Fight for Freedom in Georgia - Nursing Assignment Sample

Acute Life-Threatening And Traumatic Complex Health Condition

Question 1

Asthma is a severe airway disorder that is features by recurring and variable symptoms, the increased responsiveness of the bronchial, the airway obstruction and some inflammation. The airway encounters reduced airflow which happens frequently and such may be due to various transformations in the airway (Russell & Brightling, 2017). One could encounter the bronchoconstriction which narrows the air pathways as a response to one being exposed to irritants. The airway can also get increased responsiveness which can be caused by several factors. The factors include inflammation, the malfunctioning of the control of neurogen, and some changes to the body structures.

Airway edema can occur when asthma continues and the inflammation of the airways progresses which reduces the flow of air. Mucus can also be secreted in large amounts and the changes to structures like hyperplasia of the smooth muscles of the airway. The people who get asthma can get less reversal of their airways since the structural changes that occur may be permanent. The associated changes in the structures are associated with the loss of the functioning of the lungs that cannot be controlled by the existing therapy. Airway remodeling involves the activation of the structural cells with the aim of increasing the airflow and the airway responsiveness.

Question 2

The high Fowler’s position is useful in an asthmatic patient since it reduces the respiratory distress. The position is achieved through inclining the backrest of the bes upwards with flexed or straight knees. The position is frequently used to evaluate the hemodynamics and enhance the breathing and also the carrying out of various everyday activities like eating and talking (Maria & Hasaini, 2019). The position increases the upper torso flexion and this in turn increases the cardiovagal regulation.

2. In asthmatic patients, high concentrations of inspired oxygen is required. Therefore, when the high-flow oxygen is given, it is important to ensure that the high-flow masks like the MC masks are utilized to get the necessary concentration of the inspired oxygen to the patient (Ballestero et al, 2018). The oxygen therapy is necessary for the acute asthmatic patients to accomplish the oxygen saturations of at least 92 percent. The emergency guidelines however recommend a range between 94 and 98 percentage for whichever the situation. The oxygen therapy may also be administered through the canula even though patients with dyspnea often do not want the masks. The oxygen therapy may be simply titrated to sustain the oxygen delivered to the patient in the required percentage. If at all hypoxemia happens, the non-breathing masks are usually utilized to deliver a higher percentage of oxygen of up to 98 percent. The tracheal intubation can also be done combined with mechanical ventilation if the respiratory function completely fails.

The High-flow nasal canula oxygen therapy is useful in delivering up to 60L/min of oxygen through the nasal cannula. The device has multiple advantages which include the humidification and heating of he inspired oxygen and this reduces the mucosal damage and raises the content of water in the mucous secretions hence its simple to clear secretions. The other benefit is the increases in the high flow rates. Also, the room air is minimally entrained and the dead space on oropharyngeal is washed away. The other advantage is the enhancement of comfort using the pliable nasal prongs. Many patients usually manage well with the High-flow nasal cannula and can therefore manage to speak, sleep well and eat comfortably.

Oxygen therapy is very beneficial to the people who encounter the low oxygen states despite the reason. When necessary, the use of oxygen therapy enables individuals to become more active and mobile through reducing the breathing problems. The oxygen therapy can ensure that one gets good quality life and in most cases it increases their life expectancy. Oxygen therapy may also decrease the symptoms like fatigue, headaches, swollen ankles and irritability. Oxygen therapy is useful for growth and development of the children with lung conditions. In our case study, it was necessary to put Poppy under oxygen therapy to help in their growth.

The process also would help the patient to eliminate symptoms such as headaches that arise due to the low levels of oxygen and other behavioral challenges and problems. Poppy is asthmatic and the airways may be blocked therefore reducing the air that he breathes and the situation could worsen hence causing breathlessness. In some cases, people may encounter the reduction in the functioning of the lungs with time and this makes them to struggle to have sufficient oxygen supplied to them. Frequent oxygen therapy may enhance the quality and the life span of people struggling with breathing problems.

Question 3

Salbutamol

The mechanism of action is through the formation of the intracellular cyclic adenosine monophosphate which promotes the binding of intracellular calcium to cell membrane (Salbutamol et al, 2019). The action lowers the calcium concentration in the cells and this ends in the relaxation of smooth muscles and bronchodilation.

Poppy was given Salbutamol to reduce symptoms of asthma and others like breathlessness, wheezing and coughing. The medication works through relaxation of the muscles in the airways of the lungs and this increases the breathing by the patient.

The nursing assessment when giving Salbutamol include getting the blood pressure, the heart rates and checking for lung sounds.

The clinical response is the dilation of the airways.

The clinical observations include checking the blood pressure, the heart rate.

Hydrocortisone

The mechanism of action of hydrocortisone is the production of the natural hormone corticosteroids. The hormone has the ability for anti-inflammatory actions and the suppression of the immune response (Wang et al, 2018). The hydrocortisone helps in upregulating receptors, decreases microvascular permeability and reduces the secretion of mucus. The steroids are thought to function through binding a glucocorticoid receptors and it in turn activates and gets attached to the cell nucleus.

The pathologic characteristic of asthma is the inflammation of the bronchial airways. The hydrocortisone helps in reducing inflammation hence can help in treating asthma condition.

The nursing consideration include advising the patient on the fact that corticosteroids cause immunosuppression and may cause symptoms of infection. The patient should be instructed to be avoid people who may be having a contagious disease and any possible infection should be report immediately. In case a patient is under a long duration treatment, they should consult the physician before they stop their medication.

The clinical response expected is the reduced vasodilation and permeability of capillaries, protein catabolism, renal excretion of calcium and stability of the capillary walls.

The clinical observations when administering hydrocortisone include checking for any warning signs of under-replacement when one is sick.

Ipratropium Bromide

The mechanism of action of Ipratropium bromide prevents the muscarinic receptors of acetylcholine. The drug prevents vagally mediated reflexes through antagonizing the process of acetylcholine and the transmitter agent is produced from the vagus nerve (Kola et al, 2018).

Ipratropium bromide is important in an asthmatic patient causes the dilation of the airways in the lungs.

The nursing consideration includes advising the patient not to go beyond the prescribed doses of the drug. The patient should rinse their mouths after using each inhaler. They should also have drinks frequently and also utilize the sugar-free gum which is useful in a dry mouth.

The clinical response expected is bronchodilation.

The clinical observations that should be checked is the rate of breathing by the patient. The other observation is the toxicity of the drug such as dyspnea, throat irritation, dry mouth, headaches, cough and any gastro-intestinal motility disorders like vomiting, constipation, diarrhea and dizziness. The airway should be observed for dilation.

References

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

Ballestero, Y., De Pedro, J., Portillo, N., Martinez-Mugica, O., Arana-Arri, E., & Benito, J. (2018). Pilot clinical trial of high-flow oxygen therapy in children with asthma in the emergency service. The Journal of pediatrics, 194, 204-210.

Moore, L. E., Kapoor, K., Byers, B. W., Brotto, A. R., Ghods-Esfahani, D., Henry, S. L., ... & Stickland, M. K. (2019). Acute effects of salbutamol on systemic vascular function in people with asthma. Respiratory medicine, 155, 133-140.

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.

Kola, M., HacıoÄŸlu, 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.

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