401210 Health Variations 3: Asthma Pathophysiology & Care Plan

This nursing assignment delves into the pathophysiology of asthma, focusing on a case study of an 18-year-old male admitted with severe breathlessness. It details the inflammatory processes and immune responses involved in asthma, including the roles of APCs, T-cells, and interleukins. The assignment further discusses nursing interventions such as peak flow monitoring and pharmacological strategies, highlighting the use of corticosteroids, immunomodulators, and bronchodilators. It also examines the mechanisms of action and evaluation of drugs like salbutamol, nebulized ipratropium bromide, and IV hydrocortisone in managing acute asthma. The document concludes with a list of references adhering to APA style, providing a comprehensive overview of asthma management from a nursing perspective.

Running head: BACHELOR NURSING ASSIGNMENT
BACHELOR NURSING ASSIGNMENT
Name of the Student
Name of the University
Author note

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Answer 1
The pathophysiology of asthma and related symptoms are easily visible on the patient’s
physiology because of the inflammatory effects and activation of different cell types (Chawes et
al., 2012). On the exposure of foreign material, the inflammatory cells start interaction with
different cell types and mediators that causes the visible symptoms on the person’s health and
wellbeing (Neame et al., 2015). This section discusses about the case study of Jackson Smith a
18 year old man who was admitted to the emergency department of the healthcare facility due to
severe breathlessness. While receiving patient history it was informed by the patient’s family that
the patient is suffering from asthma from the age of 2. Afterwards his admission to the
emergency ward of the healthcare facility, clinical manifestations were collected which indicated
to the presence of severe case of dyspnea, elevated heart and breathing rate (32 breathes per
minute), shortness of breath and increased blood pressure 150/85 mmHg. Besides these the
patient was also observed of having wheezing sounds, increased pulse rate up to 130 beats per
minute and these clinical manifestations indicated towards the symptom of auscultation of lungs.
Several physical examinations were conducted by the healthcare professionals to determine the
lung expansion of the patient and after conduction of X-ray test it was determined that the
patient’s lungs and peripheral areas were swollen and hyper inflated lung fields were witnessed.
Further, on the assessment of blood gas it was found that 90% SO2 PaCO2: 50mmHg and
HCO3: 25mEq/L are the readings. Hence, after the accumulation of clinical manifestation, the
pathogenesis of the acute care asthma in the patient will be discussed.
Prior to identification of the pathogenesis, the commencement of the inflammation
process which is responsible for the emergence of the acute care asthma in the patient will be

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understood (Custovic et al., 2013). There are different host factors such as genetics and
environmental exposure which plays an important role in making the patient’s immune system
react to the allergenic response to the body (Alangari, 2014). As per the case study, Jackson is a
sufferer of asthma from his childhood, therefore for the emergence of acute asthma innate
immunity, respiratory infection, allergens, respiratory infections and other environmental issues
such as pollens or duct particles (Lim et al., 2012). Therefore, while analyzing the emergence of
asthma for this patient, allergens and associated reaction will be discussed. APC or antigen
presenting cells gets activated after the inhalation of foreign allergens and after that it engulfs the
allergens and presents them to the T-cells. after this, the naïve T cells activates the inflammatory
factors which acts as a cascade to activate the respiratory epithelium and helps in the release of
the thymic stromal lymphoprotein and other mediators such as interleukins leukocytes and others
that ultimately regulated the allergic reaction and then present those foreign proteins to the naïve
T cells (Chung et al., 2014, Doeing & Solway, 2013). Afterwards, there are two ways using
which the T cells are provided to the allergic reactions such as TH-2 and TH-17. Due to the TH-
2 involvement, the B cells starts producing the immunoglobulin E with the help of interleukin 4
and 13. These cells are also very important for the increased allergic reaction as the IgE binds to
the mast cells which gets activated and then in the presence of interleukin 4 which activates the
inflammatory reaction and cascade (Nievas & Anand, 2013). Further, these mediators such as
macrophages, eosinophil, neutrophils and so on gets activated that leads to airway damage and
stimulation sof the T cells with presence of bronchoconstriction, which is seen in the case study
of Jackson. Besides these, there are symptoms such as shortness of breath, elevated pulse rate
and breathing rate that indicated to the fact that the patient has chronic inflammation due to the
presence of leukocytes and epithelium. In this situation, due to the increased inflammation, the

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inflammatory cells are recruited to the epithelium cells which involves the lungs on the cascade
and helps in the creation of the cycle leading to chronic inflammatory symptom (Kudo,
Ishigatsubo & Aoki, 2013).
Answer 2
Peak flow monitoring and pharmacological strategy will be used as two nursing
interventions and care plan for Jackson and his acute asthmatic condition. Both of these
management strategies are discussed below.
Immediate patient care should be implemented in the care process for Jackson as he has
been admitted to the emergency ward of the healthcare facility after being affected with acute
asthmatic condition (Beasley, Semprini & Mitchell, 2015). Therefore it is important to
implement strategies using which, proper care and immediate intervention could be provided to
the patient. In this situation, immediate care becomes important to be implemented in the care
process because of the increased anxiety, depression and aggressiveness the patient faces due to
progressive and continuous dyspnea. In this aspect corticosteroids will be used which is the
group of primary medications, using which the alleviating symptoms of acute severe asthma are
treated (Tong, 2016). This medication is important in providing immediate relief by lowering the
peak flow variability and increasing the airway functions. Besides these, immunomodulators,
short acting beta 2 and anticholinergic are also applied in the pharmacological intervention for
the patient (Kaminuma et al., 2012). The second intervention which will be applied in the care
process is the monitoring of the peak flow while providing external force for expiration or
exhalation. The higher airflow during the application of these intervention helps in the
identification of the severity of the acute asthmatic condition and the degree of intervention need

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to apply to overcome the situation. Further, it helps in the identification of complications the
patient is facing or will be facing in the future (Tong, 2016). Therefore, using the peak flow
monitoring related intervention, it is helpful in determining that corrective actions and prevention
measures are being utilized by the healthcare facility (Beasley, Semprini & Mitchell, 2015).
Answer 3
Salbutamol: this drug is provided to the patients as aerosols and hence it works as a β2-
adrenoreceptors which works on the mechanism of the smooth muscle which is covering the
bronchi (Neame et al., 2015). The primary mechanism of this medication is associated with this
epinephrine as it helps in the binding of the drug to that of the epinephrine’s active site. This
bonding helps in the stabilization of the receptor that increases the number of cAMP which
further triggers the intracellular cascade therefore potassium ion releases (Uzkeser et al., 2012).
In this course, the number of calcium ion decreases and the muscle contraction ability also
decreases. On the other hand while using Salbutamol, this works as a β2 receptors that triggers
the relaxation of the muscle. The evaluation of this drug will be done by analyzing the patient
improvement and health enhancement (Neame et al., 2015). Further, the effectiveness of the drug
will be determined by monitoring the side effects such as pains, fatigue, depressants, headache
and muscle cramps (Uzkeser et al., 2012).
Nebulised ipratropium bromide: this drug is used mostly in the chronic pulmonary
disorder which is used properly with inhaled beta2-agonists therefore; it is used in the treatment
of reversible obstruction of the airway. The actual mechanism of the drug related to the blockage
of the muscarinic receptors. Due to this, the muscarinic receptors relieve and therefore minimize

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the symptoms related to the COD. And therefore, the evaluation will be observed by determining
the patient improvement (Nievas & Anand, 2013).
IV Hydrocortisone 100mg: this are natural glucocorticoids which works by to modifying
the immune responses which are related to diverse stimuli and then helps to increase the
metabolic effects. This drug possesses saltretaining properties that is further used in the
substitution of adrenocorticol deficiency syndrome. Further the evaluation of the patient outcome
will be done by observing the patient condition and determining the side effects of the drug
(Salvi et al., 2012).

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References
Alangari, A. A. (2014). Corticosteroids in the treatment of acute asthma. Annals of thoracic
medicine, 9(4), 187.
Beasley, R., Semprini, A., & Mitchell, E. A. (2015). Risk factors for asthma: is prevention
possible?. The Lancet, 386(9998), 1075-1085.
Chawes, B. L., Poorisrisak, P., Johnston, S. L., & Bisgaard, H. (2012). Neonatal bronchial
hyperresponsiveness precedes acute severe viral bronchiolitis in infants. Journal of
Allergy and Clinical Immunology, 130(2), 354-361.
Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., ... & Boulet, L. P.
(2014). International ERS/ATS guidelines on definition, evaluation and treatment of
severe asthma. European respiratory journal, 43(2), 343-373.
Custovic, A., Johnston, S. L., Pavord, I., Gaga, M., Fabbri, L., Bel, E. H., ... & Ryan, D. (2013).
EAACI position statement on asthma exacerbations and severe asthma. Allergy, 68(12),
1520-1531.
Doeing, D. C., & Solway, J. (2013). Airway smooth muscle in the pathophysiology and
treatment of asthma. Journal of applied physiology, 114(7), 834-843.
Kaminuma, O., Ohtomo, T., Mori, A., Nagakubo, D., Hieshima, K., Ohmachi, Y., ... &
Kitamura, N. (2012). Selective down regulation of Th 2 cell mediated airway‐ ‐
inflammation in mice by pharmacological intervention of CCR 4. Clinical &
Experimental Allergy, 42(2), 315-325.

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Kudo, M., Ishigatsubo, Y., & Aoki, I. (2013). Pathology of asthma. Frontiers in microbiology, 4,
263.
Lim, W. J., Akram, R. M., Carson, K. V., Mysore, S., Labiszewski, N. A., Wedzicha, J. A., ... &
Smith, B. J. (2012). Non invasive positive pressure ventilation for treatment of‐
respiratory failure due to severe acute exacerbations of asthma. Cochrane database of
systematic reviews, (12).
Neame, M., Aragon, O., Fernandes, R. M., & Sinha, I. (2015). Salbutamol or aminophylline for
acute severe asthma: how to choose which one, when and why?. Archives of Disease in
Childhood-Education and Practice, 100(4), 215-222.
Neame, M., Aragon, O., Fernandes, R. M., & Sinha, I. (2015). Salbutamol or aminophylline for
acute severe asthma: how to choose which one, when and why?. Archives of Disease in
Childhood-Education and Practice, 100(4), 215-222.
Nievas, I. F. F., & Anand, K. J. (2013). Severe acute asthma exacerbation in children: a stepwise
approach for escalating therapy in a pediatric intensive care unit. The journal of pediatric
pharmacology and therapeutics, 18(2), 88-104.
Nievas, I. F. F., & Anand, K. J. (2013). Severe acute asthma exacerbation in children: a stepwise
approach for escalating therapy in a pediatric intensive care unit. The journal of pediatric
pharmacology and therapeutics, 18(2), 88-104.

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Salvi, M., Vannucchi, G., Currò, N., Introna, M., Rossi, S., Bonara, P., ... & Ratiglia, R. (2012).
Small dose of rituximab for graves orbitopathy: new insights into the mechanism of
action. Archives of ophthalmology, 130(1), 122-124.
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Uzkeser, H., Cadirci, E., Halici, Z., Odabasoglu, F., Polat, B., Yuksel, T. N., ... & Atalay, F.
(2012). Anti-inflammatory and antinociceptive effects of salbutamol on acute and chronic
models of inflammation in rats: involvement of an antioxidant mechanism. Mediators of
inflammation, 2012.