Acute Severe Asthma Concept Map and Nursing Strategies - WSU 401210

This project analyzes acute severe asthma through a concept map and answers to guided questions based on a case study. The assignment delves into the pathogenesis of the condition, examining factors like airway inflammation, defective antiviral immunity, and allergen exposure. It also explores effective nursing strategies for asthma management, including both pharmacological and non-pharmacological interventions, such as patient education and environmental control. Furthermore, the project details the mechanisms of action of key drugs like Nebulised Salbutamol, Nebulised Ipratropium bromide, and IV Hydrocortisone, along with essential nursing implications for their administration. The assignment emphasizes the importance of monitoring drug effects and providing appropriate patient care to manage and control acute severe asthma effectively. References include books and journals related to asthma and nursing care.

health variations

Table of Contents
CONCEPT MAP..............................................................................................................................1
Question 1. Pathogenesis of Acute Severe Asthma.........................................................................2
Question 2. Nursing strategies with evidence based rationale.........................................................3
Question 3. Mechanism of action of drugs and nursing implications..............................................4
REFERENCES................................................................................................................................6

CONCEPT MAP
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Question 1. Pathogenesis of Acute Severe Asthma
Health is an integral part of every human being and nurses have to care for patients that
suffer from any sort of illnesses by utilising certain strategies. They are responsible for treating
patients so that they are able to prevent such illnesses (Ishmael, 2011). Pathogenesis of acute
Severe Asthma in an 18 year old patient will be done. It is a method through which the
origination and development of diseases are found out. This helps in getting an in-depth analysis
of specific illnesses, so that doctors and nurses can ascertain courses of action that needs to be
taken for a patient. In the case of Jackson Smith's, he has been diagnosed with acute severe
asthma. He is 18 years old and has hyper inflated lung fields. The normal respiratory rate of a
young adult is 12 to 16 breaths per minute, blood pressure amounts to less than 120/80 and pulse
rate is between 70 to 100 beats in a minute (Castillo, Peters, & Busse, 2017). But Jackson
breathes 32 breaths in a minute, has blood pressure of 150/85 and his heart beats 130 times in a
minute. This shows that there are serious issues regarding his lungs. The pathogenesis of Jackson
shows various factors that has caused this disease.
Airway Inflammation
Inflammation can be any allergic reaction that triggers asthma and this occurs due to
development of influx of eosinophils combined with cellular infiltrate. This means that there is
swelling and redness in the bronchial tubes of Jackson, from an early age (King, James,
Harkness, & Wark, 2018). He must have been prone to allergies, since his childhood and this has
developed into severe acute asthma and causing inflammation in his airway. This has led to his
extreme wheezing and heavy breathing.
Defective anti viral immunity
Jackson did not have a good immune system since his birth and this caused viral
infections to breed and eventually spread in this lungs. This led to type 2 inflammatory
conditions that kept developing inside his breathing canal (Ishmael, 2011). Inhalation of diseases
can directly infect the upper respiratory which reduces the airway viral load, which is why
Jackson has now been diagnosed with severe acute asthma.
Bacterial Infections
Jackson might have attracted some bacterial infections, which led to impairment of
mucociliary clearance and increase in production of mucus inside lungs. This could have caused
bacterial infections in the respiratory system, therefore leading to severe acute asthma (Carr et
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al., 2018). There are some microbes that develop in children which is what Jackson experienced
in his early childhood and caused him to have asthma.
Allergen Exposure
Allergens present in the environment can lead to asthma. When Jackson was a child,
there are possibilities of him being attracted to indoor allergens, thus causing mast cell
activation, such as histamine. This diminishes innate immune response and therefore leading to
loss of asthma control. It causes multiple allergies and makes it extremely difficult for an
individual to breathe, even in resting position (Ishmael, 2011). The area in which Jackson lived
in was exposed to dust, which eventually led to development of asthma.
Pollutants
Jackson might have been exposed to pollutants such as smoke of tobacco, ozone and
other harmful gases, since his birth. These cause development of persistent wheezing and further
severity in asthma. It leads to lower respiratory tract damage which later develops into an
infection.
Hence, Jackson was exposed to various allergens and pollutants,from the time he was
born. This caused many infections due to breeding of bacteria inside his lungs. This led to his
innate and adaptive immunities to stop responding overtime. Infections cause inflammation
inside the airway and this led to abnormal lung mechanics (Castillo, Peters, & Busse, 2017). This
is the pathogenesis of his current illness. When growing up, there was not much care taken
regarding the environment in which he lived and this eventually lead to severe acute asthma at
the age of 18.
Question 2. Nursing strategies with evidence based rationale
Asthma Management
Nurses can opt for asthma management, a strategy that includes various goals such as
aiding Jackson by maintaining normal activity levels by starting exercises at an initial level.
They can take him out for walks in a clean environment and include him in games that do not
require excessive movements, such as table tennis. Nurses can give him breathing exercises on a
regular basis as well. This will help help in controlling his breathing, which can cause Jackson to
start reaching normal respiratory levels (Gahart, Nazareno, & Ortega, 2016). Jackson can be
provided with a plan that has been created by his nurse. In this, there can be a time table where in
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number of tablets and when they have to be taken will be mentioned. It can also include different
zones in which Jackson is not allowed to enter as it can lead to making his condition worse.
Non-pharmacological management
Nurses can use this intervention, in which they can use strategies that involve treatment
of habits of the patient. This can be reducing or stopping smoking and intake of tobacco,
reducing weight if obese and preventing allergies by adopting certain practices. Jackson can be
placed in an environment that can reduce the chances of inhaling smoke or other such pollutants
that can lead to worsening of his severe acute asthma (Price, Fletcher, & Van Der Molen, 2014).
This will help in reducing episodes of asthma and minimise coughing and inflammation in his
airway. Nurses can educate Jackson about his illness and give him guidelines on how to take care
of himself, in case he is alone and suffers from an asthma attack. Educating him can be
extremely useful as he will be able to learn about preventive measures, so that he can control his
illness.
Hence, nurses are required to learn strategies, so that they can treat and care for patients
like Jackson in a systematic manner because severe acute asthma is a very serious illness and
there can be many factors that contribute to its development.
Question 3. Mechanism of action of drugs and nursing implications
a) Mechanism action of following drugs
Nebulised Salbutamol is a drug for patients that suffer from severe acute asthma, in
which the chronic bronchospasm is managed (Tashkin, 2016). A proper dosage of 2.5 mg, 4
times a day can be taken by Jackson. This can go up to 5 mg, but there should not be excessive
use or else it can lead to severe attack and death.
Nebulised Ipratropium bromide (4/24) is another drug that has been prescribed to
Jackson. This is for treating reversible bronchospasm that is associated with chronic obstructive
pulmory disease. It has to be inhaled by the patient and requires a dosage og 250 to 500
micrograms for 3 to 4 times a day (Skidmore-Roth, 2018). But this can cause hypersensitivity
and discomfort in vision, of used excessively.
IV Hydrocortisone 100 mg (6/24) has been prescribed to Jackson and it helps to reduce
inflammation in airways. He can consume 100 mg per day, depending on the dosage but this can
cause side effects such as acne, indigestion and insomnia (Hydrocortisone (Rx), 2018).
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b) Nursing implications while administering above drugs
There are various drugs that are given to asthmatic patients and they have to be used in
proper amounts so that this disease can be controlled to an extent. It is important for nurses to
monitor the intake of these drugs as they have different side effects and Nurses have to ensure
that the patient is consuming the right and prescribed dosage. Jackson can be given the required
amount by nurses so that they can monitor the changes occurring in his respiratory system
(Gahart, Nazareno, & Ortega, 2016). Nebulised Salbutamol and Nebulised Ipratropium
bromide does not cause much side effects and this drug has to be taken under supervision.
Hence, nurses can accurately analyse how Jackson's body is behaving, so that she can further
advice required drugs for improving his severe acute asthma. If he shows any signs of effects
due to IV Hydrocortisone 100 mg, nurses can report to the doctor, so that they can treat him
accordingly.
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REFERENCES
Books and Journals
Carr, T. F., Stern, D. A., Halonen, M., Wright, A. L., & Martinez, F. D. (2018). Non‐atopic
Rhinitis at Age 6 is Associated with Subsequent Development of Asthma. United
Kingdom: Clinical & Experimental Allergy.
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.
Gahart, B. L., Nazareno, A. R., & Ortega, M. (2016). 2017 Intravenous Medications-E-Book: A
Handbook for Nurses and Health Professionals. United States : Elsevier Health
Sciences.
Ishmael, F. T. (2011). The inflammatory response in the pathogenesis of asthma. The Journal of
the American Osteopathic Association, 111(11_suppl_7), S11-S17.
King, G. G., James, A., Harkness, L., & Wark, P. A. (2018). Pathophysiology of severe asthma:
We’ve only just started. Respirology, 23(3), 262-271.
Price, D., Fletcher, M., & Van Der Molen, T. (2014). Asthma control and management in 8,000
European patients: the REcognise Asthma and LInk to Symptoms and Experience
(REALISE) survey. NPJ primary care respiratory medicine, 24, 14009.
Skidmore-Roth, L. (2018). Mosby's 2019 Nursing Drug Reference E-Book. United States :
Elsevier Health Sciences.
Tashkin, D. P. (2016). A review of nebulized drug delivery in COPD. International journal of
chronic obstructive pulmonary disease, 11, 2585.
Online
Hydrocortisone (Rx). (2018). [Online]. Retrieved from: :
<https://reference.medscape.com/drug/a-hydrocort-solu-cortef-hydrocortisone-
342744#4>
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