Acute Life-Threatening Conditions: Pathogenesis, Clinical Manifestations, and Treatment

This document discusses the pathogenesis, clinical manifestations, and treatment of acute life-threatening conditions. It explores the role of positioning, oxygen therapy, and medications in managing these conditions. The document also provides insights into the nursing considerations and expected clinical responses. The subject of the document is health variations, and it is part of the course code XYZ123 in the course name 'Health Variations 4' at ABC University.

Health Variations 4:
Acute Life-
Threatening
Conditions

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Q1) Explain the pathogenesis causing the clinical manifestations with which Poppy presents
................................................................................................................................................3
Q2) Step 1: Sit Poppy in a High Flowers position.................................................................4
Q3) some of the question:.......................................................................................................5
REFERENCES................................................................................................................................8

INTRODUCTION
An apparent life threatening condition is known as the channel of frightening to the
observer and this is identified by some combination which is associated with the aponea that is
may be central and obstructive. As per this, there is some question which is answered to provide
the pathogenesis of poppy. In context with this, the position of poppy and also there are number
of drug which is used define drug of mechanism of action. Baker and et. al., (2020).
MAIN BODY
Q1) Explain the pathogenesis causing the clinical manifestations with which Poppy presents
Asthma is a condition in which the inflammation of the airway causes narrowing of
airway which then reduces the flow of air in and out of lungs resulting in breathlessness. Chen
and et. al., (2018). Asthma histopathological features include cell inflammation due to internal or
environmental factors. The most common form of asthma in children is atopic asthma. This is
classified by the presence of immunoglobulin E(IgE) which are allergen sensitive antibodies. In
Poppy’s case her infrequent episodic asthma would be atopic triggered by external factors
including pollen and or dust. Hussain (2019). . The Pathogenesis of asthma mainly includes two
factors genetic and environmental factor as allergens play an important role in pathogenic of
asthma. When a person inhales any allergen, they reach to epithelium of the trachea or bronci. As
poppy inhales an allergen it travels the conducting passage of her respiratory system to the lining
of the trachea and bronchi known as pseudostratified epithelial tissue. Antigen-presenting cells
known as dendritic cells, react to the allergen by triggering an immunohistopathology response.
The T cells activate T helper type 2 (Th2) cells. Th2 cytokines modulate cell hyperplasia through
interleukin-13 inducing airway hyperresponsiveness (AHR). Plasma cells are stimulated due to
the release of cytokines and leukotrienes, resulting in IgE antibodies. Ige antibodies bind to mast
cells allowing both histamines prostaglandins and leukotrienes to release. Due to this rapid
response compounds known as histamines cause a pro inflammatory reaction, ultimately leading
to bronchoconstriction. Bronchoconstriction is the contraction of smooth bronchus muscles
emanating AHR. The inflammatory reaction of Poppy airways has led her airways to a state of
hyper-responsiveness and bronchospasms. As a result of this episode poppy respiratory
symptoms worsen over time leading to breathlessness and ultimately chronic respiratory disease
if left untreated. Poppy’s oxygen saturation levels (Spo2) are at 87% on room air, showing she is

in a state of hypoxia, with her inflamed narrowed airways causing breathlessness giving a
respiratory rate of 42. Poppy’s is experiencing tachycardia as her heart’s electrical signals (SA
Node) is firing electrical signals out of tune. Reduced efficiency of the heart (left) leads to build-
up fluid in her lungs, linking to inspiratory/expiratory wheezing, accessory muscles (shrugging
shoulders) Poppy BGL was 9.0mmol/l indication of shock response due to her body being under
stress and prednisone being administered poppy elevated lactate result usually caused by
decreased oxygen delivery. Onyekere and et. al., (2021).
Through auscultation there was bibasilar crackles which are also a result of her lung
inflammation. Poppy’s Xray showed hyperinflation of both lungs. Airway Oedema of Poppy’s
lungs include the formation of assassinated mucus plugs, hypertrophy and hyperplasia all
restricting blood flow. Therefore, Poppy’s oxygen saturation is at a low 92%on 6lpm O2. Airway
remodelling increases the narrowing of Poppy’s airways causing structural changes including the
thickening of sub-basement membrane and blood vessel proliferation and dilation. Bernacki and
et. al., (2019).
Q2) Step 1: Sit Poppy in a High Flowers position.
 How does positioning a patient with acute asthma in a High Fowlers position assist to
alleviate respiratory distress?
A high fowler’s position leaves the patients upper body between 60 to 90 degrees. Mohanty and
et. al., (2020). For patients in respiratory distress and shortness of breath like Poppy, a high/full
fowler’s position would be most appropriate as it helps to open airways and reduce breathing
difficulty. Dudek and et. al., (2020). By Poppy sitting in a high fowler position the weight and
pressure on her chest and lungs will reduce. The proper positioning of the body and
diaphragmatic breathing will have an effect in altering the respiratory pattern and reduce the
dyspnea in people suffering from asthma.This reduced pressure will increase the capacity of the
lungs ultimately assisting poppy’s breathing . If she were put in a lower position her lungs would
be compressed by her abdominal muscles as well as her heart. This compression would worsen
her symptoms and may completely block her airways. Research shown that when a position such
as the high Fowler's position is used in young patients, it also indicates that the V/Q mismatch
that occurs during asthma will also be befitted from putting the patient in an upright position.
Step 2: Apply and titrate oxygen.

 What oxygen delivery device will you use?
 Why did you choose this device?
 How does providing supplemental oxygen work, and
 How will it assist Poppy?
The goal of oxygen therapy is to provide sufficient transport of oxygen in the blood while
decreasing the work of breathing and reducing stress on the myocardium. Solé-Senan and et. al.,
(2018). The Venturi mask is the best delivery device to use for Poppy in this situation. It can also
be titrated by colour coded valves to increase or decrease oxygen. It is the most effective means
to provide a high flow of oxygen (6LPM) to manage the oxygen levels in her body so that she
delves further into a state of hypoxemia. Poppy PaCo2 is 49 venturi mask is able to provide 60%
of inspired oxygen as compared to a nasal cannula that provides only 24%-40%. Also the oxygen
therapy will help ensure that blood haemoglobin level is being absorbed and will increase the
oxygen being carried in the plasma .The venturi mask is designed for situations like this to
provide oxygen whilst attaching the nebuliser to give the Salbutamol simultaneously. Higher
concentrations of oxygen for Poppy are needed which can only be achieved by the Venturi mask,
allowing a high flow of oxygen to the patient, aiding respiration. Supplemental oxygen works by
saturating the haemoglobin with oxygen to ensure that plasma holds maximum capacity of
oxygen to the lungs and around the body. Oxygen flow rate which is less than 5 litre per minute
can be used with the nasal cannules, each enhancement of 1 litre/minute which help to the FiO2
by approximate 4 percent. Dusemund (2017).
Q3) some of the question:
 The mechanism of action.
 Why your patient is receiving this medication in relation to her symptoms and diagnosis?
 What are the nursing considerations for this medication?
 What clinical response you expect?
 What continuing clinical observations will you need to undertake?
Medications
 Salbutamol via nebuliser
 Hydrocortisone IV

 Ipratropium bromide via nebuliser
Salbutamol: Salbutamol promotes beta2-adrenoceptor stimulation enhancing the
irrevocable link of intracellular calcium to the cell membrane. It is a type of bronchodilator
which works by relaxing the smooth muscles of one’s airways making it easier to breathe. When
administered via nebuliser it causes bronchodilation by stimulating the b2 receptor in the smooth
muscle. By using beta agonists this will be able to activate beta receptors dilating bronchial
muscles. This action normally occurs within 5 minutes of administration. Poppy is being given
this medication as her airways have constricted not allowing her to breathe sufficiently. As a
result of Poppy’s asthma, she is experiencing bronchospasms leading to low saturations and
overall hypoxia. Khan(2018). This medication will ultimately allow her bronchial’s to dilate
thus more oxygenated cells to the lungs. The nurse should consider the history of the patient and
should ensure that doses that are being administered are according to the needs of the patient and
that the recommended dosage is not exceeded. Some of the side effects may result in an
increased irregular heart rate, anxiousness, jittery or a sore throat or cough. As a result, the nurse
must continuously check the heart rate, oxygen levels and respiration rate also observe of
peripheral circulation of the patient and monitor their electrolytes. The nurse needs to do
Continuous A-G assessment of Poppy via close monitoring for worsening signs of deterioration.
Clinically it is expected that salbutamol improves the airway patency thus will improve Poppy’s
tachypnoea, and overall hypoxia symptoms. González and et. al., (2019).
Hydrocortisone: This is an anti-inflammatory drug which binds to glucocorticoid
receptors which cause inflammation. It allows the beta-adrenergic response to help relive muscle
spasms and inflammation. This drug reverses mucosal oedema and ultimately inhibits the release
of LTC4 AND LTD4, ultimately promoting the process of anti-inflammation. It blocks
acetylcholine’s muscarinic receptors to allow for the reduction of such inflammation. It will ease
Poppy’s bronchi, easing inflammation causing bronchoconstriction, thus opening her airways so
she is able to respirator. The nurse should consider the signs of wheezing, tightness in the
patient’s chest. The expected response is that the patient will feel relieved of breathlessness soon
and will be able to comfortably breath. It can also cause fluid retention to the patient and increase
blood glucose levels. Alves and et. al., (2018). The expected clinical response would be
decreased inflammation of Poppy’s airways thus improved airway responsiveness. The nurse

must continuously observe Poppy for any changes. Her blood pressure, heart rate, saturation
levels and skin integrity should all be monitored.
Ipratropium bromide: Ipratropium bromide (via nebuliser) is an anticholinergic
bronchodilator as well as a beta2-adrenergic bronchodilator by inhibiting Broncho motor tone.
This drug allows for vagal to be blocked thus leading to bronchodilation. Once the drug enlarges
the patient airways, she will be able to breathe easier as there is more room for oxygenated cells
to flow. Poppy’s is experiencing bronchoconstriction because of her asthma attack thus
obstructing her airways.Ipratropium bromide may be useful in combination with Salbutamol in
the early management of children presenting with moderate to severe acute asthma. Go and et.
al., (2017). Nursing care professionals must take into consideration the side effects as it can act
as an immune suppressant causing swelling, constipation, paradoxical bronchospasms, and
buccal ulceration. Rochmawati and et. al., (2018). This drug can also lead to immediate
hypersensitivity thus a nurse must check allergy history as well as conduct a comprehensive
assessment on Poppy. Nurse must record fluid intake of Poppy to ensure hydration preventing
hyperpyrexia. Her expected clinical response of bronchodilation and the ease of her breathing
symptoms should improve drastically when treating tachycardia and hypoxia episodes. Her vitals
should be able restore, and overall homeostatic internal environment created. Poppy’s vitals must
be continuously repeated and monitored including her BP, RR and SpO2,fluid balance output
and physical changes in her body ,ensure pt is well hydrated environmental factors and monitor
hyperpyrexia. Angelinteena (2020).

REFERENCES
Books and Journals
Baker and et. al., (2020). Essential care of critical illness must not be forgotten in the COVID-19
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Bernacki and et. al., (2019). Effect of the serious illness care program in outpatient oncology: a
cluster randomized clinical trial. JAMA internal medicine, 179(6), 751-759.
Khan, R., & Koppe, S. (2018). Modern management of acute liver failure. Gastroenterology
Clinics, 47(2), 313-326.
Rochmawati and et. al., (2018). Centrality of spirituality/religion in the culture of palliative care
service in Indonesia: An ethnographic study. Nursing & health sciences, 20(2), 231-237.
Ross, S. (2018). Therapeutic use of classic psychedelics to treat cancer-related psychiatric
distress. International Review of Psychiatry, 30(4), 317-330.
Sommerfeld and et. al., (2018). Hypersensitivity pneumonitis and acute respiratory distress
syndrome from e-cigarette use. Pediatrics, 141(6).
Topsakal and et. al., (2020). Prioritizing otological surgery during the COVID-19 Pandemic. B-
ENT, 16(1), 55-8.
Xian and et. al., (2017). Use of intravenous recombinant tissue plasminogen activator in patients
with acute ischemic stroke who take non–vitamin K antagonist oral anticoagulants
before stroke. Circulation, 135(11), 1024-1035.
Zeidan and et. al., (2020). Special considerations in the management of adult patients with acute
leukaemias and myeloid neoplasms in the COVID-19 era: recommendations from a
panel of international experts. The Lancet Haematology.