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Health Care Essay: Case Study Analysis of a Patient with Asthma


Patient situation:
Mr Noel Smith a 55-year-old retired mining manager presents to the local Emergency Department with marked dyspnoea and audible wheeze increasing over the past 24 hours. He was diagnosed with asthma 20 years ago.

Mr Smith recently divorced from his wife of 15 years. While he used to be very active socially, he has withdrawn from family and friends since the divorce. He smokes 30 cigarettes a day, consumes 3-4 standard drinks daily and his diet is high in saturated fat and sodium. Mr Smith is independent with daily care and mobility however, he does not exercise routinely.

Mr Smith does not routinely visit his General Practitioner (GP). Over the past 5 years, his episodes of coughing and wheezing have increased. Mr Smith only takes his prescribed medications sporadically or when his symptoms worsen. He acknowledges that he once had an asthma action plan but admits that he does not understand it or has never had it reviewed by his GP. He does not feel that his diet or weight contributes to his asthma and states that exercise only makes him feel “puffed”.

Apply the Clinical Reasoning Cycle in this health care essay to identify and describe how you would assess, intervene and evaluate care for the case study “Mr Noel Smith”.

Part A. Collect cues and recalls knowledge (400 words)

  1. From the provided patient situation and current patient information, identify the relevant patient cues/information and using best available scholarly evidence explain how these relate to asthma pathophysiology.
  2. Analyze the subjective and objective data in the current patient information table and compare normal vs abnormal signs and symptoms. From this comparison provide an interpretation of his overall health status with support from the best available scholarly evidence.

Part B. Identify problems, establish goals, take action and evaluate outcomes (1000 words)

  1. Identify and discuss the acute and chronic problems/issues for Mr Noel Smith. Provide a rational for the identified problems based on the cues/information collected from Part A.
  2. From the chronic problems/ issues identified, outline ONE (1) SMART goal developed in collaboration with Mr Noel Smith. Ensure all the elements: S (specific) M (measurable) A (achievable), R (realistic) T (timely) elements are incorporated.
  3. Identify relevant nursing interventions that will assist Mr Noel Smith in achieving the identified SMART goal. Using the best available scholarly evidence provide a rationale as to why these interventions are appropriate for Mr Smith.
  4. Using best available scholarly evidence, describe the strategies you would use to evaluate the effectiveness of the nursing interventions you identified in Question 3.

Part C. Contemplate/reflect on new learning (400 words)

Critically discuss the role of the nurse in facilitating self-efficacy and self-management for patients (and their families) living with a chronic condition in order to achieve improved health outcomes and quality of life. Use the best available scholarly evidence to support your discussion.


Part -A

Information regarding Asthma
Through the provided scenario of Mr. Noel Smith, it is discovered that he is a patient of asthma, and effective information needs to be evaluated through which it can be understood what type of asthma pathophysiology are the reason for his attack. An asthma attack can occur through the exposure of asthma triggers and different triggers are there through which a person can be the victim of the attack (Gruber et al, 2016). It even needs to be remembered that the triggers cannot be the same for everyone as environmental aspects are different for every people. In the case of Mr. Noel Smith, there are some important data from where it gets cleared that tobacco smoke is an important aspect of his Asthma attack. Tobacco smoke is unhealthy for every people especially for those who are having asthma. It is evident from the case study that Mr. Noel has a regular habit of smoking with the largest amount which consists of 30 cigarettes per day. Further outdoor air pollution even can trigger an asthma attack. Through the case study, it has confirmed that he was a mining manager and thereby it is an easy understanding to note that he is much exposed to outer environmental pollution (Strzelak et al, 2018).Apart from these two main aspects some other aspects are also accustomed or interlinked with his condition where colds,RSV(respiratory sanctity virus) even can be effective for triggering an asthma attack.

The triggering aspects can further facilitate normal and abnormal symptoms of Asthma for Mr. Smith where it has observed that early symptoms of asthma can have a cough, shortness of breath, weak wheezing or coughing, etc (Taghavi, Ghasemi, &Goodarzi, 2017). On a specific concern, it can be said that muscles surrounding the band blocking the airways trigger to tighten which is called bronchospasm. During the attack, the Airways lining gets swollen and inflamed and produces thick mucus comparing to the normal. The issue finally creates a problem for breathing, coughing,wheezing, shortness of breath, etc. Severity in the condition can be abnormal asthma symptoms with two aspects for the case of Mr. Smith. It is found that he is having issues with rapid breathing, fatigue, difficulty in sleeping;wheezing which is audible, and most importantly his reluctance to exercise properly as the strength of the body gets affected through the asthma attack and do not help him for further exaggeration through any sort of exercise (Goncalves et al, 2016).

Part - B

Chronic problem with the rationale
The case study of Mr. Smith has confirmed that he is a patient of asthma for 20 years and thus he becomes a patient of chronic and acute asthma. The symptoms of asthma attack even facilitated the same concern as he is having increasing issues with audible wheezing, coughing, and shortness of breath, and chest tightness. It is even observed through the case study that in last 24 hours Mr. Smith has deteriorated and facilitates difficulties in the ability to breathing followed by decreased lung function (Ohta et al, 2020). The chronic and acute asthma of Mr. Noel Smith even confirms that he confined himself in his room and left socializing whereas previously he was a much social person. The chronic issue of asthma even describes the difficulty in speaking which might be a serious concern for Mr. Noel Smith and thus it can be understood that he needs immediate medical care. Hislifestyle like having a smoke, drinking, and an unhealthy diet influences his chronic conditions. The referred symptoms show all the information of the case study is considered as a chronic issue as it stays more than 20 years for him and research facilitates more than 3 months of disease longing can be referred as chronic as per the findings of the US National Centre for Health Statistics. Further, chronic disease cannot be prevented whether only control through proper medication and clear planning are the concerns for Mr. Smith to treat her asthma. The most important consideration in this regard has been offered by World Health Organization which states that a chronic disease cannot be passed from person to person and mostly having a long duration with slow progression (Saxby et al, 2019). All the issues of Mr. Smith prove the fact that it is a long recovery process with slow progression.

Smart goal for Mr. Smith

Specific- in order to offer recovery for Smith, it is important to objectify goals for the care plan where active along with maintaining symptomcontrol needs to be facilitated.

Measurable- everyday normal activity level needs to be measured to check the improvement where exercise even needs to be implemented. Through the case study, it has been seen that Mr. Smith is not interested in any sort of activity and much reluctant towards exercise. However for better recovery, it is important to check whether he is maintaining an effective activity level and doing exercise regularly (Gionfriddo, Hagan, & Rank, 2017).

Attainable- It is important to maintain pulmonary function as much as possible to align it at a normal level.

Relevant- For a patient like Mr. Smith it is important to prevent exacerbations of asthma to improve condition towards betterment. A further adverse effect, unhealthy diet, and smoking even need to be eliminated from his daily routine to objectify a better care plan.

Time - as it is already stated that chronic diseases like asthma have slow progression and cannot be recovered entirely thereby it is a time-consuming factor however the increased difficulties of Mr. Smith can effectively be addressed through the proper care plan in less timing (Warren et al, 2016).

Intervention plan
For a patient like Mr. Smith nursing intervention objectifies the referred smart goal by offering the utmost care plan. In order to facilitate the concern nurses can perform certain intervention which finally sustains the goals for offering betterment to the patient as well as decrease the suffering level for the patient.

Assess history- to offer a customized better care plan for Mr. Smith the nurse needs to assess his history or medical reports. The concern is important for two reasons - for understanding the patient condition as well as history two objectives of the care plan and through the history, it can even be understood if Mr. Smith has an allergic reaction to any medication before designing the care plan (Parikh, Keller, & Ralston 2018).

Assess respiratory status- in the smart goal it has stated that maintaining regular checkups for the patient is important and for the referred concern throughout observation it is important to check respiratory status as symptoms of acute serious asthma can be observed through respiratory status, breathing problem and chest tightness.

Assess medication- it is stated that chronic disease asthma cannot be recovered rather intervention needs to objectify betterment for the patient like Mr. Smith. In the entire process, proper medication for the patient is important. A nurse plays the role of observing patients' responses to the given medication to understand whether it is apt for his health or needs to be changed. In order to objectify underlying respiratory infection antibiotics even can be included in the medication.

Pharmacology therapy- in the pharmacologic therapy section it has been observed that if the prescribed medications are serving the purpose followed by the betterment of the patient. In the therapeutic session, it has even been observed if the medication needs to be supported with certain activities or exercises as for opening betterment to a chronic patient like Mr. Smith, it is important to have certain activity levels.

Fluid therapy- observing fluid for the patient is even important as prevention is the main object for the intervention of Mr. Smith where dehydrating states through a fluid can better serve the purpose (Pappalardo et al, 2019).

The care plan needs to be evaluated to understand the type of plan. For successful evaluation of intervention needs to be incorporated by the nurse where Airway patency maintenance needs to be checked as a breathing problem can be caused through this (Ludden et al, 2019). It even needs to be observed that clearance or expected action of secretions if properly working. Through the reduced or absent sound of breathing, improved oxygen exchange, and noiseless respiration it can be understood that the care plan is serving its purpose. Verbal understanding regarding the therapeutic management regiment and its causes can even offer proper findings for the care plan. Behavioral change of the patient can even state improvement or clearway maintenance through the effectiveness of the care plan (Ebrahim, Soliman, &Mohamed, 2020). Corrective and preventive action obtained by the nurse can even offer significant findings for the efficacy of the care plan as these two actions as per the stated goals can offer betterment in the condition of the patient Mr. Smith in less timing.

Part - C
In order to make the care plan, successful prevention is more important than a cure for which Mr. Smith needs to be the self-efficient and self-managed person for his acute chronic disease asthma. The nurse must make the patient effective enough for self-efficacy along with self-management where he can be taken care of himself as he does not have anyone for taking care of him (Vas et al, 2017). A nurse needs to obtain a collaborative approach to make the patient understand regarding complete therapy of treating asthma in his home to maintain the care plan implemented by the nurse. In this concern, health education is even important as through this the patient can understand complications or normal conditions regarding his health. Thereby a nurse needs to be the teacher for Mr. Smith to teach him health education where he would come to know all the associated factors for asthma and treatment procedure. Offering motivation to the patient is most important for a nurse as it is evident that chronic diseases like asthma cannot be cured rather can only be improved condition. keeping this concern in the mind it is the responsibility of the nurse to make the patient motivated to lead his normal life or to back to his normal life as the case study shows that he becomes unsocial day by day and is not showing any interest in physical activities with is not a good concern for a treatment plan. Through the intervention plan to make himself-managed and self-effective to take care of him, he needs to be understood the importance of leading normal life leaving an unhealthy diet, habit of smoking, and other bad habits to maintain the improved condition followed by betterment further. The referred concern can only be objectified through effectiveness by the ability to impress patients (Hooft et al, 2017). The concerned further facilitate that effective communication on the part of a nurse is the most important as well as leadership quality needs to be there for a nurse in his behavior to lead the patient towards betterment.

Ebrahim, N. G., Soliman, N., & Mohamed, O. (2020).Nursing interventions for School Age Children with Bronchial Asthma in a Rural Area.Egyptian Journal of Health Care, 11(3), 196-207.

Gionfriddo, M. R., Hagan, J. B., & Rank, M. A. (2017). Why and how to step down chronic asthma drugs. Bmj, 359, j4438.

Goncalves, C., Wandalsen, G., Lanza, F., Goulart, A. L., Solé, D., & Dos Santos, A. (2016).Repercussions of preterm birth on symptoms of asthma, allergic diseases and pulmonary function, 6–14 years later. Allergologiaetimmunopathologia, 44(6), 489-496.

Gruber, K. J., McKee-Huger, B., Richard, A., Byerly, B., Raczkowski, J. L., & Wall, T. C. (2016). Removing asthma triggers and improving children's health: The Asthma Partnership Demonstration project. Annals of Allergy, Asthma & Immunology, 116(5), 408-414.

Ludden, T., Shade, L., Reeves, K., Welch, M., Taylor, Y. J., Mohanan, S., ...& Dolor, R. J. (2019). Asthma dissemination around patient-centered treatments in North Carolina (ADAPT-NC): a cluster randomized control trial evaluating dissemination of an evidence-based shared decision-making intervention for asthma management. Journal of Asthma, 56(10), 1087-1098.

Ohta, N., Suzuki, Y., Ikeda, H., Noguchi, N., Kakuta, R., Suzuki, T., ...& Ishida, Y. (2020). Efficacy of endoscopic sinus surgery for eosinophilic chronic rhinosinusitis with asthma. Allergology International, 69(1), 144-145.

Pappalardo, A. A., Paulson, A., Bruscato, R., Thomas, L., Minier, M., & Martin, M. A. (2019). Chicago Public School nurses examine barriers to school asthma care coordination. Public Health Nursing, 36(1), 36-44.

Parikh, K., Keller, S., & Ralston, S. (2018). Inpatient quality improvement interventions for asthma: a meta-analysis. Pediatrics, 141(5), e20173334.

Saxby, N., Beggs, S., Battersby, M., & Lawn, S. (2019). What are the components of effective chronic condition self-management education interventions for children with asthma, cystic fibrosis, and diabetes? A systematic review. Patient Education and Counseling, 102(4), 607-622.

Strzelak, A., Ratajczak, A., Adamiec, A., &Feleszko, W. (2018). Tobacco smoke induces and alters immune responses in the lung triggering inflammation, allergy, asthma and other lung diseases: a mechanistic review. International journal of environmental research and public health, 15(5), 1033.

Taghavi, M., Ghasemi, R., &Goodarzi, M. (2017).The effectiveness of mindfulness-based cognitive therapy (MBCT) on Depression, Anxiety and Somatic Symptoms in Asthma patients.Razi Journal of Medical Sciences, 24(154), 27-36.

vanHooft, S. M., Been?Dahmen, J. M., Ista, E., van Staa, A., &Boeije, H. R. (2017). A realist review: What do nurse?led self?management interventions achieve for outpatients with a chronic condition?.Journal of Advanced Nursing, 73(6), 1255-1271.

Vas, A., Devi, E. S., Vidyasagar, S., Acharya, R., Rau, N. R., George, A., ...& Nayak, B. (2017). Effectiveness of self?management programmes in diabetes management: A systematic review. International journal of nursing practice, 23(5), e12571.

Warren, C. M., Dyer, A., Blumenstock, J., & Gupta, R. S. (2016). Leveraging mobile technology in a school-based participatory asthma intervention: Findings from the Student Media-Based Asthma Research Team (SMART) study. American Journal of Health Education, 47(2), 59-70.


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