NUR2204 Clinical Reasoning Assignment 2022

NUR2204 CLINICAL REASONING ASSIGNMENT CASE STUDY
TEMPLATE
Question 1
Asthma can be defined as a pulmonary disorder that is characterised by
tightening of respiratory smooth muscles, inflammation of the respiratory
tubes and episodes of bronchoconstriction. An acute asthma attack takes place
in the middle of a chronic disease of Asthma.
Asthma is related to immune T cell helper Type-2 (Th2), common for other
atopic conditions. Enhanced level of Th2 in the airways, cytokines, including
interleukin (IL)-4, IL-5, IL-9 and IL-13, release unique cytokines along with
facilitating the production of eosinophilic inflammation and immunoglobulin
E (IgE) (McCracken et al., 2017). In effect, IgE development causes the
release of inflammatory mediators, such as histamine as well as cysteinyl
leukotrienes, leading to bronchospasm (smooth muscle contracture in the
airways), edemas and decreased mucus secretion, contributing to hallmark
symptoms of asthma (Ebell, Marchello & O'connor, 2017). In the early stage
of an immune response to the stimulus, the mediators as well as cytokines
propagate further the inflammatory reaction (the late-phase asthmatic
reaction), resulting in gradual swelling of the airways and bronchial
hyperactivity. With time, recovery of airways induces additional lung disease
and serious airway congestion with recurrent asthma exacerbations (Cardet et
al., 2016).
Question 2 (a) The two complications from Asthma that can be experienced by Frances due
to sudden Asthma attack are as follows:
i. Status asthmaticus
ii. Extreme difficulty in breathing leading to respiratory failure
Question 2 (b)
According to researchers, for an individual, suffering from Asthma, there exist
a risk of his/her immune system getting inflamed as well as swollen while
he/she is around certain irritants. For Frances, the fur of the cat at her friend’s
house possesses the potential to act as an irritant (Essat et al., 2016). Chest
pain resulting from acute asthma can take place due to two primary medical
conditions, namely, Pneumomediastinum and Pneumothorax.
Pneumomediastinum is a condition that takes place when an individual
develops air in between the mediastinum, a space between the lung and the
other organs in the cavity of the chest, including the heart (Varricchi et al.,
2017). The Pneumothorax condition takes place when air leaks in the space
between chest walls and lungs.
Question 3 (a)
Salbutamol refers to a fast-acting as well as selective beta2-adrenergic
receptor agonist that is used for treating acute Asthma Conditions (Emma et
al., 2018). The mode of action of Salbutomol includes opening up the medium
and large airways of the lungs, relaxing airway smooth muscle along with
increasing airflow in order to provide rapid relief of acute asthma symptoms
(Jose et al., 2019). The results of the treatment start in about 10-15 minutes
and typically achieve a cumulative duration of 30 minutes.
Question 3 (b)
The two most common side effects of Salbutalmol include Headache and
increased heart rate.
Question 3 (c)
The chief role of nurses before providing the patients with Salbutamol is to
conduct an in-depth assessment of the patient’s condition and strictly follow
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NUR2204 CLINICAL REASONING ASSIGNMENT CASE STUDY
TEMPLATE
the considerations associated with the medication (Zaidan et al., 2020). The
nursing assessment should primarily involve listening to the sound of the lung,
measuring the blood pressure and heart rate of the patient prior to the usage as
well as during the usage of Salbutamol, in case the patient is suffering from
productive cough, it is highly crucial to assess the amount, colour as well as
consistency of the sputum (Javor & Grle, 2019). Along with this, prior to use
the medication, nurses should assess whether the patient possess paradoxical
bronchopasm, which is the opposite of the intended reaction of the Salbutomol
(Green, 2018). For Patients who are being assessed with paradoxical
bronchopasm should not be administered Salbutomol. The chief reason behind
this is instead of decreasing Broncoconstriction, it may get increased resulting
in enhanced wheezing and difficulty in breathing (Thomson & Hasegawa,
2017). Along with these, the following considerations also needs to be
assessed by nurses prior to the usage of Salbutamol by nurses:
 overactive thyroid gland
 Diabetes
 excess body acid (Scott & Chavasse, 2019)
 low potassium rate in blood
 diminished blood flow through arteries of the heart
Question 4
Considering the fact that Frances is suffering from a Acute Asthma attack, it is
highly crucial for the Nurse to assess the respiratory status of the patient with
the help of monitoring severity of the symptoms. Along with this nurse should
assess the breathing sound of Frances along with her peak flow in order to
understand the criticality of the issue (Busuttil, 2019). This assessment
should be followed by the assessment of the oxygen saturation level with the
help of pulse oximeter (Fergeson, Patel & Lockey, 2017). This assessment will
help the nurse to understand how much oxygen the red blood cells of the
patent are carrying. Low oxygen saturation level may indicate occurrence of
Hypoxemia and in such case effective step should be taken to enhance the
oxygen level in the blood of the patients (Shoda et al., 2020). Finally, the vital
signs of the Frances should be monitored by the nurse and noted down in order
to ensure effective and prompt treatment to acute Asthma (Mohamed et al.,
2018).
Question 5
Asthma is one of the primary reasons behind Hypoxemia amongst adults and
Children. Consdering the fact that that abnorimality in Frances ‘s oxygen
saturation level has been noticed, it can be clearly understood that she is
suffering from Hypoxemia (Hiscocket al., 2020). Hypoxia happens as the
body's tissues hold a decreased volume of oxygen. Hypoxemia refers to a
lowering of PO2 than normal, if the flow of gas is disrupted, CaO2 is
sufficient, or tissue hypoxia is present.
The drop of Oxygen saturation level may either be caused by incorrect supply
or by inadequate oxygen usage in the tissues. There is a risk of hypoxemia and
hypoxia still. If there is a compensatory rise in hemoglobin and cardiac
production (CO), the patients can experience hypoxemia without hypoxia.
In case of Frances, Asthma is the reason behind Hypoxemnia. During an
Asthma attack, it becomes difficult for the lungs of the patient to obtain air due
to narrow airways. Moreover, the act of coughing for clearing lungs takes
away more oxygen and making the symptom worse.
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NUR2204 CLINICAL REASONING ASSIGNMENT CASE STUDY
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Question 6
The fur shaded from animals like Cat and Dogs can makes an Asthma attack
worse. Animal dander, which are small particles are carried though air. If an
individual who have asthma, inhales the same, he or she may develop a good
number of respiratory effects in response to the animal danger. Majority of
time, symptoms are noticed immediately after the exposure, however, patients
can develop symptoms even after an hour or two. According to Israeland
Reddel (2017), animal danger in majority of times results in allergic symptoms
instead of typical symptoms of Asthma. The most common response to
Animal danger includes:
 Runny and stuffy nose
 Scratchy throat
 Watery, itchy, red eyes
 A rash or irritated skin
In case of Frances, exposure to her friend’s cat had resulted in inhalation of
Animal danger which in turn resulted in allergic reaction.
Question 7
The first nursing problem of Frances that needs to addressed at highest priority
is her shortness of breath. The oxygen saturation level of the blood has
dropped down to 94 percent which ideally should be at 98 percent.
The second nursing problem of Frances includes red through with enlarged
cervical glands. This may need to address on an emergency basis since it may
lead of severe infection (Ahmed et al., 2018).
The third nursing problem needing immediate attention included Frances’s
high blood pressure level.
Question 8
As the intervention of Hypoxemia due to Asthma, Frances needs to be given
Short acting beta agonists like Albuterol as an emergency treatment through
nebulizer. This will reduce her shortness inbreathing (Fergeson et al., 2017).
In order to treat the enlarged Cervical Lymph nodes, Frances may be given
antibiotics or nonsteroidal anti-inflammatory drugs like ibuprofen (Scott &
Chavasse, 2019).
Question 9
In order to educate Frances, so that sudden Asthma attacks can be prevented
in future, the following steps can be taken:
1. Frances will be made aware of the action or circumstances that she
needs to avoid in order to prevent asthma attack. For instance, she
should avoid direct or indirect contact with furry animals (Thom,
2017)
2. A written action plan for guided self management will be provided to
Frances.
Question 10 The two signs and symptom that will help the nurse to identify improvement
in Frances’s condition includes:
1. Lack of wheezing sound
2. Reduced shortness of breathe
To diagnose, the degree to which her Shortness of breath has got reduced,
Lung function tests or spirometric measures will be taken (Thomson &
Hasegawa, 2017). In case her SaO2 is 98 percent or higher improvement
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