Case Study Analysis: Acute Exacerbation of Asthma in a 9-Year-Old Girl

This case study analyzes the case of Poppy, a 9-year-old girl admitted to the ICU with an acute exacerbation of asthma. The analysis begins with an overview of Poppy's medical history, including her diagnosis of infrequent asthma at age 2. It explores the pathogenesis of asthma, considering both allergic and infectious triggers, and discusses the physiological mechanisms involved, such as airway inflammation, mucus production, and immune responses. The study emphasizes the importance of patient positioning, specifically highlighting the benefits of Fowler's position for respiratory distress. It also details the use of oxygen supplementation via nasal cannula. The case study then delves into the pharmacological interventions, including Salbutamol via nebulizer, Hydrocortisone IV, and Ipratropium Bromide via nebulizer, explaining their mechanisms of action and clinical applications in managing asthma symptoms. The analysis references several research papers to support the discussion. The assignment covers patient assessment, treatment, and nursing interventions in a case of acute asthma.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the Student
Name of the University
Author Note

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CASE STUDY ANALYSIS
Q1. Here in the case of poppy, it can be seen that Poppy is a 9 year old kid. She is suffering from
acute asthma situation. The clinical prevention measures have been implemented for the patient
after admission to the emergency department. However, Poppy has been diagnosed with
infrequent asthma at the age of 2. Thus, it can be stated that the asthma is one of the most
common chronic illnesses among the global population. Asthma is commonly caused due to the
infection or inflammation in the air way towards the lungs. The inflammation can cause the
roughness of the airway or constriction of the airway as well. This condition can lead to the
development of the breathing issues Poppy experiencing. Thus, there can be several possibilities
which can develop the acute condition of the patient. Hence, based on the knowledge regarding
asthma it can be found that this can be either a result of an allergic condition or hereditary
complex issue. Hence, it can be stated that the issue faced by the patient can be marked as a
result of allergic situation as there is no specific medical history of the parents regarding asthma
is present. However, there is a possibility of bacterial infection, pollen or dust based allergic
reaction induction process for the patient. On the other hand, there is also a possibility of the
bacterial infection which can cause disorder in the mucociliary clearance and increase the mucus
production in the lung (Castillo, Peters & Busse, 2017). Thus, it can be stated that the possibility
of the lower airway inflammation. Thus, tighten the muscle of the airways is the primary
pathogenesis of asthma development. On the other hand, production of the mucus can develop
blockage in the air tubes and the lungs. Thus, the mucus blockage can be the cause of the
negative situation. On the other hand, allergen reaction the receptors of the immune system can
react which leads to the release of IgE. The antigen binds to the IgE receptors and lead to
degranulation of basophil and the mast cell (Turner et al., 2018). Histamine and prostaglandin
D2 release is the result of this degranulation which effectively promote or induce the blood flow

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CASE STUDY ANALYSIS
to the tissues. Release of histamine, prostaglandin D2 which are immune substances then triggers
the constriction of the smooth muscles of the airway and induces the mucous secretion. All these
factors lead to the induction of the inflammation and thus, the patients experience the breathing
issues. In this context it can be found that the Streptococcus pneumoniae and the Haemophilus
influenzae are the dominant bacterial entities which develops the infection and the inflammation
in the airway tract. Thus, the children exposed to bacteria or allergen reactions can be found with
the affected airway which leads to asthmatic conditions. In this context, it can also be stated that
the immune response of the children is weak and the development of asthma quite common if
exposed to these negative factors (Russell & Brightling, 2017). Hence, it can be found that
earlier mentioned factors can be marked as the pathogenesis for the development of the asthma
of Poppy.
Q2. Patient positioning is one of the most important decision for the health care professional. It
has been seen that the wrong decision or improper positioning of a patient can lead to even death
of the patient. Based on this factor, it can be found that a patient with distress in breathing or
shortness of breath need to decrease the weight on the chest and the lungs. Thus, the positioning
should focus on shifting the weight of the body to other parts than the chest of the person. In this
context, it can be seen that the Fowler’s position is also known as the sitting upright position can
be effective in this process (Maria & Hasaini, 2019). It can be termed as the semi sitting position.
Here, the person would sit in a 45 to 60 degree angle. The knees of the person should be bent or
straight. Hence, this position lets the abdomen muscles to be relaxed and subsequently the airway
muscles can relax as well. Thus, this position can be marked as the most reliable position for a
person who has respiratory distress. As poppy is experiencing acute asthma Fowler’s position

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CASE STUDY ANALYSIS
can reduce the muscular constriction which can reduce the distress of the patient regarding
breathing or alleviate the respiratory distress (Pal, Tiwari & Verma, 2017).
In case of poppy, it has been seen that the oxygen saturation is lower than the normal
state. Hence, it can be stated that the oxygen supplementation is required for the patient. In this
context, it can be found that the nasal cannula is the most common and useful device for the
oxygen delivery. It can be helpful for the patient to eat, talk and drink at the same time when
using the device for breathing support (Pilar et al., 2017). On the other hand, it also effective in
the process of reducing the risk of carbon dioxide rebreathing. It has also been seen that the
process of the nasal cannula usage is also less problematic for the patient and also the health care
professional as it is not complex (Geng et al., 2020). Thus, it can be used in this situation of the
patient as the patient is experiencing a distress in the breathing process. This process will be
helpful for Poppy as the supplemental oxygen through the nasal cannula increases the oxygen
saturation in the body of Poppy. The SpO2 was 92 per cent in Poppy’s case which has been seen
to be increased by providing supplementary oxygen. Hence, it will effectively help in the case of
Poppy.
Q3. Salbutamol via nebulizer
It is a bronchodilator for the patients with asthma and also chronic obstructive pulmonary
disease and reduces the breathing issues. Salbutamol 100 μg 12 puffs used via nebulizer puffs
are used to reduce the breathing issues. It has been seen that this medicine can broaden the
airway through the lung which can support the airflow. It can be marked as the selective beta 2
receptor agonist which effectively relaxes the airway muscles and reduces the bronchial
constriction (George et al., 2017). Thus, the bronchial constriction is the main issue for the
patient. Hence, the patient can be provided with this medicine as it will effectively reduce the

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CASE STUDY ANALYSIS
issue. The medicine would be provided by the doctor and the nurse should follow the prescribed
process and dosage. The response of the medicine should effectively reduce the breathing
distress of the patient and help the patient breath normal. The nurse should implement close and
regular observation by checking the vital signs of the patient.
Hydrocortisone IV
This medicine binds with the glucocorticoid receptor and downstream different
inflammatory actions such as the inhibition of phospholipase A2, NF-kappa B. Hence, it reduces
the inflammatory reactions in the airway tract and the helps the airway to properly flow the air
(Wang et al., 2018). Thus, the breathing issues can be reduced in case of Poppy by implementing
this medicine. The medicine would be provided by the doctor and the nurse should follow the
prescribed process and dosage. The response of the medicine should effectively reduce the
breathing distress of the patient and help the patient breath normal. The nurse should implement
close and regular observation by checking the vital signs of the patient.
Ipratropium Bromide via nebulizer
This medicine acts as the antagonist for the muscarinic acetylcholine receptor and
inhibition of this receptor leads to the inhibition of the action of the parasympathetic nervous
system of the airway. Hence, it leads to the reduction of the secretion of mucous (Memon et al.,
2016). Thus, this medicine effectively improves the breathing as it opens the broad and medium
airways. The medicine would be provided by the doctor and the nurse should follow the
prescribed process and dosage. The response of the medicine should effectively reduce the
breathing distress of the patient and help the patient breath normal. The nurse should implement
close and regular observation by checking the vital signs of the patient.

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CASE STUDY ANALYSIS
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.
Geng, W., Batu, W., You, S., Tong, Z., & He, H. (2020). High-Flow Nasal Cannula: A
Promising Oxygen Therapy for Patients with Severe Bronchial Asthma Complicated with
Respiratory Failure. Canadian Respiratory Journal, 2020.
George, M., Joshi, S. V., Concepcion, E., & Lee, H. (2017). Paradoxical bronchospasm from
benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient
with acute severe asthma. A case report and literature review of airway effects of BAC.
Respiratory medicine case reports, 21, 39-41.
Maria, I., & Hasaini, A. (2019, October). The Effect of Semi Fowler Position on The Stability of
Breathing among Asthma Patients at Ratu Zalecha Hospital Martapura. In Third
International Conference on Sustainable Innovation 2019–Health Science and Nursing
(IcoSIHSN 2019). Atlantis Press.
Memon, B. N., Parkash, A., Khan, K. M. A., Gowa, M. A., & Bai, C. (2016). Response to
nebulized salbutamol versus combination with ipratropium bromide in children with
acute severe asthma. JPMA. The Journal of the Pakistan Medical Association, 66(3),
243-6.
Pal, A. K., Tiwari, S., & Verma, D. K. (2017). Effect of recumbent body positions on dynamic
lung function parameters in healthy young subjects. Journal of clinical and diagnostic
research: JCDR, 11(5), CC08.

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CASE STUDY ANALYSIS
Pilar, J., i Alapont, V. M., Lopez-Fernandez, Y. M., Lopez-Macias, O., Garcia-Urabayen, D., &
Amores-Hernandez, I. (2017). High-flow nasal cannula therapy versus non-invasive
ventilation in children with severe acute asthma exacerbation: An observational cohort
study. Medicina Intensiva (English Edition), 41(7), 418-424.
Russell, R. J., & Brightling, C. (2017). Pathogenesis of asthma: implications for precision
medicine. Clinical Science, 131(14), 1723-1735.
Turner, D. L., Goldklang, M., Cvetkovski, F., Paik, D., Trischler, J., Barahona, J., ... & Farber,
D. L. (2018). Biased generation and in situ activation of lung tissue–resident memory
CD4 T cells in the pathogenesis of allergic asthma. The Journal of Immunology, 200(5),
1561-1569.
Wang, Z. W., Fu, X. Y., Yao, N., Gong, Z. H., Cheng, X. L., Duan, H. J., & Ren, Y. (2018).
Effects of combined administration of Radix Angelicae Sinensis and hydrocortisone on
the therapeutic action in the murine asthma model. Zhongguo ying yong sheng li xue za
zhi= Zhongguo yingyong shenglixue zazhi= Chinese journal of applied physiology,
34(4), 379-384.