University Nursing Assignment: Asthma Case Study of Patient Ron

This nursing assignment presents a case study of Ron, a 16-year-old admitted to the hospital with an asthmatic attack. The report utilizes the Roper-Logan-Tierney model for assessment, focusing on activities of daily living, and identifies Ron's persistent breathing difficulty, low oxygen saturation, and chest pain as key clinical problems. The pathophysiology of asthma, including the impact of allergens, irritants, and smoking, is explored. Nursing care priorities are established to restore breathing patterns, clear airways, reduce chest pain, and improve knowledge deficits. The report details interventions such as monitoring vital signs, administering medications, promoting effective cough, ensuring a calm environment, and providing patient education on asthma triggers and inhaler use. The assignment highlights the importance of patient education, and ongoing assessment to improve patient outcomes.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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Patient scenario
Ron is a 16 years old boy Essex. He had been admitted to the hospital with asthmatic
attack. Ron’s asthmatic attacks becomes acute especially at the time of falls. At the time of the
history taking, it was found that Ron’s mother suffered from allergic rhinitis. In the year 2014,
Ron had been diagnosed with the Asthma. He had admitted that he had been introduced to
smoking and often smokes when he hang out with his friends. Within the last years, he had been
admitted to the hospital two times due to the exacerbation of asthma. On final admission he has
been prescribed with Ventolin, Seretide. He had been admitted via the emergency department for
regular salbutamol nebulizers. He had reported that he could not sleep overnight and had been
complaining the about chest tightness.
The following vital signs have been obtained-
PaO2 : 70 mmHg
PaCO2: 53mm Hg
HCO3 : 20 mmHg
SpO2 : 87 %
pH: 7.2

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Systematic assessment
The Roper –Logan – Tierney model for nursing care can be referred to as a framework
which has been done on the basis of the activities of daily living (ADL). The main aim of using
this framework is to conduct an assessment throughout the care of the patient. This model has
been used to the prepare checklist and is often used for assessing how the life of a patient can be
altered and modified due to the burden of illness, admission or injury to a hospital rather than as
a way of planning the for enhancing the independence and the quality of life of the patient
(Holland and Jenkins 2019).
Asthma is a chronic illness that is featured by irreversible and obstruction of the airways
where the airway of a person always gets the inflamed, swells and becomes narrow to form extra
mucus making it difficult to breathe with exacerbations often indicating the worsening for the
disease. The nurse would first assess for the activities of daily living –“breathing”. Diagnosis of
asthma should be able to regulate that the episodic symptoms of the obstruction of airflow are
present, the airflow obstruction is partially reversible and that all the alternative diagnoses are
eliminated (O’Connor and Carey 2017). A physical examination needs to be initiated focusing on
the chest, skin and the upper respiratory tract. It is necessary to check whether the patient is able
to breathe properly. On physical examination, Ron was found alert, but looked anxious and was
breathless or exertion and rest. He was observed and the vital signs were noted for establishing
baseline observations. The respiration rate along with the character was assessed for achieving an
indicator of the respiratory function, and these are regarded as the sensitive predictors of
deterioration of the health conditions. Ron was assessed for wheezing and the abnormal breath
sounds. The respiratory depth was 29 breaths per minute, she was wheezing along with shallow
breathing and the patient was using the accessory muscles for the breathing. The pulse oximetry

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and the arterial blood gases were measured for assessing the severity of the exacerbations.
Assessment of Ron’s sputum was necessary for assessing Ron’s ability to expectorate or cough
out the excess mucus. The consistency, color and the smell of the sputum produced at the time of
coughing were charted and the sample was sent to the laboratory to analyze any occurrence of
infection. One of the important activities of daily living that has been listed in the Roper Logan-
Tierney model of nursing are preservation of a safe milieu for the patient. Nurses should
immediately the try to understand the trigger of the asthmatic attack and get it removed
(O’Connor and Carey 2017). The case study reveals, that Ron suffers from such asthma attacks
at the time of falls and also indulges in smoking whenever he hang out with his friends.
Blood pressure was observed to be 140/90 mmHg in a sitting position. The second
activity that was accessed is the “temperature’. The temperature was about 37.5 degree Celsius.
Effective communication is one of the crucial element for assisting the patient to with the
optimal level of functioning in the daily life (Holland and Jenkins 2019). Hence, it is necessary
to assess whether Ron is alert and is capable of communicating with the nurse. Ron might be
unable to communicate due to pain and excessive respiratory distress. A pain assessment was
carried out to identify the intensity of pain. Again the nurse in the clinical area should observe
and note down the problems, like the hydration status of the patient. The water intake helps the
body cells to replenish the nutrients required by the cells to maintain the normal functioning of
the body. The nurse should note whether eating or drinking in the patient is compromised
anyway (Holland and Jenkins 2019). It has been recorded in many of the studies that mild
dehydration is common in acute childhood asthma.

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Hence the main, clinical problem that has been identified for Ron, is the persistent
breathing difficulty that he had been experiences, the low oxygen saturation level and his chest
pain.
Pathophysiology
It is revealed from the cases study that Ron is suffering from acute asthma and respiratory
distress. The pathophysiology of asthma is quite complex, and involves a lot of changes in the
airways. In severe exacerbations of asthma, the contraction of the bronchial smooth muscles
occurs that causes narrowing of the airways in response to a varieties of stimuli including the
allergens and the irritants (Maslan and Mims 2014). Cold air can cause acute
bronchoconstriction. It has already been stated in the case study that Rom suffers from asthmatic
attack especially at the time of falls. The lining of the airways are lined by a layers of fluid and
mucus that assist the body to remove the harmful particles from the airways. Cold air is dry and
it irritates the airway, to become irritated and swollen (Seys et al. 2015). In cold weather, the
body tends to produce more mucus that is stickier and thicker than the normal mucus. Again,
during winter people are prone to spend more time indoors where dust, molds and pet dander
flourishes (Khan 2014). They are likely to trigger asthma. As the inflammation of the airways
progresses, some of the other factors limits the airflows, which includes inflammation, edema,
inflammation and hyper-secretion of the mucus, forming the inspissited mucus plugs, as well as
causing structural changes like hypertrophy as well as hyperplasia of the smooth muscles in the
airways. Hyper-responsiveness of the airways as an aggressive bronchoconstriction response to a
varieties of stimuli (Maslan and Mims 2014). The mechanisms that influences the airway hyper-
responsiveness are more than one and involves inflammation, structural changes, and
dysfunctional neuro-regulation. This appears to be the main factor in determining the degree of

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airway responsiveness. This causes the narrowing of the airways and thus respiratory distress
(Guilbert, Bacharier and Fitzpatrick 2014).
At the time of history taking, Ron had admitted that he often smokes whenever he hangs
out with his friends. Tobacco smoke has been linked with an increased chance for the
commencement of asthma. Smoke irritates the airways and makes them swollen and filled with
sticky mucus. Furthermore, the permeability of the airway mucosa is increased, that can lead to
the increased clearance of the any corticosteroid that is being inhaled (Aanerud et al. 2017). As
published in the WHO reports, asthma is strongly found in the families and is about half because
of the genetic vulnerability and more due to the environmental influences (Thomsen 2015).
There are very few papers that have actually proved, that maternal risk of asthma pose greater
risk than that of paternal risk, which indicates that in utero and post-natal non-genetic factors can
contribute to vulnerability for asthma (Lim, Kobzik & Dahl, 2010). Hence, this can be related to
the fact that Ron’s mother suffered from allergic rhinitis.
It is evident from the cased study that Ron was wheezing. Wheezing or whistling like
sound is produced due to the tightening, blocking and inflammation of the airways (Silvestri et
al. 2013). Additionally, the accessory muscles are generally not used during normal breathing,
but are generally used at the time of increased metabolic demand. At the time of an asthmatic
attack greater pressure is needed for pushing the air through the bronchus. This causes an
increased use of the accessory muscles to breathe. The low oxygen saturation at the time of
asthma is due to the fact, which at that time, hypoxia can occur making it hard to get air in to the
lungs. Hence, the oxygen level drops drastically at the time of asthma attack (Sarkar, Niranjan
and Banyal, 2017). In asthma exacerbation, the patient displayed both high heart rate and
respiratory rate due to the fact that the heart beats more to supply more oxygen to the body,

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increasing the heart rate. Chest pain can also be caused probably due to the bronchoconstriction
and the bronchospasm.
Nursing care
Priorities of care and rationale for the care provided
The main clinical priorities for Ron, is to restore the ineffective breathing pattern, to conduct a
successful airway clearance, to decrease the chest pain and improve his deficit of knowledge.
In order to restore the breathing pattern, Nurses should assess the vital signs as required,
as amplified Blood Pressure, Respiratory Rate and Heart Rate can be seen at the time of initial
hypoxia and hypercapnia. Severe BP, HR and respiratory failure can occur. Nurses should assess
for the breath sounds like wheezes, any signs for dyspnea, chest retractions, flaring of nostrils,
use of accessory muscles. This due to the fact that presence of adventitious sounds can indicate
towards worsening of the conditions or development of additional complications like pneumonia
(Walker and Reznik 2014). Nurses should assess and monitor the oxygen saturation, the
emaciated expiratory flow rates and forced expiratory volume as measured by the respiratory
therapist. The severity can be monitored by the data of the peak expiratory flow rates or the
presence of paradoxical pulse (Barker and Everard 2015). The arterial blood gases can be
measured to see the presence of any respiratory alkalosis. Hypoxemia can lead to an increased
respiratory depth and rate. The patient can be administered with short acting beta- 2- adrenergic

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agonist and corticosteroids (Usmani 2015). They act as bronchodilators and can be helpful in
reducing the irritation in the airways carrying oxygen to the lungs. The patient should be
encouraged for pursed lip breathing for the exhalation, as it increases the forms of breathing by
moving the air out of the lungs (Pinnock 2015). The head of the bed needs to be elevated, as it
promotes expansion of lungs and assist in breathing.
For an effective airway clearance, it is necessary to assess the effectiveness of cough and
the amount, odor, color and viscosity of the secretions, as coughing is a normal method for
clearing the throat and the passage of the irritants and mucus. The low oxygen saturation shall be
maintained by administering IV fluids and medicines. IV fluids has been found to be helpful for
the clients with dehydration. Oxygen therapy has been found to correct hypoxemia. Ron should
be kept calm as keeping a client calm prevents the occurrence of asthma attacks (Lalloo et al.
2013). Nurses should also assess for the signs of anxiety, feelings of fear and panic, tachycardia
and uneasiness, and provide a calm and quiet environment, as retaining calmness will decrease
the oxygen and the work of breathing (Bush and Fleming 2015). After the respiratory distress
has been managed to some extent, Ron should be assessed for the knowledge of tobacco use and
should be informed about the ill effects of tobacco use and how can triggers symptoms of allergy
and asthma, such as avoiding triggers like smoke, pollens, pet dander. Ron should be taught
about how to administer inhalers and nebulizers or to use precautions like face mask, while going
out in cold. The client has to know that medications like bronchodilators and anti-inflammatory
agents reduce the prevalence of asthma exacerbations.
Factors affecting the type of care provided
There are certain factors that affects the type of care provided. Factors like genetics, poor
design of the inhaler device, smoking, economic factors and improper compliance to medicines

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affects the type of care provided. Again family and the environmental factors like the pets at
home, air pollution, cold air and exposure to pollen are some of the important determinants of the
poorly controlled asthma (Gandhi et al. 2013). It has been stated in the studies that health literacy
of the parents as well as the client influences asthma control. Peer pressure is another important
factor that can influence Ron to smoke. Higher health literacy has been found to be associated
with a higher perceived self-efficacy in the management of asthma (Gandhi et al. 2017). Poor
hydration and nutrition in children can be associated to poor asthma control. It is the duty of the
nurse to teach the client about proper follow up or strategies like log book or phone reminder, so
that the client does not miss medicines.
Evaluation
On successful nursing interventions, Ron will maintain an optima breathing pattern, as
evidenced by relaxed breathing, absence of dyspnea and will display a normal respiratory
pattern. An effective coping mechanism, will be displayed by the client. The client will be able
to articulate a lessening in the level of the anxiety in the client as proved by the calm demeanor
of the patient and the cooperative behavior of the client. On successful education to the patient,
by the nurses, clients and the significant others will be able to verbalize the knowledge of the
clinical condition and the ways to manage the diseases and community resources for helping the
clients.
Implication for future nursing practice
One of the important implication of this study and the use of Roper-Logan – Tierney
model, is that the framework can be used as a guidance for the modern nurses to assist a patient
in conducting their daily activities of living. It should not be forgotten the daily chores of life are
mostly affected by these types of chronic diseases. It is the duty of the nurses to check how well

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patients had been managing asthma. Knowledge of a Roper Logan Tierney model, can helps the
nurses to chalk out a care plan to assist him in self-management of the disease. Some of the
major nursing interventions that can be applied are pharmacological interventions, application of
oxygen therapy to increase the oxygen saturation and proper airways clearance technique.
Hence, such nursing interventions would be helpful in mitigating the asthma exacerbations in the
client and will help him to lead a normal life.

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References
Aanerud, M., Carsin, A.E., Sunyer, J., Dratva, J., Gislason, T., Jarvis, D., deMarco, R.,
Raherison, C., Wjst, M., Dharmage, S.C. and Svanes, C., 2015. Interaction between asthma and
smoking increases the risk of adult airway obstruction. European Respiratory Journal, 45(3),
pp.635-643.
Barker, N. and Everard, M.L., 2015. Getting to grips with ‘dysfunctional breathing’. Paediatric
respiratory reviews, 16(1), pp.53-61.
Bush, A. and Fleming, L., 2015. Diagnosis and management of asthma in children. bmj, 350,
p.h996.
Gandhi, P.K., Kenzik, K.M., Thompson, L.A., DeWalt, D.A., Revicki, D.A., Shenkman, E.A.
and Huang, I.C., 2013. Exploring factors influencing asthma control and asthma-specific health-
related quality of life among children. Respiratory research, 14(1), p.26.
Guilbert, T.W., Bacharier, L.B. and Fitzpatrick, A.M., 2014. Severe asthma in children. The
Journal of Allergy and Clinical Immunology: In Practice, 2(5), pp.489-500.
Holland, K. and Jenkins, J. eds., 2019. Applying the Roper-Logan-Tierney Model in Practice-E-
Book. Elsevier Health Sciences.
Khan, D.A., 2014, September. Allergic rhinitis and asthma: epidemiology and common
pathophysiology. In Allergy & Asthma Proceedings (Vol. 35, No. 5).
Lalloo, U.G., Ainslie, G.M., Abdool-Gaffar, M.S., Awotedu, A.A., Feldman, C., Greenblatt, M.,
Irusen, E.M., Mash, R., Naidoo, S.S., O'Brien, J. and Otto, W., 2013. Guideline for the

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management of acute asthma in adults: 2013 update-Part 2: March 2013. SAMJ: South African
Medical Journal, 103(3), pp.189-200.
Lim, R. H., Kobzik, L., and Dahl, M. 2010. Risk for asthma in offspring of asthmatic mothers
versus fathers: a meta-analysis. PloS one, 5(4), e10134. doi:10.1371/journal.pone.0010134
Maslan, J. and Mims, J.W., 2014. What is asthma? Pathophysiology, demographics, and health
care costs. Otolaryngologic Clinics of North America, 47(1), pp.13-22.
Maslan, J. and Mims, J.W., 2014. What is asthma? Pathophysiology, demographics, and health
care costs. Otolaryngologic Clinics of North America, 47(1), pp.13-22.
O’Connor, M. and Carey, E., 2017. The role of nurses in supporting people with intellectual
disabilities to manage asthma. Learning Disability Practice, 20(1).
Pinnock, H., 2015. Supported self-management for asthma. Breathe, 11(2), pp.98-109.
Sarkar, M., Niranjan, N. and Banyal, P.K., 2017. Mechanisms of hypoxemia. Lung India:
official organ of Indian Chest Society, 34(1), p.47.
Seys, S.F., Daenen, M., Dilissen, E., Van Thienen, R., Bullens, D.M., Hespel, P. and Dupont,
L.J., 2013. Effects of high altitude and cold air exposure on airway inflammation in patients with
asthma. Thorax, 68(10), pp.906-913.
Silvestri, M., Franchi, S., Pistorio, A., Petecchia, L. and Rusconi, F., 2015. Smoke exposure,
wheezing, and asthma development: A systematic review and meta‐analysis in unselected birth
cohorts. Pediatric pulmonology, 50(4), pp.353-362.