Pathogenesis and Nursing Strategies for Acute Exacerbation of Asthma

This document discusses the pathogenesis causing clinical manifestations in acute exacerbation of asthma and provides nursing strategies to manage the condition. It covers topics such as the role of inflammation, nursing interventions like positioning and oxygen therapy, and assessment for each medication. The document also includes references for further reading.

Short Answer based on one case study
of acute life-threatening and or
traumatic complex health condition

TABLE OF CONTENTS
MAIN BODY...................................................................................................................................1
QUESTION 1. EXPLAIN THE PATHOGENESIS CAUSING THE CLINICAL
MANIFESTATIONS WITH WHICH POPPY PRESENTS...........................................................1
QUESTION 2 NURSING STRATEGIES.......................................................................................2
Sit Poppy in a High Fowlers position.........................................................................................2
Apply and titrate oxygen.............................................................................................................2
QUESTION 3. ASSESSMENT FOR EACH MEDICATION........................................................3
Salbutamol via nebuliser.............................................................................................................3
Hydrocortisone IV.......................................................................................................................3
Ipratropium Bromide via nebuliser.............................................................................................3
REFERENCES................................................................................................................................5

MAIN BODY
Poppy is a 9 year old female who has worsening respiratory systems. She is unable to talk within
full sentences. She has been given nebulised Salbutamol with 6LPM of O2, IVF. Poppy has
been acknowledged to the ICU because of her deteriorating respiratory function and has
also been diagnosed with acute exacerbation of asthma disease.
QUESTION 1. EXPLAIN THE PATHOGENESIS CAUSING THE
CLINICAL MANIFESTATIONS WITH WHICH POPPY PRESENTS.
Asthma is considered to be as the long term inflammatory disease associated with the airway
of lungs. It is also characterized as various set of recurring symptoms and variables. The parental
disease associated with the Asthma are Obstructive lung disease. The key symptoms mainly
includes dyspnoea, wheezing, cough and chest tightness. One of the key characteristics
associated with the asthma is associated with the airway inflammation which eventually leads to
airflow obstruction. The Poppy in turn tends to have key symptoms associated with the Poppy
are speaking of the single word and the airway is also clear. Poppy in turn is also exposed to the
accessory muscle use, tracheal tug and shoulder shrugging on inspiration. The key symptoms
associated with the asthma are dyspnoea, wheeze, cough and chest tightness. There seems to be
airflow limitation which eventually results in various sets of physiological changes which are
usually irreversible. The key reason associated with the shortness of breath in Polly is mainly
associated with various irritants like chemical fumes and extreme weather conditions. In asthma,
the airways in turn tends to largely respond to the various exaggerated way associated with the
inflammatory mediators like irritant, allergen and various other set of triggers such as cold air,
pollution, respiratory infection, etc. Some of the prominent mediators which are released at the
time of acute allergic asthmatic period are histamine, leukotrienes, interleukins, prostaglandins
and nitric oxide (Mechanisms and Management of Asthma Exacerbations, 2018). Acute
exacerbation of asthma tends to eventually result in contraction of the bronchial which
eventually narrows down the airway in response to the exposure to the various set of irritants and
allergens. Acute exacerbation of asthma leads to the shortening of the breath. Asthma in turn is
considered to be as the chronic inflammatory disorder within the air passage of Poppy.
Inflammation of the airways in turn largely contributes to the limitation in the airflow,
respiratory systems, airways hyper- responsiveness and disease chronicity (Zahran & et.al.
(2018)). There are high degree of persistent change which eventually results in mucus
1

hypersecretion, sub- basement fibrosis angiogenesis, and injury to the epithelial cells, etc.
Moreover, Gene by the environment is considered to be as one of the most effective interaction
associated with the asthma. The key changes associated with the airflow limitation which results
in the change in the airways which mainly includes Bronchoconstriction, airway hyper-
responsiveness, airway edema, airway remodelling, etc. Acute exacerbation of asthma in turn is
considered to be as the one of the major serious treatment challenge (Mechanisms and
Management of Asthma Exacerbations, 2018). A severe acute exacerbation of asthma which
eventually results in use of proper set of medications and hospitalization for the patient which
eventually helps in the better results and outcomes.
QUESTION 2 NURSING STRATEGIES.
Sit Poppy in a High Fowlers position
The High Flower position is considered to be as one of the effective position for the patient
where the head is elevated as high as possible. The upper-half of the patient body is between 60
degree to 90 degree angle when distinguished with the lower-half of the body of the patient . The
High Fowlers position which helps in effectively alleviating the compression of the chest which
in turn tends to largely occur because of the gravity (Kleniewska & Pawliczak, (2017)). It is very
prominent in increasing the comfort related with the various set of activities like eating, drinking,
etc. However, Poppy tends to have asthma which eventually results in respiratory distress and
shortness of breath. Therefore, High Flower position in turn is considered to be as one of the
most prominent transporting position which results in respiratory distress (Rothers & et.al.
(2018)). The key reason of choosing High Fowlers position is that it results in improving the
breathing in Poppy.
Apply and titrate oxygen
Titrate oxygen is one of the prominent approach as it helps the health care practitioners to
effectively reach the 88% to 92% of the oxygen. It is very crucial to have appropriate level of
the oxygen which helps in relieving Hypoxia among the patient (Riiser, (2015)). Titrated oxygen
treatment is prominent to be prominent in significantly reducing mortality hypercapnia and
respiratory acidosis. Moreover, the titrated oxygen is very prominent for the various health care
practitioners in order to critically determine the oxygen level within the patient.
Supplemental oxygen is prominent in improving the various organ function. Supplemental
oxygen is prominent in improving the various asthma or respiratory distress symptoms (Coffey,
2

Torretti, & Mancuso, (2015)). Oxygen therapy is appropriately carried out with the help of nasal
canula or mask. It helps in efficiently providing patient with appropriate set of O2 to the
asthmatic patient. It also helps in opening up the airways by appropriately reducing negative
drain related with the health outcomes of asthma. Use of Hudson mask is used for the Poppy
because it is very useful in maximizing the inspired oxygen concentration up to 60%.
QUESTION 3. ASSESSMENT FOR EACH MEDICATION.
Salbutamol via nebuliser
Salbutamol via nebuliser is given to the patient in order to effectively treat acute
exacerbation of asthma (Gon & Hashimoto, (2018)). Salbutamol via nebuliser is an effective
medication which helps in relieving the key symptoms associated with asthma such as shortness
of breath. The key mechanism action of Salbutamol via nebuliser to act on beta2-adrenoceptors
of bronchial muscles in order to provide bronchodilation. It helps in prevention of asthma
attacks. The key side effects of Salbutamol via nebuliser are dry mouth, feeling nervous, nausea,
cardiac effects, uneven heartbeat, restlessness, etc. The nursing consideration associated with the
Salbutamol via nebuliser is that, the nurses should listen to the sound of the lungs, obtain proper
set of blood pressure, evaluating the heart rate before and during the use of the Salbutamol via
nebuliser. This medicine is useful in alleviating the asthma attacks and rescue inhalers.
Hydrocortisone IV
The poppy has been taking Hydrocortisone 100mg which is considered to be very useful in
effectively resolving acute exacerbation of asthma problems. The key mechanism action of
Hydrocortisone IV helps in suppressing the immune responses. The key side effects associated
with the Hydrocortisone includes drowsiness, increased sweating, headache, nausea, weight gain,
upset stomach, rash, skin changes, etc. which largely influence the health of the patient. The key
nursing consideration is that, the patient must focus on telling the doctor all the medications
which the patient has been taking in order to eliminate such side effects (Mechanisms and
Management of Asthma Exacerbations, 2018). The patient is advised to carry long term
treatment and focus on consulting the physicians before taking and stop taking the
Hydrocortisone IV.
3

Ipratropium Bromide via nebuliser
Ipratropium Bromide via nebuliser is one of the most prominent steroid which helps in
enlarging the air pass of the patient lungs. It is useful in treating various positive symptoms of
patient with asthma (Russell, & Brightling, (2017)). Ipratropium Bromide blocks the muscarinic
receptors of acetylcholine. The key side effects are throat irritation, dizziness, cough, dry mouth,
dyspnea, etc. The nursing consideration related with the Ipratropium bromide is that patient is
requested to rinse the mouth after every usage of the in haler. The patient must not use more than
the specified dose by the doctor. The patient can also use sugar free gums and the Poppy must
also frequently intake water which helps in saving patient from the dry mouth. Moreover,
another effective nursing consideration is that, Poppy must in turn focus on effectively seeking
various set of medical attention to attain better asthma care results and outcomes.
4

REFERENCES
Books and Journals
Alizadeh, Z., Mortaz, E., Adcock, I., & Moin, M. (2017). Role of epigenetics in the pathogenesis
of asthma. Iranian Journal of Allergy, Asthma and Immunology, 16(2), 82.
Coffey, M. J., Torretti, B., & Mancuso, P. (2015). Adipokines and cysteinyl leukotrienes in the
pathogenesis of asthma. Journal of allergy, 2015.
Dunican, E. M., & Fahy, J. V. (2015). The role of type 2 inflammation in the pathogenesis of
asthma exacerbations. Annals of the American Thoracic Society, 12(Supplement 2), S144-S149.
Gon, Y., & Hashimoto, S. (2018). Role of airway epithelial barrier dysfunction in pathogenesis
of asthma. Allergology International, 67(1), 12-17.
Kleniewska, P., & Pawliczak, R. (2017). The participation of oxidative stress in the pathogenesis
of bronchial asthma. Biomedicine & Pharmacotherapy, 94, 100-108.
Riiser, A. (2015). The human microbiome, asthma, and allergy. Allergy, Asthma & Clinical
Immunology, 11(1), 35.
Rothers, J & et.al. (2018). Maternal cytokine profiles during pregnancy predict asthma in
children of mothers without asthma. American journal of respiratory cell and molecular
biology, 59(5), 592-600.
Russell, R. J., & Brightling, C. (2017). Pathogenesis of asthma: implications for precision
medicine. Clinical Science, 131(14), 1723-1735.
Zahran, H. S & et.al. (2018). Vital signs: asthma in children—United States, 2001–
2016. Morbidity and Mortality Weekly Report, 67(5), 149.
Online
Mechanisms and Management of Asthma Exacerbations. 2018. [ONLINE]. Available through<
https://www.atsjournals.org/doi/full/10.1164/rccm.201810-1931CI>
5