Case Study: Asthma Management, Medication, and Teach-Back Method

This clinical case study delves into the multifaceted management of asthma, focusing on pharmacological interventions and patient education. It addresses the physiological changes associated with asthma, such as airway constriction and inflammation, and explores the role of medications like salbutamol and fluticasone in alleviating symptoms and preventing attacks. The study emphasizes the importance of proper inhaler technique and the application of the teach-back method to ensure patient understanding and adherence to treatment plans. Furthermore, it considers potential triggers like dehydration during sporting activities and the need for proactive management to prevent asthma exacerbations, particularly in situations like traveling. This case study highlights the significance of comprehensive care in improving patient outcomes and quality of life for individuals with asthma.

Clinical case study

Table of Contents
QUESTION 1...................................................................................................................................3
QUESTION 2...................................................................................................................................3
QUESTION 3...................................................................................................................................4
QUESTION 4...................................................................................................................................5
QUESTION 5...................................................................................................................................6
QUESTION 6...................................................................................................................................6
QUESTION 7...................................................................................................................................7
REFERENCES................................................................................................................................8

QUESTION 1
Due to presence of Asthma in individual, there can be risk of triggering, which may include
the swollen of airways from inside. This has the potential to narrow the space for the air to move
in along with out of lungs. In this there are some of the physiological changes which may include
the change in muscle wrap which can observed around the airways which get tighten and make
breathing even harder. During the asthma attack there are some of the changes in the respiratory
system which may include the contraction of muscle wall along with lining of the airways which
may get swollen and inflamed. These can lead to make some changes in the airway and narrows
the path that further aggravate by increase in the secretions from the mucus membrane and lead
to block it by getting smaller (Chen et. al., (2022)).
When asthma is not managed effectively then, there can be risk of getting airway
remodelling which refers to serious condition which can be there in individual when asthma get
untreated or poorly managed. In this, lungs become scarred where asthma medicine does not
work it get difficult to move air through the airways. Here, Allira is facing difficulty in breathing
which also include the shortness of breath. She is not getting better while taking and struggle for
getting breath. Allira may face also some respiratory changes which can lead to create high
impact on the delivery of better and effective response which includes lungs and airway. Allira
airways may get highly effected due to getting asthma and narrowing of airway due to swollen of
the airways which create minimise the air passage which restrict to pass air in large amount and
create difficulty in breathing to get sufficient oxygen. It can also be observed through measuring
the oxygen level which has shown decrease in the oxygen level.
Here, asthma refers to the condition which leads to narrow the airways, swell and produce
extra mucus which can lead to affect the breathing and make it difficulty. It also triggers the
coughing, wheezing and shortness of breath. There are some of the clinical sign of asthma which
can show a changes in the respiratory changes of Allira that may include the bronchospasm,
mucus production, inflammation which can lead to cause the sign and symptoms like wheezing,
shortness of breath, trouble breathing (Nilsen et. al., (2019)).
QUESTION 2
Salbutamol is one of the medication which are effective for any individual with Asthma.
This is the one which are given through the nebuliser to treat the severe asthma attacks. Here,

nebuliser refers to a machine which can help to deliver the medicine as mist inhaled through face
mask which are given by a doctor or health care professional. Here, salbutamol refers to a type of
medicine which are known by bronchodilator which have the work by relaxing individual muscle
of airways within lungs which can help and make easier to breath. Salbutamol is a beta2-
adrenergic receptor which can smooth airway muscle and lead to activation of adenyl cyclase
which increase the intracellular concentration of cyclic-3’,5’-adenosine monophosphate. It
related the muscle and smoothen all the airways from trachea to terminal bronchioles (Lombard
et. al., (2020)). It also has the functional antagonist which relax the airway irrespective of
involved spasmogen which can protect against bronchoconstrictor challenges. Salbutamol is the
controlled clinical trials which have high impact on the respiratory doses which produce higher
cardiovascular effects.
There are some of the potential side effect of the salbutamol which can lead to create
negative health impact on individual who consume them. These some side effect of salbutamol
includes the dry mouth, headache, bad taste in mouth and inability to sleep. There are some of
the nursing consideration of the salbutamol which may include the monitoring respiratory rate,
lungs sound before and after administration, Relieve GI upset, monitoring drug response (Rees,
(2019)). There is need to ensure about monitoring of individual respiratory which can include the
oxygen deficiency which should be taken in care through providing proper oxygen supply to
patient with asthma. Nursing staff should also ensure about taking care of the individual
medication and its impact which should be proper and can provide relief to the individual with
asthma.
QUESTION 3
It is important to take use of asthma medication as an inhaler which can allow to get better
protection through asthma attack. In this, through using the correct way it can allow to deliver
medication in proper amount and effectively. It is necessary to use the asthma inhaler correctly to
avoid the risk of getting asthma attack which are associated with taking care of impact that can
lead to create high impact on the delivery of asthma which are associated with proper
pharmacological impact. Proper inhaler technique can be important because when individual use
it incorrectly then, there is risk of asthma instability, increased short acting b2-agnoist use or
increased hospital visits (Jia et. al., (2020)). In this, there is need to ensure that individual is

using the inhaler correctly which can also include as the breath out all the way and pushing much
air to pass out as possible.
There are some of the steps which should be followed to use the inhaler in correct way to get
higher effectiveness. This may include getting ready, breathe in slowly, holding breath, keep
inhaler clean, replacing inhaler and storing inhaler (Nguyen et. al., (2018)).
Getting ready includes the instruction which are associated with the using of inhaler for
when and how. In this, there is need to take cap off, then look inside the mouthpiece through
getting ensure there is nothing. Shaking inhaler hard for 10 to 15 times before use.
In Breath in slowly step there is need to hold the inhaler with mouthpiece down and place
lips around mouthpiece which can form tight seal. When it starts to slowly breathe through
mouth, then pressing down on inhaler one time can help to keep breathing slowly and deeply.
Holding breath steps includes the taking off of inhaler form mouth. In this, there is need to
ensure about holding breath to slowly count to 10. Here, it is needed to pucker lips and breath out
slowly through mouth. After this, there is need to wait for one minutes before taking next puff.
Then put the cap back on the mouthpiece and ensure about it closes (Nguyen et. al., 2018)).
QUESTION 4
Preventer are effective which can help to prevent asthma symptoms along with preventing
attacks which allow to reduce the inflammation like swelling and redness in airways, which can
make less sensitive. This can be there to reduce the impact of low dose of corticosteroid within
lungs. When asthma is left untreated then there is risk of getting occurrence of airway
remodelling which refers to a serious condition that can happen to an individual when asthma is
untreated or poorly managed. In this, there are some of the observation can be done like lungs
become scarred, asthma medicine does not show its proper impact and less air is able to pass or
move through the airways (Prasad et. al., (2020)). It can also create physiologic mechanism
changes where inflammation can lead to decrease the radius of airway. This can lead to
compliance of lungs slightly which can increase the work of breathing. When asthma is untreated
then there is also loss of the surface layer of lungs which are associated with thickening of lungs
and reduce the volume of air passes through it.

QUESTION 5
Preventer is the one which is highly helpful in providing control over the asthma symptoms
and help to prevent the asthma attack. These can be effective in reducing the inflammation
within the airways which can make them less sensitive. Fluticasone oral inhalation is effective
and are used for preventing difficulty in breathing, wheezing, chest tightness and coughing
which are caused by asthma within individual like adult or child (Lynch et. al., (2021)). This is
the class of medication which are called as corticosteroids. This works by decreasing individual
swelling along with irritation within airways which allow to make easier breathing. There are
some of the side effect of Fluticasone propionate which may include nausea, headache, vomiting
and diarrhoea. There are also some of the nursing consideration which may include the
observation for the paradoxical bronchospasm which includes the wheezing, cough, dyspnoea
which are specially at higher or excess doses. This may also include the nursing assessment
through taking information about individual history and physical exam who is using inhaled
steroids. They should also include the nursing diagnosis and care planning which includes the
drug therapy that have risk of injury related with immunosuppression, deficient knowledge
regarding drug therapy and acute pain due to local effect of drug (Jackson et. al., (2020)). Here,
preventers can be used on daily basis which can help to prevent the asthma symptoms whereas,
reliever medication should be taken when there it is necessary to relieve symptoms. Reliever
should be used when there is any symptom of asthma which can help to provide quick relief
during asthma attack.
QUESTION 6
Teach-back refers to a method which includes the information through using a way of
checking understanding through asking individual about the state their own words. What they
need to know or do regarding their health. This method refers to a way which can help individual
to confirm about explaining things in such a manner that can help to understand by the patient.
This can allow healthcare professional to get ensure that idnivdual is able to understand the
instruction which they should know to take care of their health. This can also help to get confirm
about the information is delivered effectively to patient. Here, in case of asthma with Allira, she
need to have the information which includes the instruction about different cases of getting
asthma attack. In this, she need to get ensure that Allira should have the information about the

effective response to react with using the knowledge and instruction which can be used that has
provided by the nursing staff using the inhaler (Oh et. al., (2021)).
Here, Allira is getting out of country where she need to have the proper information and
instruction which should be follow in case of asthma attack. This can allow to avoid the risk of
asthma attack and make the hospitalisation situation. Through using the teach-back method allow
to ensure the healthcare professional that there is improvement in patient understanding and their
adherence. It also helps to decrease call backs and cancelled appointments and help to improve
the patient satisfaction along with outcomes.
Through applying this method can allow Allira to get understanding of the instruction
more effectively and allow to use those instructions when there is risk of asthma attack. This can
be helpful to Allira to prevent the asthma attack when she is out to travel with her family to
South Australia. There are outcomes that Allira should not need for the medical assistance during
travelling and visiting her family’s traditional land. She herself can be able to make her condition
more effectively (Holman et. al., (2019)).
QUESTION 7
Due to sporting, Allira may get dehydrated which is one of the reason which lead to cause
muscle spasm or cramps which are linked with getting hydrated with time. This can be there due
to prolonged use muscle. Due to sport activity Allira need to inhale more oxygen which required
to get better and effective response to deliver the risk of muscle cramps. This can face due to
daily activity of Allira which are sporting. Due to this, she may face difficulty in breathing and
due to having the case of asthma she need quality air with higher volume which can lead to
shortage of air at that time and needed for inhaler. In this, there is need to ensure about various
symptoms which are also associated with the using inhaler. There is need to prevent the muscle
cramps which may include avoiding the dehydration which play and important role in dealing
with preventing muscle cramps. It can be done through using plenty of liquids every day.
Stretching muscles can also help to prevent the risk of muscle cramps which can help to perform
well to Allira (Singh et. al., (2019)).

REFERENCES
Books and Journals
Chen, L., Nasab, E. M., & Athari, S. S. (2022). Effect of Loaded Glycyrrhizic Acid on PLGA
Nano-particle on Treatment of Allergic Asthma. Iranian Journal of Allergy, Asthma &
Immunology, 21(1).
Holman, C. K., Weed, L. D., & Kelley, S. P. (2019). Improving provider use of the teach-back
method. Journal for Nurses in Professional Development, 35(1), 52-53.
Jackson, D. J., Busse, W. W., Bacharier, L. B., Kattan, M., O’Connor, G. T., Wood, R. A., ... &
Altman, M. C. (2020). Association of respiratory allergy, asthma, and expression of the
SARS-CoV-2 receptor ACE2. Journal of Allergy and Clinical Immunology, 146(1), 203-
206.
Jia, X., Zhou, S., Luo, D., Zhao, X., Zhou, Y., & Cui, Y. M. (2020). Effect of pharmacist‐led
interventions on medication adherence and inhalation technique in adult patients with
asthma or COPD: A systematic review and meta‐analysis. Journal of clinical pharmacy
and therapeutics, 45(5), 904-917.
Lombard, E., Gates, J., & Ruickbie, S. (2020). Acute asthma exacerbations: tips from the shop
floor. British Journal of Hospital Medicine, 81(12), 1-10.
Lynch, S. V., & Vercelli, D. (2021). Microbiota, epigenetics, and trained immunity. Convergent
drivers and mediators of the asthma trajectory from pregnancy to childhood. American
journal of respiratory and critical care medicine, 203(7), 802-808.
Nguyen, T. S., Nguyen, T. L. H., Van Pham, T. T., Hua, S., Ngo, Q. C., & Li, S. C. (2018).
Pharmacists’ training to improve inhaler technique of patients with COPD in
Vietnam. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1863.
Nguyen, T. S., Nguyen, T. L. H., Van Pham, T. T., Hua, S., Ngo, Q. C., & Li, S. C. (2018).
Pharmacists’ training to improve inhaler technique of patients with COPD in
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Nilsen, K., Thien, F., Thamrin, C., Ellis, M. J., Prisk, G. K., King, G. G., & Thompson, B. R.
(2019). Early onset of airway derecruitment assessed using the forced oscillation
technique in subjects with asthma. Journal of Applied Physiology, 126(5), 1399-1408.
Oh, E. G., Lee, H. J., Yang, Y. L., & Kim, Y. M. (2021). Effectiveness of discharge education
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patient safety, 17(4), 305-310.
Prasad, B., Nyenhuis, S. M., Imayama, I., Siddiqi, A., & Teodorescu, M. (2020). Asthma and
obstructive sleep apnea overlap: what has the evidence taught us?. American journal of
respiratory and critical care medicine, 201(11), 1345-1357.
Rees, S. (2019). SALBUTAMOL. Journal of Prescribing Practice, 1(4), 165-165.
Singh, G., Kesar, S., Sambyal, A., & Grover, S. (2019). Role of bambuterol in the management
of bronchial asthma. Indian Journal of Respiratory Care, 8(1), 27.