Pathophysiology, Nursing Interventions and Mode of Action of Drugs for Asthma

This article discusses the pathophysiology of asthma, nursing interventions and mode of action of drugs. It covers the symptoms, risk factors and effective nursing care for asthma patients. The article also highlights the importance of early diagnosis and management of asthma.

Running head: HEALTH VARIATION 3
HEALTH VARIATION 3
Name of the student:
Name of the University:
Author note:

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Question 1: Pathophysiology:
Asthma is defined as the condition in which excessive mucus is produced by the lungs
which results in the narrowing of the air passages of the lungs hence creates breathing problem
(Fergeson, Patel & Lockey, 2017). In addition to breathing problem other symptoms such as
wheezing and coughing are also developed. It has been reported that asthma leads to minor
nuisance in some cases whereas, in some severe cases it may lead to life threatening situation
(Grosso et al., 2018). Research has indicated that severe acute asthma cannot be cured
completely, however, the symptoms could be managed with effective nursing interventions
(Arabkhazaeli et al., 2017). In this scenario, the patient Jackson has been diagnosed with asthma
at childhood (age-2years) and due to lack of management the condition has developed to the
severe stage. The patient has been found to be suffering from severe dyspnea or breathlessness.
(Boulet, 2017) has reported that dyspnea is one of the common consequences of asthma,
however, it may occur due to other medical conditions as well. Such symptoms mainly develops
due to the narrowing of the airways of lungs. Such symptom may develop for a short time, while
in severe acute asthma the symptom may lead to prolong suffering and chronic condition as well
(Fergeson, Patel & Lockey, 2017).
In addition Jackson has been presented with high BP such as 150/85 and high respiratory
rate as well (32 breaths per minute). Less partial pressure of oxygen (60 mmHg, normal range
75-100 mmHg) and high partial pressure of carbon dioxide (50 mmHg, normal range 38-42
mmHg) has been reported in the blood gas test of the patient. Hence, it can be demonstrated that
the patient has been suffering from poor oxygen intake (Boulet, 2017). As mentioned before, in
case of asthma, the air ways of lungs become narrow which limited the oxygen intake, hence the
patient suffers from breathing problem. In such condition the heart needs to compensate, thus the

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heart started to work harder which leads to the consequence of high BP and increase in
respiratory rate as well (Grosso et al., 2018). Furthermore, the case study has reported that,
Jackson was unable to speak a complete sentence in one breath. Research has indicated that it is
required to present adequate amount of oxygen in lungs in order to speak a complete sentence in
one breath. In case of asthma, due to narrowing of airways of lungs the patient become unable to
intake adequate amount of oxygen hence, fails to speak a complete sentence in one breath
(Fergeson, Patel & Lockey, 2017). In addition, such poor oxygen supply also leads to the
development of hypoxia as well (Grosso et al., 2018).
Furthermore, in case of Jackson, diminished breath sound and wide spread wheezing is
also identified during assessment. Research has considered diminished breath sound and wide
spread wheezing as common consequences of severe acute asthma. The combination of
production of excessive mucus with tightening and swelling of muscle results in narrow air ways
in the lungs which leads to the development of such symptoms in case of asthma (Arabkhazaeli
et al., 2017). On the other hand, the x-ray report of Jackson has represented the hyper-inflated
lungs. (Fergeson, Patel & Lockey, 2017) has reported that the blockage of air passages trapped
the air in lungs, thus, air could enter the lungs but it cannot escape which results in the
overinflated lungs. Such condition may occur due to excessive production of mucus which
interfere with the air expulsion and leads to the consequence of hyper-inflated lungs as well. This
is another risk factor that results in wide spread wheezing, diminished breathing sound and
breathlessness (Grosso et al., 2018). Research has reported about various risk factors that
contributes to the development of asthma. Such factors include, past history of respiratory
diseases such as pneumonia or tuberculosis, family history of asthma or other respiratory
disorder, exposure to pollens, pet dander or chemical, workplace irritants and other allergic

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reactions (Rönmark et al., 2016). It is required to diagnose the illness at early stage in order to
manage it in an effective manner, otherwise it may results in severe condition like Jackson.
Question 2: Nursing interventions:
One of the most important part of nursing care is the appropriate diagnosis through
proper health assessment. This is because health assessment helps to identify the potential factors
that has contributed to the development of health issue, main problem of the patient and helps to
introduce effective care approach to resolve the issue of the patient (Fergeson, Patel & Lockey,
2017). Thus, the first nursing intervention in this scenario would be health assessment of the
patient. In this regards it has been found that auscultation is one of the most effective process for
the assessment of asthma. The process includes listening to the anterior and posterior sides of the
chest starting from the top to the bottom with the help of the stethoscope. In addition the patient
should be taught about taking slow and deep breath through mouth with proper pace. Full cycle
of inspiration and expiration need to be listen carefully to recognize the presence of wheeze or
diminished breath sound while contrasting the pitch, quality and duration of the sound with
normal breathing sound (Arabkhazaeli et al., 2017).
The second nursing intervention needs to focus on the breathlessness due to asthma. In
this regards oxygen therapy would be efficient choice (Apter, 2014). During asthma increase in
the intrathorasic pressure influence the lumen of the bronchial to block the exhalation of air,
hence air enters the lungs but it could not escape. Additionally, restrict alveolar ventilation leads
to the consequence of hypoxemia. In this situation oxygen therapy provides adequate oxygen to
reduce the effect of hypoxemia by improving the oxygen supply (Miguel-Montanes et al., 2016).
Oxygen could be provided through nasal cannula or mask as well. It is required to maintain 1-6
LPM oxygen for nasal cannula and 5-8 LPM oxygen for mask and in both cases the rate of flow

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of oxygen per litter should be 4% (Futie et al., 2016). It would help the patient to resolve the
complications of asthma in an effective manner.
Question 3: Mode of action of drugs:
Salbutamol: It is an effective drug that helps to minimize the complications of asthma due to its
ability to enlarge the airways in lungs. The active site of the drug is the beta-2-adrenoreceptors
on the smooth muscle of bronchi. The drug binds to the active site of epinephrine and helps to
stabilize the receptors. By doing this the drug facilitate the airways in lungs in order to open up
and reduce the symptoms of severe acute asthma such as wheezing and coughing (Apter, 2014).
Ipratropium bromide: Another drug that helps to open up the air passage of lungs is Ipratropium
bromide. Acetylcholine acts as the potential factor that contributes to the narrowing and
swallowing of the air passages of lungs, which results in breathing problem. The main focus of
the drug is to reduce the impact of acetylcholine and reducing the symptom of acute severe
asthma such as breathlessness through its anti-cholinergic effect (Fergeson, Patel & Lockey,
2017).
IV Hydrocortisone: One of the common sign of acute severe asthma is the hyper-inflated lungs.
The narrowing of airways leads to the consequence of inflammation of lungs which is
responsible for hyper-inflated lungs. The drug IV Hydrocortisone has the anti-inflammatory
effect. The drug associates with the serum albumin and the globulin that binds to the
corticosteroid, thus improves the binding of the free cortisol with the receptors. In this way the
drug reduces the inflammation issue of lungs (Apter, 2014).
Beside such effectiveness of medication some adverse effect or side effects of these drugs
have been identified. For example, hydrocortisone may lead to the consequence of high BP,

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anxiety, depression, nausea and vomiting. In contrast, Salbutamol may lead to side effects such
as rapid heartbeat, chest pain and headache and the side effects of Ipratropium bromide include
headache, breathing issue and dry mouth (Fergeson, Patel & Lockey, 2017). In addition, the
issue of medication error is also reported which could leads to the adverse events. Hence, the
nurses need to monitor the condition of the patent after the administration of the drugs in order to
escalate in case of the occurrence of any adverse effect (Boulet, 2017).

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References:
Apter, A. J. (2014). Advances in adult asthma diagnosis and treatment in 2013. Journal of
Allergy and Clinical Immunology, 133(1), 49-56. Apter, A. J. (2014).
https://doi.org/10.1016/j.jaci.2013.11.005
Arabkhazaeli, A., Vijverberg, S. J., van der Ent, C. K., Raaijmakers, J. A., & Maitland ‐van der
Zee, A. H. (2017). Asthma treatment patterns in Dutch children using medication
dispensing data. Pediatric Allergy and Immunology, 28(6), 606-608.
https://doi.org/10.1111/pai.12751
Boulet, L. P. (2017). Airway remodeling in asthma: mechanisms, clinical relevance, treatment,
and prevention. Canadian Journal of Respiratory, Critical Care, and Sleep
Medicine, 1(1), 39-42. https://doi.org/10.1080/24745332.2017.1295776
Fergeson, J. E., Patel, S. S., & Lockey, R. F. (2017). Acute asthma, prognosis, and
treatment. Journal of Allergy and Clinical Immunology, 139(2), 438-447. doi:
10.1016/j.jaci.2016.06.054.
Futier, E., Paugam-Burtz, C., Godet, T., Khoy-Ear, L., Rozencwajg, S., Delay, J. M., ... &
Constantin, J. M. (2016). Effect of early postextubation high-flow nasal cannula vs
conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a
French multicentre randomised controlled trial (OPERA). Intensive care
medicine, 42(12), 1888-1898. doi 10.1007/s00134-016-4594-y.
Grosso, A., Locatelli, F., Gini, E., Albicini, F., Tirelli, C., Cerveri, I., & Corsico, A. G. (2018).
The course of asthma during pregnancy in a recent, multicase–control study on

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respiratory health. Allergy, Asthma & Clinical Immunology, 14(1), 16.
https://doi.org/10.1186/s13223-018-0242-0
Miguel-Montanes, R., Hajage, D., Messika, J., Bertrand, F., Gaudry, S., Rafat, C., ... & Dreyfuss,
D. (2015). Use of high-flow nasal cannula oxygen therapy to prevent desaturation during
tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Critical
care medicine, 43(3), 574-583. doi: 10.1097/CCM.0000000000000743
Rönmark, E. P., Ekerljung, L., Mincheva, R., Sjölander, S., Hagstad, S., Wennergren, G., ... &
Lundbäck, B. (2016). Different risk factor patterns for adult asthma, rhinitis and eczema:
results from West Sweden Asthma Study. Clinical and translational allergy, 6(1), 28.
https://doi.org/10.1186/s13601-016-0112-0