Efficacy of Telemedicine on Asthma Control

The assignment requires a comprehensive analysis of the effects of telemedicine on asthma control and patients' quality of life in adults. It involves a systematic review and meta-analysis of existing research studies, including articles from reputable sources such as The Journal of Allergy and Clinical Immunology: In Practice, International Journal of Nursing Knowledge, and SAGE journals. The assignment aims to provide an evidence-based answer to the question of whether telemedicine improves asthma control and quality of life in adults.

NURSING CASE STUDY

Table of Contents
INTRODUCTION...........................................................................................................................3
PRIORITY 1....................................................................................................................................3
PRIORITY 2....................................................................................................................................5
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................9

INTRODUCTION
Nursing is a profession in which care & treatment is provided to patients. Objective
behind providing this facility is to promote health and prevent illness among individuals of all
age. This report includes two priority problems in faces on Asthma Breathing Problem and
Problem of Audible Wheeze. Further, this report include prevention for both of these problems.
According to Clinical Reasoning Cycle it is assessed that patient is suffering from
Asthma and facing problem in breathing and Audible Wheeze. After that a plan is to be made as
to prevent this problem by taking interventions such as Breathing Diagnosis and Medical Care.
Further, plans made during this cycle is implemented by monitoring, observing and improving
patients health. At last result from the implementation of plan is analysed as by checking
improvement in health of patient.
PRIORITY 1
Breathing Problem- This problem causes fro Asthma, Allergy and Sinusitis. As Simon
is a patient of Asthma this problem is identified in him and it is necessary to resolve his problem
of breathing. Further, patient is suffering from Adult-onset Asthma thus, he requires daily
treatment and care. Patient's respiratory rate is 32 and the minimum breathing rate needs to be 72
hence it is necessary for giving intervention to patient. Nurse needs to understand this problem
by giving medical diagnosis and treatment to patient. Further, daily treatment is also required for
individuals as breathing plays a vital role in living a health life(Breathing retraining for patients
with dysfunctional breathing: A series of five single-subject AB designs with long-term follow-
up. 2016).
Medical Intervention helps patients in giving them treatment and removing their
problems. Diagnosis of Asthma Breathing Diagnosis is an most important intervention given
to patient and it is given to the patient before treating them. Diagnosis consists of three problems
such as Medical History, Observation and Physical Examination. Process of diagnosis is started
with examining physical health of patient. For this nurses require to collect personal details of
patients and assess health status of his family members. Various types of test are also done by
nurses for breathing diagnosis such as Pulmonary Function Test this intervention is required to
check functioning of lungs of patients. After this a breathing test is being done which is known
as Spirometry. With this test nurse can assess & measure at what rate patient can blow(Melo and

Silva, 2017). Thus, for breathing diagnosis for an Asthma patient Spirometry Test is
best(Edwards, Kennington and Walker, 2016).
Nurses are also require to take X-ray of chest and heart as breathing rate of Simon is very
low which causes him some serious problems. If problem of patient is not accurately assessed by
X-ray report than CT- scan of chest is to be done for completing diagnosis of patient(Patients’
experiences of breathing retraining for asthma: a qualitative process analysis of participants in
the intervention arms of the BREATHE trial. 2017).
Further, allergy test also helps in identifying problem of breathing. With this doctor or
nurses can find out what is triggering breathing problem in patient this further helps in
identifying related symptoms of this problem and giving solutions to patients. After Breathing
Diagnosis a daily care and treatment is given to patient in accordance with results of diagnosis.
Health Promoting Nursing Intervention- According to this intervention Nurse are
required to give all the information about treatment of Asthma to the patient. Education is given
to patient related to medical intervention and creating awareness among family members of
patient(Breathing Invention. 2018).
Nurse needs to give personal care to patient as his breathing rate is very low for this a
Asthma Action Plan is prepared which includes a plan of medication which patient has to tack to
overcome from his breathing problem. Breathing & Pulse Rate of patient also assessed by nurse
4 times a day which helps in measuring improvement in pulse & Breathing rate. Pulse rate of
Simon is also 132 which is inappropriate as daily monitoring and treatment is
required(Chongmelaxme and Dilokthornsakul, 2019).
For overcoming from this problem patient needs to get Vaccinated so that it can prevent
problem of influenza & pneumonia. Nurses should give medicines to patient on time. Further,
while giving personal care to patient it is also necessary for nurses to check inhaler used by
patient. They need to check medical prescription of patient and change his prescription according
to change in his health. Breathing treatment & medical therapy such as Beta-Agonists,
Anticholinergics and Corticosteroids(Efficacy of a School-Based Behavioral Intervention for
Urban Adolescents with Undiagnosed Asthma: A Controlled Trial. 2016).

As patient is an adult and he is suffering form high breathing problem than an Airway
Cart Treatment is given to him so that his breathing can be controlled. While observing patient
his respiration is to be recorded and observed on a timely basis. Colour of patients skin is also
need to be observed by nurse if his skin is getting blue than it indicates that there is lack of
oxygen and he is facing problem in taking breath. Colour of patients skin gets dusky if his
colour is dark. Sitting Position of Patient is also required to observe as it also helps in measuring
breathing. If patient is upright then it indicates that he is facing problem in breathing.
Observation of all of these problems helps in handling & treating breathing problem of
patient(Pike and Harris, 2018).
Nurses also need to change sitting position of patient and make changes in their position
so that he can get comfortable which further helps in improving breathing rate of individual.
Proper hygiene is to be provided to patient so that he can get fresh air and oxygen is to be given
to them during washing & bathing. Oral hygiene is also essential to provide to patient as if he
take s breath fro mouth than it can causes dry affect(Behavioral Interventions in Asthma:
Breathing Training. 2015).
Nurses have to check what type of food & drinks are consumed by patient and advice is
to be given to patient as they have to drink 2 litres of fluid daily which reduces risk of
dehydration that in turn reduces problem of breathing(Bochenek, 2017).
During Intervention various types of therapy are required to give patient to resolve
problem of breathing such as Oxygen Therapy and Inhaled Bronchodilators.
PRIORITY 2
Simon is suffering from audible wheeze and is unable to speak in full sentences which lead
patient in severe situation. He requires urgent medical attention for effective results and
outcomes for the patient (Chong & et.al (2016)). Lower respiratory rates and breathlessness
affect Simon. Excessive sweating and bluish skin are some of the major problems faced by
Simon which adversely affect the health. Asthma wheezing means there is small passage and
airway of the lungs which make him impossible to breathe properly and leads to swelling,
muscle tightening and mucus. Wheezing is caused due to chronic respiratory condition that affect
bronchial tubes and cause swelling and spasms (Wheezing, 2019). Airways can usually tighten
due to certain medications, infections, allergies, asthma, gastroesophaegal reflux disease, etc.

The main cause of Asthma is due to genetics, viral infection, hygiene hypothesis and
allergy (McDonald and et.al (2017)). The major symptoms related with wheezing is shortness of
breath, stuffy nose, coughing, chest tightness, fever, loss of voice, swelling of tongue or lips,
bluish tinge around nails or mouth. Simon has respiratory illness and could not exercise due to
his breathing problem. He is Cyanotic and is visibly anxious and distressed which is also one of
the major problem with Simon (Stumbles & et.al (2018)). Cyanosis occurs due to oxygen
depletion in the body which is caused due to deoxygenated blood. The skin turns out to be blue
or purple because the tissue near the surface of the skin have low oxygen saturation. There are
various types of inhalers like metered dose inhaler, auto-haler, accuhaler, Ellipter, DuoResp
Spiromax, Turbuhaler.
Simon must focus on reliever medication which helps them feel relief from wheezing.
The patient must use blue puffer in order to take proper medication which helps in proper and
effective functioning of lungs (Hollams & et.al (2017). Reliever medication helps in opening up
the airways so that immediate control can be taken to reduce the wheezing problem. Reliever
medication must be used 4 to 6 times in a day, as access inhaling can leads to rapid heart rate
(Pollution, climate change, and childhood asthma in Australia, 2018).
The healthcare practitioners must focus on involving patients and their family members
ion order to take accurate decision in a consistent and timely manner and educate them about
their medication and the cause of the problem for better recovery and quality results and
outcomes. Health care practitioners must focus on long term asthma medication for quality
results and outcomes for Simon (Coleman & et.al (2018, January)). He must focus on breathing
exercises so that more oxygen can reach lungs, use of nebulizers and rescue inhalers must be
used daily to control asthma. Simon must take medication for bronchodilators which will help in
relaxing the tight muscles in lungs.
Nurses must focus on giving effective medication to the Simon which helps in relieving
and controlling the cause of Asthma in patients. Health practitioner must effectively identify the
symptoms and must sure Simon to stay away from such cause which leads to increase in Asthma.
Self management intervention is mainly used by the patient itself to take proper
medication on order to control the asthmatic problem for higher results and outcomes. Simon
must focus more on improvising the breathing problem which helps in controlling wheezing

problem and also helps them in speaking fluently (Lundbäck & et.al). The patient must focus on
lip breathing for more effective flow of oxygen in the lungs which helps in controlling the
asthma for healthy and quality living of life. Simon must focus on drinking warm water.
As per the article (Daily inhaled corticosteroids or montelukast for preschoolers with
asthma or recurrent wheezing: A systematic review, 2018), Inhaled corticosteroids helps in long
term medication control for Asthma. Long acting Beta agonists and Theophylline are some
measures and medications which helps health care practitioners in controlling long term asthma
control medication. Quick relief medication helps in relaxing the airway muscles for efficient
flow of oxygen which helps in controlling wheezing (Sly & Holt, P. G. (2018)). Inhaled
corticosteroids helps in reducing swelling inflammation in airways for effective oxygen supply in
lungs. Long term use of inhaled corticosteroids cause impaired growth in adolescents, skin
thinning, bruising, reduced bone mineral density (Understanding Wheezing -- Diagnosis &
Treatment, 2019). .
This helps Simon in reduced depression and anxiety. Healthcare practitioners must focus
on the consumption habit of Simon. He must not smoke and must also consumer healthy food
and fruits. Simon must avoid eating junk food and oily foods (Is the consumption of fast foods
associated with asthma or other allergic diseases?, 2018).
Consumption of fatty food which adversely affect the health must be avoided for
effective results and outcomes. Parents, teachers and nurses must work together in order to
put higher supervision on Simon and must focus on avoiding hassles with different individuals.
He must not do exertion in order to gain effective and quality results for Simon.
CONCLUSION
From the above study it has been concluded that, Simon is suffering from Asthmatic
problem. The main problem with Simon is that his respiratory rate is low i.e., around 32 breaths
per minute. Pulse oximetry reveals an SaO2 of 88% and pulse rate is around 132. Simon is
suffering from breathing problem which is the major problem with him. Another major
associated with Simon was that has an audible wheeze and he is not able to speak in full
sentences effectively and efficiently. Simon is very anxious and is suffering from depression and
stress. For the breathing problem healthcare practitioners suggested various interventions like
breathing diagnostics which helps in controlling pulse rate and respiratory rate of the patient. To

control wheezing problem healthcare practitioners and family members and friends to work
collaboratively to inhale and take proper medication for effective flow of oxygen in the body and
helps in recovery of cells so that oxygen is transmitted in each part of the body effectively.

REFERENCES
Books and journals
Chong, C & et.al (2016). Criteria led discharge reduces length of hospital stay for children with
acute asthma. Journal of Asthma.53(1). 1-1.
McDonald, V. M and et.al (2017). Severe asthma: current management, targeted therapies and
future directions—a roundtable report. Respirology. 22(1). 53-60.
Stumbles, P. A & et.al (2018). Principles for nursing practice: Persistent asthma. Elsevier
Australia.
Hollams, E. M & et.al (2017). Vitamin D over the first decade and susceptibility to childhood
allergy and asthma. Journal of Allergy and Clinical Immunology. 139(2). 472-481.
Coleman, L. A & et.al (2018, January). Nasal Fluid IRF7, CXCL9 and CXCL10 Protein Levels
Do Not Reflect Altered Nasal Cell mRNA Expression Responses to Different Human
Rhinovirus Species in Children with Asthma and Wheezing Exacerbations.
In AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE (Vol.
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Sly, P. D., & Holt, P. G. (2018). Pollution, climate change, and childhood asthma in
Australia. Lancet. 391. 462-512.
Lundbäck, Bo & et.al. "Is asthma prevalence still increasing?." Expert review of respiratory
medicine 10, no. 1 (2016): 39-51.
Steinemann, A. (2018). Prevalence and effects of multiple chemical sensitivities in
Australia. Preventive medicine reports.10. 191-194.
Gibson, P. G., & McDonald, V. M. (2017). Management of severe asthma: targeting the airways,
comorbidities and risk factors. Internal medicine journal. 47(6). 623-631.
Abu-Hamour, B., & Al-Hmouz, H. (2017). Practices of Primary School Teachers in Supporting
Students with Asthma in Jordan. Meta-cognitive Strategies in Problem Solving for
Children with Learning Difficulties in Mathematics at the Primary Level.
……………………………….... 37.32(1).180.

Garcia-Marcos, P. W., Asher, M. I., Ellwood, P., & Garcia-Marcos, L. (2018). Breath Sounds in
Epidemiology. In Breath Sounds (pp. 53-73). Springer, Cham.
Australia, H. (2018). Asthma medication.
Bochenek, J.M., 2017. Easy Breathing for Elementary School Children with Asthma at Dayton
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Pike, K.C. and Harris, K.M., 2018. Interventions for autumn exacerbations of asthma in
children. Cochrane Database of Systematic Reviews, (3).
Chongmelaxme, B. and Dilokthornsakul, P., 2019. The effects of telemedicine on asthma control
and patients' quality of life in adults: a systematic review and meta-analysis. The Journal
of Allergy and Clinical Immunology: In Practice. 7(1). pp.199-216.
Edwards, J., Kennington, E. and Walker, S., 2016. Priorities for asthma R&D in Europe: A
systematic approach.
Melo, J. and Silva, J., 2017. University and public health system partnership: a real-life
intervention to improve asthma management. Journal of Asthma. 54(4). pp.411-418.
Ekim, A. and Ocakci, A.F., 2016. Efficacy of a transition theory-based discharge planning
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