Asthma Issues: Symptoms, Pathogenesis, Diagnosis, Nursing Interventions, and Medications

This article discusses acute severe asthma, its symptoms, pathogenesis, diagnosis, nursing interventions, and medications like nebulised salbutamol, Atrovent, and intravenous hydrocortisone. It also includes the role of nurses in managing the health condition of the patient with acute severe asthma. The article is relevant to the subject of respiratory health and can be useful for students studying nursing, medicine, or related courses.

Running Head: ASTHMA ISSUES
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Asthma Issues
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Table of Contents
Question 1.............................................................................................................................................2
Question 2.............................................................................................................................................5
Question 3.............................................................................................................................................6
References.............................................................................................................................................8

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Question 1
Acute severe asthma
Acute severe asthma is a serious disorder that is characterized by the bronchospasm
which is refractory to an outpatient therapy. It is an emergency condition that usually needs
immediate medical attention (Bayes & Thomson, 2016). It can be caused by infection, severe
stress, cold weather, air pollution, several allergic reactions, exposure to chemicals and
smoking (Sandrock & Norris, 2015).
Symptoms
Sign & symptoms associated with this health disorder includes short & shallow
breaths, wheezing, coughing, difficulty in breathing, heavy sweating, trouble in speaking,
fatigue & weakness, panic or confusion, abdominal pain, back pain, blue-tinted lips or skin,
loss of consciousness, and neck muscle pain (Carr, Berdnikovs, Simon, Bochner &
Rosenwasser2016).
Pathogenesis
As discussed in the case study Mr Jackson had acute severe asthma with severe
dyspnoea, inability to speak a sentence in a single breath, increased blood pressure and
auscultation of the lungs due to wheezing sounds (Castillo, Peters, & Busse, 2017). The
pathogenesis of Mr Jackson’s health condition includes different processes such as Asthma
effects of airways, damage to the epithelial part, mucous excessive secretion, oedema,
bronchospasm and airway remodelling. Airways affected by asthma might be the reason of
Mr Jackson had issues like breathing difficulty, wheezing sound and dyspnoea. As mentioned
in Mr Jackson’s clinical manifestation ha had symptoms like wheezing sound and inability to
speak complete sentence, this is because adequate air should be there in lungs to speak and in

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case of Mr Jackson does not had adequate air in his lungs. This may be caused by airway
obstruction. Asthma-related consequences include affecting trachea, bronchi, and bronchioles
that together form a part of the lower respiratory tract. The disorder causes
bronchoconstriction or the abnormal narrowing of Airway due to the epithelial damage, high
production of mucus, bronchospasm, oedema, and damage to the soft muscles (Lambrecht, &
Hammad, 2015).Damage to the epithelial linings is also contributed to the clinical
mennifestations cuased in case if Mr Jackson. In asthmatic condition the layers of the cells
that make the lining of airways are damaged. The epithelial shedding or discard of this
epithelium can leads to hyper-responsiveness of the airways in different ways such as loss of
barrier ability, loss of enzymes, and exposure of the sensory nerves of the body. The
abnormal changes may also take place in subepithelial layers like laying down the collagens
(Johnston et al., 2016). Hyper-secretion of the mucus leads to various health condition
associated with acute severe asthma as mentioned in cane of Mr Jackson. Asthma may also
cause the mucus-secreting cells to proliferate or divide abnormally and results in expended
mucus gland. The increased secretion of mucus may form viscid mucus that can be occluded
in the airways of the respiratory tract (Shen et al., 2018). Oedema is the health conditional
may cause health problems like wheezing sound. Capillaries of the airways may also leak or
dilated. The consequences of this leakage lead to increased secretion of the airways,
abnormal mucociliary release, and oedema, which may further cause contraction of airways
and hyper-responsiveness. This condition is also become the reason for wheezing sound
occurs when Mr Jackson inhale and exhale (Powell, 2016). Bronchospasm is considered as
the feature of asthma in which the sharp contraction of bronchial soft muscle takes place and
the airways narrowing. This might be the reason of occurrence of wheezing sound in case of
Mr Jackson. Remodelling is another condition of airways that occur in the lower respiratory
tract. This is caused due to the uncontrolled or poorly controlled asthma, alteration in cell and

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tissue structure. This may also the reason of wheezing sound in Mr Jackson’s case scenario
(George, Joshi, Concepcion, & Lee, 2017). The normal cellular pathogenesis of this health
disorder includes stimulation of b cells to produce IgE by triggering factors. This leads to
activation of t helper cells. The allergens crosslinks the IgE on the mast cells and trigger the
release of histamines and other different inflammatory mediators. This may leads to increased
mucus secretions, vasodilation and contractions of soft muscles. This causes airways
obstruction and finally acute severe asthma. These might be the reason Mr Jackson had issues
like wheezing sounds, dyspnoea, and breathlessness.
Diagnosis of Acute severe airways
It is the simple method to test lung function that measures the highest flow of the air
from the forced expiration which started from the position of highest lung inflation. The
measurement of PEF is easy and fast to understand once the patient successfully perfumes the
test. The patient has been diagnosed by using X-ray. The x-ray is the imaging method to test
the abnormal respiratory function. It uses small amounts of radiation in order to produce a
picture of the organs bones, tissues of the body. When these rays focused on the chest the
abnormalities or disease of the airways, blood vessels, blood and heart can be identified. It
can also help the physician to examine if there is a fluid in the lungs.
As discussed in the case study Arterial blood gas has been taken form Mr Jackson’s
body to diagnose the health issue. This method is really important to identify the acute severe
asthma. It helps to determine the important key feature of these features such as a low
pressure of PaCo2. It basically measures the arterial gases like oxygen and CO2. In these tests,
a small amount of blood is taken from the patient.

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Question 2
Nurses have the various roles in managing the health condition of the patient with
acute severe asthma such as assessing the patient for previous allergies and medical history.
Educating the patient about self-management of asthma-related issues and what to do in
asthma attacks is necessary. For Mr Jackson some essential nursing interventions should be
provided are: assessing the patient's current clinical manifestations and managing the ICU
management, mechanical ventilation, and examine any sign form patient that may be life
threating. Two of the most important nursing strategies are:
Oxygen therapy
Therefore oxygen therapy might be the good intervention as the patint admitted to the
emergency department for issues like wheeze sounds, decreased oxygen saturation and
impaired lung functioning. This therapy can be implemented in patent’s care setting to
provide him proper oxygen transfer to achieve the health goals for him. This can be a most
important nursing strategy to manage Mr Jackson’s oxygen related isseus. The indication
involves the distress and respiratory arrest; decreased levels of SPO2 and elevated arterial
CO2 pressure. The oxygen pressure should be controlled by using oxygen administration
devices such as Hudson mask and Venturi mask with the concentration to achieve maximum
criteria of requirement of oxygen for Mr Smith (Levy, Alladina, Hibbert, Harris, Bajwa, &
Hess, 2016).
Positioning
Positioning can play an important role to provide a better oxygen transfer in case opf
Mr Jackson. As discussed in the case scenario Mr Jackson has been transferred to the ICU
department for airway related issues. The patient positioning might be a key part of the health
care setting. As asthma treatment takes more time to achieve than other health issues.

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Therefore the patient should be familiar with the knowledge related to the disease and body
position at the bed. Different studies reported that the diseased person with acute severe
asthma can inhale and exhale easier in the forward leaning position, as it enable the person to
use his accessary muscles, and improve the effects of gravitational force which pulls his
abdominal wall down and increase the intra-abdominal pressure. For Mr Jackson another
position named volume pressure curve shifts to the left side can be helpful, which is helpful
to create negative intra-thoracic pressure and help the body to move the diaphragm down in
forward leaning position (Charriot et al., 2017).
Question 3
Administration of the drug to the patient
Nebulised Salbutamol
As mentioned in the case study Mr Jackson Nebulised Salbutamol has been prescribed
for him to deal with Airways obstruction. The Salbutamol is the medicine that mediates
bronchodilation by stimulating the receptor beta2 available on the muscles of the airway. This
cause the muscle to relax and airways to expand that are previously narrowed. This drug can
be administered by using a nebulizer that is O2 driven. This should be provided within the
five minutes of the patient with Status Asthmaticus. The patient should be involved in the
decision making for a route to administer this drug. The Oxygen nebulisations are considered
as the safest choice. The flow rate should be managed properly at the time of delivery of this
drug. Adverse reactions of this medicine are tachycardia, hypokalemia, and tremor. The
nurses need to assess those side effects and report to the doctor immediately and record the
outcome of the medicine (Lefebvre et al., 2015)

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Atrovent (Ipratropium bromide)
The medicine Ipratropium bromide has also been administered to Mr Jackson. This
medicine is basically used to open the medium and the large airways in the lungs that are
narrowed due to a health condition. This anticholinergic agent blocks the muscarinic
receptors and helps the airways to dilate by causing the muscle relaxation. This drug works
by producing maximum bronchodilation compare to other drugs. Adverse reactions of this
medicine are sinus pain, coughing, dry mouth, headaches, chills, stuffy nose. The nursing
intervention, in this case, is to stop to the administration of the drug and call the doctors to
report the condition and keeping a record of these health outcomes.
Intravenous hydrocortisone
This medicine is used to deal with acute severe asthma. The inflammation occurs in this
health condition can be reduced by using this corticosteroid. Side effects of this drug are
nausea, weight gain, excessive sweating, and skin changes. Nurses should notice these
symptoms and call for the doctors and other staff (George, Joshi, Concepcion, & Lee, 2017).

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References
Bayes, H. K., & Thomson, N. C. (2016). Acute severe asthma in adults. Medicine, 44(5),
297-300.
Carr, T. F., Berdnikovs, S., Simon, H. U., Bochner, B. S., & Rosenwasser, L. J. (2016).
Eosinophilic bioactivities in severe asthma. World Allergy Organization
Journal, 9(1), 21.
Castillo, J. R., Peters, S. P., & Busse, W. W. (2017). Asthma exacerbations: pathogenesis,
prevention, and treatment. The Journal of Allergy and Clinical Immunology: In
Practice, 5(4), 918-927.
George, M., Joshi, S. V., Concepcion, E., & Lee, H. (2017). Paradoxical bronchospasm from
benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient
with acute severe asthma. A case report and literature review of airway effects of
BAC. Respiratory medicine case reports, 21, 39-41.
George, M., Joshi, S. V., Concepcion, E., & Lee, H. (2017). Paradoxical bronchospasm from
benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient
with acute severe asthma. A case report and literature review of airway effects of
BAC. Respiratory medicine case reports, 21, 39-41.
Gray, M. P., Keeney, G. E., Grahl, M. J., Gorelick, M. H., & Spahr, C. D. (2016). Improving
guideline-based care of acute asthma in a pediatric emergency
department. Pediatrics, 138(5), e20153339.

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Johnston, S. L., Szigeti, M., Cross, M., Brightling, C., Chaudhuri, R., Harrison, T., & Mallia,
P. (2016). Azithromycin for acute exacerbations of asthma: the AZALEA randomized
clinical trial. JAMA internal medicine, 176(11), 1630-1637.
Lambrecht, B. N., & Hammad, H. (2015). The immunology of asthma. Nature
Immunology, 16(1), 45.
Leclair, T., & Allen, G. B. (2018). Acute Respiratory Failure/Acute Respiratory Distress
Syndrome (6th ed.). Philadelphia, PA Critical Care Secrets E-Book, 188.
Lefebvre, P., Duh, M. S., Lakeville, M. H., Goal, L., Desai, U., Robitaille, M. N., & Lin, X.
(2015). Acute and chronic systemic corticosteroid-related complications in patients
with severe asthma. Journal of Allergy and Clinical Immunology, 136(6), 1488-1495.
Levy, S. D., Alladina, J. W., Hibbert, K. A., Harris, R. S., Bajwa, E. K., & Hess, D. R.
(2016). High-flow oxygen therapy and other inhaled therapies in intensive care
units. The Lancet, 387(10030), 1867-1878.
Lommatzsch, M., & Virchow, C. J. (2014). Severe asthma: definition, diagnosis and
treatment. Deutsches Ärzteblatt International, 111(50), 847.
Powell, C. V. (2016). Acute severe asthma. Journal of paediatrics and child health, 52(2),
187-191.
Sandrock, C. E., & Norris, A. (2015). Infection in severe asthma exacerbations and critical
asthma syndrome. Clinical reviews in allergy & immunology, 48(1), 104-113.
Shen, Y., Huang, S., Kang, J., Lin, J., Lai, K., Sun, Y., & Huang, K. (2018). Management of
airway mucus hypersecretion in chronic airway inflammatory disease: Chinese expert

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consensus (English edition). International journal of chronic obstructive pulmonary
disease, 13, 399.