PCAL Workshop for 401210: Health Variations 3

This article discusses acute severe asthma, its causes, diagnosis, treatment and nursing strategies. It also includes a concept map and guided question response. The article is relevant for the subject Health Variations 3 under course code 401210. The college or university is not mentioned.

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Running head: PCAL Workshop for 401210: Health Variations 3
PCAL Workshop for 401210: Health Variations 3
Concept Map and Guided question response
Assessment 2

PCAL Workshop for 401210: Health Variations 3
Table of Contents
Introduction......................................................................................................................................3
Concept map....................................................................................................................................3
Guided question response................................................................................................................4
Answer 1......................................................................................................................................4
Answer 2......................................................................................................................................5
Answer 3......................................................................................................................................6
Conclusion.......................................................................................................................................7
References........................................................................................................................................8
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Introduction
In this age, the intensity of disorders are increasing at a rapid pace within the individual and due
to this, the death rate is augmenting significantly. Among many others, the most noteworthy ones
are respiratory infections or asthama that results in stress and varied allergic symptoms and many
others. Therefore, to minimise these aspects, proper treatment need to be used by the patients.
Concept map
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It is formerly known as status asthmaticus which is defined
as severe asthma that does not include response to repeated
courses of beta-agonist therapy including inhaled
subcutaneous epinephrine, albuterol or levalbuterol.
Airway limitation manifests as life-threatening.
Acute Severe Asthma
Diagnosis
Non-acuteAcute
Moderate/ Mild Life-threatening or Severe
-Test of patients
for analyzing
breathing.
- Analyzing the
symptoms
-Kinds of treatment
had on past
-Number of breaths
per minute
-Amount of oxygen
and carbon dioxide in
the blood
-X-ray to analyze
lung infections
Cause of the Disease
Constant monitoring,
observing the triggers,
communication with the
patient about the situation,
medication
Prevention
Smoking, air pollution,
respiratory infections, cold
weather, severe stress, exposure
to irritants or chemicals
Remission rates are low
based on milder cases, risk
increases to smokers, a
risk of death
Prognosis
Aetiology
Non-atopicAtopic
-IgE response
to
environmental
antigen
critically
ingested or
inhaled
-Respiratory
infections
-Severe stress
-Smoking
-Severe
allergic
reactions
Treatment
Nursing & non-
pharmacotherapy
Pharmacotherapy
-Effective care of the
patient
-Constant monitoring
of breathing
-Dietary
recommendations
-Oxygenation for
SaO2 less than 92%
- Oral, inhaled or
injected
corticosteroids to
reduce inflammation
- Higher doses of
inhaled support
-Bronchodilators
-Bronchodilator
-Anticholinergic
such as Ipratropium
bromide
-An anti-
inflammatory such
as magnesium
sulfate
Pathogenesis
Trigger exposure to viral
respiratory infections
Defective anti-viral
immunity
Allergic reaction
Chronic Inflammation
Permanent structural
changes due to allergen
exposure
-A diameter of the
airway for
breathing
-Reaction to
therapies

PCAL Workshop for 401210: Health Variations 3
Guided question response
Answer 1
Acute severe asthma triggers from viral respiratory infections, nonadherence to therapies,
smoking, exposure to allergens and other drugs. However, based on the situation of Jackson
significant assumptions can be established due to the cause of his attack through his clinical
manifestations. The pathogenesis that is causing the clinical manifestations as presented in the
case of Jackson Smith is highly critical. The symptoms that have been observed in Jackson
includes severe dyspnoea, lower respiratory rate, lower blood pressure rate, lower pulse rate as
well as auscultation of lungs that highly inflated. There is a huge possibility that the causes of
dyspnoea initiated form the allergens primarily originated in the cardiac or respiratory region,
(Edmonds et al. 2012). Also, based on the medical history of Jackson it has been analyzed that
he was diagnosed with severe acute asthma at the age of 2 which states that the inflammation of
such critical manifestations initiated at that age. On the other hand, the viral respiratory
infections including bronchoconstriction can be a significant cause of such manifestations.
Furthermore, the narrowing down of airway due to muscle contraction in response to exposure of
stimuli incorporating irritants or allergens could its primary cause. Later the pathogenic process
initiated with the lower respiratory rate of 32 breaths per minute. This is the reason behind the
inability to speak sentences in one breath along with severe dyspnoea case due to allergens,
(Farah et al. 2012). The lower blood pressure of 150/85 mmHg is also caused due to
lymphocytes due to development of airway inflammation caused by overproduction of IgE based
on the increased production of eosinophils which critically suppressed the breathing. Also, this
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PCAL Workshop for 401210: Health Variations 3
led to diminished breath sounds as well as a widespread wheeze. The hyper-inflated lungs that
were analyzed from the X-ray also revealed that the respiratory infections triggered the asthma
attacks that were faced by Jackson at the age of 2. Also, the airway inflammation was caused due
to response therapy, intensity as well as the cellular pattern.
Also, as he was prescribed under some medications due to asthma attacks, there is a huge
possibility that he did not follow up routine checkups or continued the medicine. This, in turn,
led to both functional and structural changes, (Green & Pavord, 2012). The structural changes
that would be possible based on the clinical manifestations include angiogenesis, sub-basement
fibrosis, smooth muscle hypertrophy, mucus hypersecretion as well as injury to epithelial cells.
Also, the viral respiratory infections caused due to allergens can be the primary cause of such
structural challenges. On the other hand, the functional changes include loss of lung function
which resulted highly inflamed as well as shortness of breaths. The lymphocytes could also
disrupt the airway function. Also, the pulmonary function might also be declined due to heavy
smoking activities along with environmental factors including allergens. At the age of 2 declines
in lung function cannot be anticipated however at the age of 18 such declinations can be
observed which resulted in airflow obstruction leading to such a critical situation. Also,
Anticholinergics led to bronchodilation by lowering the intrinsic vagal tone of the airway, which
was the major reason behind Jackson’s inability to speak. The neutrophils, dendritic cells as well
as macrophages have been possible to be activated due to allergens which resulted in airway
functional changes causing such manifestations, (Holt & Sly, 2012). The inflammatory mediators
including cysteinyl-leukotrienes also affected the lung functions that led to such critical
symptoms in the patient. Hence, the major pathogens causing such condition of Jackson is due to
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lung infection as well as a respiratory infection that led to shortness of breath as well as such
clinical manifestations that have been identified.
Answer 2
To mitigate such criticality in Jackson as well as manage it efficiently, significant nursing
strategies are required to adopt. The first strategy that can be significantly adopted based on
nursing to manage the situation of Jackson is administering occasional exercises under
continuous supervision, (Watts & Chavasse, 2012). As Jackson is suffering through shortness of
breath and his respiratory rate was also affected, exercises along with continuous supervision are
highly required. Also, to achieve the oxygen saturation above 90%, it is highly required exercises
which would certainly reduce pulmonary vasoconstriction, as well as supplementary oxygen,
must be kept ready. Also, exercising appropriate techniques needs to be provided as it would
assist stimulate receptors in airways smooth muscles which would relieve bronchoconstriction
that would reduce the resistance to airflow and would enhance the process of breathing,
(Kennedy et al. 2012). Herbal medicine should be prescribed to Jackson to relieve the acute
episodes and enhance the mechanism with strong doses of medicines. Acupuncture can also be
used to aerosolize the routes which would reduce the tension in the lung tissues by monitoring
the initial response of Jackson. In case the attack becomes much more critical then ventilation is
required as it could be effective for treating the cause efficiently. Breathing exercises and
techniques would also assist in Jackson’s case that led to bronchodilation which would enhance
the ability to speak a complete sentence.
The 2nd strategy that needs to be administered is systematic diets and clean room atmosphere that
would reduce the inflammation caused in the airway. It is a significant system that would assist
to treat a patient for moderate to severe asthma attacks, (Tsai et al. 2012). Also, such a dietary
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system and clean environment must be prescribed and must be administered during the initial
stages after observing the situation. Also, constant supervisions by creating an enhanced
atmosphere with effective care can also be administered that would certainly enhance the
situation of Jackson and would decrease the need for mechanical ventilation and any other
nebulizers, (Lim et al. 2012). This kind of therapy would assist to manage airway secretions and
treat issues of lungs and respiratory infections extensively. By administering these two nursing
strategy based on the situation of Jackson and clinical manifestation could highly make the
situation at ease. Furthermore, it would also give him relief and smooth flow of air without any
inflammation in the lungs. On the other hand, as this case relates to highly acute severe asthma, it
would reduce the severe need of medication as each of the strategies has its own positive impacts
that would certainly improve the condition of Jackson extensively.
Answer 3
As continuous nebulized Salbutamol and nebulized Ipratropium bromide (4/24) and IV
Hydrocortisone 100mg (6/24), these medications have a significant impact on Jackson as well as
their mechanisms are highly distinct. Nebulised Salbutamol works as quick-relief medications.
Also, as the condition of Jackson states that he is suffering through severe acute asthma, short-
acting beta2 agonists like nebulized Salbutamol is highly recommended. It would also relieve the
bronchoconstriction due to such acute episodes. It assists in the airway for smooth muscles and
decreases the resistance to airflow. On the other hand, in case it would be provided through the
process of inhalation or aerosolized routes, it might not reach the lower airways as well as the
lung tissue of Jackson. This in would highly disrupt the airflow and reduce tidal volume
extensively, (Papadopoulos et al. 2012).
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Anticholinergics are a critical issue that has been observed in Jackson’s case that led to
bronchodilation by lowering intrinsic vagal tome of the airway. For such treatment, the
mechanism of nebulized Ipratropium bromide (4/24) has been prescribed as it produces
bronchodilation as well as enhances the pulmonary function of Jackson. Also, the adverse
reaction to cardiovascular is also minimized. On the other hand, the adverse reaction of
nebulized Ipratropium bromide is its impact on the cardiovascular system. However, in this case,
it is assumed to be minimal due to which such implications would be managed efficiently,
(Silvio Torresa et al. 2012).
IV Hydrocortisone 100mg is a kind of corticosteroids that assists to suppress the airway
inflammation by restricting inflammatory migration of cells and activation. Also, it assists to
block late e phase reactions to the allergens. It reduces hypersensitivity, edema as well as
secretions, (Powell et al. 2012). It should be administered for 3 to 10 days and in the case of
Jackson 5 to the 10-day course is significant as it would enhance the condition suffered due to
severe acute asthma. On the other hand, these doses have negative nursing implications as well if
not held continuous supervisions including relapse that would critically worsen the situation,
(Pavord et al. 2012). Hence, nebulized Salbutamol and nebulized Ipratropium bromide (4/24)
and IV Hydrocortisone 100mg (6/24) medications must be provided to Jackson under effective
supervision to mitigate the negative nursing implications associated with it. Based on the clinical
manifestation, these medications would enhance the present situation of Jackson by therapeutic
care is highly required for reducing the chance of its occurrence again.
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Conclusion
Conclusively, it may be mentioned that proper clinical manifestation is essential in order to
mitigate any sort of infections hampering the health of the human beings. Failure to do so, might
prove extremely harmful for the individual to retain the life in the future in an effective way.
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References
Edmonds, M. L., Milan, S. J., Camargo Jr, C. A., Pollack, C. V., & Rowe, B. H. (2012). Early
use of inhaled corticosteroids in the emergency department treatment of acute
asthma. Cochrane Database of Systematic Reviews, (12).
Farah, C. S., King, G. G., Brown, N. J., Downie, S. R., Kermode, J. A., Hardaker, K. M., ... &
Salome, C. M. (2012). The role of the small airways in the clinical expression of asthma
in adults. Journal of Allergy and Clinical Immunology, 129(2), 381-387.
Green, R. H., & Pavord, I. (2012). Stability of inflammatory phenotypes in asthma.
Holt, P. G., & Sly, P. D. (2012). Viral infections and atopy in asthma pathogenesis: new
rationales for asthma prevention and treatment. Nature medicine, 18(5), 726.
Kennedy, J. L., Heymann, P. W., & Platts‐Mills, T. A. (2012). The role of allergy in severe
asthma. Clinical & Experimental Allergy, 42(5), 659-669.
Lim, W. J., Akram, R. M., Carson, K. V., Mysore, S., Labiszewski, N. A., Wedzicha, J. A., ... &
Smith, B. J. (2012). Non‐invasive positive pressure ventilation for treatment of
respiratory failure due to severe acute exacerbations of asthma. Cochrane database of
systematic reviews, (12).
Papadopoulos, N. G., Arakawa, H., Carlsen, K. H., Custovic, A., Gern, J., Lemanske, R., ... &
Zar, H. (2012). International consensus on (ICON) pediatric asthma. Allergy, 67(8), 976-
997.
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Pavord, I. D., Korn, S., Howarth, P., Bleecker, E. R., Buhl, R., Keene, O. N., ... & Chanez, P.
(2012). Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-
blind, placebo-controlled trial. The Lancet, 380(9842), 651-659.
Powell, C., Dwan, K., Milan, S. J., Beasley, R., Hughes, R., Knopp-Sihota, J. A., & Rowe, B. H.
(2012). Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database
Syst Rev, 12.
Silvio Torres, M. D., Nicolás Stucco, M. D., Juan José Boscha, M. D., Tomás Iolstera, M. D.,
Alejandro Siabaa, M. D., Rivarolaa, M. R., & Schnitzlera, E. (2012). The effectiveness of
magnesium sulfate as initial treatment of severe acute asthma in children, conducted in a
tertiary-level university hospital. A randomized, controlled trial. Arch Argent
Pediatr, 110(4), 291-296.
Tsai, C. L., Lee, W. Y., Hanania, N. A., & Camargo Jr, C. A. (2012). Age-related differences in
clinical outcomes for acute asthma in the United States, 2006-2008. Journal of Allergy
and Clinical Immunology, 129(5), 1252-1258.
Watts, K., & Chavasse, R. J. (2012). Leukotriene receptor antagonists in addition to usual care
for acute asthma in adults and children. Cochrane Database of Systematic Reviews, (5).
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