How to Answer Case Study Questions -

Running head: SHORT ANSWER EXAM BASED ON CASE STUDY
SHORT ANSWER EXAM BASED ON CASE STUDY
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1SHORT ANSWER EXAM BASED ON CASE STUDY
Answer 1
Poppy presented clinical manifestation of distress in the respiratory tract that was
eventually diagnosed to be asthma. Asthma is a long-term inflammatory disorder of the
airways present in the lungs. It can be stated that the disease is caused due to a number of
factors that include both environmental and genetic factors. According to Russell and
Brightling (2017), the common signs and symptoms of asthma include coughing, intermittent
dyspnea and wheezing. It is characterized by a variable limitation in the inflow of air and
hyperresponsiveness of the airway that can be demonstrated as an overstated expanded
response of the airways due to various kinds of stimuli. Genetic predisposition or atopy to
establish the action of specific IgE antibodies against common allergen is one of the most
identifiable risk factors in this case. Gon and Hashimoto (2018) opined that the internal
abnormalities in the function of smooth muscle present in the respiratory tract, interaction of
epithelial and mesenchymal cells that appear to be restrained and injury or inflammation
leading to airway remodelling are some of the clinical manifestations of asthma. There are
different phenotypes of asthma that contribute to stating the fact that it is a syndrome
associated with a large number of underlying mechanisms. The physiological, inflammatory,
and structural aspects are found to contribute to the pathogenesis of the disease. This can be
done by reviewing the elements that help in assessing the clinical signs and syndrome of the
disease and its treatment process. According to the study of Pathinayake et al. (2018), the
limitation of airflow in asthma is recurrent and is caused due to a number of changes in the
respiratory tract. These include bronchoconstriction, where the airways are narrowed down as
a result of which there is interference in the airflow. As seen in the case of Poppy, acute
exacerbation of asthma occurred that could be thought to be due to constriction of the
bronchial smooth muscle that obstructs the airways due to the presence of allergen or external
stimulus. With the persistence and progression of inflammation, other factors can be observed

2SHORT ANSWER EXAM BASED ON CASE STUDY
to limit the airflow, such as edema, mucus hypersecretion, inflammation and formation of
mucus plugs. Nie et al. (2019) opined that structural change such as hyperplasia or
hypertrophy could also be caused changes in the airflow that may not respond to normal
treatments. Airway hyperresponsiveness is one of the major features of asthma. It can be
defined as a contractile response to various challenges with methacholine and is associated
with the severity of asthma. The mechanism of this factor is several and include
inflammation, structural change, and dysfunctional neuroregulation. The airway remodelling
is stated to be an irreversible limitation of airflow among some of the patients (Izuhara et al.,
2017). This is stated to be an advanced loss of lung function, which cannot be treated with the
currently available treatment. This aspect is associated with activation of various structural
cell as a result; it involves a permanent change in the airway that obstruct the airflow and
increase the responsiveness of the airway thus, the patient loses its ability to respond to the
treatment in an appropriate manner.
Answer 2
Response to 1
According to Mariani, Hamzah and Solikin (2018), fowler’s position is one of the
standard positions for patients allowing them to sit in a semi-setting place, which is about 45
to 60 degrees and the knees are either in a bent or straight position. As per the case study,
Poppy was made to sit in a High Fowler’s position that indicates that she was made to sit on a
90 degrees position or upright. Maria and Hasaini (2019) opined that it is an interventional
strategy that is used for promoting the level of oxygen by allowing maximum expansion of
the chest and is usually implemented during the events of respiratory distress. The position is
found to help in relaxation of the tension in the abdominal muscle hence, facilitating an
improved breathing opportunity. In the case of patients who cannot move or infants, this

3SHORT ANSWER EXAM BASED ON CASE STUDY
particular position is used for easing the compression in the chest, which usually occurs due
to the gravitational force. Therefore, it supports various activities such as eating and
breathing of patients.
Response to 2
1. The oxygen delivery device that will be used for attaining the goal of keeping SpO2
92-95% is a nebuliser that will help in opening the airway of the patient, Poppy, initially. The
use of oxygen therapy can be used when the condition is stable, which will help to offer extra
oxygen to the lungs.
2. The reason nebuliser is chosen as the oxygen delivery device in the case of Poppy, the
nine-year-old patient, is because it is useful in delivering multiple dosages of drugs directly
into the lungs in a quick and effective manner. Munro, Vos and Mignot (2018) opined that in
this manner, a wide range of medicines is administered to the patient in one go and the
correct dose of each is directly targeted to the lungs thus, offering an improved treatment of
the symptoms exhibited by the patient. It is in the form of liquid medicine that is present in a
fine mist that can be inhaled in an easy manner by the patients deep into the lungs.
3. In order to combat the lack of oxygen in the lungs of a patient who has asthma, it is
critical to administer supplementary oxygen through oxygen therapy. This will help in
providing the lungs with an adequate amount of oxygen required for sufficient functioning of
the lungs. In case of Poppy, it will be beneficial for her as it will not allow her to breathe
easily by opening the airways that have been blocked for a long time, it will help in reducing
the negative impact on her health that occurred due to loss of oxygen in the body. Thus, with
the help of nebuliser. The supplementary oxygen can be provided from time-to-time to the
lungs that will help in flowing it to different parts of the body. Di Fiore et al. (2019) opined
that the additional oxygen would help in reliving the critical symptoms exhibited by the

4SHORT ANSWER EXAM BASED ON CASE STUDY
patient suffering from an asthma attack, including shortness of breath, dizziness, fatigue, and
other symptoms making the person alert. Poppy was found to unable to speak properly and
thus undertaken a peak flow.
Answer 3
Salbutamol via nebuliser
Salbutamol is a selective beta-2- adrenoreceptor agonist. When administered on a
patient at a therapeutic dose, it acts as a receptor of the bronchial muscle, which helps in
bronchodilation. It acts within five minutes and is effective in treating patients with asthma. It
can be seen that Poppy, the patient in concern, is diagnosed with asthma with the chest x-ray
revealing that there is hyperinflammation in the lungs and her respiratory function was
deteriorating; thus, this medication was given to her. According to the study of Usmani et al.
(2018), it can be seen that hypersensitivity reactions such as rash, dermatitis, urticarial,
erythema have been observed. Thus, the nurse needs to have precautions before administering
the drug to the patients. The clinical response that can be expected after a given therapeutic
dose of salbutamol via nebuliser to the patient, Poppy, was improved in her breathing that
will include no distress in the respiratory tract as it will help in relaxing as well as opening
the airways in the lungs. The continuing clinical observation that can be observed is to
measuring the oxygen saturation, change in blood volume in the skin that will indicate
improvement in the condition of the patient
Hydrocortisone IV
The hydrocortisone is similar in action with cortisol that is a naturally occurring
hormone produced in the adrenal glands. The corticosteroids have the potential of exhibiting
anti-inflammatory action. Laaninen et al. (2016) opine that hydrocortisone is a glucocorticoid
receptor agonist; as a result, it improves the beta-adrenergic response in the body. This, in

5SHORT ANSWER EXAM BASED ON CASE STUDY
turn, will help in relieving the muscle spasm in the lungs. Moreover, it acts in reversing the
mucosal edema and decreases vascular permeability by the process known as
vasoconstriction and finally, it inhibits the release of LTD4 and LTC4 thus, support inn
treating asthma. It can be clearly seen from the chest X-ray that there is a hyperinflammation
in the lungs of the patient, thus, with the anti-inflammatory property, this drug will be used
for reducing the inflammation in the lungs and the constriction in the airway allowing her to
breathe. According to Wald et al. (2020), the drug needs to be given based on the response,
severity, and the age of the patients. The adverse effects of the drugs include sodium and
fluid retention, abrupt withdrawal in case of acute adrenal insufficiency; therefore, the
nursing assessment includes history and physical condition of the patients. The clinical
response involves improvement in the condition of the patient and the continual clinical
observation includes oxygen saturation rate and the reaction of the patients on a physical
basis.
Ipratropium Bromide via nebuliser
Ipratropium Bromide is an anticholinergic agent that helps in blocking the muscarinic
receptors of acetylcholine and it acts as a bronchodilator by enlarging the airways in the lungs
(Lee et al. 2016). As Poppy presented asthma and the airways in the lungs are constricted, not
allowing enough air inside; therefore, this medicine was given. The nursing precaution
involves overlooking that the patient does not exceed the permissible or prescribed dosage,
and rinsing the mouth after every use. This will help her to breathe without any tightening of
chest or issue. The oxygen saturation needs to be measured on a continuous basis.

6SHORT ANSWER EXAM BASED ON CASE STUDY
References
Di Fiore, J. M., Dylag, A. M., Honomichl, R. D., Hibbs, A. M., Martin, R. J., Tatsuoka, C., &
Raffay, T. M. (2019). Early inspired oxygen and intermittent hypoxemic events in
extremely premature infants are associated with asthma medication use at 2 years of
age. Journal of Perinatology, 39(2), 203-211.
Gon, Y., & Hashimoto, S. (2018). Role of airway epithelial barrier dysfunction in
pathogenesis of asthma. Allergology International, 67(1), 12-17.
Izuhara, K., Suzuki, S., Ogawa, M., Nunomura, S., Nanri, Y., Mitamura, Y., & Yoshihara, T.
(2017). The significance of hypothiocyanite production via the
pendrin/DUOX/peroxidase pathway in the pathogenesis of asthma. Oxidative
medicine and cellular longevity, 2017.
Laaninen, M., Sand, J., Nordback, I., Vasama, K., & Laukkarinen, J. (2016). Perioperative
hydrocortisone reduces major complications after pancreaticoduodenectomy. Annals
of surgery, 264(5), 696-702.
Lee, Y. H., Kwon, G. Y., Park, D. Y., Bang, J. Y., Jang, D. M., Lee, S. H., ... & Noh, G. J.
(2016). Efficiency of a New Mesh‐Type Nebulizer (NE‐SM 1 NEPLUS) for
Intrapulmonary Delivery of Ipratropium Bromide in Surgical Patients. Basic &
clinical pharmacology & toxicology, 118(4), 313-319.
Maria, I., & Hasaini, A. (2019, October). The Effect of Semi Fowler Position on The Stability
of Breathing among Asthma Patients at Ratu Zalecha Hospital Martapura. In Third
International Conference on Sustainable Innovation 2019–Health Science and
Nursing (IcoSIHSN 2019). Atlantis Press.

7SHORT ANSWER EXAM BASED ON CASE STUDY
Mariani, M., Hamzah, H., & Solikin, S. (2018, October). EFFECTIVENESS OF OXYGEN
ACTIVITY THERAPY LOW FLOW SYSTEM BINASAL KANUL WITH SOW
FOWLER POSITION TO REDUCE PAIN IN PATIENTS OF ACUTE CORONER
SIDE IN ULIN RSUD. In International Conference on Heath Care and Management
2018 (Vol. 1, No. 1).
Munro, S., Vos, W., & Mignot, B. (2018). P166 Use of in silico deposition modelling to
evaluate the lung deposition patterns of budesonide delivered from different inhaler
devices in patients with severe asthma.
Nie, X., Wei, J., Hao, Y., Tao, J., Li, Y., Liu, M., ... & Li, B. (2019). Consistent biomarkers
and related pathogenesis underlying asthma revealed by systems biology
approach. International journal of molecular sciences, 20(16), 4037.
Pathinayake, P. S., Hsu, A. C. Y., Waters, D. W., Hansbro, P. M., Wood, L. G., & Wark, P.
A. (2018). Understanding the unfolded protein response in the pathogenesis of
asthma. Frontiers in Immunology, 9, 175.
Russell, R. J., & Brightling, C. (2017). Pathogenesis of asthma: implications for precision
medicine. Clinical Science, 131(14), 1723-1735.
Usmani, O. S., Biddiscombe, M. F., Yang, S., Meah, S., Oballa, E., Simpson, J. K., ... &
Maher, T. M. (2018). The topical study of inhaled drug (salbutamol) delivery in
idiopathic pulmonary fibrosis. Respiratory research, 19(1), 25.
Wald, E. L., Sanchez-Pinto, L. N., Smith, C. M., Moran, T., Badke, C. M., Barhight, M. F., &
Malakooti, M. R. (2020). Hydrocortisone-Ascorbic Acid-Thiamine Use Associated
with Lower Mortality in Pediatric Septic Shock. American Journal of Respiratory and
Critical Care Medicine, (ja).