Pathophysiology and Nursing Management of Acute Asthma: A Case Study

This article discusses the pathophysiology and nursing management of acute asthma through a case study of Jackson Smith. It explains the pharmacological and peak flow monitoring strategies used in the care plan for Jackson. It also evaluates drugs like Salbutamol, Nebulised Ipratropium Bromide, and IV Hydrocortisone 100mg. The article provides references to recent literature to support the discussion.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the University
Author note

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Concept map

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Acute Severe Asthma
Causes
Respiratory infections, stress,
cold weather, air pollution,
smoking and severe allergic
reactions [8].
Clinical manifestation
Increased chest pain, severe
breathing issues and shortness of
breath, low peak expiratory flow,
wheezing and coughing [2].
Prognosis
The prognosis of asthma is not well
described however, it can develop
chronic obstructive pulmonary
disorder. Besides with proper care
and medication remission also
could be achieved [6]
Management
The management of acute
asthma includes,
bronchodilators,
corticosteroids and ample
amount of oxygen [4].
Course
Over acidaemia which
was associated with acute
severe asthma and in the
course, it affected the lung
capacity of the patient
leading to asthma [5]
Pathogenesis
The pathophysiology of acute severe asthma is a complex process and inclusive of airway
inflammation, intermittent airflow obstruction, and bronchial hyperresponsivenes [1].
Prevention
Monitoring asthma trigger,
using peak flow monitor,
avoiding pollution and dusts
and using inhaler [7]
Diagnostic procedures
Lung functional tests are carried out to
determine the functionality of lungs,
these are spirometry and methacholine
challenge test [3].

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References:
1. Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., ... & Stockley, R. A. (2013). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American
journal of respiratory and critical care medicine, 187(4), 347-365.
2. Agarwal, R., Chakrabarti, A., Shah, A., Gupta, D., Meis, J. F., Guleria, R., ... & ABPA Complicating Asthma ISHAM Working
Group. (2013). Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification
criteria. Clinical & Experimental Allergy, 43(8), 850-873.
3. Vogelmeier, C. F., Criner, G. J., Martinez, F. J., Anzueto, A., Barnes, P. J., Bourbeau, J., ... & Frith, P. (2017). Global strategy
for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive
summary. American journal of respiratory and critical care medicine, 195(5), 557-582.
4. 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.
5. Reddel, H. K., Bateman, E. D., Becker, A., Boulet, L. P., Cruz, A. A., Drazen, J. M., ... & Lemanske, R. F. (2015). A summary
of the new GINA strategy: a roadmap to asthma control. European Respiratory Journal, 46(3), 622-639.

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6. Walford, H. H., & Doherty, T. A. (2014). Diagnosis and management of eosinophilic asthma: a US perspective. Journal of
Asthma and allergy, 7, 53.
7. Olin, J. T., & Wechsler, M. E. (2014). Asthma: pathogenesis and novel drugs for treatment. Bmj, 349, g5517.
8. Papaiwannou, A., Zarogoulidis, P., Porpodis, K., Spyratos, D., Kioumis, I., Pitsiou, G., ... & Tsiouda, T. (2014). Asthma-
chronic obstructive pulmonary disease overlap syndrome (ACOS): current literature review. Journal of thoracic
disease, 6(Suppl 1), S146.

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Answer 1
Pathophysiology of acute asthma depends on the inflammatory symptoms and interaction of different cell types and multiple
mediators due to which the physiological features are visible on the patient affected with it. In this provided case study of Jackson Smith (18)
who was admitted to the emergency department of the helathcare facility after the severe breathlessness related episode (Doeing & Solway,
2013). It was informed by the family members of the patient that he was suffering from this disease since his childhood. as the patient was
admitted to the emergency ward, the clinical manifestations were collected such as severe episodes of dyspnea, shortness of breath, increased
heart rate up to 32 breaths per minute, increased blood pressure, elevated pulse rate up to 130 beats per minute and wheezing sound of breath
which is also known as the auscultation of lungs (Gelb et al., 2015). Further to determine the lung expansion, the physicians conducted a
chest x-ray that determined hyperinflation of lungs and surrounding area. Besides these the blood gas was assessed that determined 90% SO2
PaCO2: 50mmHg and HCO3: 25mEq/L and therefore, using these clinical manifestation, the pathogenesis of Jackson’s acute asthmatic
syndrome could be understood (Doeing & Solway, 2013).
While discussing the pathogenesis the initiation of the inflammatory processes should be clearly understood. in this, the host factors
such as particularly the genetics and environmental exposure plays an important role that make the immune system react to the environmental
factors. As per Jackson’s case study, the emergence of asthma occurred at an early stage indicating towards innate immunity, genetics,
allergens, respiratory infections, and other environmental factors (Nievas & Anand, 2015). In this pathogenesis related to allergic reaction is
the most important. The antigen presenting cells or APCs engulfs the allergens from the environment and then presents them to the naïve T

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cells. Further, the the inflammatory factors then activates the respiratory epithelium that eventually releases the thymic stromal
lymphopoietin as well as other inflammatory mediators that sends the leukocyte that eventually triggers the allergic reaction. Dendric cells
also play an important role in increasing the allergic reaction and presenting those allergens to the naïve T cells. Further they present the t
cells in two different aspects such as the T-helper 2 and Th17 cells (Alangari, 2014). These Th 2 cell induces the immunoglobulin E antibody
production from the B cells using interleukin 4 and interleukin 13. These cells are important for the allergic reaction as IgE binds to the mast
cell surfaces and basophiles in the presence of interleukin 4 that is the primary reason for the inflammatory reaction. These inflammatory
mediators are the reason due to which the neutrophiles, macrophages, eosinophiles and others damages the airway, stimulations related to T
cells, bronchoconstriction of the lungs, creating such clinical manifestation for Jackson (Doeing & Solway, 2013).
Other than these, Jackson also develops chronic inflammations due to which he started having symptoms related to shortness of
breath and higher respiratory rate. These symptoms occur due to the presence of respiratory epithelium and leukocytes. Due to the presence
of mediators in the inflammatory pathway the inflammatory cells are recruited to the epithelium cells and the then eventually infiltrates the
lungs and then creates a cycle for chronic inflammatory symptoms leading to epithelium damage and remodeling of airway and therefore, the
blood pressure as well as the respiratory rates also gets increased (Kudo, Ishigatsubo & Aoki, 2013). Further, genetics could also be
responsible for the emergence of asthma in Jackson as Kaiko et al. (2013) determines that genetic sis involved in the production of IgE,
airway hyper responsiveness and dysfunctional regulation of inflammatory mediators such as chemokines, cytokines, and growth factors.

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This leads to the production of modified genes, due to which, people with such genetic mapping develops Asthma in their lifetime and
hence, Jackson also developed acute asthma related condition (Kudo, Ishigatsubo & Aoki, 2013).
Answer 2
The two nursing strategies which will be included in the care plan for Jackson will consist of pharmacological strategy and peak flow
monitoring. These both management strategies are discussed below with the support of evidences from recent literatures.
As the patient, Jackson has been admitted in the emergency department of the healthcare facility and is suffering from acute asthmatic
syndrome, it is important to implement immediate intervention using which the patient condition could be controlled (Price et al., 2013). This
is because, due to progressive and continuous dyspnea, patient starts showing signs of increased aggressiveness, anxiety, which affects the
asthma related condition. Therefore the medications which will be used for Jackson are Corticosteroids, which is primary medication if the
patient develops alleviating symptoms so that it can enhance the patient’s airway function, and decreases the peak flow variability ( Chung et
al., 2013). Further, immunomodulators, anticholinergics, as well as short acting beta 2 could also be used in pharmacological intervention of
Jackson as Chung et al. (2013) mentions that these drugs in acute asthmatic related condition helps in the reduction of prevent the binding of
mast cell with basophile, decreasing the tone related issues of airway and relief the acute condition of the asthma respectively. The second
strategy will be Peak flow monitoring, which is also an important intervention or strategy for patients affected with acute asthma as it helps to

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measure the highest airflow during a forced expiration or exhalation. Moorhead et al. (2013) also mentioned that in people with moderate and
severe asthma, this intervention should be implemented. Therefore, the potential complications could be easily identified and preventive and
corrective action could be taken against the disease condition. Further it also helps in the improvement of congestion and breath sounds or
wheezing which is one of the primary clinical manifestations of the disease (Mebazaa et al., 2015).
Answer 3
Salbutamol: it is inhaled in the form of aerosol and therefore it acts as β2-adrenoreceptors which acts on the smooth muscles that covers
the bronchi. Further, it helps in the binding to the epinephrine’s active site which in the course helps in the stabilization of the receptor which
in the course makes more amount of cAMP that in the triggers the intracellular cascades to release the potassium ion (Gallenmüller et al.,
2014). This decreases the intracellular calcium ion that helps in the hindrance of muscle contraction ability. Salbutamol in this place works as a
other β2 receptors that helps in the relaxation of these muscles and hence, provides relief to the patient (Hahner, Burger-Stritt & Allolio, 2013).
Nursing effect will be evaluated by patient observation and patient’s improvement will be used for the identification of effectiveness of drug.
Further, the side effects will also be monitored and patient will be provided with pain killers and anti depressants so that anxiety, headache,
and muscle cramps will be removed (Tashkin & Ferguson, 2013).
Nebulised ipratropium bromide: This drug is associated with chronic pulmonary disorder and it is used with concomitantly with
inhaled beta2-agonists for the treatment of reversible obstruction of the airway (Nouira et al., 2014). This drug blocks the muscarinic receptors
that associated with acetylcholine and thereby reliefs the COPD related condition of the patient. Further, to treat the dizziness, nausea,

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headache that will be maintained by observing the patient condition and understanding his mental and physical stability (Tashkin & Ferguson,
2013).
IV Hydrocortisone 100mg: IV Hydrocortisone 100mg: this drug is naturally occurring glucocorticoids, having saltretaining properties
which is used in the replacement of adrenocorticol deficiency syndrome (Hahner, Burger-Stritt & Allolio, 2013). It helps to modify the
immune response related to diverse stimuli and then increases the metabolic effects. This drug has similar side effects as the abovementioned
drugs due to which the management mechanism will depend on the patient observation. Further, evaluation will be carried out after observing
patient condition and improvement (Alani & Seymour, 2014).

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References
Alangari, A. A. (2014). Corticosteroids in the treatment of acute asthma. Annals of thoracic medicine, 9(4), 187.
Alani, A., & Seymour, R. (2014). Systemic medication and the inflammatory cascade. Periodontology 2000, 64(1), 198-210.
Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Boulet, L. P. (2013). International ERS/ATS guidelines on
definition, evaluation and treatment of severe asthma. European Respiratory Journal, erj02020-2013.
Doeing, D. C., & Solway, J. (2013). Airway smooth muscle in the pathophysiology and treatment of asthma. Journal of applied
physiology, 114(7), 834-843.
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.
Gelb, A. F., Yamamoto, A., Verbeken, E. K., & Nadel, J. A. (2015). Unraveling the pathophysiology of the asthma-COPD overlap syndrome:
unsuspected mild centrilobular emphysema is responsible for loss of lung elastic recoil in never smokers with asthma with persistent
expiratory airflow limitation. Chest, 148(2), 313-320.

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Hahner, S., Burger-Stritt, S., & Allolio, B. (2013). Subcutaneous hydrocortisone administration for emergency use in adrenal
insufficiency. European journal of endocrinology, EJE-12.
Kaiko, G. E., Loh, Z., Spann, K., Lynch, J. P., Lalwani, A., Zheng, Z., ... & Diener, K. R. (2013). Toll-like receptor 7 gene deficiency and
early-life Pneumovirus infection interact to predispose toward the development of asthma-like pathology in mice. Journal of Allergy
and Clinical Immunology, 131(5), 1331-1339.
Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in microbiology, 4, 263.
Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S., ... & McDonagh, T. (2015). Recommendations on pre‐
hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European
Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. European
journal of heart failure, 17(6), 544-558.
Moorhead, S., Johnson, M., Maas, M. L., & Swanson, E. (2018). Nursing Outcomes Classification (NOC)-E-Book: Measurement of Health
Outcomes. Elsevier Health Sciences.
Nievas, I. F. F., & Anand, K. J. (2013). Severe acute asthma exacerbation in children: a stepwise approach for escalating therapy in a pediatric
intensive care unit. The journal of pediatric pharmacology and therapeutics, 18(2), 88-104.

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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.
Price, D., Bosnic-Anticevich, S., Briggs, A., Chrystyn, H., Rand, C., Scheuch, G., ... & Inhaler Error Steering Committee. (2013). Inhaler
competence in asthma: common errors, barriers to use and recommended solutions. Respiratory medicine, 107(1), 37-46.
Tashkin, D. P., & Ferguson, G. T. (2013). Combination bronchodilator therapy in the management of chronic obstructive pulmonary
disease. Respiratory research, 14(1), 49.