Priority Problems in Asthma: Ineffective Airway Clearance and Impaired Gaseous Exchange

1Bachelor of nursing (2nd year)
Bachelor of nursing (2nd year)
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2Bachelor of nursing (2nd year)
Introduction
The case study is about a 14 years old boy named as Simon, who had been presented in to
the emergency department with acute respiratory distress and wheezing. Simon had been unable
to speak in full sentences. This assignment will describe the priority problems of Simon and link
them to the assessment data and the underlying pathophysiology of the clinical condition. It will
also provide sets of interventions to solve the problems support by valid literary evidences.
Priority problems related to the assessment data and the pathophysiology
Clinical priority 1
The assessment data reveals, that Simon, a 14 years old boy had been admitted the
emergency department, with subsequent wheezing. One important priority problem identified
from Simon is ineffective airway clearance that is the evident from the wheezing sound of the
patient. It evident that the boy had been under an asthmatic attack. Asthma is a chronic
inflammatory disorder of the airways that causes airway responsiveness, respiratory symptoms,
airflow limitations, disease chronicity (Maslan & Mims, 2014). The ineffective airway clearance
is due to the accumulation of excessive mucus in the airways. Airway edema that has been found
to further limit the airflows, which includes edema, inflammation, mucus hyper secretion and the
formation of inspissited mucus plug (Edwards et al., 2016). The wheezing in the asthmatic
patient is mainly caused due to the narrowing of the airways and subsequent interference with
the airflow. At the time of asthmatic attack, the bronchial smooth muscles contract to narrow the
airways in response to the irritants. Wheezing occurs when the small airways of the lungs
become narrow, that makes the lungs difficult to breathe, and can cause a whistling sound at the

3Bachelor of nursing (2nd year)
time of breathing out (Melen & Pershagen, 2012). The allergen –induced bronchoconstriction is
due to the release of IgE dependent release of the mediators from the mast cells, including the
histamines, tryptase, leukotrienes and the prostaglandins that directly comes in contact with the
smooth muscles (Doeing & Solway, 2013). Bronchoconstriction, where the smooth muscles of
the airways contract to narrow the airways in response to allergen. In case of Simon, it is evident
from the case study, that he was playing soccer, hence it can be said that he might have come in
exposure to certain allergens like cold air or pollen grains or normal dusts. Another phenomena
that occurs within the airways is the occurrence of airway edema (Seys et al., 2013). With the
progression of the disease, there are some other factors that limits the airflow through the
airways, such as excessive accumulation of mucus as well as structural changes including
hypertrophy and hyperplasia of the smooth muscles (Kudo, Ishigatsubo & Aoki, 2013). Airway
responsiveness is another factor that is an exaggerated bronchoconstrictor response to a wide
variety of stimuli. The mechanism behind the occurrence of airway hyperresponsive are multiple
and might include inflammation, dysfunctional neuro-regulation and the structural changes.
A nursing goal is normally constructed to help individuals, families, communities and
groups to reach an optimum state of wellbeing by restoring, maintain and promoting the health.
Hence a nursing goal will be developed for Simon.
Nursing Goals: To clear the secretions or obstructions from the respiratory tract for maintain a
clear airway.
Interventions
 In case of excessive airway obstruction due to the accumulation of mucus plugs, it is first
necessary to assess the signs and the symptoms of airway obstruction (Amirzade et al.,

4Bachelor of nursing (2nd year)
2013). In this case a tube has to be placed such that the air can pass through the lungs easily
(Frota, Loureiro, & Ferreira, 2013). Suctioning helps in the rapid clearance of the secretion
and restrict the airways from getting blocked and leads to an improvement in the breathing
procedure. A small tube known as the suction catheter is attached to the suction and is placed
in the airways, for removing the secretions (Leddy & Wilkinson, 2015). It is a relatively
quick procedure and each insertion of the suction catheter will not last more than 10-15
seconds. As stated by Heidari and Shahbazi, (2017), suctioning has complications like
damaging the airway, hypoxemias and bronchoconstriction, alterations in the mean arterial
pressure, disturbances in heart rhythm and the pneumonia. Hence, it is the duty of the nurses
to have enough knowledge about the implementation of this techniques (Bledsoe et al.,
2014). According to the NMBA standards, it is the duty of the nurses to remain accountable
to patient safety.
 Another important intervention that can be used for an effective airway clearance is the use
of nebulizers and bronchodilators (Bledsoe et al., 2014). Bland aerosols have been found to
be effective against in secretion clearance (Lima et al., 2016). Secretagogues (expectorants)
has been found to be effective in increasing the volume of the water and the mucus in the
airways (Lima et al., 2016). There are key studies that have suggested that it showed an
improvement in the lung function but at the cost of bronchospasm (Cates, Welsh & Rowe,
2013).
Nursing is not only about giving medications, but also about dispensing of medication or
administering treatment. They are responsible for reeducating the patients to us the devices like
nebulizers or bronchodilators (Kwok & Chan, 2014). Before the administration of the medicines