Understanding Asthma: Symptoms, Pathogenesis, and Nursing Strategies

Running head: HEALTH VARIATION
HEALTH VARIATION
Name of the Student
Name of the University
Author Note

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Question 1
This case scenario reveals the fact that Jackson Smith has possibly suffered from an asthmatic
attack. The normal clinical manifestation of asthma is chest tightness, cough, and respiratory
distress. Some of the important symptoms of asthma that is common to most of the patients
with asthma are, airway obstruction due to airway inflammation, formation of mucus plug
and wide spread wheezing. The pathogenesis of the airway obstruction is due to a variety of
changes taking place in the airways, such as the bronchoconstriction (Bonini & Usmani,
2015). This is caused due to the contraction of the bronchial smooth muscles in response to
the exposure to a variety of stimuli including the allergens and the irritants.
Bronchoconstriction is again caused due to the release of the IgE dependant mediators like
tryptase, histamine and prostaglandins. In addition to this airway oedema formed due to the
inflammation of the airways also restricts the passage of airway causing widespread
wheezing. Wheezing is the musical sound that is produced when air is passed through a
limited area through the airways. A wide spread wheezing can be noticed in this patient
which is the most important symptoms of asthma. Other stimuli such as exposure to cold,
dust and other irritants can also trigger asthmatic attacks (Bonini & Usmani, 2015).
Airway hyper responsiveness is an important manifestation that is mainly caused due
to airway inflammation. Permanent or partial structural changes may occur in the airways
causing a gross loss in the lung function that cannot be recovered by any current therapy.
Airway remodelling also involves the activation of a number of cells, that can increase the
airway obstruction and airway responsiveness, which normally renders the patients less
responsive to any kind of therapies.
The case study reveals that the patient suffered from acute dyspnoea. It has to be
remembered that dyspnoea is the primary symptom of asthma. The exertional dyspnoea in

HEALTH VARIATION
case of asthma is due to some complex pathological mechanisms like dynamic hyperinflation,
an increased ventilatory demand, impaired capacity, hypercapnia, hypoxemia and the neuro-
mechanical dissociation. A large number of inflammatory cells are responsible for the
inflammation of the airways. Activation of the mucosal mast cells releases
bronchoconstriction mediators. Increased number if eosinophil have been observed in
patients suffering from asthma.
It is also evident from the case study that smith was having a low oxygen saturation
level than the normal value, which is above 95 %. Low oxygen saturation is common during
an asthma attack. This is due to the fact that low amount of oxygen reaches the blood. The
respiratory rate in the patient was found to be much higher than the standard value ( Papazian
et al., 2016). This can be explained simply by the fact that the amount of air entering the
lungs in each of the breath is reduced and hence the person needs to take more breaths to
cope up with the normal oxygen demands of the body ( Papazian et al., 2016). Diminished
breath sound is another symptoms of asthma. Decreased sound signifies air or fluid round the
lungs or the increased thickness of the chest walls or reduced flow of air in to the lungs.
Serum lactate level has been found to increase during asthmatic attack. According to a study,
high serum lactate levels has been observed in patients taking IV or nebulised salbutamol
(Rodrigo, 2014). The aggressive attack of the Beta agonists during asthmatic attack have
been found to be responsible for the increased lactate concentration. When a chest x-ray was
performed a hyper-inflated lungs was noticed. Hyper inflated lungs can be caused due to the
blockages in the air passage that interferes with the expulsion of air from the lungs. Normally
mild inflation of the lungs takes place at the time of asthma exacerbation. However
hyperinflation of the lungs are more common in patients with chronic obstructive pulmonary
disease (COPD). The recorded pulse rate of Jackson Smith is greater than the standard value.

HEALTH VARIATION
Rapid pulse during an asthmatic attack is probably due to the fact that the heart pumps more
rapidly to send blood to different parts of the body. Rapid pulse during an asthmatic attack
can also be due to psychological reasons. Panic attack due to breathlessness can be the cause
of an elevated pulse rate.
Question 2
Two high priority nursing strategy for managing Jackson
 One of the clinical nursing priority to manage asthma in Jackson Smith is to maintain an
optimal breathing pattern in the patient. This can be evidenced by relaxed breathing in the
patient, normal respiratory pattern and absence of dyspnoea in the patient. Optimal
breathing pattern in the patient is facilitated by administering medicines like short acting
beta-2-adrenergic agonist like Albuterol, Terbutaline (Murphy et al., 2013). Optimal
breathing is also facilitated by encouraging the patient to use a pursed lip breathing for
the inhalation. Management of effective breathing pattern also involves proper
monitoring of the oxygen saturation level and assessing the presence of the paradoxical
pulse of greater than 12mm Hg (Lalloo et al., 2013).
Rationale: Short acting beta agonist acts as bronchodilators. They tend to relax the inner
muscular lining of the airways. The inhaled corticosteroids helps in the reduction of the
inflammation of the airways that carry air to the lungs (Cates, Welsh & Rowe, 2013).
Pursed lip breathing can help in improving the breathing pattern by moving the used air
out of the lungs and oxygen to enter the lungs. Paradoxical pulses should be assessed
because paradoxical pulse occurs when there is an abnormal decrease in the systolic
pressure at the time of inspiration.