Asthma is a common inflammatory condition of the airways associated with episodes of reversible over-reactivity of the airway smooth muscles. The membrane and the powerful lumens of the bronchi and bronchioles become thickened, hence the enlargement of the mucous glands. This, therefore, reduces airflow within the lower respiratory tract (Mayo Foundation, 2019). The walls become inflamed and thicken hence inflammatory exudates and an invasion of inflammatory cells, in particular, eosinophils. In the event of an asthmatic attack, spasmodic tightening of the bronchiolar muscle, rather bronchospasms, narrows the airways, thereby leading to the production of excessive secretion of thick, sticky mucus which then further narrows the airway (Silva, et al., 2015). Therefore, expiration achievement is limited. As a result, the lungs become hyper-inflated, and severe shortness of breath (dyspnea) and wheezing arise. During severe acute attacks, there is obstruction within the bronchi due to the mucus plugs hence airflow blockage. As a result, acute respiratory failure, hypoxia, as well as possible death, may arise (Mayo Foundation, 2019).
Persons with asthma attacks have their lungs inflamed and swollen at the inside walls. The membranes of the linings of the narrowed and swollen airway secrete extra mucus resulting in an asthmatic attack. The attack explains that the patient finds it harder to breathe, causing wheezing and coughing due to narrowed airways. The symptoms of asthma are controlled as the patient works with the doctor to manage different attacks from varied environments (Pogson & McKeever, 2011).
This assignment aims to discuss nursing care management for an adult patient with asthma. Also, there will be detailed assessment, planning, implementation and evaluation of the needs of the patient. Another main focus in this discussion is the maintenance of a safe surrounding, especially for asthmatic patients. It is important to note that the activities of living are connected. For instance, in every other dependent body activity, breathing is vital. The nursing management, pharmacological management, as well as the investigations carried out, will be discussed in details (Silva, et al., 2015).
The pathophysiology of asthma includes an analysis of diagnosis and treatment. The asthmatic patient reveals many pathophysiological factors, including inflammation of the constricted airways and resistance, which manifests with wheezing, dyspnea, as well as coughing. Asthma affects the entire breathing system exclusive of the lungs (Mayo Foundation, 2019). The damage of epithelial and muscle tissue, excessive mucus, bronchospasms, leads to excessive mucus, causing a sharp reduction of the smooth muscles in the bronchial and narrowing of airways (Mayo Foundation, 2019). Oedema leads to leakage of the microvascular tissue and narrowing of the airway. Airway capillaries widen and leaks, hence secretion accumulation and impairing of mucus clearance. Prolonged asthma attacks increase the number of both cells and glands that secrete mucus (Mayo Foundation, 2019). Increased secretion of mucus causes thickening of mucus plugs responsible for airway blockage. It is injuring of the epithelium that results in epithelial peeling hence airway impairment. Epithelial loss of functioning allows penetration of the allergens, leading to hyper-responsive of the airways (Mayo Foundation, 2019). The degree of inflammation determines the extent of the inflammation along with the patient’s immunologic response. Asthma causes a loss of enzymes of the inflammatory response for mediator breakdown, along with reflexive neural effects from exposure of the sensory nerves. Asthma leads to remodeling of airway and changes to tissue and cells within the lower respiratory tract (Silva, et al., 2015).
As a result, there is permanent damage to the fibrotic. The transformation is irreversible, translating to continued loss of normal functioning of the lungs and decreasing therapy response. Asthma attacks vary from one person to another. The patients experience shortness of breath, tightness of the chest and pain. Atopic asthma starts at childhood and links to present triggers initiating wheezing and arising after response and exposure to the various allergen, including particles of dust and smoke, grass, animals, pollen various drugs and foods. Excessive extraction of 1Ge occurs initiating B-lymphocyte activation (Mayo Foundation, 2019). The 1Gs bonds to the inflammatory cells leading to a release of substances, for instance, nitric oxide, chemokines, allergic reactions, leukotrienes, prostaglandin D2 as well as cytokines (Silva, et al., 2015). The result includes triggering inflammation of the airway and bronchoconstriction. During gestation, smoking women put their unborn baby at higher levels of 1Gs and hyper responsiveness, as well as asthma development. Exposure to various forms of exposure causes a similar effect. non-atopic asthma does not include 1G response and triggers occurring in adults which seconds viral infection (Silva, et al., 2015).
McQueen et al. (2018) say that non-specific factors that may precipitate asthma attacks include upper respiratory tract infection, air pollution, cold air, cigarette smoking, emotional stress, and strenuous exercise. Asthma is genetically hereditary. In other words, one can be born with asthma or passed on from one generation to another (Mayo Foundation, 2019). There are two clinical categories of asthma, which generally give rise to identical symptoms and management is similar (McQueen et al., 2018).
During assessment, the clinician may want to know; symptoms that client presents with, when then appear and their triggers. If the client has a history of smoking, is exposed to polluted air and irritants e.g. chemical fumes, sprays and perfumes. If there is the presence of elevated body temperatures and allergic reactions such as sneezing, itchiness. Presence of asthma history in the family. If on any medications. Presence of pets in the house. When the client gives positive responses, then the clinician comes up with the diagnosis of asthma.
An asthma diagnosis includes history taking, physical examination and a lung function test. History taking is done when the clinician notes down the patient’s personal, medical, and family history. It is also inclusive of any known allergies related. This is then documented in the individual’s medical records for future reference. Physical examination transpires when the clinician employs the stethoscope to listen to the sounds from the lungs of the patient. In other words, the clinician examines the entire breathing system (McQueen et al., 2018). This is to rule out the sufficient airway passage. A lung function test is when the clinician utilizes instruments such as the spirometer for monitoring the sufficient airway flow in and out of the lungs. A spirometer measures the amount of air one can inhale and exhale as well as the time in which air can be blown out (McQueen et al., 2018).
Nurses diagnose asthma beyond tightness of the chest, wheezing, shortness of breath, coughing, as well as symptoms which cause harm during the night and goes following treatment. Thus, asthma examination requires two significant tests, i.e. pulmonary function tests (PFTs) as well as peak expiratory flow (PEF). Patients with asthma show declined forced expiratory volume (FEV1) and forced vital capacity (FVC) within a second. Also can be determined using a spirometer.
Thus, clinicians require ruling conditions that decrease FEVI causing signs and symptoms mimicking asthma. The diseases include gastroesophageal reflux disorder, vocal cord dysfunction, cardiac pain, heart failure, upper-airway obstruction, chronic obstructive pulmonary disease, foreign body aspiration, hyperventilation, and cystic fibrosis (Sastre & Davila, 2018). Asthma, being a chronic lung disease, disturbs over 23 million individuals in the United States, together with 7 million children.
The standard practice of asthma defines a variety of excellent approaches in general. The practices are essential in clinical decision making concerning asthma. These guidelines lay emphasis on the significance of asthma control by focusing on two domains, that is, current damage and future risks, whereby they assess asthma severity with a rationale of therapy commencement and asthma monitoring for the benefit of the continuing treatment (Sastre & Davila, 2018).. Recent directions on prescriptions, recommendations concerning patient awareness in situations past the doctor’s office, and guidance for monitoring exposures from the surroundings that trigger asthma symptoms. Research has shown that it is possible for a patient to control asthma symptoms through proper self-management, responsible daily activities among others. This minimizes symptoms such as less times of waking up through the nights due to asthma attacks hence normal lung function achievement.
7002.1.2: Evaluation of Pharmaceutical Impact
Sastre & Davila (2018) asserted that mainstream of asthma programs are planned within the idea of the wide-ranging utility of pharmacological management for enduring management. In addition to pharmacological management, self-management awareness about programs has turned out to be crucial in improving patients’ monitoring sense as well as personal reliability for their asthma (McQueen et al., 2018).
The graduate examines pharmaceutical influences, together with physical, mental, financial, and life routine factors taking place in the selected disease processes.
The asthma signs and symptoms include sick days from work and school, as well as interfering with recreational activities. The bronchial tubes could narrow permanently, affecting proper breathing (Sastre & Davila, 2018). The attacked suffer emergency visits to the hospitals to control severe asthmatic attacks is a loss of time and lowering of production. The side effects of asthma drugs go for a long-time causing disease to the body while stabilizing asthma. However, the proper treatment creates a huge difference to prevent both short and long-term asthma complications (Sastre & Davila, 2018).
According to McQueen et al. (2018), asthma is a long-term disease requiring regular treatment and monitoring to enable people to control their life. Thus, affected persons must learn to follow their action plan, get pneumonia and influenza vaccinations and prevent flu from triggering asthmatic attacks. People at prone locations must learn to avoid asthma triggers such as fleeing from allergens such as pollen, mould, air pollution, which worsen asthma attacks. All persons must monitor their breathing patterns and recognize warning signs, including slight coughing, wheezing, shortness of breath, and others. A home peak flow meter records the peak airflow and measures it regularly. It is essential to identify and treat attacks at their early stages to avoid severe attacks. Patients need not treatment start to manage symptoms. The decline of peak flow measurements creates preparedness to an upcoming attack.
Thus, people must take given instructions and stop immediately to activities that trigger attacks. However, if the symptoms continue, the patients must seek medical help. Moreover, it is essential to take medication as prescribed without considering that the asthma condition is improving. One must concentrate on proper consuming of medicine and taking the appropriate dosage (Pogson & McKeever, 2011).
7002.1.3: Managing Care Transitions
The graduate considers relevant pharmacological subjects in handling patient care transitions. Management of asthma involves acute as well as long-term management depending on the age, illness, degree of disease seriousness, plus comorbidities. The nurse requires determination of the patient’s complete medical history before treatment start (American Academy of Allergy, 2019). Drugs for treatment include angiotensin-converting enzyme inhibitors, beta-blockers, and cholinergic, nonpotassium-sparing diuretics, among others indicated to patients taking asthma agents (Carona et al., 2015).
Rescue (quick-relief) drugs
The rescue drugs for short-term illnesses are meant to relief and, lead to bronchodilation, assist in treating and preventing an asthma attack. The quick-relief drugs work in minutes and stay active for at least six hourly. The adverse reactions could consist of palpitations as well as jitteriness. The quick-relief drugs involve ipratropium bromide inhaler (Atrovent), short-acting beta2-agonists, plus oral corticosteroids (American Academy of Allergy, 2019). The Ipratropium bromide, an anticholinergic, combines with short-acting beta2-agonists in various situations. The Beta2-agonists for quick relief involve albuterol, metaproterenol, terbutaline, plus levalbuterol.
Carona et al. (2015) say that oral corticosteroids, including prednisone and methylprednisolone, is essential for brief periods in acute asthma attacks that are unresponsive to the usual treatments. The long-term usage decreases infection resistance and reduces children’s growth and development (Carona et al., 2015).
Long-term control agents
The agents stop asthmatic attacks that are followed by chronic symptoms. They comprise of corticosteroids, long-acting beta-agonists (LABAs), and combined inhalers containing both LABA and a corticosteroid. The drugs’ effect may take days or weeks towards the maximum achievement (American Academy of Allergy, 2019). The LABAs last for 12 hours when combined with an inhaled corticosteroid; otherwise, when prescribed separately, a severe asthmatic attack may arise. The LABAs are in effect in easing symptoms, enhancing airway function as well as reducing peak flow inconsistency (Carona et al., 2015). A systemic preparation is employed to achieve fast treatment of the asthma, to control severe and persistent asthma, to manage moderate and serious exacerbations, to quicken recapture as well as to relapse prevention. It is important to note that the LABAs are not designated for instant relief of symptoms.
Medications such as Cromolyn sodium and nedocromil are anti-inflammatory drugs that are normally prescribed in children with mild to moderate symptoms. They are contraindicated in acute asthma exacerbations. Methylxanthines are bronchodilator in combination to with inhaled corticosteroids prescribed for mild to moderate symptoms. They mainly relief symptoms that come at night. Anti-leukotriene are effective bronchoconstrictors that similarly open blood vessels besides permeability modification. Their mode of actions is by inhibiting leukotriene synthesis otherwise receptor obstruction where leukotrienes are applicable.
Managed Disease process
Access to care, life expectancy, outcomes in patients with well-managed asthma
The doctor examines symptoms such as coughing, wheezing, chest tightness, production of sputum, and fatigue. The key indicators of asthma include high pitched whistling sounds in children as they breath out. The exhaled nitric oxide testing is inexpensive and useful complement to the spirometry used with all patients to realize the functioning of the lungs, assess effectiveness of inhaled corticosteroids, and determine if patients take medication. Patients with well-managed asthma reveal proper flow of air into the lungs with minimal attacks.
Management of asthma at national and international level include;
National and international control of asthma include use of inhaled short acting bronchodilator such as terbutaline, fenoterol, and salbutamol to control the disease. The method applies among mild asthmatic patients (Ministry of public health and sanitation, 2011). Patients with severe disease require high to moderate doses of inhaled steroids along with long acting beta agonist and a leukotriene having a slow release theophylline.
Managed Disease Factors
Asthmatic patients assisted with caregivers adopt behaviors for managing asthma including correct use of inhalers regularly, monitoring symptoms and management of triggers. Adherence to inhalers moderate’s relationships between actual and prescribed exposure to drugs (Dima, Bruin & Ganse, 2016). The patients require inhaling drugs at recommended intervals and quantity. The inhalers must be correctly performed. Avoiding triggers reduce exposure to immediate environment that initiates asthma. Self-monitoring among patients gives a positive feedback of prior behaviors and their effects.
Unmanaged disease factors
In various situations the patient does not manage to meet prescriptions given by the doctor. They do not check the technique of the inhaler, ensure their they follow their written action plan, and fail to check out on modifiable risk factors. Their ignorance directly exaggerates their situation.
A4ai. Patients, families & populations.
Asthma affects patients, families, and populations in the community since children between 12-14 show a rate of 44/1000/years with the disease are increasing. The disease is prevalent in urban areas as compared to the rural areas. Children up to 5 years show a rate of 23/1000 children each year. Adult females demonstrate 1.8 times greater incidences of asthma than adult males (Ministry of public health and sanitation, 2011). More than 40 million people suffer from asthma in the United States, while other countries have more than 18% of their population suffering from asthma. It is estimated that more than 300 million people in the world will be suffering from asthma by 2025. The rates show a high disease burden as children aged 5-14 years showing high prevalence in the world. Thus, it is among the highest chronic conditions causing disability-adjusted life years(DALYs). Asthma increases with age, as the per capita cost accelerates among patients aged more than fifty years.
Asthma leads to high costs for the patients, families, and the general population. Patients who fail to control asthma end up having persistent symptoms which impair their quality of life, reduce their self-esteem, and compromise their social interaction. They increase psychosocial trauma which cause fatal outcomes (Ministry of public health and sanitation, 2011). Economically asthma is very costly to treat and control due to direct costs of medical consultations, drugs, and costs of hospitalization. Indirect costs of asthma affected patients result in absenteeism, persistent treatment from illnesses, and premature deaths.
Managing the disease in current healthcare organization
The current healthcare organizations require to assess control and adjust therapy as required. Second, prescribe and adjust medications. Third step provide recommended immunizations. Fourth, manage triggers. Educate the patient and family.
C2. Evaluation method
Each health care organization require to implement each strategy.
In the process of assessing control and adjusting required therapy, it depends on the severity of the disease within 2 to 6 weeks after medication. The doctors require to adjust therapy if no improvement is noted, as well as alternative diagnosis. There should be provision of recommended immunizations for all persons on asthma (Ministry of public health and sanitation, 2011). The healthcare professionals require knowledge on ways of managing triggers through exploring changes to the patient’s environment, test all patients on allergy, and consider subcutaneous allergen immunotherapy. Lastly, the patients should be educated about asthma and issued with an action plan.
The graduate differentiates between general information and related investigative findings to monitor and reduce pathologies and risk factors to encourage ideal patient results. Asthma results from exposure to many irritants and substances triggering allergies (allergens) (Carona et al., 2015). These substances include cold air, physical activity, respiratory infections including the common cold, airborne objects such as dust particles, mould spores, animals, smoke, various medications including ibuprofen and naproxen (Aleve) (American Academy of Allergy, 2019). Stress and strong emotions are possible triggers of asthma together with sulfites and preservatives put in foods and beverages such as wine, alcohol, and treated potatoes. GERD disorder involves acids from the stomach backing to the throat (Carona et al., 2015).
Risk factors include having a relative whose blood has asthma, an allergic condition, including allergic rhinitis and atopic dermatitis (American Academy of Allergy, 2019). Overweight persons (obesity), smokers, exposure to second-hand smoke, fumes, and chemicals used in hairdressing, agriculture, and industries (Drazen et al., 2012).
According to Kennedy, Stoner & Boorish (2016), asthma management depends on appropriate patient education and their families on the usage of peak flow meter, optimization of the environmental gearstick, recognition of asthma signs and symptoms. The doctor emphasizes on smoking cessation significance and yearly immunizations. Complications of asthma include respiratory diseases such as influenza and pneumonia. Further complications include status asthmaticus and atelectasis (Carona et al., 2015).
Knowledge is the vital element to quality asthma care. Despite the availability of national guidelines for the care of asthmatic patients, not all clinicians choose to take the ideal management guidelines. As a result, disappointments have been pointed out in areas such as lack of treatment for those patients who experience asthma symptoms for more than two days in every week (Peters, 2014). With a standard medication program, lack of patient-specific recommendations on upgrading the surroundings and an explanation concerning the significance of taking responsibility on, motivational absence for patients to observe their peak flow readings and noting down in a diary — also, absence of on paper and updated learning materials (Peters, 2014).
7002.1.5: Care Management
The graduate participates in applicable patient and population data to improve pathopharmacological management plans for people. There is no cure for asthma, but when properly diagnosed, a treatment plan is initiated until the patient can manage the condition. An immunologist is best qualified in diagnosing and treating asthma (Peters, 2014).
Patients who experience repeated episodes of asthma should go through tests to recognize the substances that trigger the symptoms. Likely causes are dust, roaches, certain cloth types, pets, for instance, cats, soaps and detergents, specific edibles and pollen (Chang et al., 2012).
American Academy of Allergy. (2019). Asthma: Allergic Asthma and Immunology. Retrieved from https://www.aaaai.org/conditions-and-treatments/asthma
Chang, E., et al. (2012). Aspirin Exacerbated Respiratory Disease: Burden of Disease. Allergy and Asthma Proceedings, 33 (2): 117-121.
Drazen, M. et al. (2012). A Patient with Asthma Seeks Medical Advice in 1828, 1928 and 2012. The New England Journal of Medicine, 366 (9): 827-834.
Dima, A., Bruin, M., & Ganse, E. (2016). Mapping the Asthma care process: Implications for research and practice. The Journal of Allergy and clinical immunology, 4(5),868-876.
Kennedy, L., stoner, N., & Boorish, L. (2016). Aspirin Exacerbated Respiratory Disease: Prevalence, Diagnosis, Treatment and Considerations for the Future. Journal of Rhinology & Allergy, 30(6): 407-413.
Mayo Foundation. (2019). Asthma. Mayo clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653
McQueen, B., et al. (2018). Cost-Effectiveness of Biological Asthma Treatments: A systematic Review and Recommendations for Future Economics Evaluations. PharmacoEconomics, 36(8): 957-971.
Ministry of public health and sanitation. (2011). Guidelines for asthma management in Kenya. Ministry of public health and sanitation,1-74.
Peters, P. (2014). Asthma phenotypes: nonallergic (intrinsic) asthma. The Journal of Allergy and Clinical Immunology, 2(6): 650-652.
Pogson, Z. & McKeever, T. (2011). Dietary Sodium Manipulation and Asthma. The Cochrane Database of Systematic Reviews, 16(3); doi: 10.1002/14651858.CD000436.pub3
Sastre, J., & Davila, I. (2018). A New Paradigm for the Treatment of Allergic Diseases. Journal of Investigational Allergology & Clinical Immunology, 28(3): 139-150.
Silva, N., Carona, C., Et al. (2015). Quality of life in pediatric asthma patients and their parents: a meta-analysis on 20 years of research. Expert Review on Pharmaeconomics & Outcomes Research, 15(3): 499-519.