A Case Study of the Management of Asthmatic Patient at a Community Clinic

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A Case Study of the Management of Asthmatic Patient at a Community Clinic
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Introduction
Asthma is one of the leading chronic respiratory illness in the world, with almost 235 million
people being diagnosed with the disease (WHO, 2017). Asthma is often perceived to be a
disease that affects only the lungs, but recent studies have shown that it may be as a result of
a combination of several airway diseases that affect the whole respiratory tract, and this
assertion is evidenced by the fact that asthma mostly co-occurs with other atopic disorders,
especially allergic rhinitis (Bourdin et al., 2009). Notwithstanding the remarkable
developments in the diagnosis and management of asthma in the last years, in addition to the
accessibility of detailed and standardized local and global clinical practice procedures for the
disorder, the prevention and management of asthma remain suboptimal. The latest asthma
statistics indicate that approximately 80% of asthma deaths take place in both developed and
developing countries (WHO, 2017). This paper aims at providing the current status of
asthma in the world, the management and care of moderate exacerbation of asthma using a
case study design of an asthmatic adult patient in the community care clinic by a general
practice nurse. Expert knowledge and skill alongside evidence from the research will be used
in this case study to offer nursing care and management for Esther who was brought to the
clinic by her brother and was diagnosed with moderate asthma. This critical review will also
address the role of the nurse in helping Esther with self-management of asthma.
Definitions
Asthma is a chronic inflammatory illness of the respiratory system. The chronic inflammation
is linked to extreme narrowing of the airways in response to triggers like allergens and
training that results in repeated symptoms like shortness of breath, wheezing, chest
constriction and coughing. The symptom occurrences vary regarding the extent of airflow
obstruction in the lungs which can be reversed naturally or with the correct intervention
(GINA, 2018).

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The condition of a patient and the right intervention can be determined by a nurse through a
comprehensive clinical assessment which entails the utilization of subjective and objective
information (Potter et al., 2016). However, asthma is a complex disease whose diagnosis can
be a challenge (BTS/SIGN, 2016). Unlike other illnesses that can readily be ascertained by
using symptoms, asthma symptoms such as wheezing can be observed in situations where
there is no trace of asthma development (BTS, 2014). Furthermore, some of the common
symptoms of asthma such as chest constriction, chronic cough, and narrowing of the airways
are also evident in other diseases such as bronchitis (Lockey, 2014). However, a combination
of such symptoms is a clear indication of the existence of asthma (GINA, 2018).
Clinical Diagnosis of Asthma
Daar et al. (2009) observe that patients presenting with usual symptoms of wheeze, cough
(more so after exercise, in the morning or night), and chest constriction should be checked for
asthma. The possibility of the presence of asthma is increased by the presence of a particular
trigger, some allergic disorders like allergic rhinitis, exacerbation of symptoms after using
bronchodilator medication, and family history of asthma (Pinnock et al., 2010).
Esther was presented with breathlessness, wheezing at night for a month and her conditions
are accelerated by cold weather, dust and wood smoke. Esther has moderate asthma based on
the vital signs already indicated. According to Potter et al. (2016), vital signs are essential to
nurses in finding out the required treatment and post-treatment nursing. These signs include
blood pressure, temperature, and respiration. According to the GINA (2018) guidelines on the
assessment of asthma, clinicians should continually seek information regarding the history of
wheeze, whether it is disclosed by the patient or not. Wheezing evidenced on chest
assessment should be a strong indication of the likelihood of asthma.

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Asthma Diagnostic Tests
The peak expiratory flow rate (PEFR) and spirometry are the most common tests used in
places of limited resources like that of the local community clinic. These tests are carried out
to show reversible airflow obstruction and the assurance functional imbalance in asthma. The
PEFR meter measures the optimal rate of flow produced during a forceful exhalation
beginning from the peak flow. Whereas the spirometry equally measures the peak flow in
addition to lung ventilation aspects such as the volume of air generated in the ignition second
(FEV1), and the overall volume of air generated from the lungs after total inspiration (FVC)
(Kirenga et al., 2015). Daar et al. (2009) observe that the spirometer is more precise and
generates reliable outcomes than PEFR meter.
Fortunately, both the spirometry and the PEFR meter were used to assess Esther’s case.
GINA (2018) note that the spirometry is the most preferred test, but it requires an expert
clinician to use it. Our community-based clinic had one expert clinician who was available
three times a week. Esther was diagnosed with allergic rhinitis, and PEFR and FEV1 values
were less than the projected typical values and rose beyond 12% after being administered
with a bronchodilator. Thus it is most likely that she has asthma (BTS/SIGN, 2016).
The clinical assessment and tests of Esther’s condition indicated that she had dominant
familial asthma although no personal history of asthma. She was also allergic to smoke, dust
and cold weather. Symptoms such as continued asthma symptoms, minimal physical activity,
and average airflow hindrance in addition to the PEFR and FEV1 values clearly show that
Esther has moderate persistent asthma.
The treatment procedures for asthma are provided by GINA (2018), and they were applied in
the case of Esther in accordance with her assessment based on the past medical history.
Reports on family history, individual history of atopic illnesses are significant in determining