Nursing Assignment: Case Analysis of a Patient with Asthma
Question
Task: 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.
Nursing Assignment Task:
Workbook Activity 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.
Workbook Activity 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
Workbook Activity 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
Nursing AssignmentWorkbook activity part 1:
When asthma conditions trigger which can be for multiple reasons such as massive pressure on the respiratory system, allergen, dust, or smoke, inflammation tends to occur in the airways develops massive uncontrolled gasping, chest tightening, rapid breathing as well as cough with a wheezing sound. These signs were clearly identified in the case of Jill as she was laying hockey in the field. It was reported by Jill that she attained an Upper Respiratory Tract Infection which might have caused major inflammation and infection in the respiratory tract leading to the exacerbation of her underlying asthma condition. As the inflammation occurs in the smooth muscle of the airways sustains contraction and thus leads to swelling of the muscular walls of the airways. This thus causes the development of normal airflow obstruction which is why jill was witnessing increased respiratory rate as she was unable to maintain the normal supply of air into her lungs thus cause shortness of breath (Gans&Gavrilova, 2020). It is generally due to the sensitivity of the bronchioles or the bronchi towards any foreign particle or antigens that leads to inflammation in a patient with asthma.
When these foreign particles or antigen enters the airways, it witnesses puffiness, tightening of the muscle, inflammation as well as obstruction. The condition was severe in the case of jill as she was already suffering from an infection of Upper Respiratory Tract Infection that made her airways distorted and vulnerable to pathogen attacks and inflammation leading to an asthma attack. As the respiratory rate increases due to shortness of significant supply of air to the lugs, the heart rate thus considerably increases as the hurt also witnesses a limited supply of oxygen sufficient blood (Carpaij et al., 2019). Thus, it explains the pathophysiology behind the increased heart rate in the case of Jill. As soon as the inflammation occurs, the airway witnesses an increased rate of mucus production which also serves in blocking the airways and thus leads to chest tightness, obstruction of airways, shortness of breath, difficultly to speak as well as cough with a wheezing sound. When the inflammation takes place then the number of immune cells such as eosinophils, neutrophils, lymphocytes, and plasma cells on the cells of bronchi increases. Thus, it often leads to the increasing body temperature of the patient which was why jill was witnessing increased body temperature from normal to high (King et al., 2018). The pathophysiology of asthma explains the reason behind the clinical manifestation of jill when she was admitted to the health care setting due to serve asthma attack.
Workbook activity part 2:
Inspection:
In order to assess the condition of asthma in the case of jill, it will be necessary to conduct a physical assessment and inspection with the help of assessing the signs and symptoms and changes in the normal vitals and orientation of the body. It will be necessary to assess her oxygen saturation level, respiratory rate, her blood pressure as well as the condition of chest tightness and increased heart rate. Also, a change in color of the tongue of jill will be assessed in order to see if any cyanosis occurred or not which may have a stable association with an asthma trigger (Mackintosh et al., 2021). Also, it will be necessary to assess the chest as well as the skin for any signs of allergic reaction that may have caused an asthma attack.
Palpation:
Palpation is used as a physical examination which helps in assessing the abnormalities within the skin, area of tenderness, and expansion of the respiratory area. It has been found that palpating the tracheal border with the sternal nitch serves as a helpful measure to assess and determine any abnormality of the airways. It has been stated that deviated trachea serves in helping in assessing the condition of respiratory pathology that may be caused due to asthma. Also, Lymphadenopathy can be sued as a process of palpation as abnormal size or number of the lymph node helps in assessing the condition of asthma (Ashcheulova, Kovalyova&Honchar, 2017).
Auscultation:
In order to conduct auscultation, it will be necessary to an inspection of the wheezing sound should be conducted by hearing as wheezing sound indicate the condition of asthma. It is found that wheezing sound or friction of ribs, as well as crackle sound, often helps in the identification of the condition of asthma as it explains the blockage or disruption of the normal airflow in the respiratory tract (Fujita et al., 2020). Thus, it can be used in the case of jill for assessing her condition of asthma.
Percussion:
It is used in order to assess the underlying pathology of the lungs during a severe condition such as asthma. It focuses on using resonance in order to evaluate the condition using sound as hyperinflated lung with developed hyper resonance. Sound helps in assessing the pathology and inflammation developing inside the reparatory track which is used for the assessment of infection or inflammation (Grigoryeva et al., 2020).
Workbook activity part 3:
1. Complete Pulmonary function testing: it can be used to assess and evaluate the condition of the lungs and its functioning thus it has been divided into two different parts which include:
- Lung Volumes testing: a plethysmography test is accrued out in order to assess and analyze the volume of the asthmatic patient’s lung.
- Rationale: It is so because asthma attacks may lead to developing certain changes in the lungs volume which help in the detection of the condition of asthma as asthma leads to decreasing the lung volume (Piloni et al., 2018).
- Diffusion Capacity: Diffusion capacity testing will help in assessing the normal and healthy flow of oxygen from the lungs to the blood of the patient.
- Rationale: when asthma takes place, the diffusion of the oxygen gets hampered which thus leads to disruption of the association of oxygen in the blood (Piloni et al., 2018).
2. Chest x-ray: chest x-ray is known to be one of the significant diagnostic tests for the condition of asthma as it helps in assessing a patient like Jill with a wheezing sound.
Rationale: Chest x-ray helps in assessing the inner structure and obstruction of the airway that may ad to shortness of breath and other symptoms related to asthma it also serves it assessing the hyper expansion of the lungs as well as trapping or air due to obstruction. Thus, it is known to be one of the significant diagnostic tools (Abeles et al., 2020).
3. Spirometry: it is known t be used in the case of diagnosing asthma as it helps in assessing the normal or obstructive airflow within the respiratory tract. It thus can be used in the case of jill in order to assess the reason and condition of shortness of breath and air obstruction caused by an asthma attack.
Rationale: it helps in assessing the quantity as well as the quality of the air moving in and out of the lungs which helps to evaluate any blockage or barrier in the airflow that may lead to shortens s of breath and malfunction of the respiratory tract due to information or infection. It serves as both diagnostic as well as management tests for patients with severe asthma (Ayuk et al., 2017). It helps in minimizing the risk associated with asthma and shortness of breath during acute exacerbation of asthma and is significant for the condition of jill.
References:
Abeles, M., Akerman, M., Halaby, C., &Pirzada, M. (2020). Do subtle findings on chest X-ray predict worse outcomes for paediatric asthma?. Postgraduate Medical Journal.http://dx.doi.org/10.1136/postgradmedj-2020-139165
Ashcheulova, T., Kovalyova, O., &Honchar, O. (2017).Physical methods of cardiovascular system examination.Inquiry and general inspection of the patients with cardiovascular pathology.Inspection and palpation of precordial area. Retrieved from: Topic_9_CVS.pdf (knmu.edu.ua)
Ayuk, A. C., Uwaezuoke, S. N., Ndukwu, C. I., Ndu, I. K., Iloh, K. K., &Okoli, C. V. (2017). Spirometry in asthma care: a review of the trends and challenges in pediatric practice. Clinical Medicine Insights: Pediatrics, 11, 1179556517720675. https://doi.org/10.1177/1179556517720675
Carpaij, O. A., Burgess, J. K., Kerstjens, H. A., Nawijn, M. C., & van den Berge, M. (2019). A review on the pathophysiology of asthma remission. Pharmacology & therapeutics, 201, 8-24.https://doi.org/10.1016/j.pharmthera.2019.05.002
Fujita, S., Suzuki, R., Sagara, N., Aota, A., Akashi, K., &Katsunuma, T. (2020). Three cases of diffuse panbronchiolitis in children with a past history of difficult-to-treat bronchial asthma: a case report from a single medical facility. Allergology International, 69(3), 468-470. https://doi.org/10.1016/j.alit.2020.02.007
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
Grigoryeva, N. Y., Ilyushina, T. P., Kolosova, K. S., Koroleva, N. B., Streltsova, A. A., &Soloveva, D. V. (2020). Clinical Course of Coronary Heart Disease Concomitant with Asthma. The Russian Archives of Internal Medicine, 10(2), 131-138. https://doi.org/10.20514/2226-6704-2020-10-2-131-138
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. https://doi.org/10.1111/resp.13251
Mackintosh, K. A., McNarry, M. A., Berntsen, S., Steele, J., Sejersted, E., &Westergren, T. (2021). Physical activity and sedentary time in children and adolescents with asthma: A systematic review and meta?analysis. Scandinavian Journal of Medicine & Science in Sports.https://doi.org/10.1111/sms.13937
Piloni, D., Tirelli, C., Di Domenica, R., Conio, V., Grosso, A., Ronzoni, V., ...&Corsico, A. G. (2018). Asthma-like symptoms: is it always a pulmonary issue?. Multidisciplinary respiratory medicine, 13(1), 1-3.https://doi.org/10.1186/s40248-018-0136-5
