Pathogenesis of Asthma and Clinical Manifestations

This document discusses the pathogenesis of asthma and the clinical manifestations it presents. It explains the causes of airflow limitation, bronchoconstriction, airway edema, airway hyperresponsiveness, and airway remodeling. The document also explores the complex nature of acute asthma and its impact on children.

CASE STUDY OF
ASTHMA

TABLE OF CONTENTS
Question 1..................................................................................................................................1
Pathogenesis causing the clinical manifestations with which Poppy presents......................1
Question 2..................................................................................................................................1
1. Sit Poppy in a High Fowlers position................................................................................1
2. Apply and titrate oxygen...................................................................................................1
Question 3..................................................................................................................................2
Salbutamol..............................................................................................................................2
via nebulizer...........................................................................................................................3
Hydrocortison.........................................................................................................................3
eIV..........................................................................................................................................4
Ipratropium Bromide via nebuliser........................................................................................5
REREFENCES...........................................................................................................................6

Question 1
Pathogenesis causing the clinical manifestations with which Poppy presents
Asthma is one of the most complex, common and chronic disease which is mostly found in
children. Pathogenesis of acute asthma is quite complex that involves airways inflammation,
intermittent airflow obstruction and bronchial hyperresponsiveness (Craft & et al, 2015). Poppy
was diagnosed with acute exacerbations of asthma so as per the question pathogenesis causing
clinical manifestations of asthma is limitation of airflow in asthma is caused by variety of
changes within airways that includes.
 Bronchoconstriction: it is one of the main physiological events that leads to airway
narrowing and subsequent interference with airflow.
 Airway edema: As this disease becomes more persistent, inflammation becomes more
progressive and many other factors limits airflow.
 Airway hyperresponsiveness: It is one of the major features of asthma which is an
exaggerated bronchoconstrictor response to a wide variety of stimuli.
 Airway remodeling: Sometimes airflow limitation is partially reversible. Permanent
structural chances can occur in the airway.
Question 2
1. Sit Poppy in a High Fowlers position
Ways in which position of a patient with acute asthma in a High Fowlers position assist to
alleviate respiratory distress
Positional strategies are most commonly used to improve oxygenation of patients with
acute respiratory diseases (Grossmann, 2013). It can be used for Poppy for her acute
exacerbation of asthma. It can help Poppy to assist or support airways, circulation, breathing as
well as monitor her clinical status and vital sign. High Fowlers position will provide Poppy a
comfortable position as well as will also encourage her to relax. This position will also help in
maintaining a calm environment. This position will also ensure Poppy that all the medical staff
members are there in order to ensure her safety. This position will also provide assistance to her
many activities such as breathing, eating. This position is specifically chosen for taking X- Ray
at bed side when breathing treatment is provided to Poppy.
2. Apply and titrate oxygen
What kind of oxygen delivery device will be used?
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There are three types of oxygen delivery devices low-flow, reservoir, and high-flow. In
case of Poppy High-flow oxygen delivery system will be used as it will help in supplying oxygen
concentration at flow equalling Poppy’s inspiratory flow demand
Reason for choosing this device
The main reason of choosing this high- flow oxygen device is because this device helps
in creating high enriched oxygen flow of a desired concentration. It helps in providing constant
FiO2 despite of varied respiratory rate (Kostakou & et al, 2019). It provides a safe and effective
management of asthma in Children. It is an alternate oxygen delivery system for patients like
Poppy who ae facing difficulty in breathing because of asthma.
Ways in which providing supplemental oxygen work and reason because of which this will
assist Poppy
This system will help in assisting Poppy because it will provide oxygen at greater rate
which will further help in reducing her shortness of breath and is quite suitable for children
below 10 years.
Question 3
Salbutamol
Mechanism of action
 Salbutamol stimulate adrenergic receptors that are predominant receptors in bronchial
smooth muscle.
 It leads to activation of enzyme adenyl cyclase from AMP to ATP.
 AMP increase relaxes bronchial smooth muscle, reduces airways resistance
 It also relaxes smooth muscles of airways
Reason because of which patient is receiving this medication in relation to her symptoms
and diagnosis
Reason because of which this medication is being provided to Poppy because it is mostly
used for treatment of bronchospasm due to asthma. This medicine will provide Poppy a relief in
her acute asthma condition.
Nursing considerations for this medication
Salbutamol is available as tablet, syrup, metered dose inhaler (MDI), dry powder inhaler and in
many more forms. Dose for children and adults is completely different. It is important for nurses
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to check amount of dose and form in which it is required to be provided to Poppy because it is
given in excess amount then it can have adverse effect on her condition.
Clinical response you expect
It helps in more rapid stabilization in patients which can helps in rapid discharge of the
patient.
What continuing clinical observations will be required to be undertaken
It helps in easing patient in breathing and enhances respiratory within acute asthma
patients.
via nebulizer
Mechanism of action
via nebulizer produces aerosols drugs from non-drug formulation. It blocks muscarinic
cholinergic receptors by action of acetylcholine (Chamberlain & et al, 2016). It results
in decreased contractility of smooth muscle
Reason because of which patient is receiving this medication in relation to her symptoms
and diagnosis
it has chosen as pa medication for patient because it helps in delivering medicine dosages at a
faster speed and is much effective in acute asthma.
Nursing considerations for this medication
Make Poppy sit in appropriate position, explain breathing process to the patient during this
medication.
Clinical response you expect
If air inflammation condition is improved than dose can be increased by 250 mg twice daily
every two weeks.
What continuing clinical observations will be required to be undertaken
Breathing or respiratory rate should be continued to ne measured before increasing doses.
Hydrocortison
Mechanism of action
Short term effect of this medicine is that it reduces vasodilation and permeability of
capillaries. Corticosteroids binds glucocorticoid receptor mediates bring changes in gene
expression that lead to multiple downstream effects over hours to days.
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Reason because of which patient is receiving this medication in relation to her symptoms
and diagnosis
It helps in resolving acute asthma symptoms by enhancing beta-adrenergic response to relieve
the muscle spas.
Nursing considerations for this medication
patients are instructed to avoid contact with people known with contagious illness and also report
any kind of infection as soon as possible (Villa-Roel & et al, 2019). Patients are advised to
consult the doctor before stopping the medication.
Clinical response you expect
it helps in enhancing immune system response to asthma symptoms. Favourable response is
noted, proper medicine doses within appropriate timing is also noted so that its effectiveness
can be measured.
What continuing clinical observations will be required to be undertaken
It should be continued to be used as it minimises harmful side effects of overall treatment of
acute asthma condition.
eIV
Mechanism of action
It helps in increases optimal interaction between the proteins encoded by all the genomic
segments
Reason because of which patient is receiving this medication in relation to her symptoms
and diagnosis
the reason because of which this medication is provided to the patient is because it helps in
enhancing viral replication pathway
Nursing considerations for this medication
Dose required to be given to the patient should be checked.
Clinical response you expect
Sterilises immunity of acute asthma patient
What continuing clinical observations will be required to be undertaken
it includes Regular measurement and documentation of physiological observations that are
important for assessment of patient
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Ipratropium Bromide via nebuliser
Mechanism of action
It is an anticholinergic agent that blocks muscarinic receptors of acetylcholine.
Ipratropium bromide is a bronchodilator that dilates (enlarges) airways (bronchi) in the lungs.
Reason because of which patient is receiving this medication in relation to her symptoms
and diagnosis
The main reason because of which it is provided to patients is because it enlarges airways and
also blocks effect of acetylcholine on airways
Nursing considerations for this medication
 Protect solution from light.
 Use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of
narrow-angle glaucoma.
Clinical response you expect
It responds within minutes of administration and reduces delay in response of asthma but
however it has less predictable clinical response.
What continuing clinical observations will be required to be undertaken
one of the main clinical observation which is required to be undertaken is whether the patient
have any kind of allergy from peanut because in such case this medicine is not allowed to be
taken.
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REREFENCES
Books and journals
Chamberlain, J. M., & et al (2016). Practice pattern variation in the care of children with acute
asthma. Academic Emergency Medicine. 23(2). 166-170.
Craft, J., & et al. (2015). Understanding pathophysiology (2nd ed.). Chatswood, NSW: Elsevier
Australia.
Grossmann S. (2013). Porth’s pathophysiology: Concepts of altered health states (8th ed.).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Kostakou, E & et al. (2019). Acute severe asthma in adolescent and adult patients: current
perspectives on assessment and management. Journal of clinical medicine. 8(9). 1283.
Villa-Roel, C., & et al (2019). Reasons and outcomes for patients receiving ICS/LABA agents
prior to, and one month after, emergency department presentations for acute
asthma. Journal of Asthma. 56(9). 985-994.
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