Pathophysiology of Asthma and Graves’ Disease

This document provides an explanation of terms and their signs and symptoms related to tachycardia, tachypnoea, angina, hypertension, anxiety, and tremor. It also discusses the pathophysiology of asthma and Graves’ disease, along with the generic details, indications, and actions of medications used to treat these conditions. The rational behind using a combination of drug therapy is explained, and advice on pregnancy with these conditions is provided.

PATHOPHYSIOLOGY

TABLE OF CONTENTS
TASK 2............................................................................................................................................3
Explanation of terms and their signs and symptoms...................................................................3
Action to monitor these symptoms..............................................................................................3
Pathophysiology of Asthma.........................................................................................................4
Generic Details along with indication and action........................................................................4
Graves’ diseases...........................................................................................................................5
Antithyroid drug treatment..........................................................................................................5
Rational behind using combination of drug therapy....................................................................5
Advice on pregnancy...................................................................................................................6
REFERENCES................................................................................................................................7

TASK 2
Explanation of terms and their signs and symptoms
Term Tachycardia signifies a condition where the heart rate increases for more than 100
times per minute. All the symptoms that Jolene had i.e. shortness of breath, light headedness,
increased pulse and heart rate, palpitations etc. are the direct indications that the person might be
suffering from tachycardia (Gans and Gavrilova, 2019).
Tachypnoea simply signifies an abnormally rapid breathing. Due to the lack of adequate
oxygen, the breathing becomes fast and shallow thus creating the situation which is termed as
Tachypnoea (Chapman and et.al., 2017). Tachypnoea in itself is not any disease and is just a
symptom of another major problem that a person might be undergoing through.
Angina signifies the chest pain or discomfort in that area that arises when the heart does
not pump adequate oxygen rich blood. There is a feeling of squeezing or heavy pressure on your
chest and similar discomfort can arise in arms, neckline, and jaws or in back as well. The chest
pain or discomfort is the only observational symptom of angina.
Hypertension is referred as higher blood pressure or HBP where the force of blood against
artery increases (Carpaij and et.al., 2019). The symptoms mainly include shortness in breath,
headaches or nose bleeds and signify extremely high BP.
Anxiety and tremor both are interrelated where a person having anxiety might cause
tremors in the individual. These usually occur when the person is worrying excessively and the
symptoms include muscle tensions, increase heart rate, trembling etc.
Action to monitor these symptoms
As an emergency nurse, first step would be to place the patient i.e. Jolene on a cardiac
monitor and ascertain the BP and other oxymetry readings. If the patient is unconscious, then the
patient should be given oxygen supply continuously and breathing equipment to avoid the risk of
cardiac arrest and any further complications (Singanayagam, Ritchie and Johnston, 2017).
However, if the patient is conscious, then they should be patiently asked about what symptoms
they are feeling or identify the areas that are paining especially the chest area. After adequate
information has been obtained, the next immediate step is t conduct a series of test that can assist
in diagnosing the patient. Conducting ECG i.e. Electrocardiogram is the first step that should be
taken as an emergency nurse followed by the consequent tests. Conducting an ECG gives a fair
estimate of the problem that the patient is suffering from especially for the cardiac i.e. heart
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related diseases. It also helps in establishing the heart rate and breathing rate and monitors it
regularly.
Pathophysiology of Asthma
Asthma can be termed as a clinical syndrome that is caused by inflammation or due to
modification in the air pathways in a human (King and et.al., 2018). When the airway of a
person gets inflammated due to some diseases then, it leads to recurring symptoms of
exacerbations. Asthma can be categorised as a disease that is caused due to activation of such
inflammatory cells in the lungs of an individual. This causes infiltration when left untreated and
thus affects the bronchi of a person. This alteration occurs due to collagen disposition,
hypertrophia and hyperplasia. The inflammation can be caused due to any allergic infection, due
to genetic predisposition or due to any kind of intrinsic vulnerability. The inflammation thus
caused directly leads to the obstruction of the airway, the bronchospasm etc. which basically
limits the flow of air making it difficult for a person to breathe freely (Chapman and et.al., 2017).
Sometimes, the infection in the bronchi i.e. change in the structure of bronchi also leads to
remodelling of the pathways thus leading to increased mucus secretion, reduced elasticity in
airway wall etc. The change in the smooth muscles and the inflammation of the airways
collective causes the symptoms that lead to the development of the disease of asthma in a patient.
Thus asthma can be termed as hyper responsiveness of airways or hyperactivity in the bronchial
components that is caused due to various exogenous as well as endogenous stimuli.
Generic Details along with indication and action
Ventolin: Ventolin i.e. albuterol is a beta against i.e. a recue inhaler that can prevent or treat the
bronchospasm attack caused by asthma. This prevents the tightening of the muscles and two
sprays every four to six hours is the recommended dosage for Ventolin. This is usually
recommended for people above the age of 4 years (Drijver-Messelink and et.al., 2019). The side
effect of this drug manly includes the increased pace of heartbeat and trembling or shaking of
feet or hands
Serevent: Serevent i.e. salmeterol is a beta2- andrenoceptor and is also used to relax the muscles
that helps in breathing thus preventing asthma attacks and bronchospasm as well. It also cures
COPD but cannot be replaced with rescue inhaler. It cannot be used once the asthma attack has
begun and it should always be used with an inhaled steroid medicine so that overall, the asthma
control can be for a longer time period.
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Atrovent: Atrovent i.e. Ipratropium bromide is a bronchodilator that assists in the muscle
relaxation and avoids incurrence of bronchospasm along with cure of emphysema (Klein and
et.al., 2019). It does not help in prevention of the attack because it is not fast enough and can be
used only for prevention in long term.
Graves’ diseases
Graves’ disease basically leads o an overactive thyroid or hyperthyroidism. Due to this the
immune systems directly affects the thyroid where more than the required thyroid hormone is
produced causing the thyroid gland to swell (Bartalena and et.al., 2016). The manner in which
the energy is used in the body is controlled by thyroid and therefore affecting this thyroid gland
nearly affects all the parts of the body. If the disease is not treated in a timely manner, then it can
lead to a severe affection in the bones, muscle, heart, menstrual cycle, fertility etc. The disease is
more likely to occur in females rather than males and additionally, if a family member is found
to have Graves’ disease, then the chances further increase.
Antithyroid drug treatment
Antithyroids which are also referred as thionamides are the most commonly used drugs
that can cure an overactive thyroid i.e. the Graves’ disease (Cooper, 2019). Through the use of
these drugs, the formation of the thyroid hormone gets blocked which helps in addressing the
Graves’ disease. There are basically two types of Antithyroid dugs that can be taken i.e.
propylthiouracil and methimazole. In certain parts, carbimazole is also available for treatment of
Graves’ disease. However, amongst the three, methimazole is the most preferred drug because it
reverses the entire hyperthyroidism activity very quickly and the side effects of this drug are also
very few. There are no major side effects that can occur and even if they occur, it is in extremely
rare cases and the minor effects include rashes, swelling, joint pains etc. (Dinauer, 2020).
Therefore, collectively, if Antithyroid are taken in a monitored environment regularly as per the
prescription then the treatment of overactive thyroid can be completed quickly and successfully.
Rational behind using combination of drug therapy
Usually in order to cure the Graves’ disease, doctors often recommend a combination of
medication so that the patient does not feels too much pain and the recovery process is quicker
and easier (Kummer, Hermsen and Distelmaier, 2016). The beta blockers are often
recommended along with the Antithyroid medication so that the effect of the hormones on the
remaining part of the body can be blocked effectively. These collectively also provide relief from
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the side effects that were discussed above that can arise due to Antithyroid medication such as
joints pains, swellings etc. and the patient can avoid suffering from unnecessary pain. However,
the use of beta blockers should be exercised with extreme caution because if not managed well,
then these can even lead to complications in the case of asthma. This is the same case with
Jolene as she is an asthmatic patient along with suffering from the Graves diseases (Smith and
Hegedüs, 2016). Additionally, both the problems of hyperthyroidism and bronchodilators causes
swelling and similar joint pains, muscle aches etc. and these can be collectively addressed by the
inclusion of beta blockers. Therefore, it can be concluded that the combination of drug therapy
that has been recommended to Jolene is the correct strategy of curing the problem of Graves’
disease along with the consideration f the already existing problem of asthma.
Advice on pregnancy
My Response: Jolene, you are well aware that currently you are being diagnosed with the
medicines for both the Graves’ disease and for asthma as well. Although, there are no known
causes of any complications in the pregnancy if the mother is pregnant, complications might
arise if the proper case is not take or if any severe situation arises. Now in context of Graves’
disease, you need to know that during pregnancy the thyroid hormone is already produced in
excess and though this will not affect your baby directly, the regular monitoring is a very
important aspect. However, since you have not engaged in radioiodine therapy the risk factor for
your baby is significantly lower. Overall, I would suggest that although there is no significant
harm in deciding to become pregnant right now because both your diseases are not known to
impact children and even if there are any impacts, it is rare, only when the case is too severe.
Therefore, if you decide to go for pregnancy then you are safe to do so but you would have to be
careful about your medications and regular doctor appointments because missing these can lead
to complications that can threaten both your and the child’s life.
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REFERENCES
Books and Journals
Bartalena, L., and et.al., 2016. A 2013 European survey of clinical practice patterns in the
management of Graves' disease. Clinical endocrinology. 84(1). pp.115-120.
Carpaij, O.A., and et.al., 2019. A review on the pathophysiology of asthma
remission. Pharmacology & therapeutics.. 201. pp.8-24.
Chapman, D.G., and et.al., 2017. The Duffy antigen receptor for chemokines regulates asthma
pathophysiology. Clinical & Experimental Allergy. 47(9). pp.1214-1222.
Cooper, D.S., 2019. Long-Term Antithyroid Drug Treatment of Patients With Graves’
Disease. Clinical Thyroidology. 31(6). pp.230-233.
Dinauer, C.A., 2020. The Block-and-Replace Method May Have a Role in the Management of
Pediatric Graves’ Disease. Clinical Thyroidology. 32(1). pp.17-19.
Drijver-Messelink, M.T., and et.al., 2019. Eosinophilic otitis media and eosinophilic asthma:
Shared pathophysiology and response to anti-IL5.
Gans, M.D. and Gavrilova, T., 2019. Understanding the Immunology of Asthma:
Pathophysiology, Biomarkers, and Treatments for Asthma Endotypes. Paediatric
respiratory reviews.
King, G.G., and et.al., 2018. Pathophysiology of severe asthma: We’ve only just
started. Respirology. 23(3). pp.262-271.
Klein, M., and et.al., 2019. New protagonists in asthma pathophysiology. Presse medicale
(Paris, France: 1983). 48(3 Pt 1). p.255.
Kummer, S., Hermsen, D. and Distelmaier, F., 2016. More on Biotin Treatment Mimicking
Graves' Disease. The New England journal of medicine. 375(17). p.1699.
Singanayagam, A., Ritchie, A.I. and Johnston, S.L., 2017. Role of microbiome in the
pathophysiology and disease course of asthma. Current opinion in pulmonary
medicine, 23(1), pp.41-47.
Smith, T.J. and Hegedüs, L., 2016. Graves’ disease. New England Journal of Medicine. 375(16).
pp.1552-1565.
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