Acute Asthma Case Study: Pathophysiology, Nursing Care, and Treatment

This case study examines the pathophysiology, nursing interventions, and treatment of acute asthma. It details the mechanisms of airway inflammation, bronchoconstriction, and airflow limitation in patients experiencing acute exacerbation. The study emphasizes the importance of high Fowler's position for improving oxygenation, and discusses the use of oxygen therapy via a venture mask to maintain appropriate saturation levels. The case also covers the administration and effects of various medications, including Salbutamol, Hydrocortisone IV, and Ipratropium bromide, highlighting their roles in bronchodilation, anti-inflammatory action, and management of bronchospasms. Furthermore, it emphasizes the significance of patient monitoring and nursing considerations in managing acute asthma, with references to relevant research and clinical guidelines.

Nurses Care Practice
Case Study Assessment
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Acute asthma pathophysiology
Asthma is a prevent pulmonary disease often characterized by chronic
inflammation and tightening of the smooth muscles leading to occurrences of
bronchoconstriction as observed in the patient. for the majority of the patients as the
patient onset being since childhood with inflammation and asthma deterioration.
Acute exacerbation state depicts wheezing, coughing, tightness of the chest and
shortness of breath.The pathophysiology entails adaptive and maladaptive
mechanism which results in inflammation of the airway, intermittent flow and
hyperresponsiveness of the bronchial. (Pavord et al.,2018).
The patient in the case study presents an avenue of airway inflammation which
is leading to an experience of acute asthma exacerbation. The airway Inflammation
is characterization by the varying breadth of hypersecretion, desquamation of the
epithelium, smooth muscle hyperplasia and remodelling of the airway (Castro et al.,
2018). The extent of the airway hyperresponsiveness is linked to asthma clinical
severity state. The airway inflammation is linked to the elevated levels of the
hyperresponsiveness of the bronchial leading to the occurrence of bronchospasms
and symptoms of wheezing and shortness of breath as observed from the patient's
symptoms. Further, there is an occurrence of limitation of the airflow which is often
partially reversed by airway remodelling characterized by the hypertrophy and
hyperplasia of the muscles and injury to the epithelial cells which are indicated by the
lungs hyper inflammation observed in the patient. Further, in the inflammatory
process, various cells such as eosinophils, epithelial cells, endothelial cells and
activated T cells are involved. The patient may indicate elevated mast cells size in
the smooth muscles and the lining of the airways. The masts cells are essential in
the process of the response of the bronchoconstriction especially to allergens and
stimuli which is an essential factor in acute asthma (King, James, Harkness & Wark,
2018).
The patient further has an obstruction of the airflow leading to oxygen support
through the increased rate of respiration, oximetry process and the administration of
oxygen support at the rate of 6LMP. The constriction process can be initiated
through the bronchoconstriction, oedema, plug formation and the remodelling of the
airway. The presence of chronic mucus which often entails serum proteins and cell

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debris accumulating in the airways leads to airway blockage. These occurring
structural changes linked to chronic inflammation often limits the reversibility of the
airway obstruction leading to tissue impairment. Further, the airway obstcrtuion
obstruction leads to resistance of the airflow and lowers down the expiratory flow
rates as observed in the patient. Over time it leads to an irreversible decline of the
lung function thickening the walls of the airway.
High fowler's position in severe asthma
Based on traditional nursing practices, patients experience breathing problems
are often placed in high Fowler's position, which is essential in helping patients with
average weight especially when there is no availability of artificial airway. This
approach is an intervention for improving oxygenation through the maximum
expansion of the chests and is essential during respiratory distress. Fowler’s position
is essential in facilitating the relaxation of the abdominal muscles and underlying
tension (Pal, Tiwari & Verma, 2017). Patient Poppy will be able to rest while the top
of the bed is raised, the body is inclined at an angle ranging between 90-15 degrees
depending on the position the patient is in. this position will be crucial for the patient
is allowing efficient expansion of the chests and improve the overall oxygenation
process. In a distressed respiratory state, there is widespread inflammation of the
lungs, leading to shortness of breath, increased respiratory state and changes of
skin colour. This position will be essential in facilitating a reduction in the abdominal
muscles pressure and reduces the tension. Further increasing the chest cavity
location is essential in enhancing breathing and oxygenation to patient Poppy at this
state of severe asthma (Bos, Sterk & Fowler, 2016).
Oxygen delivery system
Oxygen therapy is an essential component as hypoxia which is often the
leading cause of mortality among infants. Oxygen therapy will be administered
through venture mask. With the application of pulse oximetry, the oxygen will be
titrated easily to maintain patient saturation ranging at 92% and above.
Venture mask is often used to deliver oxygen at predetermined FiO2 (Hacohen,
& Cohen, 2019). This mechanism provides low flow oxygen than the demands of the
patient, when there is an excess of the oxygen as observed with the patient

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aspiratory flow exceeding the flow rate in the masks, room air is used which is an
essential aspect for the patient. Further, usage of this system allows for the lower set
of FiO2 and also depends on the ventilation demand of the patient (Wiley, 2016).
Using the venture mask will be essential for patient Poppy as it will delivery
oxygen between 24-60% using the white type which is essential in delivering
between 4-6 LMP as per the initiated plan of the patient. Often at times, the venture
mask can lead to an evocation of dryness of mouth, throat, nose and the respiratory
tract, as part of the clinical process oxygen humidification is recommended to
provide comfort through humidification of the inspired gas.
The oxygen delivery through high flow masks is essential in delivering the
required concentration of inspired oxygen. In acute asthma levels such as Poppy,
application of oxygen therapy is geared towards attaining saturation levels above 92.
Thus the oxygen therapy administered at 6LMP is essential to improve the patient
state.
Medication administration
Salbutamol
This is a short-acting drug with selective beta 2 adrenergic receptor agonists, it
has high specificity for beta 2 receptors compared to beta 1. It is indicated for the
prevention of relief and bronchospasms as observed in bronchial asthma, bronchitis
and pulmonary disorders. In vivo and vitro studies have demonstrated that
salbutamol has a better effect on the beta 2 adrenergic receptors. Its activation in the
airway allows smoothening of the muscles and activation of the adenyl cyclase which
increases the intracellular concentration. This increase leads to activation of the
protein kinase which is essential in the inhibition of myosin and lowers the calcium
ion concentration thus offering relaxation (Neame et al., 2015).
Salbutamol in the patient allows for the relaxation of smooth muscles in the
airway through to the trachea and bronchioles. It initiates an antagonist effect to
relax the airway. The clinical effect expected entail relaxation of the airway allowing
breathing resumption and delivery of oxygen (Neame et al., 2015). Clinical
observation expected entails relaxation and improvement of breathing within 4.6

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hours of delivery. Need for patient monitoring is essential to assess the breathing
pattern as the lungs have opened up.
Hydrocortisone IV
Hydrocortisone IV binds systolic glucortocid receptors in the body forming
receptor ligands in the cell nucleus. The bound receptor binds itself and interacts
with transcription factors, leading to the expression of drug action in the lipoproteins.
The glucocorticoid leads to inducement of lipocortin leading to binding of cell
membranes. The corticosteroids lead to enhancement of beta-adrenergic response
offering relive to the muscle spasms in the patient.
Nursing consideration is adherence to the set medication levels for the patient
and the assessment of any side effects. Expected clinical response entails the
reduction of the inflammation swelling and production of mucus in the airways of the
patient, thus enabling less inflamed asthma managing the asthmatic state (Mukerji et
al, 2015).
Ipratropium bromide
Ipratropium bromide has synthetic ammonia acting as a bronchodilator. It is
essential in the management of cholinergic mediated bronchospasms which is linked
to COPD. It acts as an anticholinergic agent through blocking of the muonic
receptors, leading to declining in the cyclic guanosine monophosphate lowering the
smooth muscle contraction (Memon, Parkash, Khan, Gowa & Bai, 2016).
This drug is essential in relaxing the muscles in the airway offering relaxative
effect on the patient. Administration of 2 inhalations in 24 hours is essential for the
patient. Nursing care and monitoring will focus on the hypersensitivity in cases of
allergy reaction.

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References
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Katelaris, C. (2018). Dupilumab efficacy and safety in moderate-to-severe
uncontrolled asthma. New England Journal of Medicine, 378(26), 2486-
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Hacohen, O. G., & Cohen, S. (2019). Precision medicine applications for severe
asthma. LymphoSign Journal, 6(4), 117-135. doi: 10.1016/j.jaci.2016.08.004.
King, G. G., James, A., Harkness, L., & Wark, P. A. (2018). Pathophysiology of
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Pal, A. K., Tiwari, S., & Verma, D. K. (2017). Effect of recumbent body positions on
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