of infection, adoption of western lifestyle, widespread
use of antibiotics and continuous or repetitive exposure to allergens impacts the balance between
Th1-type.
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Genetics: It is recognised that acute severe asthma has inheritable constituent to its
expression, but genetics is involved in eventual development of this disease. Genetics role in IgE
production , dysfunctional regulation of inflammatory mediators generation and airway hyper
responsiveness has adequately captured much attention.
Environmental factors:
Allergens: Their role is high in development of acute severe asthma. Exposure to
Alternaria and house dust mite and sensitization are essential factors in asthma development in
children. Major allergens includes inner city dwellings which is an crucial cause of sensitization
and is a risk element in asthma evolution.
Respiratory infections: At the time of infancy, various respiratory viruses is associated
with development or inception of asthma. Parainfluenza virus and Respiratory syncytial virus
(RSV) in specific, cause bronchiolitis that parallels various features of asthma (Holt and Sly,
2012). The impact of viral respiratory infection on acute severe asthma development may rely on
interaction with atopy.
Q2:
Due to high variability in severity, clinical manifestations and response to treatment,
Jackson Smith is admitted in emergency department of hospital for close monitoring and proper
treatment. The high priority nursing strategies to manager acute severe asthma of Jackson are
defined below:
Provide supplemental oxygen: As Jackson Smith is suffer from severe breathlessness, it
is necessary to provide him supplemental oxygen as soon as possible so that oxygen saturation of
90% or more can be attained and maintained (Guérin and et. al., 2013). A patient in Status
Asthmaticus inevitably suffers or undergo from Hypoxia. Providing supplemental oxygen helps
in reducing V./Q. Mismatching, pulmonary vasoconstriction and promotes bronchodilation. The
main reason of providing supplemental oxygen is the Jackson Smith is suffering from severe
breathlessness and in that case, giving supplemental oxygen helps in improving condition of
patient and provides an ease to Jackson in breathing. There is a risk of oxygen toxicity if patient
receive inspired oxygen concentration fraction greater than 0.5 to 0.6 for elongated period. Yet,
the benefit of managing more amount of oxygen may over weigh the risk. Close monitoring of
patient and titrating oxygen is necessary to minimise risk (Nursing Strategies to Manage Acute
Severe Asthma, 2018).
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Administer rapid-acting inhaled bronchodilators: Beta2 agonists stimulate beta2
receptors on relieving receptors on relieving bronchoconstriction, airway smooth muscles,
decreasing resistance to airflow and reducing work of breathing. Quick-relief medications, short-
acting beta2-agonists (SABAs), are utilised to relieve bronchoconstriction, and are signal for
exacerbations and acute episodes. Generally, the more prescribed SABAs are terbutaline,
salbutamol, pirbuterol and levalbuterol. Nebulized salbutamol can be provided continuously or
intermittently to Jackson Smith. This will help him in breathing properly. Yet, salbutamol
provided via aerosolized or inhale route may not be able to reach lower airways and lung tissue
because of decreased tidal volume & severe airflow obstruction (Louie and et. al., 2013). But,
continuous I.V. infusion of salbutamol is utilised to treat acute asthma exacerbations.
Q3:
 Nebulised Salbutamol
 IV Hydrocortisone 100mg (6/24)
 Nebulised Ipratropium bromide (4/24)
a.)
Nebulised Salbutamol: Salbutamol is inhaled as aeosol and acts at β2-adrenoreceptors on
smooth muscles close the bronchi. It binds to active site of epinephrine non covalently in
receptor and stablizes it in its active site. It stimulates intracellular adenyl cyclase that catalyse
conversion of ATP to cyclic AMP. Increased level of cyclic AMP cause bronchial smooth
muscle relaxation and inhibits release of immediate hypersensitivity mediators from cells
(Neame and et. al.,, 2015).
Nebulised Ipratropium bromide: It is an anticholinergic factor that blocks muscarinic
receptors of acetylcholine. On the basis of animal studies, it seems to inhibit vagally that
mediated reflexes by alienating the acetylcholine action (transmitter agent which is release from
vagus nerve). Increase in intracellular concentration of cGMP (cyclic guanosine monophosphate)
consequent from acetylcholine action with bronchial smooth muscle muscarinic receptors is
prevented by Anticholinergics.
IV Hydrocortisone 100mg: It is an anti inflammatory adrenocortical steroid. This is a
glucocorticoid with minerolocorticoid activities which is short acting and has rapid action. It
treats inflammation due to various conditions and diseases (Mechanism of Action of
Hydrocortisone, 2018)
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b.)
Some nursing implications required when providing drug of acute severe asthma to
Jackson Smith are defined below:
 Regular assess and close monitoring of patient to ascertain when drugs required to be
adjusted to minimise reverse reactions and improve response of patient.
 Support and assess patient's circulation, breathing, airway and monitor Jackson's clinical
status (Zhu, Kortuem and Stewart, 2013).
 Monitor fluid balance of patient as he may be dehydrated due to more insensible fluid
loss and less oral intake.
CONCLUSION
As per the above mentioned report, it has been concluded that concept map is a graphic
organiser or tool which is utilized to assist clinicians to organise and depict knowledge of
subject. Acute severe asthma is a severe disease that leads to hypoxemia. This disease rely on
interplay between host factors and environmental factors.
REFERENCES
Books and Journals
El-Hattab, A. W. and et. al., 2015. MELAS syndrome: clinical manifestations, pathogenesis, and
treatment options. Molecular genetics and metabolism. 116(1). pp.4-12.
Antonucci, E.and et. al., 2014. Myocardial depression in sepsis: from pathogenesis to clinical
manifestations and treatment. Journal of critical care. 29(4). pp.500-511.
Holt, P. G. and Sly, P. D., 2012. Viral infections and atopy in asthma pathogenesis: new
rationales for asthma prevention and treatment. Nature medicine. 18(5). p.726.
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Guérin, C. and et. al., 2013. Prone positioning in severe acute respiratory distress syndrome. New
England Journal of Medicine. 368(23). pp.2159-2168.
Louie, S. and et. al., 2013. The asthma–chronic obstructive pulmonary disease overlap
syndrome: pharmacotherapeutic considerations. Expert review of clinical
pharmacology. 6(2). pp.197-219.
Zhu, Y. X., Kortuem, K. M. and Stewart, A. K., 2013. Molecular mechanism of action of
immune-modulatory drugs thalidomide, lenalidomide and pomalidomide in multiple
myeloma. Leukemia & lymphoma. 54(4). pp.683-687.
Neame, M. and et. al.,, 2015. Salbutamol or aminophylline for acute severe asthma: how to
choose which one, when and why?. Archives of Disease in Childhood-Education and
Practice. 100(4). pp.215-222.
Online
Status Asthmaticus, 2018. [Online]. Available through:
<https://emedicine.medscape.com/article/2129484-overview>
Nursing Strategies to Manage Acute Severe Asthma, 2018. [Online]. Available through:
<https://www.nursingcenter.com/journalarticleArticle_ID=859826&Journal_ID=60691
3&Issue_ID=859810>
Mechanism of Action of Hydrocortisone, 2018. [Online]. Available through:
<https://www.pediatriconcall.com/drugs/hydrocortisone/460>
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