Pathophysiology Acute Severe Asthma

This article discusses the pathogenesis, clinical manifestations, diagnosis, treatment, nursing strategies and drugs for acute severe asthma. It also includes prevention and prognosis of the disease. Subject: Medicine, Course Code: MED101, College/University: Not mentioned.

RUNNING HEAD: PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
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RUNNING HEAD: PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
Question 1: The pathogenesis causing the clinical manifestations with which Jackson Smith
presented with
Disease: Acute Severe Asthma with severe dyspnea
Definition: Acute Severe Asthma is a chronic disease of the lungs, which can be controlled but
not cured. It results in excessive lung function variations by limiting airflow supply compared to
healthy people (Papiris, Manali, Kolilekas, Triantafillidou & Tsangaris, 2009).
AETIOLOGY:
Variation of the lung function, which restricts breathing resulting from:
 Virus induced such as Rhinovirus (RV), Respiratory syncytial virus (RSV), Influenza
virus and Human metapneumovirus (HMV)
 Bacteria induced
o Mycoplasma pneumonia
o Chlamydia pneumonia
 Occupational
o Chemical exposure
o Animal exposure
 Irritants
o Airway pollutants
 Allergen
o Tree, weed and grass pollen
o Indoor allergens
o Fungi (Hedlin, Bush, Carlsen, Wennergren, De Benedictis, Melén, Paton, Wilson
& Carlsen, 2010)
PATHOGENESIS:
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RUNNING HEAD: PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
 Immunopathogenesis includes cold symptoms which decrease in peak flow with RV
infections.
 In allergen based asthma exacerbations include increase eosinophil recruitment and
degranulation.
 Development of acute severe asthma leads to blocking of the passageway of breathing
leading to shortness of breath and decreased activities and functionalities.
Asthma is a common chronic disease, pathophysiology of asthma is rather complex includes
airway inflammation, bronchial hyper responsiveness and intermittent airflow obstruction
(Murphy & O'Byrne, 2010).
CLINICAL MANIFESTATIONS:
 Chest tightness or pain
 Short ness of breath
 Trouble sleeping from shortness of breath, wheezing and coughing
 Whistling or wheezing sound when exhaling
 Coughing or wheezing worsened by means of respiratory virus of flu or the cold
DIAGNOSIS
 History
 Physical examination
 Considering other diagnosis
 Documenting variable airflow limitation (Lemanske Jr & Busse, 2010)
TREATMENT
Acute Severe Asthma attack is triggered by flu, allergens or from other potential triggers,
treatment for which includes;
 Using proper asthma medications, including quick relief medicines
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RUNNING HEAD: PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
along with long term control medicines.
 Immunotherapy such as allergy shots can be a potential treatment.
Long-term control medications include antileukotrienes, inhaled
corticosteroids, oral corticosteroids and several other medications
(Bacharier, Boner, Carlsen, Eigenmann, Frischer, Götz & Platts‐Mills,
2008).
COURSE OF DISEASE
 With diagnosis of the disease and assessing asthma control, initial treatment appropriate
has to be started.
 Reviewing and adjusting of drug treatment periodically will enable adequate control of
the disease.
 Assisting in self-management by providing information, skills and necessary tools such
as training in inhalers, maximise adherence, writing down an asthma plan and avoiding
potential triggers.
 Management of flare-ups is essential whenever it occurs
 Most important is managing of comorbid conditions which further triggers asthma or
contribute in respiratory symptoms.
 Providing advice related to smoking, physical activities, immunisation, healthy eating
and healthy weight maintaining.
PROGNOSIS
 Prognosis of asthma is not well described and defined in chronic obstructive pulmonary
disease.
 Complete remission rates are low and possible which remains limited to milder cases.
 In some cases permanent lung function impairment might develop and patients are
admitted to intensive care units with high risk of severe asthma complications (Lugogo &
MacIntyre, 2008).
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RUNNING HEAD: PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
PREVENTION
Prevention of acute severe asthma includes the following;
 Reduced exposure to allergens
 Reduced physical exertion
 Reducing exposure to smoking areas
 Maintaining healthy diet
 Maintaining appropriate body mass
Question 2: Two high priority nursing strategies to manage Jackson and provide evidence-
based rationales for these strategies.
High priority nursing strategies to manage Jackson’s condition includes treating him with
immunization shots (Gupta, Sjoukes, Richards, Banya, Hawrylowicz, Bush & Saglani, 2011).
His oxygen levels need to be monitored and oxygen needs to be given to him so that levels of
oxygen in his body does not deplete. Monitoring of blood pressure has to be undertaken to
understand any abnormalities. A pulse measurer has to be connected as well to monitor rate of
heart beat and activity levels. Taking steps to relieve from respiratory rates of 32 breaths/minute
to 15 breaths/ minute. All necessary steps have to be taken to reduce such high rates of breaths.
SpO2 90% on room air has to be monitored and supplement oxygen has to be given. BP rate of
150/85 mmHg has to be reduced to 120/80 mm/Hg levels. The pulse rate of the patient is also
very high at 130 beats/minute, which has to be reduced to 92 beats/minute. Auscultation of lung
reflects diminished breath south and widespread of wheeze from Chest X-ray. Such wheezing
has to be reduced by regular monitoring of appropriate drug dosage. X-Rays has to conduct on
regular basis to track any signs of improvement. To ease his breathlessness immediate shots of
nebulization has to be initiated of Ipratropium bromide (4/24). To ease his nerves and reduce
possibilities of cardiac arrest oral solution of corticosteroid as per body weight has to be
administered through injection, to relieve inflammation. The solution will immediately help ease
allergic conditions and is to be continued for minimum of 3 days till symptoms eases.
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RUNNING HEAD: PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
Question 3: Three of the drugs that were given to Jackson were continuous nebulised
Salbutamol and nebulised Ipratropium bromide (4/24) and IV Hydrocortisone 100mg
(6/24). The mechanism of action of these drugs, and relate to the underlying pathogenesis
of an Acute Severe Asthma.
The three drugs that were given to Jackson included nebulized Salbutamol and nebulised
Ipratropium bromide (4/24) and IV Hydrocortisone 100mg (6/24). The underlying pathogenesis
of an Acute Severe Asthma with mechanism of action of these drugs includes broadening of the
passageway through which oxygen enters the body (Lötvall, Akdis, Bacharier, Bjermer,
Casale, Custovic & Greenberger, 2011). In clinical setting for acute asthma nebulized
bronchodilators are in common use in nebulized form. They are known to relieve symptoms of
lung disorder functionality. They enable regulation of lung function by allowing extended
passageway which allows more oxygen to enter the lungs and blood stream. In long term they
help prevent asthmatic conditions by reducing manifestation of asthmatic triggers. They
provide immediate relief by reducing calming down pulse rate and reducing heart rate, overall
having calmer effects on the lungs. The drugs are known to allow diffusion of more oxygen
into blood levels so as to reduce risks from possible cardiac arrests. Nurses are expected to
conduct continuous monitoring and evaluation of the patient’s vital signs till the patient is able
to stabilize. Further risks from reappearance of the symptoms have to be prevented as well by
providing training for self-medications and control procedures of asthmatic conditions. In long
term period nebulized dosage does not have to be monitored rather normal shots can be given
to keep a check on the symptoms.
a. The nursing implications (monitoring for and responding to adverse effects, and
evaluating therapeuticeffect) when administering these drugs to a patient with an
Acute Severe Asthma
Nursing implications is tremendous while administering of drugs to patient with an Acute
Severe Asthma. Nurses need to continuously monitor for vitals that includes pulse rates,
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RUNNING HEAD: PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
pressure monitoring for fluctuations and levels of oxygen in the blood. The patient
diagnosed with acute severe asthmatic symptoms have to be monitored continuously to
check for any signals of deterioration. Moreover, the dosage of nebulized Salbutamol has to
be administered with specific gaps in between. The dosage will continue till the patient is
able to regain normal pulse rate and pressure rates. Nursing monitoring will include regular
blood monitoring as at current levels blood pH level was at 7.35 PaO2 at 60 mmHg, HCO3
will be at 25 mEq/L, Lactation at 1 and SaO2 at 90%. It will also include regular X-Ray
monitoring, Blood oxygen levels, pulse rate and heart beat levels. Every possibility of rising
adverse effects has to be reducing to further reduce potential impacts from escalating the
situation into severe acute asthmatic conditions.
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RUNNING HEAD: PATHOPHYSIOLOGY ACUTE SEVERE ASTHMA
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