Nursing Assignment: Medical Care For Asthma Patient

Question

Task:
Nursing Assignment Case Scenario:
Jill is 18-year-old female who has presented to the A& E department complaining of shortness of breath (SOB), chest tightness, cough. It is a cool evening, and Jill was playing hockey on an out-door field when these symptoms first started. She states that she had an Upper Respiratory Tract Infection (URTI) two weeks ago. Jill has a history of Asthma but has not had an Asthma attack in about 12 months.

Current medications: Seretide inhaler and Ventolin inhaler (admits that she does not use her Seretide inhaler regularly, maybe a few times a week)

Objective data

• RR – 22bpm
• HR – 105bpm
• BP – 128/84mmHg
• T – 37.9°C
• SpO2 – 95%RA

Subjective data
Jill appears anxious and is unable to speak in full sentences.

Part 1 (400 words) – Discuss the pathophysiology of Asthma and link this with Jill’s current clinical manifestations. Your answer must be supported by relevant evidence-based literature.

Part 2 (400 words) – Discuss some abnormal findings you might identify when performing a focused Respiratory Assessment on Jill. Give a brief rationale for each. Your answer must be supported by relevant evidence-based literature.

• Inspection
• Palpation
• Percussion
• Auscultation

Part 3 (400 words) – Discuss three investigations/diagnostic tests that might be used to assist in the assessment of Jill’s condition? Write a rationale for the use of each, and what results/findings you might expect for Jill? Your answer must be supported by relevant evidence-based literature.

Answer

Answer 1:
The case study examined herein nursing assignment is focused on “Asthma” which is demarcated as a clinical condition during which the airways start producing mucus followed by narrowing and swelling of the airways. According to Gans and Gavrilova, (2020), it increases breathing difficulty causing shortness of breathing, whistling or wheezing sound, chest tightness. The above-mentioned clinical manifestation is also observed in the case of Jill. From the case study, it can be noted that Jill has been admitted to the A and E department with a complaint of shortness of breathing, cough, and chest tightness, which indicated that she might have a reoccurrence of asthma.

According to King et al., (2018), during an asthma attack, airways that are inflamed when comes in contact with environmental triggers such as pollen, dust, and smoke or some time cold environment initiates the asthma response leading to inflammation, airflow obstruction, bronchial hyperresponsiveness. In this case, it has been noted that Jill was playing outside in cold weather, hence it might happen that she got an asthma attack due to the cold environmental factor. Further, these inflammatory cells not only narrow the airways but also sometimes tighten or block the airways make the person's breathing sound like wheezing.

Apart from the above mentioned, upper respiratory infection also sometimes trigger asthma response by narrowing and swelling the airways. In the case of Jill also it has been noted that she has an episode of upper respiratory infection which might be the cause for the clinical manifestation observed (Saglani & Menzie-Gow, 2019). It is known that due to narrowing of the airways, oxygen delivery is reduced which increases the heart rate (Observed Heart rate: 105bpm, optimal level: 60-100), respiratory rate (observed rate: 22bpm, Optimal level: 12-18 bpm) and as the body starts trying to fill the oxygen demand of the lungs. It increases the shortness of breathing which eventually decreases the passage of the airway inside the lungs leading to chest tightens observed in the case of Jill. As the lungs are unable to pull out the adequate amount of oxygen required for the proper functioning of the body, blood pressure (observed BP: 128/84, optimal level: 120/80) of the individual increases which is also observed in the case of Jill.

Jill is also experiencing anxiety which is making her speech blur and also as per Dehdar et al. (2019) anxiety also induces the asthma attack by narrowing and causing inflammation. Besides, as per the case study, she has also taking Seretide inhaler irregularly which might be another reason for asthma episodes.

Answer 2:
As in the above-mentioned case of Jill, she is suffering from breathing issues, chest tightness, and other symptoms of respiratory infection, it is important to do a respiratory test. Here it is done with the help of four common techniques, Inspection, Palpation, Percussion, and Auscultation.

Inspection: Here the complete body system of the Jill is assessed based on color, size, hearing, movement, speech, symmetry, and others. As Jill is facing respiratory complications, a barrel chest can be observed which is assessed by tapping the chest with the fingers. Besides, as she is also facing chest tightness, there is an increase in the AP diameter should be assessed which will show asymmetry chest expansion (Manzar, 2020). Breathing complication is also responsible for their inability to speak due to lack of oxygen and also her oxygen level is 95%. She has also pursed lips due to heavy breathing and enhanced intercessory muscles.

Palpation: while assessing Jill as per this, decreased air movement can be noticed which is due to the reduced bilateral symmetry wall of the anterior wall. She might be also facing a reduction in vocal fremitus which is caused when the lung density is reduced due to asthma. It leads to palpation to the posterior chest wall causing chest expansion.

Percussion: Percussion is done by tapping the hands and fingers quickly into different parts of the body. It is done to locate the organ shape and size. Besides, it also helps in determining the position of the organ in order to evaluate whether there is fluid or gas in the body. During percussion of the posterior and anterior chest wall, Jill might produce lower-pitched, dull, and fluids sounds in the lungs which are known as hyper resonance (Grygus, 2017). The diaphragmatic excursion might give increased thoracic movement due to difficulty in breathing. Inferior displacement of the thoracic diaphragm might be observed due to hyperinflation.

Auscultation: During auscultating, wheezing can be observed due to the inflammation of the bi- basal lobes. In Jill decreased AE is observed due to the shortness of breathing and lack of oxygen. This step of the respiratory assessment also might give the result with prolonged expiratory phase as during asthma (Xavier et al., 2019). The accessory muscles are required to push air out which creates turbulence of airflow. Besides, forced expiration can be observed with a bell on the trachea due to chest expansion.

Answer 3:
Diagnostic tests or medical assessment is the procedure done to evaluate the severity of the condition patient is experiencing. Considering the condition of Jill, it can be stated that there are a number of diagnostic tests that will help to exactly evaluate the condition. These tests are:

1. Peak flow: One of the most simplest and common tests for a test or can also be said as a maintaining device for those suffering from asthma. This can be easily done with the help of a device named Peak Flowmeter. It helps in monitoring the security of asthma and whether the patient needs any asthma care plan (Gulla & Kabra, 2017). As in the case of Jill, she has all the symptoms of having asthma, this rest will be beneficial. The normal of the patent should be decided based on age and height. As she has already symptoms of asthma, her rate might be less than 400-700 liters per minute which is a normal peak flow rate for 18 years old.
2. Spirometry: Spirometry is a process, where the movement of oxygen from and into the lungs. It is usually done at the doctor's office, where how quickly and how much oxygen the lungs and the airways can exchange (Cottee et al., 2020). As in the case of Jill, the presence of oxygen is less causing chest tightness, the expected result should be analyzed in terms of FVC (Forced vital capacity), which might be lower than the optimal level. The optimal level of the FVC in the individual with age between 5-18 years (Jill’age is 18 years) should be 80%. Lower than 80% represents the low exchange of oxygen to the lungs which might be the expected result in the case of Jill.
3. Chest x-ray: As wheezing is observed in the case of Jill, a chest X-ray is necessary. It will help to evaluate the severity of lung infection if an. Apart from wheezing, Jill is also experiencing chest tightness, there is a chance that the test result of chest X-ray might show hyper-expansion and air trapping.
4. Arterial blood testing: This is a diagnostic procedure where the arterial blood sample is taken and tested in order to assess the amount of oxygen in the arterial blood which will eventually assist in assessing the oxygen exchange rate between the blood and lungs (Castro, Patil & Keenaghan, 2021). As in the case of Jill, the rate of absorption of oxygen is low, which indicates that she might be suffering from respiratory acidosis.

Reference:
Castro, D., Patil, S. M., & Keenaghan, M. (2021). Arterial Blood Gas. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK536919/

Cottee, A. M., Seccombe, L. M., Thamrin, C., King, G. G., Peters, M. J., & Farah, C. S. (2020). Bronchodilator response assessed by the forced oscillation technique identifies poor asthma control with greater sensitivity than spirometry. Chest, 157(6), 1435-1441. https://doi.org/10.1016/j.chest.2019.12.035

Dehdar, K., Mahdidoust, S., Salimi, M., Gholami-Mahtaj, L., Nazari, M., Mohammadi, S., ... & Raoufy, M. R. (2019). Allergen-induced anxiety-like behavior is associated with disruption of medial prefrontal cortex-amygdala circuit. Scientific reports, 9(1), 1-13. Retrieved from: https://www.nature.com/articles/s41598-019-55539-3

Gans, M. D., & Gavrilova, T. (2020). Understanding the immunology of asthma: pathophysiology, biomarkers, and treatments for asthma endotypes. Paediatric respiratory reviews, 36, 118-127. https://doi.org/10.1016/j.prrv.2019.08.002

Grygus, I. (2017). The role of physical activity in the rehabilitation of patients suffering from mild persistent bronchial asthma. Physical education, sport and health culture in modern society, (2 (38)), 140-150. https://doi.org/10.29038/2220-7481-2017-02-140-150

Gulla, K. M., & Kabra, S. K. (2017). Peak expiratory flow rate as a monitoring tool in asthma. The Indian Journal of Pediatrics, 84(8), 573-574. https://doi.org/10.1007/s12098-017-2398-x

King, G. G., James, A., Harkness, L., & Wark, P. A. (2018). Pathophysiology of severe asthma: We’ve only just started. Respirology, 23(3), 262-271. Retrieved from: https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.13251

Manzar, S. (2020). Inspection, palpation, percussion, and auscultation versus location, B-mode, M-mode, and Doppler. Pediatrics & Neonatology, 61(6), 671.https://doi.org/10.1016/j.pedneo.2020.08.003

Saglani, S., & Menzie-Gow, A. N. (2019). Approaches to asthma diagnosis in children and adults. Frontiers in pediatrics, 7, 148. https://doi.org/10.3389/fped.2019.00148

Xavier, G., Melo-Silva, C. A., Santos, C. E. V. G. D., & Amado, V. M. (2019). Accuracy of chest auscultation in detecting abnormal respiratory mechanics in the immediate postoperative period after cardiac surgery. Jornal Brasileiro de Pneumologia, 45(5). https://doi.org/10.1590/1806-3713/e20180032