Nursing Assignment on Asthma: Pathophysiology and Assessment

This nursing assignment explores the pathophysiology of asthma and provides an assessment of a case study. It discusses the development of asthma, risk factors, and the symptoms associated with the disease. The assignment also includes a health assessment plan for the patient.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
Asthma is a chronic disease of the airways in the lungs. The following nursing
assignment is based case study of Adam, a 32-year old man who is a victim of childhood
asthma and was recently admitted to hospital due to asthmatic problems after coming in
contact with his uncle who was suffering from flu. The following paper aims to analyse the
pathophysiology behind the development asthma. This will help in understanding the
assessment question that must be interrogated to Adam for highlighting the clinical priority
and framing of the person-centred care plan. At the end, the paper will highlight the nursing
assessment that must be undertaken in order to improve the overall scenario. The paper is
based on the effective management of the asthmatic condition by proper nursing assessment
and patient education.
Pathophysiology and the disease development
Asthma and Reasons of Development
Asthma is a familial disorder. Genetic predisposition, presence of faulty genes like
interleukins (IlL-4, IL-5, IL: 13) and increased secretion of IgE, eosinophils, beta adrenergic
receptors ( used for the sensing of the stress response by the use of adrenaline) and airways
hyperresponsiveness (the ability of the pulmonary airways to constrict quickly) increases the
vulnerability of developing asthma (Cartier, 2015). In case of Adam it can be said that the
familial pre-disposition is responsible for the development of re-current asthma. This is
because, the case study highlights Adam's father died at an age of 40 due to asthma. The
presence of asthmatic tendency in the family makes Adam an asthmatic patient since
childhood. Adam's general health is however good. He swims 2 kilometres three days per
week and walks 5 kilometres three days a week. Practice of swimming might also be a reason

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behind his asthmatic problem. Del Giacco et al. (2015) reported that exercise-induced asthma
are a common problem that leads to development of asthmatic tendency among the
vulnerable adults. The water of the swimming pool generally contains chlorine and frequent
exposure of chlorine during swimming can be regarded as an environmental exposure behind
the development of asthma. Del Giacco et al. (2015) also report that hard core physical
activity like cardio or high-intensity training is also detrimental for the asthmatic patient as it
induced laboured breathing. However, from the case study is it is not clear about the duration
for which he covers the five kilo-meter walk thrice per week. The time taken will be helpful
in quantifying the level of intensity of the physical exercise. However, Lochte et al. (2016)
stated that regular practice of the mild to moderate physical activity reduces the symptoms of
the asthmatic development like wheezing and cough. Aanerud et al. (2015) reported that
smoking of tobacco and weight gain due to unbalanced diet plan is the two important a
modifiable risk factors behind the development of asthma. Adam however, takes balanced
diet, avoids smoke, and drinks occasionally.
Liu (2015) reported that other modifiable risk factor behind the development of
asthma is exposure to allergens in the urban areas and exposure to the respiratory tract
infection. Weber et al. (2015) further reports decreases exposure of the certain infectious
organisms generates an immunological imbalance leading to the development of allergy and
asthmatic tendency. This is defined a hygiene hypothesis. Adam used to take flu-injection
every year as he used to get cold frequently and he used to stay away from people infected
with common cold and flu. This tendency might have resulted in the generation of hygiene
hypothesis causing outbreak of asthma in Adam.
Question that is required to be asked to Adam for Health Assessment
 Whether his swimming pool water contains chlorine

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 Whether he swims during the winter seasons as well?
 Whether he is allergic towards any environmental substance like pollen?
 Whether is workplace is filled with dust (he works in steel works) and whether he
uses face mask while on work?
 The tenure or the time-limit within which he completes the five kilometres walk per
day (three times a week)?
 Whether his uncle smokes cigarettes
 Whether he walks at night (at night there is fog and temperature is low and thus
walking under sky can increase the tendency of developing asthma)
 The ventilation status of the room (during winter poorly ventilated furnaces, heaters
and clothes dryers, fireplaces and stoves) might lead to the generation of breathing
problem
Asthma and Pathophysiology
The principal characteristic as asthma is inflammation in the airways followed by
airway hyper-responsiveness and mucus hypersecretion. This results in the obstruction in the
airways leading to the development of the symptoms like dyspnoea (laboured breathing),
chest tightness, cough and wheeze. The obstruction in the airway arising from the
physiological changes is episodic and is mainly reversible (Maslan & Mims, 2014). Thus, it
can be said that in order to manage the symptoms of asthma, Adam used to take medications
like Beclomethasone (daily) and Salbutamol (occasionally). Beclomethasone is used to
prevent and control symptoms of asthma like wheezing and shortness of breath. Salbutamol
helps in opening up the medium and large airways in the lungs (Ostrom et al., 2018).
King et al. (2018) reported that asthma in the airways is exaggerated by the
development of the inflammatory mediators in the airways. This inflammatory mediators are
inflicted either exposure from allergen or from common cold flue. In case of Adam, he was

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exposure to his uncle suffering from flue. This caused dysphonic tendency after one week
followed by increase in the temperature of the body. His was also experiencing wheezing of
breath, followed by coughing and tightness of chest. Van (2016) reported that symptoms of
bacterial flu leads to the development of pneumonia that is expressed after one week and is
mostly attribute to chest tightness, wheezing and difficulty in breathing.
The symptoms of Adams and associated pathophysiology
Makowska et al. (2016) are of the opinion that development of flu or common cold
increases the development of acute asthmatic episodes. Acute asthmatic episodes are
associated with the development of type 1 hyper-sensitivity reaction. This leads to release of
histamine, interleukins, prostaglandins, and leukotrines along with nitric oxide. The
vasoactive effects of these primary mediators of type 1 hypersensitivity reaction cause vaso-
dilation followed by increased capillary permeability. This results in increase in the flow of
the blood and inflammatory cells into the interstitial tissue. Chemotactic factors and also
produced as a result of the type 1 hypersensitivity reaction leading to the infiltration of
neutrophils, eosinophills and lymphocytes. The resulting inflammatory process produces
bronchial smooth muscle spasm leading to vascular congestion, formation of oedema, mucus
deposition and impaired mucociliary functions. The deposition of mucus along with
constriction of the smooth muscles cells of the pulmonary cavity is the reason behind the high
pulse rate (115; normal: 60 to 100 beats per minute), respiratory rate (32; normal: 12 to 20
breaths per minute) and high blood pressure (160/90; normal: 120/80mmHg). Increase in the
pulse rate and respiratory rate leads to the development of labored breathing and thereby
decreasing the overall oxygen saturation in the body (SaO2: 91%; normal: 97 to 100%) (Hall,
2015). Improper supply of oxygen within the body is the reason behind decreased partial
pressure of alveolar concentration of carbon dioxide and oxygen (Pa CO2: 28; normal: 38 to
42 and Pc O2: 74; normal: 100) (Hall, 2015).

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Medication management of Adam’s and underlying pathophysiology
Initially Adam was given salbutamol however, the condition did not improve.
According to Koc et al. (2015), salbutamol induce a significant increase in resting lung
function in hyperpnoea however, the action is temporary. Moreover, salbutamol is also
ineffective in overall function of the pulmonary arteries in channelizing the oxygen
throughout the body. Moreover, in Adam’s case he was also suffering from flu and thus his
lungs were blocked with mucus. No specific antibiotics were given along with injection of
specific steroids and thus mucus deposition is not cleared. Thus, in spite of the external
supply of oxygen, the oxygen saturation decreased along with increase in heart rate, blood
pressure and respiratory rate. Only after the administration of Ipratropium, the bronchodilator
that dilates (enlarges) airways (bronchi) in the lungs long with methyl prednisone (decrease
inflammation) along with antibiotics helped to improve his condition. The use of methyl
prednisome and Ipratropium decreased the inflammation and thus helping Adam not to use
accessory breathing muscles to induce laboured breathing (Donohue, et al., 2016).
Health Assessment to be carried out
Respiratory Health Assessment
Subjective data
The respiratory assessment will be conducted with the accumulation of the subjective
data and this includes cough (productive or non-productive) barking or hoarseness in voice.
Subjective assessment will also include dyspnoea with or without activity along with pain in
chest upon inspiration and expiration. The level of pain will be assessed with the help of the
self-reported pain scale. Few questions that will be asked to Adams for the gathering of the
subjective data include presence of night sweat, fatigue and fever at night (Lewis et al.,
2015).

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Objective Data
Inspection: visual inspection of the facial observation, colour of the skin, moisture
and temperature. The relaxed facial expression will include no significant problems in
breathing even under the conscious state of might. Pale or red colouration of the skin might
indicate the signs of shortness of breath while bluish colour indicates cyanosis. The colour of
the eyes, tongue and nails will also be noticed in order to denote the level of oxygen
saturation. Inspection of the respiratory pattern will be done by making Adam sitting upright
and then observing the pattern of respiration for a minute. For patient who cannot sit upright,
the respiratory assessment will be done by rolling to one side and then to other side.
Retraction or bulging of the interspaces indicates obstructed airways. Breathing too fast, slow
or shallow will also indicate problematic respiratory rate (Dougherty & Lister, 2015).
Palpation
This will be done by placing the index finger in the suprasternal notch at the base of
the trachea. Trachea should be placed in the midline and must be slightly moveable. Pulling
of the trachea on the either side of the neck if results from unequal intrathoracic pressure
within cavity of the chest, then it is a sign of partial to complete pneumothorax. The palmar
surface of the fingers will be used to palpate the anterior and posterior chest, palpation must
be free from pain and tenderness. Vocal fermitus must also be taken from the posterior of the
chest with the use of the ulnar side of the hand. At this time patient will be asked to
pronounce “baby” in order to create vibrations and this indicating presence of any solid
substance within the body (Lewis et al., 2015).
Percussion

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It will be performed by placing the middle finger over the non-dominant hand against the all
of the chest. The tip of the finger will be used to determine the strike rate of the distal
phalanx. The test will be helpful for the determination of the position of the diaphragm during
inspiration and expiration. Percussion sound must be low-pitched, hollow and for long
duration (Dougherty & Lister, 2015).
Adam’s allergic tendency
According to Fowler, Tavernier and Niven (2015), people who have high level of
eosinophils and immunoglobulin count are more prone in the development of the allergic
reactions like type 1 hypersensitivity reaction along with an increase in the tendency of
development of asthma. Fowler, Tavernier and Niven (2015) further highlighted that
increased concentration of the immunoglobulin in the blood and increased secretion of
eosinophil secretion in the blood plasma increased the tendency of developing allergic
reactions in comparison to the individuals with permissible limit of eosinophil and
immunoglobulin E (IgE). The blood test will be conducted in empty stomach and result of the
test will help the health physicians to prescribe desired medicine to reduce eosinophil.
The sputum test in order to detect the presence of bacteria
Kolsum et al. (2017) reported the individuals who are infected with bacteria and
suffering from breathing problems must undertake the sputum test in order to ascertain the
level of bacterial load in the mucus. Thus in order to ascertain whether Adam is completely
cure from the infection of the common cold or influenza, sputum test is required to be
undertaken. Suptum characteristics will also be analysed like clear or purulent, bloody or rust
coloured.

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Chest X-ray
The complete chest X-ray is important in order to detect the overall physiological
structure of the lungs. In asthma there occurs inflammation in the pulmonary cavities.
Moreover, in common cold there occurs accumulation fluid in the lung cavity (oedema) along
with the deposition of the thick mucus. A chest x-ray will help to ascertain the current
condition of the lungs and thus helping in further therapy planning. Chest X-ray in chronic
cough and asthma is considered as one of the systematic approach in nursing to exclude the
common causes of severity of the infection before referral to the secondary care (Turner &
Bothamley, 2016).
Nursing Intervention: Patient Education
General Education
Shin, Park and Kim (2015) are of the opinion that proper education of the patient
about the disease progression is important in order to increase the level of the disease
awareness and at the same time helps to increase the overall therapy adherence. It is the duty
of the nursing professional to indulge in therapeutic relationships for educating patient. The
case study indicates that Adam is well aware about the asthma rescue plan and thus education
will be done in association with his uncle in order to promote comprehensive outcome in the
care process. Taking primary care giver in the disease education plan helps to increase
outcome of the therapy. The education in case of Adam will be directed towards importance
of staying in isolation and the use hand hygiene and use of facial mask for the preventions of
the contagious disease like common flue (Shin, Park & Kim, 2015).
Breathing Exercise
Adam will be educated about the breathing exercise in order promote easy breathing
without the use of accessory muscles. The breathing exercise will be done based on deep

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inhalation followed by exhalation. This will be done in loop (five to ten times) per day.
Proper breathing exercise will help to overcome the cough deposition in the lungs and thus
ensuring easy breathing (Westerdahl, 2015). This will followed by education of the patient in
sleeping in the Fowler’s position whenever he is suffering from breathing problems. Fowler’s
position includes posturing of the patient’s head at an angle of 45 degree from the waist line.
This position helps to increase the over-all surface area of the diaphragm and thereby helping
to ease the process of breathing and decrease dyspnoea and poor oxygen saturation in the
body during the time of increase respiratory rate (Ceylan et al., 2016).
Conclusion
Thus from the above discussion, it can be concluded that Adam was suffering from
chronic asthmatic condition while exacerbating the symptoms of common flue. This was the
reason why medications related to asthmatic management failed to bring successful outcome
in Adama. Proper administration of antibiotics helped in complete recovery of patient by
increasing the oxygen saturation within the body along with decrease in the heart rate,
respiratory rate, blood pressure and body temperature. The further nursing assessment will be
directed towards the effective monitoring of the respiratory condition of Adam by conducting
proper respiratory assessment. This will help in understanding of the proper functioning of
the respiratory organs of Adams as his main problem lies in pulmonary organs. This will be
followed by patient-education in the domain of disease progression and management of
breathing problem with breathing exercise and Fowler’s position.

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