NSG210120 Nursing Case Study: Asthma Pathophysiology and Assessment

This case study examines the case of Jill, an 18-year-old female presenting with shortness of breath, chest tightness, and a cough, with a history of asthma. The assignment, completed for a nursing course, delves into the pathophysiology of asthma, linking it to Jill's clinical manifestations, including bronchiolar inflammation, bronchoconstriction, and excessive mucus production. The study then focuses on a focused respiratory assessment, detailing potential abnormal findings such as reduced lung expansion, crackling sounds, and abnormal respiration rates. Finally, the case study discusses diagnostic methods like X-rays, blood tests, and CT scans to identify consolidation (pneumonia, pulmonary edema, and aspiration) and outlines appropriate treatments, including medications for pneumonia, pulmonary edema management, and aspiration pneumonia treatment. The assignment is supported by evidence-based literature and provides a comprehensive overview of the patient's condition and treatment plan.

Case study

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Part 1................................................................................................................................................3
Part 2................................................................................................................................................4
Part 3................................................................................................................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................1

Part 1
The understanding of the condition and diagnose of asthma comes under the
pathophysiology of asthma. The researcher have found many phenotypes of asthma. The factors
of asthma pathophysiology that are seen in Jill's case, includes bronchiolar inflammation which
cause shortens the breath, cough as well as wheezing. Asthma is effecting Jill's various parts of
the respiratory tract and parts of lungs such as bronchi, trachea along with the bronchioles.
Bronchoconstriction with bronchospasm is caused by the excessive amount of mucus, damage in
muscle, edema as well as epithelial (Yamauchi and Ogasawara, (2019). Asthma can be defined
by the contraction of smooth muscle in bronchi, airways are tended to narrow due to
bronchospasm, the leakage of edema adds to the air narrowing process. Capillaries of airway
enlarge itself and start leaking in the process which increases the secretions. The causes the
clearance of edema as well as impairs mucus.
Increase in the secretion of mucus cells is observed in asthma along with the enlargement
of the glands that secrets mucus in Jill. The airways are blocked due to the thick mucus
produced. Extreme impairment of airway is caused due to the epithelial peeling which may be
caused due to injury in the epithelium.
A major feature in asthma is the airways becoming hyper-responsive, which is caused by
the invasion of the allergens due to the epithelium's loss of barrier functions. Jill's immune
response and inflammation will decide the extent of the degree of hyperresponsiveness.
Inflammatory mediators are broken down by the enzymes, these enzymes are lost in the
asthma, this results in neutral reflexive effect by the exposer to sensory nerve. In Jill's case,
asthma is causing the airways to undergo structural reorganization with appropriate treatment as
well as control by the use of Seretide inhaler and ventolin inhaler. These alterations in the
airways cause the tissues and cells to change in the lower respiratory tract. The changes in the
airways causes pulmonary fibrosis disease which occurs due to the permanent fibrotic damage.
The tissues get stiff and thick that makes it more difficult for the functioning of the lungs and
cause short breath. The alteration of the tissues is irreversible and do not response to the therapy
which is causing Jill to have difficulty in speaking full sentences (Camarinho and et.al, (2019).
Diagnosis of the asthma for Jill may require the measurements of peak expiratory flow as
well as the tests for the pulmonary function.

Part 2
The focused respiratory assessment is done on Jill.
Inspection
The physical test of Jill was done where she is asked to cross her arms across the chest.
She is made to say a sentence, the doctor find buzzing as she speaks, the fluid in the lung cause
the vibration to get intense due to the ability of the fluid to transmit the fluid sound.
Palpation
The doctor examined the back and the front side of the chest to identify the expansion of
the chest in asymmetrical manner. The doctor placed he thumb on each rib and asked Jill to take
deep breaths. The lung expansion in Jill is reduced that indicate the sign of pneumonia.
Percussion
The doctor lightly taps on the chest of Jill to identify the amount of air is present in the
lungs. The abnormal breathing was tested and Jill was having a crackling or bubbling sound
which indicate the pneumonia or pulmonary edema.
Auscultation
The doctor then use the stethoscope and examine the rate of respiration. The focused
respiratory assessment is done on Jill. The rate of respiration is decreased and Jill is having
problem in breathing and is suffering from shortness of the breath.
The blood pressure rate is abnormal (BP-128/84mmHg). The assess oxygen saturation
was normal. The symptoms of Jill indicate the consolidation of lungs because she is finding
difficult to breath. This is caused when the air is not getting through the consolidation, so the
lungs are not functioning properly. Lungs are taking up the fresh air and releasing the air from
the body that is causing the shortness of the breath to Jill and her skin is getting paler due to the
lack of oxygen. Jill is also experiencing the heaviness while breathing and a dry cough
(Abdulkhaleq and et.al (2018).
The lung consolidation is caused by:
 Pneumonia
The consolidation is most commonly caused by pneumonia. Jill stated that she was
suffering from Upper Respiratory Tract Infection (URTI) two weeks ago. The infection in the
lungs cause the body to send the white blood cells to fight against it. The cells that are dead and

the waste material in the body accumulate and create pus that obstruct the airways. Pneumonia is
usually caused by viruses, bacteria and fungus.
 Pulmonary edema
Pulmonary edema is caused by the congestive heart failure. The heart loses its capability
to pump blood forward and the blood is backed up in the veins of the lungs. The blood increases
the pressure in the veins that causes the blood to push into the small airways (Spadaro and et.al,
(2017).
 Pulmonary haemorrhage
In pulmonary haemorrhage the lungs starts bleeding because of the inflammation of the blood
vessels. The inflammation makes the blood vessels weak and cause the leakage of the blood in
the airways.
 Aspiration
In this case Jill might have inhaled food particles with the air into the lungs. The inhaled food
particle can cause pneumonia but the infection caused by this is harder to treat than the normal
pneumonia. The swallowing issue in some people cause to aspirate the food particles while they
are eating, this can create a big problem if not fixed on time (Semernik and et.al, (2020).
Part 3
The diagnosis of consolidation was done by:
 X-ray
The X-rays are helpful in finding the homogeneous opaque obstructed vessels that help the
doctor to find the specific problem. It gives a silhouette sign that is used to find the definite
pathology and locate the tissue loss interface in the chest. It is helpful in finding the air-
bronchogram that is the air filled in the bronchi. Helps in knowing if there is a volume loss or
not.
 Blood test
To find the level of red blood cells, the bleeding of the lungs and the blood oxygen levels. Jill's
blood oxygen levels is 95%RA. Helps in finding if the patient is suffering from Vasculitis (Dunn
and et.al (2018).
 Sputum culture
This test help in finding if the patient is suffering from any kind of infection and if yes then what
is causing it.

 CT scan
CT scan provides a better image of the consolidation in the lungs. Various conditions in the
consolidation have patterns and characteristic look that can help the doctor to understand the
disease better and help to implement better medication (Srirangan, Pushpakumara and
Wanigasuriya, (2020).
 Bronchoscopy
In this test the doctor take the sample from the lungs. This is done by inserting a tube into the
lungs containing a fibre optic camera. The camera gives a sight at the consolidation to the
doctors and the pipe is used to extract the sample to culture and study about them.
Jill is diagnosed with pneumonia, pulmonary edema and aspiration. To treat the particular
cause particular treatments and medication are given below:
For treating pneumonia, Jill is given with the medication for a particular organism that
caused pneumonia. Jill is provided with the antivirals, antibiotics or antifungals to protect against
the virus, bacteria and fungus. The medication is given to reduce the chest pain, dry cough and
fever (Liu and et.al, (2018).
For treating pulmonary edema, Jill is treated based on the cause that include the removal
of the extra fluid, lowering of the blood pressure levels in the vessels and making the heart pump
to the extent that it is able to reach the vessels without backing up.
For the treatment of aspiration pneumonia, Jill is provided with the strong antibiotics. Jill
is also treated to improve the problem of aspiration, so she can discontinue to do that and get
better. Pneumonitis is not treated with antibiotics because it is not an infection. If the condition
of Jill continue to get worse, she is provided with steroids so the inflammation can be reduced.
Jill is given supportive care so that her body heals itself (Wahidi and et.al, (2020).

REFERENCES
Books and journals
Yamauchi, K., & Ogasawara, M. (2019). The role of histamine in the pathophysiology of asthma
and the clinical efficacy of antihistamines in asthma therapy. International journal of
molecular sciences. 20(7). 1733.
Camarinho & et.al, (2019). Chronic exposure to non-eruptive volcanic activity as cause of
bronchiolar histomorphological alteration and inflammation in mice. Environmental
Pollution. 253. 864-871.
Inflammatory mediators
Abdulkhaleq & et.al (2018). The crucial roles of inflammatory mediators in inflammation: A
review. Veterinary world. 11(5). 627.
Spadaro & et.al, (2017). Simulation training for residents focused on mechanical ventilation: a
randomized trial using mannequin-based versus computer-based simulation. Simulation
in Healthcare. 12(6). 349.
Semernik & et.al, (2020). Complex System for Monitoring the Patient’s Condition and Diagnosis
of Bronchial Asthma. Journal of biomedical physics & engineering. 10(3). 367.
Mandell, L. A., & Niederman, M. S. (2019). Aspiration pneumonia. New England Journal of
Medicine. 380(7). 651-663.
Dunn & et.al (2018). The effect of lung consolidation, as determined by ultrasonography, on
first-lactation milk production in Holstein dairy calves. Journal of dairy science. 101(6).
5404-5410.
Srirangan, Pushpakumara & Wanigasuriya, (2020). A life-threatening complication due to
pulmonary haemorrhage following hump-nosed viper bite. BMC pulmonary medicine.
20(1). 1-4.
Liu & et.al, (2018). Factors affecting time to sputum culture conversion and treatment outcome
of patients with multidrug-resistant tuberculosis in China. BMC infectious diseases.
18(1). 1-7.
Wahidi & et.al, (2020). American Association for Bronchology and Interventional Pulmonology
(AABIP) statement on the use of bronchoscopy and respiratory specimen collection in
patients with suspected or confirmed COVID-19 infection. J Bronchology Interv
Pulmonol. 27(4). e52-e54.
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