Background Information
Write a case study discussing the management of a patient from your area of practice with a confirmed diagnosis of asthma. You must discuss your patients care in detail, providing a rationale for your interventions, using relevant literature, research and evidence based guidelines?
Asthma is a chronic disease. It is recognized by sporadic spasm attacks in the bronchi of the lungs inflamed at all times and instigated by allergic reactions and hypersensitivity (Trundak et al. 2014). The patient experiences breathing difficulties every time the inflamed airways are instigated. Here we are considering the case of an asthma patient, a female with a history of asthmatic attacks over an extended period. The case study follows her journey through the complicated pathways of being and persevering as an asthma patient. The route taken to manage the disease and its symptoms are also discussed in a brief detail. The physical and psychosocial impact of the disease is also discussed in the study leaning on the recorded data collected after monitoring the effects on the patient. The study concludes on a decisive note which pinpoints the facts and results of the total procedure.
The subject is a 44-year-old asthma patient. The patient is married with no children and was diagnosed with asthma as a child. The father and sister are known to be asthmatic. Personal and family history of atopy has been recorded. The patient has been on inhalable steroids for the past few years and has been asymptomatic for the period. She works fulltime as a team leader in a company on a Monday to Friday 9am-6pm basis. The experience of continuous coughing has been noted from January 2015. The patient has used her sister’s inhaler till the month of September 2015. After the symptoms of asthma had flared up, she visited the GP’s office. As noted by the GP, the patient has several triggers including cold, mold, cold weather, dust, and feather. While normal PEF was 450, the patient presented with a PEF of 250. Wheezing and low SOB was noted.
After thorough checkup, the doctor prescribed 40mg PO Prednisolone once per day for five days, 100mg Clenil two puffs in the morning and two puffs in the evening and 100 mcg Salbutamol 1-2 puffs for emergencies (Dhakal et al. 2013). The doctor advised the patient to return after a week’s time if the conditions improve and anytime if they persist. The condition improved and the patient did not return. However, it was noted that the patient asked for re-prescribing of Salbutamol and booked to meet the asthma nurse. Later the patient was prescribed Prednisolone and PO antibiotic. On further checking no crackles or wheezes were discovered; pallor, as well as periorbital dark circle, was noted along with heavy menstrual bleeding and abdominal discomfort. After a referral for pelvic scan and blood work, the results revealed low ferritin and hemoglobin. Ferrous fumarate and Norethisterone were prescribed. New asthma plan was given to counter the effect of anemia and asthma.
Physical Impact of Asthma
The physical impacts of asthma can be outright annoying or even life-threatening. The frequency and the seriousness of the attacks depend on the stage and control scenario of the disease (Pescatore et al. 2014). Symptoms and severity vary from person to person; constant symptoms are rarely seen in patients. Persistent issues are observed in a case of uncontrolled asthma and ensuing episode of the serious asthma attack. The common symptoms include coughing, wheezing, tight feeling in the chest, shortness of breath and awaking at night from bouts of coughing and wheezing (To et al. 2012). In children, the symptoms manifest in a different way. The common indications are unusual tiredness, restlessness, looking worried or scared for no reason, fast breathing, slouching, (Diep et al. 2015). In the case discussed, the patient presented with episodic bouts of wheezing and coughing. Awakening in the night and slight breathlessness was included in the list of symptoms.
The psychosocial effects are decided by many factors. Some of which are the severity of asthma, activity limitation due to asthma, available social as well as family support before, during and after the episodes of asthma, information level about disease management and coping mechanism (Pescatore et al. 2014). “Air hunger’ during the attacks can have a devastating effect on human psyche (Goodwin et al. 2014). An individual may feel terribly upset and out of control. Fear of death is another commonly experienced psychological symptom. The fear of death can persist even after the bouts have passed. Episodes occur at unexpected instances, and as is the case with every unexpected occurrence, these episodes are stressful. Constant anxiousness is another one of the commonly experienced effects. Denial, anger, guilt, embarrassment and confusion are also commonly experienced.
According to the case discussed, the patients showed signs of confusion and denial at first when the symptoms were not as pronounced. Later the patient went through a stressful phase when the disease persisted even after she used inhalable steroids. As a result, the patient visited the GP more than once. The patient also showed negligence when the symptoms were averted after the first treatment. Fear and anxiety were the reasons behind the further appointments with the GP. There is no right way of approaching such an issue. To deal with the psychosocial effects of the disease, the patient is advised to take professional help from doctors and healthcare providers. If needed, the stress and fear can be handled with the help of a professional psychologist dealing with patient care after stressful diagnosis of chronic diseases (Lindner 2014).
Psychosocial Impact of Asthma
As the case study follows the patient through the journey, the purpose of the monitoring becomes clear. The patient has had asthma for an extended period. The diagnosis was made in her childhood. After prolonged use of medications, the patient was asymptomatic. But recent development depicts the revival of the symptoms. The goal of continuous monitoring is to impose asthma control (Theoharides et al. 2012). Following a particular mechanism is needed in this process to ensure that the symptoms of the disease do not persevere and cause the patient any discomfort. The patient, in this case, was called on for a follow up to check on the disease status. The therapeutic approach was changed based on the impact of the first treatment plan. Several doses of medicines were altered, and several medications were changed to alleviate a persistent cough and wheezing. Monitoring also helps patients recognize the tendencies of inadequate asthma control. In this case, misjudging the situation, the patient discontinued the clinic visits but with proper help, she recognized the need for continued treatment and worked to achieve that.
For regular asthma control and monitoring, the medical practitioner in the scenario should ask a set of questions. The four primary questions include inquiring about daytime asthma symptoms, nocturnal awakening rate due to asthma symptoms, a frequency of short-acting medication usage and inability to perform normal activities (Moeller et al. 2015). These symptoms should be reviewed over a period of 2-4 weeks. The symptomatic frequencies and scores are recorded. Studies are conducted to understand the implication of the said questionnaire scores.
The pharmacological management of asthma includes the use of treatment options helping to elevate the control situation. The used control agents are inhaled steroids, inhaled group of cromolyn or nedocromil, bronchodilators, and the recent developmental agent anti-immunoglobulin antibodies. In the list of relief medications, corticosteroids and ipratropium are included. In this particular case, PO Prednisolone, Clenil, and Salbutamol were administered to the patient to control the advent of the disease symptoms. After reviewing the situation, several changes were made in the prescription to help in changing the outcome. Doses and medications were changed to help the patient function better.
The nonpharmacological asthma management approach includes identification and exclusion of factors that can elevate the symptoms of the disease (Jia et al. 2013). There are several things that should be avoided. The list of things to be avoided includes animal dander, dust mites, cockroaches and several other environmental triggers. Patients with resistance against any of the triggers should be advised against coming in direct contact with the agents. Another condition that can exacerbate asthma is GERD or gastroesophageal reflux disease. Patients with GERD are advised to avoid certain food and beverage items so that the condition is not aggravated. The patient was requested to maintain nonpharmacological abstinence to help control the disease better.
Importance of Monitoring
Creating an asthma control plan with the collaborative efforts of the patient and the instructor is of utmost importance if asthma control goals are to be reached (Demoly et al. 2012). This falls under self-management education in asthma management (Cabana et al. 2014). Following a facilitated plan, a patient outcome can be improved. The primary aim of self-education is to alleviate the effect of asthma on quality and functionality of life. In this case, the patient was provided with the details of the case by the practitioner. The patient based her decisions on the amassed data and decided to act according to the asthma control plan.
After following the primary asthma control and management plan the patient’s wheezing and coughing problems decreased in intensity. However, the problems persisted. As pallor and dark circles were noted several tests were performed on the patient to find the underlying problem. On further examination, the presence of low ferritin and low hemoglobin level was noted. The patient was informed of the lack and the need for change. Based on the results, several changes in the asthma management and control plan were made. The changed plan helped the patient recover from the symptoms of the problem.
The asthma action plan includes a list of do’s and don’ts. The plan includes an everyday health management plan for the particular asthma patient, symptom management plan, and asthma attack management plan (Zahran et al. 2012). The action plan can be used to remind the patient about when to take medicines, identify the triggers, check for the next due appointment time, communicate with the GP nurse or asthma instructor through the right source and to communicate with the families and friends of the patient about the dos and don’ts of an asthma attack.
In a case of the discussed patient, the symptoms did not change but decreased in intensity which called for a change in the action plan. Nevertheless, several cases have been reported which depict changes in the symptom types and manifestation, in such cases, the plans should be reviewed at periodic intervals. The patient, in this case, had to sit with the medical practitioner and the GP nurse more than once to decide on a particular action plan. The action plan was reviewed more than once to accommodate the changes in the manifestation of the symptoms. However, before the change of plan, the severity of the disease should be brought into account.
Pharmacological Management of Asthma
It is difficult to understand the reason behind the discrepancy responsible for the mismanagement of asthma (Yin et al. 2016). The recommendations are widely available, and the patients are offered several sources of information to improve their understanding of asthma control and management. Nevertheless, severe and deteriorating asthma is still present in the community and the world. Exacerbations are avoidable with continued care and medical support. The symptoms should be identified and rated based on severity. In a case of deteriorating asthma, the common symptoms are increased shortness of breath, continued chest tightness, coughing, and wheezing (Dima et al. 2015). The patient had a history of asthma-related problems but was managing the symptoms well with an inhaler. However, several symptoms increased in intensity which led her to the GP’s office. The persisting symptoms were wheezing and coughing. With an efficient and effective action plan, the symptoms were managed in the 44-year-old patient.
In conclusion, the case study reveals the chronic nature of asthma and unveils the importance of organized asthma management. Although the patient was asymptomatic for a long period in spite of being diagnosed with asthma at a young age, the symptoms suddenly flared up and could no longer be managed using the same mechanism as was previously being used by the patient. This led to repeated visits to the GP. After six weeks of treatment and asthma control, the patient’s health improved remarkably. The patient had followed an efficiently crafted asthma control plan. Occasional coughing persisted, but the use of steroid was no longer required. Management of the disease can also lead to management of the psychosocial as well as pharmacological and nonpharmacological effects. This case study reveals that the process should be systematic and closely monitored. Asthma cannot be cured, but following a strictly constructed plan, it can be managed and controlled.
References
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Demoly, P., Annunziata, K., Gubba, E. and Adamek, L., 2012. Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years. European Respiratory Review, 21(123), pp.66-74.
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Diep, R.T., Busani, S., Simon, J., Punzalan, A., Skloot, G.S. and Glassberg, J.A., 2015. Cough and wheeze events are temporally associated with increased pain in individuals with sickle cell disease without asthma.British journal of haematology, 170(5), pp.732-734.
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Theoharides, T.C., Enakuaa, S., Sismanopoulos, N., Asadi, S., Papadimas, E.C., Angelidou, A. and Alysandratos, K.D., 2012. Contribution of stress to asthma worsening through mast cell activation. Annals of Allergy, Asthma & Immunology, 109(1), pp.14-19.
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Zahran, H.S., Person, C.J., Bailey, C. and Moorman, J.E., 2012. Predictors of Asthma Self-Management Education among Children and Adults—2006–2007 Behavioral Risk Factor Surveillance System Asthma Call-back Survey.Journal of Asthma, 49(1), pp.98-106.
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