Health Variation in Acute Exacerbations of Disease

This article discusses the pathogenesis and nursing strategies for acute exacerbations of diseases like asthma. It covers the causes, symptoms, and treatment options for such conditions. The article also provides expert study material and solved assignments on Desklib.

Running head: HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
Name of the Student:
Name of the University:
Author note:

1HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
Question 1:
The disease condition of Asthma is outlined by the occurrences of obstructive
mechanisms in the airflow, along with exhibition of debilitating respiratory symptoms due to the
prevalence of certain environmental triggers or even through spontaneous action. The treatment
practices pertaining to the occurrences of asthma are concerned at present, at targeting symptoms
caused due to presence of allergens (Garcia-Larsen et al., 2016). Despite the reported
improvements in treatment procedures, followed by enhancements in the quality of life of the
concerned individual, the prevalence of exacerbations pertaining to asthma infliction continue to
be significantly high. As evident in the selected case study, the concerned patient Jackson, is
inflicted with an asthma exacerbation, known as Acute Severe Asthma, also known as ‘Status
Asthamticus’ (Teach et al., 2015). The primary pathogenesis outlining asthma exacerbations, are
due to exposures towards certain environmental factors, leading to uncontrolled and fatal
prevalence of obstructive symptoms in the lower region of the airway of the concerned patient. A
number of factors pose as potential triggers occurring in the environment, which include,
allergens, irritants or occupational sensitizers, medications such as aspirin, pollutants in the
environment, and most importantly, viral infectious agents (Engelkes et al., 2015). One of the
key symptoms pertaining to the pathogenesis of acute and severe asthma infections is
inflammation in the airways of the concerned patient, which further results in harmful symptoms
such as obstruction in the airflow as well as increased response to stimuli in the air pathways.
Such inflammation induced obstruction in the airways, results in episodes of severe difficulties in
breathing, also known as ‘dyspnoea’, as observed in the case study of Jackson. The occurrences
of difficulty in breathing or dyspnoea in asthma is associated with symptoms such as an

2HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
increased feeling of constriction and tightness in the chest, followed by exerted efforts required
in the process of breathing, which is clearly evident in the case study of Jackson (Weatherald et
al., 2017). In the situation of a possible infection by a viral strain, the concerned rhinovirus
attaches itself to the receptor intercellular adhesion molecule, in health bronchial epithelial cells
(Costa et al., 2018). This leads to the replication of single stranded RNA, which when left
unchecked further results in the formation of virions and their associated vRNAs. The escalated
emergence of these events further leads to the stimulated of nuclear factor kappa B, further
acting as causative factors to the production of pro-inflammatory cytokines. In the situation of
asthmatic bronchial epithelial cells, the defense factors pertaining to interferons, activation of
tumor suppressor genes and the resultant apoptosis remains compromised, further resulting in
continued replication of the concerned viral strain. (Kloepfer et al., 2014). When such processed
remain unchecked for prolonged time periods, there is increased replication leading to secretion
of proteases by the virus, which destroy the cellular membrane of healthy host cells. Such
uncontrolled pathogenic steps lead to the infiltration of damaging virions inside the healthy cells,
which cause lysis induced by inflammation. The cells surrounding the vicinity of the infection
suffer from the same destructive processes, which repeats the release of pro-inflammatory
cytokines further leading to the occurrences of inflammation of the air pathways of the
concerned patient and the resultant symptoms as outlined above as well as in the case study of
Jackson (Djukanović et al., 2014). An additional causative factor pertaining to the occurrence of
asthma exacerbations are the inhalation of allergens from the surrounding environment. The
presence of allergens lead to the heightened infiltration of eosinophils in the airways, further
resulting in the collaborative influence of white blood cells or lymphocytes which further lead to
release of interleukins 4 and 13, associated with inflammatory responses and the resultant air

3HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
constriction during breathing and communicating (Virchow et al., 2016). Hence, in accordance to
the case study pertaining to the disease condition of Jackson, his asthmatic exacerbation may
have been cause by inhalation of viral pathogenic strains, potential allergens or environmental
pollutants, which have resulted in inflammation of the airways and the resultant difficulty in
breathing, talking and associated dyspnoea.
Question 2
The nursing strategy for Jackson who has been suffering from asthma include
pharmacological treatment and monitoring asthma in primary care. When it comes to the former
that is pharmacological treatment, it should be initiated at the step which is most appropriate to
the severity of asthma. The patient should be told by the healthcare service provider to gargle
after inhaling corticosteroids (ICS). Along with that spacers should be prescribed for very high
doses of ICS in order to reduce oropharyngeal disposition along with lessening the side effects of
oral candida or hoarseness of the voice. In case the patient is a smoker or ex smoker, high
amount of dose of ICS may be require due to impaired absorption across the lung. During
prescribing fluticasone, it should be remembered that it posses twice as potent as the other IC, so
the dose is half that of beclomethasone or budesonide (Nowak et al., 2015).
The second strategy should include management of supplemental oxygen on urgent basis
in order to achieve oxygen saturation of 90% and even more. A healthcare service user with
acute exacerbation inevitably suffers from hypoxia. The Supplemental oxygen is capable to
reduces mismatching while promoting the bronchodilation, and reducing the pulmonary
vasoconstriction. Along with this administration of rapidly imposition of prescribed inhaled
bronchodilators should be ensured. The Beta2-agonists stimulate the beta2 receptors in the airway

4HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
smooth muscles through relieving bronchoconstriction while reducing the muscular stress for
breathing. It also decreases the resistance to airflow (Swystun et al., 2018). The most common
prescribed SABAs are albuterol which is also known as salbutamol. Apart from that, terbutaline,
levalbuterol, and pirbuterol can be prescribed as per the situation. In this case of Jackson, with
close monitoring ebulized salbutamol can be given. At the same time, if the Jackson's initial
response to SABA therapy is poor, the nurse should consider I.V. beta2-agonists.
Question 3:
Nebulised Salbutamol is prescribed for Jackson as an aerosol, that can acts at β2-
adrenoreceptors on the smooth muscle while enveloping the bronchi. In the receptor it conjugates
the non-covalently to epinephrine’s active site, and stabilizes the receptor in its active state. The
receptor tries to stabilize the active state while making more cAMP. The resultant cAMP triggers
intracellular cascades and also release of K+ at the end (Morales et al., 2014). Finally the released
K+ decreases free intracellular Ca2+, which hinders ability to contract of the bronchus muscles.
The nurse should carry out multiple monitoring to check the effectiveness of the doses while
making changes accordingly.
Pratropium of Ipratropium bromide shows the broncholytic action by reducing
cholinergic influence on the bronchial muscles. Ipratropium bromide blocks muscarinic
acetylcholine receptors, ignoring the specificity for subtypes. Hence it also enhances the
degradation process of cyclic guanosine monophosphate (cGMP) (Ruiz-Bailén et al., 2016).
Eventually it results a decreased intracellular concentration of cGMP because actions of cGMP
on intracellular calcium. It is a nonselective muscarinic antagonist. Therefore, it does not diffuse

5HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
into the blood, that prevents systemic side effects. As a result, it decreases contractility of smooth
muscle in the lung while inhibiting bronchoconstriction and mucus secretion.
IV Hydrocortisone comprises the Corticosteroids which enhances the beta-adrenergic
response in order to relieve the muscle spasm. Through reversing the mucosal edema, decreasing
vascular permeability by vasoconstriction, and inhibiting the release of LTC4 and LTD4. At the
same time, Corticosteroids reduce the mucus secretion by inhibiting the release of secretagogue
from macrophages (O’Byrne & Jaeschke, 2016). That eventually reduces the chest pain and
inflammation of the patient. . This This ability is come from the inhibition of LTB4 release. On
the other hand, eosinopenic effect of corticosteroids can also prevent the cytotoxic effect of the
major basic protein and other inflammatory mediators which are released from eosinophils.

6HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
References
Costa, L. D. C., Camargos, P. A. M., Brand, P. L., Fiaccadori, F. S., de Paula Cardoso, D. D. D.,
de Araújo Castro, Í., ... & da Costa, P. S. S. (2018). Asthma exacerbations in a
subtropical area and the role of respiratory viruses: a cross-sectional study. BMC
pulmonary medicine, 18(1), 109.
Djukanović, R., Harrison, T., Johnston, S. L., Gabbay, F., Wark, P., Thomson, N. C., ... &
Marsden, R. (2014). The effect of inhaled IFN-β on worsening of asthma symptoms
caused by viral infections. A randomized trial. American journal of respiratory and
critical care medicine, 190(2), 145-154.
Engelkes, M., Janssens, H. M., de Jongste, J. C., Sturkenboom, M. C., & Verhamme, K. M.
(2015). Medication adherence and the risk of severe asthma exacerbations: a systematic
review. European Respiratory Journal, 45(2), 396-407.
Garcia-Larsen, V., Potts, J. F., Del Giacco, S., Bustos, P., Diaz, P. V., Amigo, H., ... & Rona, R.
J. (2016). Changes in symptoms of asthma and rhinitis by sensitization status over ten
years in a cohort of young Chilean adults. BMC pulmonary medicine, 16(1), 116.
Kloepfer, K. M., Lee, W. M., Pappas, T. E., Kang, T. J., Vrtis, R. F., Evans, M. D., ... & Gern, J.
E. (2014). Detection of pathogenic bacteria during rhinovirus infection is associated with
increased respiratory symptoms and asthma exacerbations. Journal of Allergy and
Clinical Immunology, 133(5), 1301-1307.
Morales, D. R., Jackson, C., Lipworth, B. J., Donnan, P. T., & Guthrie, B. (2014). Adverse
respiratory effect of acute β-blocker exposure in asthma: a systematic review and meta-

7HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
analysis of randomized controlled trials. Chest, 145(4), 779-786., doi:
https://doi.org/10.1378/chest.13-1235
Nowak, R. M., Parker, J. M., Silverman, R. A., Rowe, B. H., Smithline, H., Khan, F., ... &
Molfino, N. A. (2015). A randomized trial of benralizumab, an antiinterleukin 5 receptor
α monoclonal antibody, after acute asthma. The American journal of emergency
medicine, 33(1), 14-20. Retrieved from:
https://linkinghub.elsevier.com/retrieve/pii/S0735675714006913
O’Byrne, P., & Jaeschke, R. (2016). Treatment of asthma: roles of different classes of
drugs. POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ, 126(12)., doi:
doi:10.20452/pamw.3761.
Ruiz-Bailén, M., Cobo-Molinos, J., Espada-Fuentes, J. C., Castillo-Rivera, A. M., & Martínez-
Ramírez, M. J. (2016). The Acute Asthma: It's just a Respiratory Disease? A Speckle
Tracking Echocardiography Study. J Clin Respir Dis Care, 2(122), 2472-1247., doi:
10.4172/2472-1247.1000122
Swystun, V., Green, F. H., Dennis, J. H., Rampakakis, E., Lalli, G., Fadayomi, M., ... & El
Mays, T. Y. (2018). A phase IIa proof-of-concept, placebo-controlled, randomized,
double-blind, crossover, single-dose clinical trial of a new class of bronchodilator for
acute asthma. Trials, 19(1), 321. Retrieved from: https://doi.org/10.1186/s13063-018-
2720-6
Teach, S. J., Gergen, P. J., Szefler, S. J., Mitchell, H. E., Calatroni, A., Wildfire, J., ... & Matsui,
E. (2015). Seasonal risk factors for asthma exacerbations among inner-city
children. Journal of Allergy and Clinical Immunology, 135(6), 1465-1473.

8HEALTH VARIATION IN ACUTE EXACERBATIONS OF DISEASE
Virchow, J. C., Backer, V., Kuna, P., Prieto, L., Nolte, H., Villesen, H. H., ... & de Blay, F.
(2016). Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults
with allergic asthma: a randomized clinical trial. Jama, 315(16), 1715-1725.
Weatherald, J., Lougheed, M. D., Taillé, C., & Garcia, G. (2017). Mechanisms, measurement
and management of exertional dyspnoea in asthma: Number 5 in the Series “Exertional
dyspnoea” Edited by Pierantonio Laveneziana and Piergiuseppe Agostoni. European
Respiratory Review, 26(144), 170015.