Clinical Reasoning Case Study 2022

Running Head: CLINICAL REASONING CASE STUDY
CLINICAL REASONING CASE STUDY
Name of the Student:
Name of the University:
Author Note:

1CLINICAL REASONING CASE STUDY
Question 1)
Asthma pathophysiology is dynamic and includes airway irritation, occasional ventilation
blocking, and bronchial hyper responsiveness (Sullivan et al., 2016). Inflammatory response
serves as a key function in the pathophysiology of asthma. Airway inflammation includes the
association of several cell types and several mediators with airways that ultimately result in the
hallmark pathophysiological features (Baiardini et al., 2015) of the disease: bronchial
inflammation and airflow restriction that result in repeated symptoms of cough, wheeze and
shortness of breath. Allergic reactions remain critical among all social influences (Shams &
Epstein, 2019). As described in the case study, Frances says that she had a terrible asthma as a
child, but she's been much improved in the last few years. In fact, the new asthmatic condition
intensified with the inclusion of their cats in her friend's room. The cats' hair may be one of the
allergens responsible for causing her asthma. The cause of airway inflammation in asthma can
be acute, subacute, or persistent, and the involvement of airway oedema and mucus production
can also lead to airflow congestion and bronchial reactivity.
Question 2)
a)
The two risks with asthma that Frances may experience involve her being faced with
chronic issues affecting her lungs, like pneumonia (Torres et al, 2015) and becoming exhausted,
which could result in her under-performance or loss of function. It may contribute to psychiatric
issues, including tension, anxiety, and depression.
b)
Asthma doesn't quite cause pneumonia directly, although patients with recurrent lung
conditions are more prone to experience pneumonia due to prior pulmonary disease or
weakening of lung tissue. Of the same cause, a person with asthma can have more serious effects
and risks with colds and flu. Numerous studies indicate that inhaled corticosteroids (Bansal et
al., 2015), which serve as the primary treatment choice for asthma, may raise the risk of
contracting pneumonia or other respiratory infections. Typical asthma flare-ups include hacking,

2CLINICAL REASONING CASE STUDY
wheezing and a sense of tightness in the lungs. Decreased lung activity results in trouble
breathing and elevated heartbeat. The wheezing may be high-pitched and whistling. While
asthma has no remedy, symptoms appear to react well to medication and effective therapies.
When microbes or viruses multiply inside the lung tissue, the body's innate immune defenses
tend to fill the lungs with mucus (Torres et al., 2015). It makes breathing more difficult and leads
a person to cough. The mucus enters the airways that constrict in reaction to infection, creating a
loss of oxygen flow in the body. As a consequence, the muscles continue to expend additional
energy, which may cause chest pressure worse.
Question 3)
a)
Studies have projected that salbutamol (Ullmann, Caggiano & Cutrera, 2015) has a fair
and equitable effect on beta2-adrenergic receptors particularly in comparison to isoproterenol.
While beta2-adrenoceptors seem to be the prevalent adrenergic receptors in the bronchial smooth
muscle and beta1 adrenoceptors are the prominent receptors in the heart, beta2-adrenoceptors in
the human heart are about 10% to 50% of the overall beta-adrenoceptors. The specific
mechanism (Zhou et al., 2017) of these receptors has not been identified, but their existence
gives rise to the likelihood that even selective beta2-agonists can have cardiac consequences.
Regulation of beta2-adrenergic receptors on the smooth muscle of the airway contributes to the
development of adenyl cyclase and an rise in the intracellular concentration of cyclic-3′,5′-
adenosine monophosphate (cyclic AMP). Salbutamol relieves the relaxed tissues of both
airways, from trachea to terminal bronchioles. This rise in cyclic AMP contributes to the
activation of protein kinase A, which also prevents myosin phosphorylation and reduces
intracellular ionic calcium concentrations, culminating in stabilization.
b)
Anxiety and palpitation are the most frequent side effects (Baiardini et al., 2015)
associated with salbutamol.
c)
With side effects, Frances can feel anxious or nervous along the way and experience an
irregular heart rate. The primary duty of the nurses will be to test (Cabilan & Boyde, 2017) and

3CLINICAL REASONING CASE STUDY
validate the order of the doctor. Secondly, there is a need to uphold the freedoms in the
administration of drugs, such as providing the correct drug to the correct individual and trying to
use the best path and at the right moment. Surveilling the vital stats of the patient as well as the
serum electrolytes, ECG and thyroid function test results need to be monitored and prescribing
the drug correctly must be achieved, because adverse reactions and tolerances that occur with
any administration (de Sousa et al., 2015). The side rails must be lifted as the patient can feel
anxious and drowsy due to this medication. In fact, it will be ensured that the space is well
illuminated and that the individual has a person next to them in the event of vertiges. This should
be monitored to determine the pulse for pacing and to include oral treatment. Eventually, upon
inhalation, the patient must gurgle to get rid of the uncomfortable aftertaste of the inhalation.
Nurses may need to auscultate the lungs for the occurrence of adventitious breathing noises that
may signify pulmonary edema, airway obstruction or bronchospasm. In fact, the person will be
checked in a certain relaxation role to promote optimal rest and sleep.
Question 4)
The nurses will track critical data and determine France's respiratory condition by
tracking the extent of signs, as well as by observing the rhythm of coughing and wheezing.
Nurses will track critical data and determine France's respiratory condition by tracking the extent
of signs, as well as by observing the rhythm of coughing and wheezing (de Sousa et al., 2015). It
is important to determine the respiratory condition of the patient by evaluating the extent of the
symptoms. In fact, the description of the medications that Frances is actually consuming and
prescribing as indicated. Frances need to be continued to be checked on for reactions to such
drugs, so an antibiotic might be used if the patient has an ongoing respiratory infection.
Question 5)
Wheezing (Shimoda et al., 2017) can result from concentrated or diffuse airway
restriction or congestion from either the larynx level to the small bronchi. Airway restriction can
be induced by bronchoconstriction, mucosal edema, exterior compression, or partial blocking of
the tumor, foreign body, or tenacious secretions. Oscillations or movements of nearly closed
airway walls are assumed to induce wheezes. Air flowing through a compressed part of the

4CLINICAL REASONING CASE STUDY
airway at high velocity induces a reduction in gas pressure and flow in the constricted region. By
the end of the day, the internal airway pressure starts to rise and scarcely reopens the airway
lumen.
Question 6)
Studies have shown that sensitivity to pet dander may trigger symptoms of asthma in
people with asthma, but pets and dander do not trigger asthma to grow (Farrokhi et al., 2015).
Frances has been known to have asthma, which indicates that she is vulnerable to periods of
airway narrowing (bronchoconstriction) or acute airway spasm (bronchospasm) due to a number
of causes. Animal Dander or fur extracts produce endotoxin, which is a compound that induces a
negative physical reaction. These endotoxins stimulate the immune cells and proteins, especially
IgE. Thereby, for those who have asthma, the inflammatory reaction consists in
bronchoconstriction or bronchospasm, which can be a cause in Frances.
Question 7)
The three high priority nursing problems can be considered as firstly the ineffective
breathing pattern (Borge et al., 2015) of Frances that can be triggered by swelling and spasm of
the bronchial tubes in reaction to inhaled irritants, pathogens, medications, allergies or
pathogens. Secondly, inadequate airway clearing (Chaves et al., 2016) can be regarded as
another problem where Frances has been shown to be unable to remove secretions or
obstructions from the respiratory tract in order to preserve a remove airway. Thirdly, the lack of
awareness or contextual details (Mammen et al., 2018) on France's asthma could be one of the
main challenges.
Question 8)
Nurses need Frances to recognize and teach her about the asthma symptoms that will
make her mindful of them and make her capable of managing those (Mammen et al., 2018).
Having Frances think about the proper usage of spacers through long, deep inhalation and
relaxing during inhalation can insure the effectiveness of the drug. This should be made clear to
Frances that the excessive application of MDI would result in medicines not going far enough to

5CLINICAL REASONING CASE STUDY
reach the airway. Assessing respiratory patterns and adventitious noises such as wheezes and
stridor is believed to be one of the key strategies to be sought in the case of an inadequate
breathing pattern.
Question 9)
In order to prevent potential asthma attacks, informing Frances on the causes and
specifics of asthma is quite necessary (Leung et al., 2015). Frances should be educated to learn
how to treat treatment will save time coupled with knowledge about what has been successful in
the past decides the correct action required. A fallacy of an asthma attack is that it can be treated
without medications by self-control and training. Knowledge in asthma self-management
(MacLeod et al., 2018) eliminates the need for repeated hospitalizations. Realizing and
recognizing allergen regulation, preventing pollution control, eliminating chemical contaminants
such as perfumes, aerosol sprays, powders, precipitators, and dietary practices may help deter
asthma attacks from happening.
Question 10)
a)
The two indicators of progress of France's situation are, first, the preservation of an
optimal breathing routine, as indicated by balanced breathing, regular respiratory rate or rhythm,
and the lack of dyspnea, and, second, the preservation of the airway system as illustrated by
consistent breathing patterns, increased oxygen circulation, usual pace and duration of breathing,
and the capacity to cough efficiently.
b)
The following outcomes can be predicted by urging Frances to perform deep breathing
and coughing exercises. It tends to remove and also expectorate residual secretions and add to
the successful clearance of mucus from the lungs. In fact, nurses will insure that Frances gets as
much downtime as practicable (Chaves et al., 2016). Fatigue is reported to be normal of
intensified breathing activity from an inadequate breathing method. Movement raises the

6CLINICAL REASONING CASE STUDY
metabolic rate and demands for oxygen. Controlling the physical resistance will help her
strengthen her health.
Question 11)
Anxiety is most often seen in asthma, and when focusing on Frances' treatment, nurses
will remain with her and help her to exercise steady, deep breathing. In addition, to remind
Frances and her important closed ones of regular supervision that will guarantee timely
intervention. The involvement of a trustworthy individual (Sweeney et al., 2016) may offer her a
sense of protection. In addition, promoting the use of relaxation strategies such as progressive
muscle relaxation, diaphragm and bagged lip breathing that help her relax as a study project that
relaxation techniques are one of the most successful ways to relieve anxiety in patients.

7CLINICAL REASONING CASE STUDY
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