Showing Various Clinical Manifestations

Running head: ANSWERS ON CASE STUDY
Answers on case study
Name of the Student
Name of the University
Author Note

ANSWERS ON CASE STUDY1
Answer 1:
Asthma is described as chronic inflammation of the respiratory tract where many
proinflammatory cells play a vital role in exerting inflammatory response against an external
allergen thereby showing various clinical manifestations such as exacerbation (Peebles &
Aronica, 2019). The clinical manifestation of asthma includes shortness of breath, recurrent
wheezing, cough and tightness in the chest. The usual presentation of asthma is displayed
through an allergic reaction which shows symptoms immediately after exposure to an
allergen. When the asthmatic person inhales the allergen, it attaches to the IgE antibody that
is presented on mast cells; therefore, degranulation of mast cells and release of inflammatory
mediators occur. These inflammatory mediators of inflammation such as prostaglandins,
leukotrienes, enzymes acts on the walls of the respiratory tract leading to obstruction of the
airways and bronchoconstriction. Due to release of inflammatory mediators, the permeability
of blood vessels increases and allows them to enter leading to swelling which is termed as
vasodilation. The allergens penetrate through the mucosal epithelial cells on the respiratory
tract causing bronchospasm, blocking of airways, mucus secretion and reduced mucociliary
function. Bronchospasm is caused by narrowing of the airway and contraction of smooth
muscles. This obstruction leads to impairment of the breathing process and causes
breathlessness during inhalation and exhalation of air. As a result of which the airways of the
patient become hyperresponsive to the external stimuli (Yokoyama & Yokoyama,
2019). However, there are certain structural changes of the airways, which is another
characteristic of asthma. This occurs because tissues are hyperinflated due to trapping of air
in the lungs. This results in rising of gas pressure in the alveoli and decreased blood entry into
the alveoli. Finally, hypoxemia occurs where the concentration of oxygen in the blood is
reduced due to decreased perfusion and results in hypoxia or inadequate oxygen supply to the
body (Bennett, Cowen, Sadofsky & Morice, 2018).

ANSWERS ON CASE STUDY2
In the case study, Poppy is suffering from severe asthmatic attacks as presented to the
ED with adverse respiratory symptoms. The nursing assessment showed that Poppy has low
oxygen saturation that is 87% which is below standard oxygen concentration (SpO2 = 90%).
Low SpO2 is an indication of hypoxia and hypoxemia (Sarkar, Niranjan & Banyal, 2017). Her
respiratory rate is above standard that is 42 breaths per min. This represents tachypnoea or
rapid breathing due to low level of oxygen in blood and this can lead to increased carbon
dioxide level in blood, resulting in rapid breathing in Poppy. Poppy is also speaking in single
sentences which means she is unable to inhale adequate amount of oxygen and shortness of
breath. This is represented as dyspnoea or exacerbation and indicate by abnormal rise in the
heart rate where normal rate is 100 beats per minute, but her heart rate is 160 beats per
minute (Berliner, Schneider, Welte & Bauersachs, 2016).
Poppy also shows symptoms such as recurrent wheezing and violent cough, which
falls under clinical manifestations of asthmatic attack. This is caused when the smooth
muscles are contracted leading to bronchospasm or bronchoconstriction as stated in the
pathogenesis of asthma. Limited expiratory showed by Poppy is associated with tachypnoea
and dyspnoea, which is another clinical manifestation of asthma occurring as a result of
inflammation of the respiratory tract. Hyperinflation of lungs detected in the chest X-ray of
Poppy is an indication of trapped air in the alveoli that does not escape (Trivedi et al., 2017).
Therefore Poppy shows limited expiratory flow which is followed by wheezing during
inspiration and expiration. Respiratory acidosis is shown by the level of arterial blood gas
that is an indication of poor exhalation of air. Acidosis is leading to increased level of carbon
dioxide and decreases her level of SpO2.