Asthma which comes from a Greek word meaning panting has been shown to be a common and chronic inflammatory disease that affects the airways. The major characteristics of the disorder include “variable and recurring symptoms, reversible airflow obstruction, and bronchospasm” (Abramson, 2005: 24). The major symptoms “wheezing, coughing, chest tightness, and shortness of breath” (Wilkins et al., 2005: 32) It is worth noting that the disease is classified based on how frequent the symptoms persist, forced expiratory volume per second as well as the rate of peak expiratory flow. Similarly, it can be classified as being atopic or non-atopic. Interestingly, the major symptoms of asthma vary from person to person also with time. For that matter, it is important to have in mind that the four major symptoms can be seen in other diseases especially respiratory ones and even in some heart diseases (Graves, 2007). Thus this makes it important to point out the characteristics of the environment in which symptoms occur. The major causes of asthma are broadly categorized into environmental and genetics.
Globally asthma is a disease of major concern which requires major intervention and management. Studies indicate that in the United States of America, New Zealand and the United Kingdom asthma rates are high in contrast to other countries like Germany, France and Japan. In Australia, asthma infections remain at a high scale. According to studies done by (Australian institute of health and welfare, 2008), approximately two million Australians suffer from asthma. Out of this population, approximately four hundred of them die annually. Asthma affects all age groups in the population although deaths are rampant as age increases (Abbott, 2006). Poor social-economic status is a major determinant of deaths in the affected population. People of low social economic status are likely to be affected more by asthma as compared to those in the middle and upper social-economic class. Age distribution in asthma shows distinctively variation in comparison to death caused by other illnesses (Heather & McLane, 2007).
According to the Australia Institute on health and welfare (2008), asthma prevalence is high in females as compared to men. They also show that there is a tendency to decrease asthma disease with increased age (Graves, 2007). In females aged between 15-24 years old, those infected annually are approximately 188 000 while those above age of 75 years old are approximately 51 000. In male population, those of age between 15-24 years old affected annually are approximately 144 000 while those above age of 75 years old are approximately 33 000 (Graford & Phillips, 2006). Taking care of those infected by asthma has proved to be a costly venture for both individuals and the Australian government as pertaining finances and expenditure. This is due to the fact that in addition to this particular disease there others illness which need financial allocation to manage them. Demand for up to date facilities is another enormous challenge facing this fight against asthma disease causing a major strain in terms of finance and expenditure (Wilkins et al., 2005).
Individuals suffering from asthma require long time pharmacological management to reduce airway obstruction through inflammation. It is essential that affected individuals avoid factors triggering asthmatic attacks (Castro & Schechtman, 2007). It is worth noting that the disease is not curable. For that matter some individuals may tend to believe that they are fine but they still have the disease and can thus flare up at any time. Nonetheless, with the current skills and knowledge about treatment as well as management of the disease, patients can still manage it and go on with normal life. However, for this to be successful, there is need to form a lose link between the patient and his/her doctor (Huckleberry & Wilson, 2007).
The case study will thus seek to outline the health of a seventeen years old patient Y presented to the Emergency and Causalities Department where I was working. The guardian accompanying the patient furnished us with information which included patient having been complaining of chest tightness, coughing, and difficulties in breathing and producing wheezing sound during breathing. This compelled us to hospitalize the patient and putting him on oxygen machine to help ventilate his airways. In addition to close monitoring pharmacological management was also required to contain his situation( Adams & Marana, 2005).
Further details regarding asthmatic conditions of the patient and the conditions in which the patient will live with for the rest of his life. Pathophysiology of patient Y’s clinical manifestations will be addressed to bring to light an understanding of asthmatic conditions to human well being. Additionally, pharmacological interventions that are needed for successful treatment of asthma along with educating the patient to successfully manage his life will be brought to light. Lastly issue pertaining the environment will also be discussed at it is one major cause of the disorder.
Pathophysiology and clinical manifestations
It is worth noting that once patient Y was presented to the Emergency and Causalities Department subjective data was obtained from him as well as the guardian who had brought him. Additionally, a clinical examination was carried out to establish objective information regarding his health status; obtaining accurate and precise information with regards to a patient is of essence to clinicians (Endecott et al., 2009). This makes the diagnosis as well as the treatment to be successful since they can be easily tailored to suit their needs. For patient Y, a number of clinical manifestations of asthma were clear regarding both subjective and objective data (Wilkins & Dexter, 1998). One of the test we carried out included using a spirometry. This helped us clinicians to establish how the patient’s lungs were working. It was possible to measure the amount of air the patient breathes in and out. Similarly, the speed of air blown out was also measured (Crisp & Taylor, 2009).
Additionally, a physical examination was carried out. I listened to the patient breathing in and out and carefully looking for signs of asthma or allergies. My team were able to note coughing, wheezing, swollen nasal passages and allergic skin conditions. Similarly, to gain further insight on the historical origin of the diseases, we sought to establish the family history of the patient. Through the examination, it was established that the patient grandfather was allergic to asthma triggers such as dust, animal fur, and pollen grains and was diagnosed with the disease at the age of 12. When we tried to establish the time of the day or period of the year when the symptoms of asthma seem to happen, it was during cold season and when dust is present. These made it possible for us to target and treat the patient while in the hospital. It is worth mentioning that there is no precise “precise physiologic, immunologic, or histologic test for diagnosing asthma” (Evans, 2008: 104). To diagonize asthma one usually base on the pattern of the symptoms exhibited which includes obstruction of airways among others.
One important subjective data obtained that resulted to the patient Y being brought to the Emergency and Casualties Department according to his guardian and the patient himself was difficulties in breathing and chest tightness. The patient reported that he could not catch his breath and sometimes felt that he was out of breath. Additionally, getting air out of his lungs was reported to be a problem (Tisane, 2006). On top of this symptom, the patient reported that he felt prior to being admitted to the hospital that his chest was being squeezed or something heavy was place on it making him feel uncomfortable hence unable to breath normally (Chalmers et al., 2007). These two major symptoms are I line with the following explanations; asthma is a reversible disease through reduction of the air way inflammation causing obstruction (Bryant & Knights, 2007).
Decrease in airway caliber is caused by enlarged mucous glands, air way proliferation or hypertrophy, which may be as a result of scar formation on the airway and inflammation. In addition narrowed air way may be due to contraction of bronchioles muscles. Immunological reaction in response to asthma attack triggers is a contributor to edema which cause decrease in lumen of airway (Dales &, Schweitzer, 2006).
Additionally, patient Y while undergoing diagnosis clearly depicted a major symptom of asthma which is wheezing. This is a musical, whistling or a hissing sound produced when one is breathing. Although it has been shown that wheezing is mainly heard when one is exhaling, patient Y also wheezed when breathing in. It is worth to note that wheezing is mainly caused by “the passage of air via narrowed airways at a higher velocity” (Cole & Mackay, 1990: 63). Similarly, it is evident that wheezes are manifested during inhalation due to bronchoconstriction which occurs naturally. For patient Y, his airways are narrow as a result of inflammation and swelling of the airways due to the diseases.
Further examination of patient Y showed that coughing was another serious symptom. When asked the possible triggers of the same the patient acknowledged that he passed through a dusty path and shared a room with a cat that was a pet to his friend. Having in mind that animal fur, dust and pollen grains can results to such asthma symptom, we deduced that dust and animal fur might have played a bigger role in triggering the disease (Dales R. & Schweitzer, 2006). Coughing has been shown to be a mechanism in which it helps one to clear sputum, removing foreign bodies as well as keeping the airways patent. Soughing is exhibited when receptors for cough situated in pharynx, trachea, large bronchi as well as visceral pleura are stimulated chemical, inflammatory, thermal as well as mechanical sources.
As suggested by (Brown & Edwards, 2008) these later create impulses to the cough center in the medulla triggering a reflex motor stimulation of respiratory muscles. The ultimate result is opening of glottis, at the same time the diaphragm contracts; similarly, thoracic as well as abdominal muscles are impacted resulting to deep inspiration. This is then followed by a reflex closure of glottis. The diaphragm also relaxes as well as contraction of respiratory muscles resulting to high pleural and alveolar pressure.
According to Wilkins, 2003 the opening of glottis then leads to creation of a large pressure gradient between alveoli and upper airways leading to releasing of air that was trapped. This comes out with foreign bodies to the upper respiratory tract making it possible to be swallowed or expectorated. It has been shown that cough in most cases depicts that the airways as well as the lung parenchyma is infected (Dempsey et al., 2009).
As indicated by Burney & Chinn, 2009, it will be rational to shade more light on how dust and animal far might have contributed to the health problem of patient Y. Bronchial inflammation is also due to allergic reaction. Breathing in allergens initiate immune reaction; for asthmatic individual antigen presenting cells which form part of body’s immune system present these stimuli to body immune system. Body’s immune system analyses it and unlike other non asthmatic people the body immune system initiate immune response through sending signal to activate humeral immune system. This leads to release of immune system antibodies to fight against the stimuli (Graford & Phillips, 2006).
Antibodies retain allergen memory and are able to recognize these allergens in future if inhaled and initiate a humeral response (Huckleberry& Wilson, 2007). Releases of chemicals cause bronchioles edema, excessive mucous secretion due to the mucus gland proliferation. In addition their also activation of cell mediated immune response. Airway smooth muscle also develops spasm due to the inflammation.
Patient management and interventions
Patient management and interventions include all strategies aimed at improving patients’ life and giving him a chance to live an independent life. Asthma is a chronic disease which require life long care and when one experiences the asthmatic attacks (Bosworth, Dudley, & Olsen, 2006). Management of asthma is based on factors such as age, extent of the disease, individuals’ health and presenting medical history. In this case, the patient was allowed to rest in bed while he was provided with oxygen machine to help in ventilation since he had exhibited serious breathing difficulties. If this could not have been done, then the patient could have experienced more difficulties in catching his breath and this might have been fatal. As a clinician, I clearly understand the need to create a warm relationship between patient and medics. Thus it was necessary to make the patient aware why he was in hospital, the medication he will receive and listening to major concerns raised by my patient. This is quite important as it will make the treatment efforts more fruitful since the patient will be fully aware of what he expects.
Additionally, the patient was adequately advised to try as much as possible to avoid being in contact with triggers of the disease. These included dust, pets such as cats and dogs among others. Those who will visit him were to be adequately informed not to bring in pets as this will make things worse for the patient. Having in mind that cold might be another cause of coughing as a symptom; the patient was advised not to take bath regularly. For that matter there was need for the patient to maintain higher standards of hygiene.
As noted previously, the four major symptoms brought forth by both the patient and his guardian was to be closely monitored. This provided clinicians with the knowledge to establish how severe the disease was. On the same note it was rational to closely check the patient’s response too the treatment and management he was being provided for instance his response to oxygen machine (Castro & Zimmermann, 2006).
Having the knowledge that inhaled medication is better than oral one, I opted for the former. This was after a careful examination of the impact of oral medication to the patient. Ideally speaking most of the disease medication work by making the bronchospasm to relax or reduce inflammation (Tisane, 2006). The preference of using inhaled medication rests on its ability to act quickly and directly on the surfaces of airways a location where the problem starts. Similarly, the rate at which the body absorbs inhaled medication is very minimal as compared to oral one. For this reason, it has fewer side effects.
According to Castro & Schechtman, 2007 among the inhaled medication I used to treat patient Y include beta-2 agonists and anticholinergics. An earlier version of adrenaline which was effective but had a number of side effects has resulted to development of beta-2 agonists. This inhale medication has the advantage of relaxing the muscular walls of bronchi leading to bronchodilation. It is worth noting that the action of the medication is within a few minutes after being inhaled and last for approximately four hours. The side effects which included headache, panic, restlessness, vomiting among others were not experienced.
I has been established that anticholinergics agent as compared to beta-2 agonists act on different types of nerves to attain relaxation as well as opening up of the bronchi. When the two inhalers are used together, the result is better. Ipratropium bromide was used and proved to take more time to act having peak effectiveness with two hours after being administered. I was also ready to use tiotropium in case other symptoms of asthma could not be revealed easily.
In order to reduce deposition as a result of the medication, I used spacers. This was a tube like chamber that is attached to MDI canister outlet. The mechanism of this equipment is that it holds the medication released for enough time making it possible for the patient to slowly and deeply inhale it. This help also in reducing the side effects to both the mouth and the throat (Port & Martin, 2009).
It is worth noting that prior to giving the patient the above stated medication; I tried to establish the kind of medication he was taking to control his problem. I realized that he was using a beta blocker (Crisp & Taylor, 2009). This kind of medication has been shown to negatively impact on the relaxation of airways making it constricted. This worsens the scenario. I advised the guardian and the patient not to use the medication since it aggravates asthma and its symptoms Australia centre for asthma monitoring, (2008).
It has been said time and again that information is power. For patient Y providing him with adequate knowledge regarding asthma was of essence. It has been shown that when patients in wards are educated and well furnished with the day to day happenings of the wards activities as well as procedures and thorough explanations on why these are necessary, then they will comply with the standards hence enhancing their chances of survival (Bosworth et al., 2006). The patient was educated on the importance of taking prescribed medication appropriately to reduce future chances of readmission as well as relapse of the symptoms such as coughing. I also furnished the patient on the best way to avoid triggers of the disease such as dust, smoke, animal fur, and irritant chemicals among other (Adams & Marana, 2005). This was done after adequately making him understand the major causes of the disease. Keeping record with regards to symptoms is also of essence and was made known to the patient. This could be done on a diary. Lastly and more importantly, the patient was made to be aware of the importance of striving to suppress the major symptoms since one seemed to cause the other (Bolisett et al., 2005).
As previously mentioned, it is apparent that the environment plays a major role in triggering or even causing asthmatic conditions. He should thus avoid; allergies triggering items like dust, pollen grains and animal fur. Although exercise is an important aspect in managing heart diseases, it can trigger asthma. In addition, the patient should avoid irritants like smoke which can trigger asthma (Abbott, 2006).
From the review of asthma through a case study of patient Y a seventeen year old, it is evident that the disease can attack any age group in the society. Through the patient it was possible to bring to light major clinical manifestation of the disease which included coughing, wheezing,, chest pain and difficulties in breathing. A clear understanding of this Pathophysiology through subjective and objective data are of essences in trying to come up with strategies that will best treat a patient.
On top of this, it is evident that patient management strategies were brought to light and included placing him in oxygen machine and making him understand why he was admitted. He was also educated regarding a number of factors such as causes of his health problems, how to avoid triggers of the problem, importance of adhering to medication among others. Environmental control also formed a section of patient intervention strategies. Similarly, inhaling medications made up of beta-2 agonists and anticholinergics. A combination of these two was shown to yield better results. The intervention strategies are aimed at nothing other than making the patient have a full control of their lives and enjoy life to the fullest despite of the diseases being incurable.
Abbott, T. (2006). New steps to improve Indigenous health. Ministry for Health. Canberra: Australian Government press.
Abramson, M. (2005). “Respiratory symptoms and lung function in older people with asthma or chronic obstructive pulmonary disease” Medical Journal of Australia, 5 (6): 23–25.
Adams, P. & Marana, A. (2005). Current estimates from the National Health Interview Survey, VitalHealth Statics. Sydney: Elsevier.
Australia centre for asthma monitoring, (2008). “Asthma preference in Australia” Health Journal, 7 (3): 12-14.
Australia institute on health and welfare (2008). Asthma disease among population. Sydney: Elsevier.
Bolisett, S. et al., (2005). “Respiratory syncytial virus infection and immunoprophylaxis for selected high-risk children in Central Australia” Australian Journal of Rural Health,13 (4): 65–70.
Bosworth, H., et al., (2006). “Racial differences in blood pressure control: potential explanatory factors” American Journal of Medicine, 12(8): 29-30.
Brown, D. & Edwards, H. (2008). Lewis’s Medical-Surgical Nursing,Sydney: Elsevier.
Bryant, B. & Knights, K. (2007). Pharmacology for Health Professionals, (2nd Ed.), Sydney: Elsevier
Burney, P. & Chinn, S. (2009). “Variations in the prevalence of asthma symptoms” Australian health Journal, 9(3): 65-67.
Castro, M. & Schechtman, H. (2007). “Risk factors for asthma morbidity and mortality in a large metropolitan city” Journal of Asthma,38(3): 625–635.
Castro, M. & Zimmermann, N. (2006). Asthma intervention program prevents readmissions in high healthcare users. American Journal of Respiratory and Critical Care Medicine, 4(9):168-169.
Chalmers, G., et al., (2007). Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Sydney: Elsevier.
Cole, R. & Mackay, A. (1990). Essential of respiratory disease. Melbourn: Churchill Livingstone.
Crisp, J. & Taylor, C. (2009). Potter and Perry’s Fundamentals of Nursing. Chats wood, Elsevier Mosby.
Dales, R. &, Schweitzer, J. (2006). “Risk factors for recurrent emergency department visits for asthma” American health journal, 6(3): 43-45.
Dempsey, J. et al., (2009). Fundamentals of nursing and midwifery a person centered approach to care. Sydney: Elsevier.
Endecott, R. et al., (2009). Clinical Nursing Skills: Core and Advanced. Melbourne, Oxford University Press.
Evans, R. (2008).”Asthma among minority children. Self-reported asthma attacks, and use of asthma medication in the European
Community Respiratory Health Survey” European Respiratory Journal,9(2): 87–95.
Graford, J. & Phillips, N. (2006). Nursing Calculations (7th Ed.),Sydney, Churchill Livingstone: Elsevier.
Graves, E. (2007). “National Hospital Discharge Survey, Vital Health Statics” Australian health journal,13(4): 21-22.
Heather, S. & McLane, K. (2007). Understanding Pathophysiology. Sydney:Elsevier
Huckleberry, M. & Wilson, D. (2007). Wong’s nursing care of infants and children Philadelphia: Mosby.
Port, C. & Martin, G. (2009). Pathophysiology Concepts of Altered Health States. Sydney, Churchill Livingstone: Elsevier.
Taylor, W. (2009). “Impact of childhood asthma on health” PediatricsJournal,2(7): 23-25.
Tisane, A. (2006). Harvard’s nursing guide to drugs (7th ed.).Sydney: Elsevier.
Wilkins, R & Dexter, J. (1998). Respiratory disease: A case study approach to patient care. Philadelphia: FA Davis Company.
Wilkins, R. et al., (2005). Clinical assessment in respiratory care. Missouri: Elsevier Mosby.