401211 Health Variations 4: Acute Asthma Case Study Analysis

This case study focuses on a child, Poppy, diagnosed with an acute exacerbation of asthma, presenting with worsening respiratory symptoms. The analysis explores the causes of asthma, including genetic and environmental factors, and discusses the role of Th1 and Th2 cytokines. The study addresses the patient's symptoms, including shortness of breath, wheezing, and low oxygen saturation, and recommends the high Fowler's position and a simple face mask for oxygen delivery. It further examines the pharmacological interventions, such as salbutamol, hydrocortisone IV, and ipratropium bromide, detailing their mechanisms of action, nursing considerations, and expected clinical responses. The case study emphasizes the importance of continuous monitoring for potential side effects and the overall management of acute asthma exacerbation in a pediatric patient.

Running head: HEALTH VARIATION 1
Health Variation
Name
Institution

HEALTH VARIATION 2
Case Study
Question 1
Poppy has been diagnosed with acute exacerbation of asthma in the emergency department. This
condition is characterized by acute incidences of increasingly worsening shortness of breath,
wheezes, chest tightness, and coughs (Dunican & Fahy, 2015). Poppy was diagnosed with
infrequent intermittent asthma at the age of 2 years. At the time of presentation at the emergency
department, Poppy’s respiratory symptoms were worsening. She could not undertake a peak flow
or talk in full sentences. Her condition deteriorated, and she was admitted to the ICU.
Asthma can be described as a chronic disease of the lungs that causes inflammation of the
airways. The inflammation is accompanied by a narrowing of the airways, thus affecting airflow.
Research has revealed that one of the causes of inflammation in asthma is an imbalance between
Th1 and Th2 cytokines. A newborn’s immune system is skewed towards the generation of Th2
cytokines. This may lead to the excessive expression of Th2, thus causing allergic reactions (Us
Dept of Health and Human Services, 2018). Genetics also plays a crucial role in the development
of asthma. Genetics plays a vital role in the production of immunoglobulin E antibody and
airway hyper-responsiveness. The chances of a child developing asthma, therefore, increase if
they have a genetic link with someone who has a history of asthma. Environmental factors such
as viral respiratory infections and airborne allergens are also important in the development of
asthma. During a child’s development, they are susceptible to infections, thus their chances of
developing cancer increase because of the massive influence of allergens and respiratory
infections on their health (Us Dept of Health and Human Services, 2018). It is also important to
note that allergens and respiratory infections work in unison to eventually lead to asthma
development in children.

HEALTH VARIATION 3
Viral respiratory infections are the most common triggers of exacerbation of asthma in kids. The
most frequent virus that causes respiratory infections is the human rhinovirus, which peaks
mostly in September (Castillo, Peters & Busse, 2017). Other common viruses that can cause
exacerbations include respiratory syncytial virus, coronaviruses, adenoviruses, and parainfluenza
viruses. Bacterial infections have also been identified to cause exacerbation by impairing
mucociliary clearance. As a result, mucus production in the lungs is increased, which may lead to
chronic inflammation of the lower airway (Castillo et al., 2017). Additionally, the respiratory
viruses are believed to cause an impairment of anti-bacterial defenses of human alveolar
macrophages, thus increasing the incidences of bacterial infections. Pollutants such as smoke
from cigarettes also provoke exacerbations of asthma (Castillo et al., 2017). This smoke can also
lead to the development of wheezes like in Poppy’s case thus making asthma more severe.
Question 2
A high Fowler's position can be described as placing a patient in an upright position with the
upper body part being at approximately 90 degrees in relation to the lower body part. This can be
done by elevating the head of the bed as high as possible. Exacerbation of asthma, like in
Poppy’s case causes respiratory distress, thus reducing oxygenation. Poppy’s saturation of
oxygen is 87% which is abnormally low. This is an indication that the amount of oxygen in her
blood is very low. To counter this low oxygen saturation, her respiratory rate increases to
increase breathing. Her respiratory rate of 42 bpm is an indication that she is struggling with
breathing. Additionally, Poppy experiences a tracheal tug during inspiration, which is another
indication of respiratory distress. Her inspiratory and expiratory wheezes are further indications
of respiratory distress due to blocked airways. She cannot undertake a peak flow due to possibly

HEALTH VARIATION 4
blocked airway. It is, therefore, important to place Poppy in a position that will aid in increased
airflow into her lungs. The best position for her case is a high Fowler's position.
High Fowler's position helps in increasing the lung volume by reducing the pressure of body
habitus on the lungs, thus aiding in oxygenation. The high Fowler's position helps in eliminating
pressure from the diaphragm, thus allowing air exchange in larger volumes (Chanif & Prastika,
2019). The administration of the nebulizer thus becomes more effective because breathing is
maximized. The high Fowler's position, therefore, helps in reducing the effects of shortness of
breath and thus improves breathing.
The best oxygen delivery device in Poppy’s case is a simple face mask. This device is important
in standardizing the delivery of moderate oxygen concentration at a FiO2 range between 40%
and 60% (Haque, Rizvi & Arif, 2016). Additionally, the case study indicates that Poppy required
an oxygen flow of 6LPM. The best device for this liter flow of oxygen is a simple face mask.
Furthermore, this device helps in reducing the work of breathing and moderating the respiratory
rate. Therefore, the simple face mask is very useful in providing supplemental oxygen. The
supplemental oxygen helps in achieving and maintaining the targeted level of SpO2. As a result,
the balance of oxygen in the blood is restored, thus helping in maintaining several biological
functions of the body.
Question 3
Salbutamol works by relaxing the airway muscles, thus keeping the airways open in the lungs.
As a result, airflow through the bronchial tubes is increased, thus relieving symptoms of
shortness of breath, wheezing, and cough (Drugs.com, 2019). Poppy is receiving this medication
because she has been diagnosed with an acute exacerbation of asthma. She displays symptoms of

HEALTH VARIATION 5
difficulty in breathing as evidenced by a tracheal tug. Additionally, she has wheezes during both
inspiration and expiration. Poppy also has hyperinflated lungs, thus necessitating the
administration of this medication. This medication, however, has side effects that the nurse
should consider during administration. These nursing considerations include allergic reactions,
hypersensitivity reactions, tremor, and tachycardia. The use of this medication is also cautioned
for patients with hypertension. It is expected that Poppy will experience a reduced work of
breathing. Additionally, it is expected that her wheezes will reduce. It is important to continually
monitor Poppy for possible salbutamol toxicity that can be characterized by worsening
tachycardia.
Hydrocortisone IV works by reducing the inflammation in the lungs, relieving muscle spasms,
and reducing mucosal edema. It is important to note that asthma causes inflammation of the
airways, thus causing difficulty in breathing. Hydrocortisone IV is therefore used to reduce the
inflammation (Wilder & Shiralkar, 2015). A nurse must, however, be careful to ensure that
Poppy does not experience hormonal changes and variations in blood glucose levels.
Additionally, this medication can affect growth in children. Furthermore, Hydrocortisone IV
affects the immune system, thus increasing the patient’s risks of developing infections. Some of
the side effects of hydrocortisone IV include trouble sleeping, nausea, headache, and acne. The
expected clinical response includes a reduced work of breathing and reduced episodes of asthma
attacks. The nurse must, however, undertake continuous clinical observations like a continuous
assessment of Poppy’s SpO2. This will help in ensuring that the oxygen saturation does not fall
below the targeted value.
Ipratropium Bromide works by relaxing the airway muscles, thus keeping the airways open to
enhance easy breathing. This medication is, therefore, important in controlling the symptoms of

HEALTH VARIATION 6
wheezing and shortness of breath that may arise as a result of asthma (Nomura et al., 2017).
Poppy is receiving this medication because she has an acute exacerbation of asthma. She exhibits
symptoms of shortness of breath as she is unable to undertake a peak flow. Additionally, he has
wheezes during inspiration and expiration. Ipratropium Bromide is, therefore, suitable for
controlling her symptoms. A nurse must, however, consider the allergic implications of this drug
before administration. This drug may also blur vision and make a patient dizzy (Nomura et al.,
2017). This medication is expected to reduce the work of breathing and enhance sufficient
gaseous exchange. This should be evidenced by Poppy being able to undertake a peak flow.
Additionally, it is expected that Poppy does not experience wheezes. A nurse should
continuously observe Poppy for signs of difficulty in breathing, which may occur due to
Ipratropium Bromide poisoning.

HEALTH VARIATION 7
References
Castillo, J. R., Peters, S. P., & Busse, W. W. (2017). Asthma exacerbations: pathogenesis,
prevention, and treatment. The Journal of Allergy and Clinical Immunology: In
Practice, 5(4), 918-927.
Chanif, C., & Prastika, D. (2019). Position of Fowler and Semi-fowler to Reduce of Shortness of
Breath (Dyspnea) Level While Undergoing Nebulizer Therapy. South East Asia Nursing
Research, 1(1), 14-19.
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.
Haque, A., Rizvi, M., & Arif, F. (2016). Pediatric Oxygen Therapy: A Clinical Update. Journal
of Ayub Medical College Abbottabad, 28(3), 630-634.
Nomura, O., Morikawa, Y., Hagiwara, Y., Ihara, T., Inoue, N., Sakakibara, H., & Akasawa, A.
(2017). Ipratropium bromide for acute asthma in children: A retrospective
trial. Arerugi=[Allergy], 66(7), 945-952.
Salbutamol Advanced Patient Information - Drugs.com. (2019). Retrieved 16 April 2020, from
https://www.drugs.com/cons/salbutamol.html
US Dept of Health and Human Services. (2018). Guidelines for the Diagnosis and Management
of Asthma. [Place of publication not identified]: LULU COM.

HEALTH VARIATION 8
Wilder, C., & Shiralkar, S. (2015). Childhood asthma in the Emergency Department: An
audit. International emergency nursing, 23(2), 197-202.