Jackson Case Study Assignment: Pathogenesis, Clinical Features, Diagnosis, and Nursing Strategies

This case study discusses the pathogenesis, clinical features, diagnosis, and nursing strategies for Jackson's acute severe asthma. It includes interventions such as immediate pharmacological care and peak flow testing. Medications used, such as Salbutamol, Nebulised ipratropium bromide, and IV Hydrocortisone 100mg, are also discussed.

Running head: JACKOSN CASE STUDY ASSIGNMENT
JACKOSN CASE STUDY ASSIGNMENT
Name of the Student
Name of the University
Author note

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iology [9]: The allergic reactions causes inflammation and this inflammation is caused by foreign proteins inhaled through the aerosols and others
Pathogenesis
Airflow limitation in asthma is caused by several consequences within the airway which includes the bronchoconstriction, airway hyper responsiveness, airway edema, airway remodeling and so on. Further, the pathophysiology of acute severe asthma
Risk factors [8]
Smoking
Sedentary lifestyle
osure to dirt and dust
Clinical features
Elevated respiratory as well as heart beat
Severe chest pain and shortness of breath
Abnormal lowering of blood pressure
Wheezing sound and coughing at night
Chest pressure [2]
Diagnosis [3]
Peak flow testing of expiratory rate can be used as a diagnostic procedure for the identificatio
Spirometry and NeSO4 could be used as another testing method for diagnosis of the process
Primary prevention
Do not smoke
dirt, smoke or dust to avoid allergic reactions
ation exercise daily. [7]
Treatment
Medical treatment [4]
Nursing acute phase
Frequent evaluation of breathing or respiratory rate and provide the patient with corticosteroids
Oxygen saturations – administer oxygen if required
Screen for breathing expiration
Further it is important to manage hydration and nutrition
Rehabilitation
Passive and active movement of the patient
Encourage activities provided by physiotherapists, speech and occupational therapies
Secondary treatment
Course of disease [5]
Acute severe asthma is a major threat to patients as if it is untreated can lead to death of the patient.
The course of disease starts with allergic reactions and then arises inflammation which results in acute severe asthma
Complications
Inability to breathe
High chest congestion
Less blood pressure
who suffer from allergic reactions, faces acute severe asthma in their lifetime [6]
Causes
Atherosclerosis
Diagnos
ed by

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References
1. Powell, C. V. (2016). Acute severe asthma. Journal of paediatrics and child health, 52(2), 187-191.
2. Powell, C., Kolamunnage-Dona, R., Lowe, J., Boland, A., Petrou, S., Doull, I., ... & MAGNETIC Study Group. (2013).
Magnesium sulphate in acute severe asthma in children (MAGNETIC): a randomised, placebo-controlled trial. The Lancet
Respiratory Medicine, 1(4), 301-308.
3. Meert, K. L., McCaulley, L., & Sarnaik, A. P. (2012). Mechanism of lactic acidosis in children with acute severe
asthma. Pediatric Critical Care Medicine, 13(1), 28-31.
4. Silvio Torresa, M. D., Nicolás Sticcoa, M. D., Juan José Boscha, M. D., Tomás Iolstera, M. D., Alejandro Siabaa, M. D.,
Rivarolaa, M. R., & Schnitzlera, E. (2012). Effectiveness of magnesium sulfate as initial treatment of acute severe asthma in
children, conducted in a tertiary-level university hospital. A randomized, controlled trial. Arch Argent Pediatr, 110(4), 291-
296.
5. Raimondi, G. A., Gonzalez, S., Zaltsman, J., Menga, G., & Adrogué, H. J. (2013). Acid–base patterns in acute severe
asthma. Journal of asthma, 50(10), 1062-1068.
6. Ohn, M., & Jacobe, S. (2014). Magnesium should be given to all children presenting to hospital with acute severe
asthma. Paediatric respiratory reviews, 15(4), 319-321.

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7. Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Boulet, L. P. (2014). International ERS/ATS
guidelines on definition, evaluation and treatment of severe asthma. European respiratory journal, 43(2), 343-373.
8. Pavord, I. D., Korn, S., Howarth, P., Bleecker, E. R., Buhl, R., Keene, O. N., ... & Chanez, P. (2012). Mepolizumab for severe
eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial. The Lancet, 380(9842), 651-659.
9. Garcia, G., Taillé, C., Laveneziana, P., Bourdin, A., Chanez, P., & Humbert, M. (2013). Anti-interleukin-5 therapy in severe
asthma. European Respiratory Review, 22(129), 251-257.

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Answer 1
This answer will discuss about the case study of Jackson and his acute severe asthma
associated health condition. Jackson is a 18 year old boy who was admitted to the emergency
department of the healthcare facility after having a severe attack of acute asthma at 9 pm and
while admitting to healthcare facilities, the professionals noted the primary clinical situation as
severe breathlessness. The pathogenesis of asthma was completely visible on the patient and his
health condition because of the inflammatory symptoms and activation of different mediators
and cells types. It should be mentioned in this context that due to the presence of foreign
particles, dirt dust or other foreign materials are responsible for the inflammatory responses due
to which different cell types start interacting with these antigens and causes the emergence of
these symptoms in the body of the patient (Chung et al., 2014). Further in the case of Jackson, it
was disclosed by the family members of the patient that he was admitted to the healthcare facility
prior to this issue at the age of 2 due to asthmatic symptoms were relieved at that time.
Therefore, the emergence of acute severe asthma was related to his childhood asthmatic
condition and hence, while collecting the clinical manifestation, this was one of the major issues
which were collected (Guérin et al., 2013). Besides this, the presence of severe dyspnea were
also seen with the presence of elevated heart rate, blood pressure (150/85 mmHg) and shortness
of breath. Further, other symptoms such as wheezing sound while breathing, increased pulse rate
(130 BPM) and auscultation of lungs were also seen in case of Jackson. Besides to collect more
detailed assessment of the patient condition, several physiological assessments were also
collected such as X-ray assessment of the lung and from the assessment it was seen that the lung
and peripheral areas were swollen and hyper inflation were observed in the lungs. Further, from
the blood gas analysis the amount was noted as 90% SO2 PaCO2 which was 50mmHgand

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HCO3: 25mEq/L was among the other readings. Hence, in this case the pathogenesis should be
discussed as per the case study of Jackson.
The pathogenesis of acute severe asthma is associated with the commencement of the
inflammation process due to which the symptoms are visible on the patient’s body (Schmidt et
al., 2014). While discussing the reason for pathogenesis of the disease it should be mentioned
that the emergence of inflammation is associated with several factors such as genetics,
environmental factors, allergens, pollens and respiratory infections due to which it is associated
with the acute severe asthma related condition (Sellers, 2012). As the patient is suffering from
the asthmatic condition since his childhood the pathophysiology related to innate immunity
should be discussed. As the foreign particles enter the human body, the antigen presenting cells
starts engulfing them to present them to the T cells (Chung et al., 2014). These t cells then using
a cascade presents the foreign proteins to the other cells such as T helper cells, and then releases
interleukins, stromal lympho-proteins, which acts as a allergic condition regulator and this in
turn activates the B cells that finally produces the immunoglobulin E which finally activates
interleukin 4 and 13 (Goodacre et al., 2013). These are important for the enhancement of the
allergic condition and inflammation because in the process it tends to activate cells such as
macrophages, eosinophiles, neutrophiles and other cells which increase the inflammation
symptoms. This is because the IgE works by combining itself to macrophages which ultimately
engulfs the foreign proteins and then by releasing interleukins increase the inflammatory
symptoms in the host body (Sellers, 2012). Further, there are several mediator cells which
increase the airway damage by introducing the bronchoconstriction, which is visible in the case
of Jackson (Serhan, 2014). Further as the patient was having clinical symptoms of shortness of
breath , higher respiratory and pulse rate and so on, therefore, it should be mentioned that the

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patient was suffering from acute severe asthma due to the presence of innate immunity related
pathophysiology as well as chronic inflammatory symptoms (Schmidt et al., 2014).
Answer 2
The two nursing strategy which will be used for the for the treatment of the Jackson and
his sever acute asthmatic condition will be providing him with the immediate pharmacological
care so that his condition could be relieved and then assess the severity of the condition for
further health improvement interventions. Both of these nursing interventions and management
strategies has been mentioned in the segment below:
As the patient has been admitted to the emergency ward of the facility, immediate care
plan is a must for the Jackson. This immediate care will include strategies using which
immediate care and help can be provided to the patient to relief his shortness of breath and chest
congestion. Further due to these, the patient may suffer from depression, anxiety which can lead
to anger in patients (Zemek et al., 2012). Hence, it is the responsibility of the healthcare facility
to implement the process in care for patient. Therefore, the first intervention will be applied to
lower the peak flow of the process and then help the patient with medications such as
corticosteroids, short acting beta 2 and anticholinergics and immunomodulators so that the
airflow within the airway could be increased the patient condition could be relieved (Ponikowski
et al., 2016). On the other hand, the second intervention will be determining the peak flow of
expiration or the maximum for and maximum output the patient is applying for the determination
of the process. This applied force and intensity of breathing will help the patient to decide the
severity of the disease and hence,, the healthcare professionals will be able to use their ideations
and interventions to treat such patient condition. Therefore, these are the interventions using

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which the acute severe asthma related condition of Jackson will be treated and further
intervention will be decided (Alhazzani et al., 2013).
Answer 3a
Salbutamol: this is the medicine which was used by the healthcare professionals for the
treatment of Jackson. This medicine is provided to the patient in the form of aerosol and
therefore, the primary mode of action of this drug is associated with its β2-
adrenoreceptors actions (Gallenmüller et al., 2014). The primary action of this drug is on the
smooth muscles which covers the bronchi (Sharma et al., 2014). The primary mode of action of
this drug is associated to the attachment of the drug to the epinephrine’s binding site and hence,
it initiates the bonding by stabilizing the receptor that increases the number of cAMP that
eventually releases the potassium ion through a cascade that triggers the intracellular cascade
(Gallenmüller et al., 2014). Nebulised ipratropium bromide: This is the medicine which is
primarily used in case of chronic pulmonary disorder due to which is comes in the form of an
inhaler containing beta2-agonists and helps in the treatment of reversible obstruction of the
airway. The mode of action of this drug is associated with the blockage of muscarinic receptors
and by relieving this receptor this drug helps in minimizing the symptoms such as COPD. IV
Hydrocortisone 100mg: this drug is the natural glucocorticoids which has a mode of action
associated with changing the immune response by diversifying the stimuli and then help in the
identification and enhancement of the metabolic effect of the drug.
Answer 3b
Using Salbutamol helps to relieve the smooth muscles. Further for the evaluation, the
assessor should be able to assess the patient improvement after the consumption of the medicine

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and also by determining the side effects that increases with the failure of the drug in determining
the patient benefit (Sharma et al., 2014). This iis the implication of the drug and the evaluation
process to understand the drugs activity and responsiveness.
On the other hand, the evaluation of the drug Nebulised ipratropium bromide could be
done by using the patient improvement or evolution (Nouira et al., 2014). Further the
effectiveness could be assessed by determining the patient’s improvement and ability to inhale
ample amount of oxygen. The third medicine IV Hydrocortisone 100mg, and its effectiveness
should be determined by the patients peak flow expiration rate so that it can impart in
patient improvement. The evaluation of the drug could be done by determining the patient
improvement and conducting the peak flow assessment so that the expiration related force could
be identified (Alam, Rahman & Ershad, 2012).

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References
Alam, M. R., Rahman, M. A., & Ershad, R. (2012). Role of very short-term intravenous
hydrocortisone in reducing postdural puncture headache. Journal of anaesthesiology,
clinical pharmacology, 28(2), 190.
Alhazzani, W., Alshahrani, M., Jaeschke, R., Forel, J. M., Papazian, L., Sevransky, J., & Meade,
M. O. (2013). Neuromuscular blocking agents in acute respiratory distress syndrome: a
systematic review and meta-analysis of randomized controlled trials. Critical care, 17(2),
R43.
Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Boulet, L. P.
(2014). International ERS/ATS guidelines on definition, evaluation and treatment of
severe asthma. European respiratory journal, 43(2), 343-373.
Gallenmüller, C., Müller-Felber, W., Dusl, M., Stucka, R., Guergueltcheva, V., Blaschek, A., ...
& Abicht, A. (2014). Salbutamol-responsive limb-girdle congenital myasthenic syndrome
due to a novel missense mutation and heteroallelic deletion in MUSK. Neuromuscular
Disorders, 24(1), 31-35.
Goodacre, S., Cohen, J., Bradburn, M., Gray, A., Benger, J., Coats, T., & 3Mg Research Team.
(2013). Intravenous or nebulised magnesium sulphate versus standard therapy for severe
acute asthma (3Mg trial): a double-blind, randomised controlled trial. The Lancet
Respiratory Medicine, 1(4), 293-300.

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Guérin, C., Reignier, J., Richard, J. C., Beuret, P., Gacouin, A., Boulain, T., ... & Clavel, M.
(2013). Prone positioning in severe acute respiratory distress syndrome. New England
Journal of Medicine, 368(23), 2159-2168.
Nouira, S., Bouida, W., Grissa, M. H., Beltaief, K., Trimech, M. N., Boubaker, H., ... & Boukef,
R. (2014). Magnesium sulfate versus ipratropium bromide in chronic obstructive
pulmonary disease exacerbation: a randomized trial. American journal of
therapeutics, 21(3), 152-158.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., ... & Jessup,
M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic
heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart
failure of the European Society of Cardiology (ESC). Developed with the special
contribution of the Heart Failure Association (HFA) of the ESC. European journal of
heart failure, 18(8), 891-975.
Schmidt, M., Bailey, M., Sheldrake, J., Hodgson, C., Aubron, C., Rycus, P. T., ... & Combes, A.
(2014). Predicting survival after extracorporeal membrane oxygenation for severe acute
respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival
Prediction (RESP) score. American journal of respiratory and critical care
medicine, 189(11), 1374-1382.
Sellers, W. F. S. (2012). Inhaled and intravenous treatment in acute severe and life-threatening
asthma. British journal of anaesthesia, 110(2), 183-190.
Serhan, C. N. (2014). Pro-resolving lipid mediators are leads for resolution
physiology. Nature, 510(7503), 92.

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Sharma, U. K., Kushwaha, M., Tiwari, H., & Prakash, A. (2014). A review on mesoporous silica
nanoparticles loaded salbutamol sulphate. World J Pharm Pharm Sci, 3, 251-271.
Zemek, R., Plint, A., Osmond, M. H., Kovesi, T., Correll, R., Perri, N., & Barrowman, N.
(2012). Triage nurse initiation of corticosteroids in pediatric asthma is associated with
improved emergency department efficiency. Pediatrics, peds-2011.