Acute Life-Threatening and Traumatic Complex Health Condition Assignment Sample

Subject Name : Nursing

Case Study: Poppy

Question 1. The clinical manifestations with which a 9-year-old Poppy presented in the emergency department were that she was not able to undertake a peak flow. She was not able to speak in full sentences and her chest X-ray showed hyperinflation in both the lung fields. She has significant deteriorating respiratory function on her arrival to ED and there was a diagnosis of acute exacerbation of asthma. She has a medical history of asthma diagnosed when she was two years old and on nursing assessment, the abnormal vital signs were assessed. Hypoxia is a condition that developed in people with asthma because of an inadequate amount of oxygen supply to the body parts including tissues.

This is the main reason for various clinical manifestations like breathlessness and increased respiratory rate. In this condition, there is a mismatch of V/Q that further causes narrowing of the airways (Russell & Brightling, 2017). This increases the work of breathing in a patient as a result of which the patient put in extra efforts to breathe. This is characterized by an increased respiratory rate and heart rate. Asthma is a chronic condition in which there is a narrowing of the airways and the airways inflammation causes the airflow limitation thus increased work of breathing. This is a result of bronchial smooth muscle contraction (bronchoconstriction) that is actually because of an IgE- dependent release of the mediators like prostaglandins, histamine and leukotrienes.

This causes airflow obstruction which is also caused because of the hyperinflated lungs. The clinical manifestations of cough, wheeze and the most common symptom that is shortness of breath due to bronchial inflammation and the obstruction in the air that passes through airways. The airway inflammation is also due to lymphocytes that overproduces IgE and eosinophils and this causes airway hyperresponsiveness (Gon & Hashimoto, 2018). Hypoxia is caused due to the flow of non- oxygenated blood and this has a huge impact on the lungs also. This non- oxygenated blood is also delivered to the body parts but this inadequate supply of oxygen leads to the clinical manifestations in the patients with asthma.

Wheezing is also the common manifestation that happens due to mucous and constriction that is present in the airways and the inability of these narrowed airways to expel the air. The nursing assessment details of the patient show low magnesium levels in the patient that states impaired lung function because as per the study conducted, the low dietary magnesium intake is strongly associated with the high risk of wheezing and impaired lung function (Izuhara et al., 2017). This is the reason that magnesium sulfate is also used as a bronchodilator for the treatment of asthma. The clinical manifestations of increased heart rate and increased respiratory rate are due to a patient experiencing difficulty in breathing.

They require accessory muscles which compensates the difficulty of breathing and retractions of the chest wall adjacent to the ribs is also common. The narrowed airways are responsible for increased work of breathing, ventilation-perfusion imbalance and hyperinflated lungs (Eddy et al., 2019). Acute asthma exacerbations are associated with cough, shortness of breath and wheezing. This is an inflammatory disease that mainly takes place in the airways that are known to be affecting the individual due to the wide range of cellular- and cytokine-mediated mechanisms of tissue injuries.

Question 2. (a) Fowler's position is the position in which a patient is made to sit in the angles between 30 degrees to 90 degrees that make the patient feel comfortable. This position alleviates the compression of the chest of the patient that takes place due to gravity (Sekiguchi et al., 2019). This technique of position is best to be used in children with respiratory distress. It is a position of sitting upright during eating as it would help the patient in carrying out normal breathing process. This nursing strategy is highly effective in helping the patient alleviating respiratory rate and heart rate symptoms. In complete Fowler's position the patient is made to sit in an upright position that is 90 degrees and in semi- Flower's position, the patient is made to sit in 30- 45-degree angle position (Maria & Hasaini, 2019). This is highly effective in making the patient comfortable and to make the patient breathe normally.

Question 2. (b) The second nursing strategy for the management of the patient Poppy's condition is the administration of oxygen therapy. The patient will be administered oxygen 6L because the condition is serious using Hudson mask. This is one of the best equipment used for the administration of oxygen because this allows the delivery of the desired concentration in an effective manner (Adetunji et al., 2017). This nursing strategy will also help in achieving the standard oxygen saturation rate that is 92% that will improve the condition of the patient. The Hudson mask is the first choice for delivery of oxygen to the patient. The Hudson masks deliver oxygen concentrations up to 60% and it helps in maintaining a targeted SpO2 level in the children with asthma (Millette et al., 2018).

Question 3. The medications of Poppy are:

Salbutamol via nebulizer: This medicine is generally the first medicine given to the patients with the complications of asthma. This is a selective beta- 2 receptor stimulant that works on the bronchial smooth muscles. This is given to Poppy through nebulizer that is inhaled route of administration. This route of administration is the most effective method of administration because this method facilitates the direct stimulation of beta- 2 receptors in the bronchial smooth muscles and this works as one of the best bronchodilators (Gaugg et al., 2017). The initiation of the release of calcium ions takes place in which adenyl cyclase is stimulated which in turn increase the levels of cAMP.

Many compounds are known to obstruct the smooth breathing process and salbutamol helps in inhibiting the release of these compounds. The production of intracellular cyclic adenosine monophosphate (cAMP) is facilitated by salbutamol that increases the binding of the intracellular calcium to the cell membrane. The relaxation of smooth muscles of the lungs and airways is achieved due to this action of salbutamol that decreases calcium concentration within the cells (Honmane et al., 2019). It is used to treat bronchospasm. The nursing consideration will be the route of administration and expected outcome will be an improvement in respiratory rate and breathlessness. The nurse will monitor the vital signs of the patient.

Hydrocortisone IV: this is a corticosteroid that decreases the mucus secretion by facilitating the inhibition of the release of secretagogue from macrophages (Prodanovic et al., 2018). This is anti-inflammatory medicine in which corticosteroid inhibits the late phase reaction by inhibiting the inflammatory responses and also interfering with chemotaxis (Barnes, 2019). It is effective in asthma patients and is administered to Poppy for her clinical manifestation and exacerbations of acute asthma. The nursing consideration will be the route of administration and the concentration of this medicine. The nurse will keep monitoring the vital signs like blood pressure and heart rate and the improvements will be noted. The desired outcomes include improvement in the condition of asthma and vitals like respiratory rate.

Ipratropium Bromide via nebulizer: This is an anticholinergic (parasympatholytic) agents that facilitate the blockage of muscarinic receptor of acetylcholine. This relaxes the muscles around the airways and this has a direct impact on improving the work of breathing (Kola, Hacioglu, Erdol & Turk, 2018). The desired outcome is an improvement in the condition of asthma and it will improve the clinical manifestations of wheezing and shortness of breath. The nursing considerations are the doses and route of administration. The nurse will monitor the vital signs so that improvements and any abnormal values can be noted and immediate action can be taken.

References

Adetunji, S. A., Adekola, O. O., Desalu, I., & Kushimo, O. T. (2017). Management of early postoperative hypoxemia: a comparative performance of Hudson face mask with nasal prongs. Ain-Shams Journal of Anaesthesiology, 10(1), 84.

Barnes, P. J. (2019). Pharmacology of asthma and COPD. ERS Handbook of Respiratory Medicine, 344.

Eddy, R., McCormack, D. G., Kirby, M., & Parraga, G. (2019). CT Airway Count as a Biomarker of Asthma Pathogenesis: Severe Asthma and ACOS in Never-Smokers. C108. COPD: Phenotype, Mechanism, And Treatment, A5769-A5769.

Gaugg, M. T., Engler, A., Nussbaumer-Ochsner, Y., Bregy, L., Stöberl, A. S., Gaisl, T., ... & Sinues, P. M. L. (2017). Metabolic effects of inhaled salbutamol determined by exhaled breath analysis. Journal of Breath Research, 11(4), 046004.

Gon, Y., & Hashimoto, S. (2018). Role of airway epithelial barrier dysfunction in pathogenesis of asthma. Allergology International, 67(1), 12-17.

Honmane, S., Hajare, A., More, H., Osmani, R. A. M., & Salunkhe, S. (2019). Lung delivery of nanoliposomal salbutamol sulfate dry powder inhalation for facilitated asthma therapy. Journal of Liposome Research, 29(4), 332-342.

Izuhara, K., Suzuki, S., Ogawa, M., Nunomura, S., Nanri, Y., Mitamura, Y., & Yoshihara, T. (2017). The significance of hypothiocyanite production via the pendrin/DUOX/peroxidase pathway in the pathogenesis of asthma. Oxidative Medicine and Cellular Longevity, 2017.

Kola, M., Hacıoğlu, D., Erdöl, H., & Türk, A. (2018). Bilateral acute angle closure developing due to use of ipratropium bromide and salbutamol. International Ophthalmology, 38(1), 385-388.

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.

Millette, B. H., Athanassoglou, V., & Patel, A. (2018). High flow nasal oxygen therapy in adult anaesthesia. Trends in Anaesthesia and Critical Care, 18, 29-33.

Prodanovic, D., Keenan, C. R., Langenbach, S., Li, M., Chen, Q., Lew, M. J., & Stewart, A. G. (2018). Cortisol limits selected actions of synthetic glucocorticoids in the airway epithelium. The FASEB Journal, 32(3), 1692-1704.

Russell, R. J., & Brightling, C. (2017). Pathogenesis of asthma: implications for precision medicine. Clinical Science, 131(14), 1723-1735.

Sekiguchi, H., Kondo, Y., Fukuda, T., Hanashiro, K., Baba, M., Sato, Y., ... & Matumoto, T. (2019). Noninvasive positive pressure ventilation for treating acute asthmatic attacks in three pregnant women with dyspnea and hypoxemia. Clinical Case Reports, 7(5), 881.