Pathogenesis of Acute Severe Asthma
This answer will discuss about the case study of Jackson and his acute severe asthma associated health condition. Jackson is a 18 year old boy who was admitted to the emergency department of the healthcare facility after having a severe attack of acute asthma at 9 pm and while admitting to healthcare facilities, the professionals noted the primary clinical situation as severe breathlessness. The pathogenesis of asthma was completely visible on the patient and his health condition because of the inflammatory symptoms and activation of different mediators and cells types. It should be mentioned in this context that due to the presence of foreign particles, dirt dust or other foreign materials are responsible for the inflammatory responses due to which different cell types start interacting with these antigens and causes the emergence of these symptoms in the body of the patient (Chung et al., 2014). Further in the case of Jackson, it was disclosed by the family members of the patient that he was admitted to the healthcare facility prior to this issue at the age of 2 due to asthmatic symptoms were relieved at that time. Therefore, the emergence of acute severe asthma was related to his childhood asthmatic condition and hence, while collecting the clinical manifestation, this was one of the major issues which were collected (Guérin et al., 2013). Besides this, the presence of severe dyspnea were also seen with the presence of elevated heart rate, blood pressure (150/85 mmHg) and shortness of breath. Further, other symptoms such as wheezing sound while breathing, increased pulse rate (130 BPM) and auscultation of lungs were also seen in case of Jackson. Besides to collect more detailed assessment of the patient condition, several physiological assessments were also collected such as X-ray assessment of the lung and from the assessment it was seen that the lung and peripheral areas were swollen and hyper inflation were observed in the lungs. Further, from the blood gas analysis the amount was noted as 90% SO2 PaCO2 which was 50mmHgand HCO3: 25mEq/L was among the other readings. Hence, in this case the pathogenesis should be discussed as per the case study of Jackson.
The pathogenesis of acute severe asthma is associated with the commencement of the inflammation process due to which the symptoms are visible on the patient’s body (Schmidt et al., 2014). While discussing the reason for pathogenesis of the disease it should be mentioned that the emergence of inflammation is associated with several factors such as genetics, environmental factors, allergens, pollens and respiratory infections due to which it is associated with the acute severe asthma related condition (Sellers, 2012). As the patient is suffering from the asthmatic condition since his childhood the pathophysiology related to innate immunity should be discussed. As the foreign particles enter the human body, the antigen presenting cells starts engulfing them to present them to the T cells (Chung et al., 2014). These t cells then using a cascade presents the foreign proteins to the other cells such as T helper cells, and then releases interleukins, stromal lympho-proteins, which acts as a allergic condition regulator and this in turn activates the B cells that finally produces the immunoglobulin E which finally activates interleukin 4 and 13 (Goodacre et al., 2013). These are important for the enhancement of the allergic condition and inflammation because in the process it tends to activate cells such as macrophages, eosinophiles, neutrophiles and other cells which increase the inflammation symptoms. This is because the IgE works by combining itself to macrophages which ultimately engulfs the foreign proteins and then by releasing interleukins increase the inflammatory symptoms in the host body (Sellers, 2012). Further, there are several mediator cells which increase the airway damage by introducing the bronchoconstriction, which is visible in the case of Jackson (Serhan, 2014). Further as the patient was having clinical symptoms of shortness of breath , higher respiratory and pulse rate and so on, therefore, it should be mentioned that the patient was suffering from acute severe asthma due to the presence of innate immunity related pathophysiology as well as chronic inflammatory symptoms (Schmidt et al., 2014).
Nursing Strategies for Treatment
The two nursing strategy which will be used for the for the treatment of the Jackson and his sever acute asthmatic condition will be providing him with the immediate pharmacological care so that his condition could be relieved and then assess the severity of the condition for further health improvement interventions. Both of these nursing interventions and management strategies has been mentioned in the segment below:
As the patient has been admitted to the emergency ward of the facility, immediate care plan is a must for the Jackson. This immediate care will include strategies using which immediate care and help can be provided to the patient to relief his shortness of breath and chest congestion. Further due to these, the patient may suffer from depression, anxiety which can lead to anger in patients (Zemek et al., 2012). Hence, it is the responsibility of the healthcare facility to implement the process in care for patient. Therefore, the first intervention will be applied to lower the peak flow of the process and then help the patient with medications such as corticosteroids, short acting beta 2 and anticholinergics and immunomodulators so that the airflow within the airway could be increased the patient condition could be relieved (Ponikowski et al., 2016). On the other hand, the second intervention will be determining the peak flow of expiration or the maximum for and maximum output the patient is applying for the determination of the process. This applied force and intensity of breathing will help the patient to decide the severity of the disease and hence,, the healthcare professionals will be able to use their ideations and interventions to treat such patient condition. Therefore, these are the interventions using which the acute severe asthma related condition of Jackson will be treated and further intervention will be decided (Alhazzani et al., 2013).
Salbutamol: this is the medicine which was used by the healthcare professionals for the treatment of Jackson. This medicine is provided to the patient in the form of aerosol and therefore, the primary mode of action of this drug is associated with its β2-adrenoreceptors actions (Gallenmüller et al., 2014). The primary action of this drug is on the smooth muscles which covers the bronchi (Sharma et al., 2014). The primary mode of action of this drug is associated to the attachment of the drug to the epinephrine’s binding site and hence, it initiates the bonding by stabilizing the receptor that increases the number of cAMP that eventually releases the potassium ion through a cascade that triggers the intracellular cascade (Gallenmüller et al., 2014). Nebulised ipratropium bromide: This is the medicine which is primarily used in case of chronic pulmonary disorder due to which is comes in the form of an inhaler containing beta2-agonists and helps in the treatment of reversible obstruction of the airway. The mode of action of this drug is associated with the blockage of muscarinic receptors and by relieving this receptor this drug helps in minimizing the symptoms such as COPD. IV Hydrocortisone 100mg: this drug is the natural glucocorticoids which has a mode of action associated with changing the immune response by diversifying the stimuli and then help in the identification and enhancement of the metabolic effect of the drug.
Medications Used for Treatment
Using Salbutamol helps to relieve the smooth muscles. Further for the evaluation, the assessor should be able to assess the patient improvement after the consumption of the medicine and also by determining the side effects that increases with the failure of the drug in determining the patient benefit (Sharma et al., 2014). This iis the implication of the drug and the evaluation process to understand the drugs activity and responsiveness.
On the other hand, the evaluation of the drug Nebulised ipratropium bromide could be done by using the patient improvement or evolution (Nouira et al., 2014). Further the effectiveness could be assessed by determining the patient’s improvement and ability to inhale ample amount of oxygen. The third medicine IV Hydrocortisone 100mg, and its effectiveness should be determined by the patients peak flow expiration rate so that it can impart in patient improvement. The evaluation of the drug could be done by determining the patient improvement and conducting the peak flow assessment so that the expiration related force could be identified (Alam, Rahman & Ershad, 2012).
References
Alam, M. R., Rahman, M. A., & Ershad, R. (2012). Role of very short-term intravenous hydrocortisone in reducing postdural puncture headache. Journal of anaesthesiology, clinical pharmacology, 28(2), 190.
Alhazzani, W., Alshahrani, M., Jaeschke, R., Forel, J. M., Papazian, L., Sevransky, J., & Meade, M. O. (2013). Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials. Critical care, 17(2), R43.
Chung, K. F., Wenzel, S. E., Brozek, J. L., Bush, A., Castro, M., Sterk, P. J., … & Boulet, L. P. (2014). International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. European respiratory journal, 43(2), 343-373.
Gallenmüller, C., Müller-Felber, W., Dusl, M., Stucka, R., Guergueltcheva, V., Blaschek, A., … & Abicht, A. (2014). Salbutamol-responsive limb-girdle congenital myasthenic syndrome due to a novel missense mutation and heteroallelic deletion in MUSK. Neuromuscular Disorders, 24(1), 31-35.
Goodacre, S., Cohen, J., Bradburn, M., Gray, A., Benger, J., Coats, T., & 3Mg Research Team. (2013). Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. The Lancet Respiratory Medicine, 1(4), 293-300.
Guérin, C., Reignier, J., Richard, J. C., Beuret, P., Gacouin, A., Boulain, T., … & Clavel, M. (2013). Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, 368(23), 2159-2168.
Nouira, S., Bouida, W., Grissa, M. H., Beltaief, K., Trimech, M. N., Boubaker, H., … & Boukef, R. (2014). Magnesium sulfate versus ipratropium bromide in chronic obstructive pulmonary disease exacerbation: a randomized trial. American journal of therapeutics, 21(3), 152-158.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., … & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975.
Schmidt, M., Bailey, M., Sheldrake, J., Hodgson, C., Aubron, C., Rycus, P. T., … & Combes, A. (2014). Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. American journal of respiratory and critical care medicine, 189(11), 1374-1382.
Sellers, W. F. S. (2012). Inhaled and intravenous treatment in acute severe and life-threatening asthma. British journal of anaesthesia, 110(2), 183-190.
Serhan, C. N. (2014). Pro-resolving lipid mediators are leads for resolution physiology. Nature, 510(7503), 92.
Sharma, U. K., Kushwaha, M., Tiwari, H., & Prakash, A. (2014). A review on mesoporous silica nanoparticles loaded salbutamol sulphate. World J Pharm Pharm Sci, 3, 251-271.
Zemek, R., Plint, A., Osmond, M. H., Kovesi, T., Correll, R., Perri, N., & Barrowman, N. (2012). Triage nurse initiation of corticosteroids in pediatric asthma is associated with improved emergency department efficiency. Pediatrics, peds-2011.
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