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Acute severe asthma
Acute severe asthma is a serious disorder that is characterized by the bronchospasm which is refractory to outpatient therapy. It is an emergency condition that usually needs immediate medical attention (Bayes & Thomson, 2016).
Causes of Acute severe asthma
The causes of these serious health concepts issues include respiratory infection, severe stress, cold weather, air pollution, several allergic reactions, exposure to chemicals and smoking (Sandrock & Norris, 2015).
Sign & symptoms associated with this health disorder includes short & shallow breaths, wheezing, coughing, difficulty in breathing, heavy sweating, trouble in speaking, fatigue & weakness, panic or confusion, abdominal pain, back pain, blue-tinted lips or skin, loss of consciousness, and neck muscle pain (Carr, Berdnikovs, Simon, Bochner & Rosenwasser2016).
As discussed in the case study the patient had acute severe asthma with severe dyspnoea, inability to speak a sentence in a single breath, increased blood pressure and auscultation of the lungs due to wheezing sounds (Castillo, Peters, & Busse, 2017). The pathogenesis of patient’s health condition includes different processes such as Asthma effects of airways, damage to the epithelial part, mucous excessive secretion, oedema, bronchospasm and airway remodelling.
Asthma effects on the airways
Asthma-related consequences include affecting trachea, bronchi, and bronchioles that together form a part of the lower respiratory tract. The disorder causes bronchoconstriction or the abnormal narrowing of Airway due to the epithelial damage, high production of mucus, bronchospasm, oedema, and damage to the soft muscles (Lambrecht, & Hammad, 2015).
Damage to the epithelial linings
In asthmatic condition, the layers of the cells that make the lining of airways are damaged. The epithelial shedding or discard of this epithelium can leads to hyper-responsiveness of the airways in different ways such as loss of barrier ability, loss of enzymes, and exposure of the sensory nerves of the body. The abnormal changes may also take place in subepithelial layers like laying down the collagens (Johnston et al., 2016).
Hyper-secretion of the mucus
Asthma may also cause the mucus-secreting cells to proliferate or divide abnormally and results in expended mucus gland. The increased secretion of mucus may form viscid mucus that can be occluded in the airways of the respiratory tract (Shen et al., 2018).
Capillaries of the airways may also leak or dilated. The consequences of this leakage lead to increased secretion of the airways, abnormal mucociliary release, and oedema, which may further cause contraction of airways and hyper-responsiveness (Powell, 2016).
It is considered as the feature of asthma in which the sharp contraction of bronchial soft muscle takes place and the airways narrowing. This might be the reason of occurrence of wheezing sound in the patient.
Remodelling of the airways
Remodelling is the condition of airways that occur in the lower respiratory tract. This is caused due to the uncontrolled or poorly controlled asthma, alteration in cell and tissue structure (George, Joshi, Concepcion, & Lee, 2017).
Diagnosis of Acute severe airways
Measurement of Peak expiratory flow
It is the simple method to test lung function that measures the highest flow of the air from the forced expiration which started from the position of highest lung inflation. The measurement of PEF is easy and fast to understand once the patient successfully perfumes the test.
The x-ray is the imaging method to test the abnormal respiratory function. It uses small amounts of radiation in order to produce a picture of the organs bones, tissues of the body. When these rays focused on the chest the abnormalities or disease of the airways, blood vessels, blood and heart can be identified. It can also help the physician to examine if there is a fluid in the lungs.
Arterial blood gas analysis
This method is really important to identify the acute severe asthma. It helps to determine the important key feature of these features such as a low pressure of PaCo2. It basically measures the arterial gases like oxygen and CO2. In these tests, a small amount of blood is taken from the patient.
Nurses have various roles in managing the health condition of the patient with acute severe asthma such as assessing the patient for previous allergies and medical history. health professional education the patient about self-management of asthma-related issues and what to do in asthma attacks is necessary. Assessing the patient's current clinical manifestations and managing the ICU management, mechanical ventilation, and examine any sign form patient that may be life threating. Two of the most important nursing strategies are:
Managing ICU conditions
ICU management is important to provide the adequate environment to the patient and to manage the vital condition of the patient. As mentioned in the case scenario the patient has breathing related issues, therefore it is important to manage the conditions. The nurses should manage the oxygen saturation and manage the proper oxygen resources in the ICU unit in an emergency condition. The nurses need to manage the O2 equipment that is being used to provide oxygen to the patient (Gray, Keeney, Grahl, Gorelick, & Spahr, 2016).
Improvement of gas exchange
Improving gas exchange and decreasing the work for breathing done by the patient, which can be done by using mechanical ventilation. This is important to stop any complication that can occur during the respiration process. This condition can be determined by moderate-severe dyspnoea. With the help of accessory muscles and the abdominal part and hyperactive acidosis, heart rate reduced to less than 25 beats per minute and the tachypnoea the gas exchange can be identified. The strategies related to ventilation include controlling volume nodes, low tidal volume to decrease the risk of barotrauma, and increase the expiratory times and reduce the auto peep, extrinsic peep and low respiratory rates (Lommatzsch & Virchow, 2014).
Administration of the drug to the patient
The Salbutamol is the medicine that mediates bronchodilation by stimulating the receptor beta2 available on the muscles of the airway. This cause the muscle to relax and airways to expand that are previously narrowed. This drug can be administered by using a nebulizer that is O2 driven. This should be provided within the five minutes of the patient with Status Asthmaticus. The patient should be involved in the decision making for a route to administer this drug. The Oxygen nebulisations are considered as the safest choice. The flow rate should be managed properly at the time of delivery of this drug. Adverse reactions of this medicine are tachycardia, hypokalemia, and tremor. The nurses need to assess those side effects, report to the doctor instantly and record the outcome of the medicine (Lefebvre et al., 2015)
Atrovent (Ipratropium bromide)
It is also called Ipratropium bromide. This medicine is basically used to open the medium and the large airways in the lungs that are narrowed due to a health condition. This anticholinergic agent blocks the muscarinic receptors and helps the airways to dilate by causing the muscle relaxation. This drug works by producing maximum bronchodilation compare to other drugs. Adverse reactions of this medicine are sinus pain, coughing, dry mouth, headaches, chills, stuffy nose. The nursing intervention, in this case, is to stop to the administration of the drug and call the doctors to report the condition and keeping a record of these health outcomes.
This medicine is used to deal with acute severe asthma. The inflammation occurs in this health condition can be reduced by using this corticosteroid. Side effects of this drug are nausea, weight gain, excessive sweating, and skin changes. Nurses should notice these symptoms and call for the doctors and other staff (George, Joshi, Concepcion, & Lee, 2017).
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4. George, M., Joshi, S. V., Concepcion, E., & Lee, H. (2017). Paradoxical bronchospasm from benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient with acute severe asthma. A case report and literature review of airway effects of BAC. Respiratory medicine case reports, 21, 39-41.
5. George, M., Joshi, S. V., Concepcion, E., & Lee, H. (2017). Paradoxical bronchospasm from benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient with acute severe asthma. A case report and literature review of airway effects of BAC. Respiratory medicine case reports, 21, 39-41.
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13. Shen, Y., Huang, S., Kang, J., Lin, J., Lai, K., Sun, Y., & Huang, K. (2018). Management of airway mucus hypersecretion in chronic airway inflammatory disease: Chinese expert consensus (English edition). International journal of chronic obstructive pulmonary disease, 13, 399.