Acute Exacerbation of Asthma Assignment 2022

Acute exacerbation of asthma
Nursing
Institution
Student assignment

Acute exacerbation of asthma
Acute exacerbation of asthma
Question 1
Pathogenesis of asthma
Asthma is a respiratory condition that causes inflammation of the airway. Acute
exacerbation of asthma is a sudden and severe onset of symptoms of asthma (Zhang et al. 2019).
Pathogenesis is a complex process and involved more than one processes. Exposure to an
allergen such as dust mites causes infiltration of cells of inflammation. These include
lymphocytes, eosinophils, neutrophils, epithelial cell injury and activation of mast cells. These
cells together contribute to the inflammation of the airway, limiting airflow. This airflow
limitation in asthma is recurrent and is caused by such factors as bronchoconstriction, airway
hypersensitivity, airway edema and airway remodeling. Some of the signs and symptoms of
asthma include coughing, shortness of breath, chest pain, chest tightness or chest pressure and
wheeze (Zuo et al. 2019).
Bronchoconstriction is the contraction of a bronchial smooth muscle causing narrowing
of the airway commonly caused by exposure to an allergen or irritants. This is mediated by IgE
dependent mediators such as histamine, leukotrienes, prostaglandins and tryptase, which directly
on smooth muscles and cause constriction. Other contributors include irritants such as extreme
physical activities of cold water. Use of NSAID drugs has also been found to cause
bronchoconstriction (Russell and Brightling 2017). Poppy has symptoms of a wheeze and
difficulty in breathing as he speaks in single words, use of accessory muscles and shoulder
shrugging when breathing in. This is due to the narrowing of the airway.
As the disease progresses and inflammation becomes more persistent, and other factors
contribute to limiting airflow. Edema of the airway, increased mucus production and formation
of mucus plugs further contribute to the symptoms. Poppy is presenting with RR of 42 breaths
per minute (normal 16-30bpm) in order to compensate for respiratory acidosis and shrugging of
shoulders when breathing in which is an indication of labored breathing. Heart rate increases
(HR 160 bpm, normal 60-100 bpm) to increase blood supply to tissues as there is decreased
oxygen supply. Poppy presents with respiratory acidosis as evidenced by the ABG results. This
is due to the accumulation of carbon IV oxide due to impaired expiration and inspiration. These
symptoms are as a result of inflammation of the airway structures, edema and increased mucus

Acute exacerbation of asthma
secretion as discussed above. Lung hyperinflation is also another symptom presented by Poppy
as the air gets trapped in the lungs causing them to become more inflated. Structural changes of
the airway can also result, such as hyperplasia or hypertrophy of the smooth muscles. This makes
the treatment of asthma more difficult and worsens the symptoms further (Petsky, Li and Chang
2017).
Another contributor is airway hyperresponsiveness. This is extreme contractile responses
to challenges with methacholine correlates with the clinical severity of asthma.
Hyperresponsiveness can be influenced by inflammation, structural changes and dysfunctional
neuro regulation. These factors contribute to the worsening of symptoms of asthma (Teo et al.
2017).
Finally, airway remodeling is a permanent structural change in the airway. This includes
thickening of the sub-basement membrane, hypertrophy of soot muscles, dilation and
proliferation of blood vessels and mucus plug hyperplasia. These changes results due to
structural cells activation leading to a permanent remodeling of airway structures. This
eventually causes permanent limitation in airflow. It is also believed to be caused by continuous
remodeling and repair contributes to further permanent structural changes (Fehrenbach, Wagner
and Wegmann 2017). This contributes to Poppy’s recurring symptoms of asthma.
Question 2: Nursing strategies
High Fowlers position
Managing the patient with asthma in a high fowler’s position is important as it helps ease
breathing. High fowler’s position is positioning the patient in an upright sitting position (90
degrees) with the knees flexed or slightly extended. This position is used in an even of
respiratory distress as it facilitates maximum chest expansion. This is achieved as this position
facilitates relaxation of the tension of abdominal muscles, improving breathing. This position is
also important in alleviating compression of the chest by abdominal contents due to gravity. It
also prevents aspiration, especially in children and immobile patients. Positioning Poppy in this
position will help alleviate the difficulty in breathing and promote ease in breathing (Sekiguchi et
al. 2019).

Acute exacerbation of asthma
Oxygen therapy
A high –flow oxygen delivery system is used to supply oxygen to the patient as it
supplies oxygen at a given concentration and a flow that either equals or exceeds patients flow
demand. This is important as exact patient's FiO2 can be achieved especially in patients with
distress. A venture mask will be used as it creates high-flow enriched oxygen and at a required
concentration. It also provides a constant and accurate FiO2 (24-40%) as required by the patient
and is used when there is suspected CO2 retention. Poppy is presenting with respiratory acidosis
as reported by the ABG results, which is an indication of CO2 retention. This mask is, therefore,
appropriate for poppy (Humphreys et al. 2017).
Oxygen humidification is usually not necessary when using this device and oxygen
delivery is 10 LPM. Providing oxygen therapy to the patient is beneficial as it increases oxygen
supply to the lungs and subsequently to the blood. Therefore, there is an increased supply of
oxygen to the tissues correcting acidosis. An impulse will be sent to the respiratory regulatory
center to decrease respiratory rate to normal (Martinez et al. 2019).
Question 3
Salbutamol via nebulizer
Mechanism of action
Salbutamol is a selective beta 2 adrenergic receptor agonist and is used in the treatment
of asthma. Beta 2 receptors are located in the lungs. This drug activates the beta 2 adrenergic
receptors initiating a transmembrane cascade involving G protein and adenylyl cyclase
increasing cAMP and activates protein kinase A. Intracellular calcium decreases inhibiting
myosin light chain phosphorylation preventing airway smooth muscle contraction and relieves
bronchospasm (Katsunuma et al. 2019).
The patient is receiving this drug because he is experiencing difficulty in breathing.
Administration of this drug will, therefore, relax the airway and ease breathing to the patient. The
nurse should monitor for any changes in respiratory rate and heart rate as she administers the
drug and continues monitoring vital signs. The expected clinical response is the alleviation of
symptoms (Dispas et al. 2017).

Acute exacerbation of asthma
Hydrocortisone IV
It is a corticosteroid anti-inflammatory hormone receptor agonist. It inhibits arachidonic
acid through the involvement of phospholipase A2 and lipocortins inhibitory proteins. This
controls the synthesis of leukotrienes and prostaglandins, which are responsible for
inflammation. It suppresses the migration of polymorphonuclear leukocytes and increases
capillary permeability causing the anti-inflammatory effect (Wang et al. 2018).
The patient is taking the drug to alleviate symptoms such as wheeze and difficulty in
breathing due to inflammation. The nurse should assess for any history of infections and
hypothyroidism and any change in condition. Vital signs should be monitored and side effects of
the drug. The expected response is to alleviate symptoms caused by inflammation (Dombrowski
et al. 2019).
Ipratropium Bromide via nebulizer
It is an anticholinergic drug which blocks muscarinic receptors of acetylcholine. It
antagonizes the action of acetylcholine by inhibiting reflexes mediated by the vagus nerve. It in
turns relaxes the muscles of the airway, therefore used to treat symptoms such as shortness of
breath and wheeze (Carotenuto, Perfetti, Calcagno and Meriggi 2018).
The patient is receiving the drug because he is experiencing shortness of breath, wheeze
and difficulty in breathing. The nurse should never administer the drug to a patient who has
hypersensitivity to atropine and monitor urine output and worsening of symptoms as the drug is
known to cause urinary retention and inflammation of the airway (Donohue et al. 2016).
The expected clinical response is reduced or cleared symptoms of asthma.

Acute exacerbation of asthma
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