Incorporating Asthma Patient Interview: Understanding Symptoms and Triggers | Clinical Practice Integration

In this assessment we will discuss about intergrating practice and below are the summaries point:- Patient interview conducted with an adolescent asthma patient, discussing symptoms and triggers. Clinical reasoning applied to assess the patient's situation, considering past history and potential triggers. Identification of allergic rhinitis and pet allergies as contributing factors to the patient's asthma symptoms.

Running head: INTEGRATING PRACTICE
INTEGRATING PRACTICE
Name of the Student
Name of the university
Author’s note

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Assessment 1
In my academic practice, I had been allocated to interview an adolescent patient suffering
from asthma. The treatment of the asthma initiates from history taking and physical assessment.
While conducting a patient interview the initial task is to provide a non-hostile environment,
making he room for free expression of the patients’ grievances.
Case scenario: Alice had been admitted to the emergency department with severe respiratory
distress. On presenting to the ED, she was hemodynamically stable and revealed wheezing on
Auscultation. She was nebulized immediately with Salbutamol and Ipratropium. After re
application of the medicines she showed slow recovery. She had past history of allergic rhinitis
and has a pet dog at home. She admitted that she had started smoking recently.
Interview
Nurse : Hello, Alice , how are you feeling now.
Alice: I am feeling fine now.
Nurse: When did you started having the symptoms?
Alice: Since, childhood , it worsens during the winters.
Nurse: Was your asthma associated to the allergies?
Alice : Yes, my last doctor said that I have allergic rhinitis.
Nurse: So, what are your triggers?
Alice: well, cold air, dust, pollen grains

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Nurse: how do you care for your allergies? Do you use face mask?
Alice: Of course not! I’ll look horrible in that! (Still struggling to breath hence I asked the patient
to relax)
Nurse: Do you have pet at your place?
Alice: Yes, Lucy, my dog, he’s adorable!
Nurse : Have you received any kind of Asthma education before?
Alice: Well yes. The previous doctor said not to smoke anymore, she asked me to wear a face
mask while bathing Lucy.
Nurse: You still smoke?
Alice: Yes, I do it when I feel freaked out or too much stress related to my studies.
Nurse: Alright. Have you ever tried any alternative forms of treatment like yoga, swimming,
dietary change or breathing exercises and vocal cord therapy?
Alice: No
Nurse: Well Alice, that’s enough for today. Just relax and take rest.
Clinical reasoning cycle
Consider the patient situation
Alice has been admitted in to the emergency department with severe respiratory distress.
She was hemodynamically stable and revealed wheezing on Auscultation.

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Collecting cues
Alice was suffering from bronchoconstriction with characteristics wheezing, which is a
important clinical manifestation of asthma (Mims, 2015). The wheezing and chest tightness
might be because of the accumulation of the inspissited mucus plugs in the airway, thus
restricting the passage of air through the airways forming a whistling sound (Killeen & Skora,
2013). The bronchoconstriction in the patient might be because of the presence of any exogenous
or endogenous stimuli. As stated by the patient, she had a past history of allergic rhinitis and also
rears a pet. Cold air or exposure to pollens and dusts also triggers asthma symptoms.
Processing of the information
The case study states the Alice past history of allergic rhinitis. There are research
evidences showing that allergic rhinitis and allergic asthma frequently coexists (Khan, 2014).
The atopic disease of the nose and the lungs are related to each other as for both there is a
common epithelium and same mucosal susceptibility (Vernon et al., 2015). Again pet danders or
the proteins present in the skin flakes, feces, urine and saliva can trigger the asthma symptoms.
Hence, Lucy coming in contact with Alice might worsen her symptoms. Alice had also stated
that she has started smoking whenever she feels stressed out. Cigarette smoking is related with a
subsequent decline of the lung function changes are observed in the inflammatory mechanism of
the smokers (Aanerud et al., 2016) . Sputum abnormalities can also be visible in patients
suffering from asthma.
Identify the problem
The two clinical priorities that has been observed in Alice are- Respiratory distress and
chest tightness and the low oxygen saturation level.

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Establish goals
 To restore the optimal breathing pattern in the nurses
 To restore the oxygen saturation level
 To maintain the airway patency as evidenced by clear breathing sounds, no wheezing.
Take action
In order to reduce the breathing trouble in Alice nebulizers with salbutamol and
Ipratropium can be used immediately. The oxygen saturation should be monitored by using the
oxygen saturation level by using the pulse oximetry (Koczulla, Vogelmeier, Garn & Renz,
2017). Again, it is necessary to monitor the test results. Chest x-ray results should be evaluated
as chest x-ray can provide information regarding the presence of any infiltrates or the presence of
barotrauma. The patient can be encouraged to cough, as it is a natural way to clear the throat and
the passage of mucus, irritants (Koczulla, Vogelmeier, Garn & Renz, 2017). Alice should be
assessed for the breath sounds and other adventitious sounds like stridor and wheezes.
Evaluation
Any improvement or deterioration in the patient condition would be witnessed by taking
feedback from the client. With effective intervention, the client will be able to maintain an
optimal breathing pattern as proved by relaxed breathing (Walker & Reznik, 2014). The patient
will be able to verbalize her understanding about the cause and the therapeutic management of
the treatment regimen. The effectiveness of the intervention can be proved by maintaining the
airway patency as proved by the clear breathing sounds, an improved oxygen exchange and the
depth of the respirations (Killeen & Skora, 2013).

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Reflecting on the new process of learning
By assessing Alice, I came to know more about the different types of asthma triggers as
triggers might vary from patient to patient. From next time onward I will make sure, that I take
consent from the patient before touching her for taking the vital signs. For this patient I forgot to
obtain consent while taking the vital signs. Furthermore, I have also learned that it is necessary to
develop a therapeutic relationship with the patient, at the time of history taking. I should also
strengthen my critical reasoning skills in order to understand the underlying pathophysiology of
a clinical condition.

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Reference
Aanerud, M., Carsin, A. E., Sunyer, J., Dratva, J., Gislason, T., Jarvis, D., ... & Svanes, C.
(2015). Interaction between asthma and smoking increases the risk of adult airway
obstruction. European Respiratory Journal, 45(3), 635-643.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.
Khan, D. A. (2014, September). Allergic rhinitis and asthma: epidemiology and common
pathophysiology. In Allergy & Asthma Proceedings (Vol. 35, No. 5).
Killeen, K., & Skora, E. (2013). Pathophysiology, diagnosis, and clinical assessment of asthma
in the adult. Nursing Clinics, 48(1), 11-23.
Koczulla, A. R., Vogelmeier, C. F., Garn, H., & Renz, H. (2017). New concepts in asthma:
clinical phenotypes and pathophysiological mechanisms. Drug discovery today, 22(2),
388-396.
Mims, J. W. (2015, September). Asthma: definitions and pathophysiology. In International
forum of allergy & rhinology (Vol. 5, No. S1, pp. S2-S6).
Vernon, M. K., Bell, J. A., Wiklund, I., Dale, P., & Chapman, K. R. (2013). Asthma control and
asthma triggers: the patient perspective. Journal of Asthma & Allergy Educators, 4(4),
155-164.

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Walker, T. J., & Reznik, M. (2014). In-school asthma management and physical activity:
children’s perspectives. Journal of Asthma, 51(8), 808-813.