400418 Health Advancement and Health Promotion

 Pathogenesis causing clinical manifestations.

Asthma is a chronic inflammatory airway condition commonly characterized by wheezing, coughing, and dyspnea, which are all signs of airway obstruction. They may occur randomly, most often at night or early in the morning, after exercise, or in response to an allergen. An exacerbation of underlying airway inflammation causes these signs and decreased ventilation. Although the mediators and cells associated with these exacerbations are likely to vary according to the stimulus. The final result will likely be blockage of smooth muscle, bronchoconstriction, and inflammation of respiratory airways due to accumulation of cells in the bronchioles.

The existence of intrinsic airway inflammation is critical for the diverse phenotypic characteristics of asthma. This inflammation is complex and exhibits different but overlapping sequences that represent multiple facets of the condition. Acute asthma attacks are typically caused by bronchospasm and are treated successfully by bronchodilator treatment.  Bronchodilators are medications such as beta-antagonists which mainly relaxing the muscles in the lungs and causing the expansion of bronchi Acute and chronic inflammation impairs the calibre and flow of the airways and the underlying bronchial hyperresponsiveness, increasing the likelihood of bronchospasm Denholm et al. (2020).

The primary physiological occurrence in asthma that results in clinical symptoms is airway narrowing and resulting obstruction of airflow. Bronchial smooth muscle contraction (bronchoconstriction) happens immediately in acute asthma exacerbations to close the airways in reaction to a range of symptoms, such as allergens and irritants. Allergen-induced acute bronchoconstriction is caused by the mast cell release of mediators such as histamine and prostaglandins that constrict the airway smooth muscle directly DeBaun and Strunk (2016). In certain patients, aspirin may also induce acute airflow restriction. Studies suggest that this non-IgE-dependent reaction includes mediator release from airway cells (Powell 2016).

 Additionally, other causes such as work out, chilly air, and irritants may block severe airflow. Stress can also contribute to the onset of asthma exacerbations. The underlying mechanisms are unknown but may include increased production of pro-inflammatory cytokines.

The High Fowler's posture is a medical position where the patient lies raised with the upper body and head at an angle of 60° to 90° to the lower body. In the given case study, it will aid in the relaxation of abdominal muscle tension, allowing for better breathing. The Fowler's posture alleviates the weight and strain of the Peter’s habitus on the chest and lungs, thus increasing the lungs' capacity. A venturi mask will be used to deliver oxygen to the Peter. This is because a venturi mask can provide a controlled amount of oxygen to the patient, normally 24% to 50% during the delivery of supplemental oxygen (Denholm et al. 2020).

Supplemental oxygen supplies additional oxygen to the lungs, mitigating the harmful effects of oxygen deficiency on the patient's body. In the case study, supplemental oxygen will help Peter relieve symptoms such as shortness of breath, fatigue, dizziness and depression. It will also keep other organs of the body functioning as it replaces the depletion created by difficulties in breathing and shortness of breath.Salbutamol is a selective beta2-adrenergic receptor agonist with a short lifespan used in the treatment of asthma.

The mechanism of action

As beta2-adrenergic receptors on the respiratory system smooth muscle are activated, adenyl cyclase is energized, and the intracellular concentration of cyclic-3′,5′-adenosine monophosphate rises (cyclic AMP). This rise in cyclic AMP stimulates protein kinase A, inhibiting myosin phosphorylation and decreasing intracellular ionic calcium concentrations, leading to relaxation (Fergeson et al., 2017).

Nursing consideration

Use low doses for short periods; opioid resistance can develop with repeated use.

Maintain a beta-adrenergic antagonist on hand (a cardioselective beta-blocker, such as atenolol, can be used in the event of cardiac arrhythmias).

Prepare an inhalation solution by diluting 0.5 mL 0.5 per cent solution with 2.5 mL regular saline; administer by nebulization over 5–15 minutes.

Salbutamol loosens up smooth muscles of the trachea, bronchioles, and bronchioles terminals Kim et al. (2018). It works as a practical antagonist to ease the respiratory system regardless of the spasmogen, defending against all bronchoconstrictor challenges. Increased cyclic AMP concentrations have been linked to the induction of mediator release from mast cells in the airway.

Peter is receiving salbutamol since it is used to treat respiratory conditions such as coughing, wheezing, and shortness of breath. It calms the muscles of the airways leading into the lungs, thus easing breathing (Ullmann, Caggiano, & Cutrera,  2015).

Salbutamol has several adverse effects that should be considered.  Typically, it causes the patient to feel nervous, changes in taste, coughing, and heart palpitations. This is a natural reaction to a dose and the nurse should inform Peter’s parents the anticipated side effects. Salbutamol should not be used in patients considered to be hypersensitive to adrenergic amines. 

Before and after salbutamol use, the nurse should watch for respiratory sounds and take blood pressure and pulse rates. It is critical to determine the volume, colour, and quality of sputum produced by a patient who has a productive cough.       Additionally, it is crucial to examine paradoxical bronchospasm, which is the reverse of the albuterol-induced reaction. Rather than alleviate bronchoconstriction, it exacerbates it, resulting in increased wheezing, and difficulty breathing. Nursing evaluations should also consider the efficacy of therapy depending on the age of peter, who is only ten years old.

After administering salbutamol to the patient, some of the expectations are a change in the heart rhythm and a slight change in blood pressure.

Hydrocortisone IV

Cortisol, or hydrocortisone, is a glucocorticoid that the adrenal cortex secretes. Hydrocortisone is a medication that is used to treat immune, infectious, and neoplastic diseases.

The mechanism of action

Corticosteroids have a short-term consequence of decreasing capillary vasodilation and permeability (Chamberlain et al., 2016). Corticosteroids act via the glucocorticoid receptor to alter gene expression, resulting in a cascade of downstream results over hours to days.

Glucocorticoids repress neutrophil apoptosis and demargination. They inhibit phospholipase A2, thus reducing the formation of arachidonic acid derivatives; they inhibit NF-Kappa B and other pro-inflammatory transcription factors. They energize the expression of anti-inflammatory genes such as interleukin-10.

Nursing consideration

Occlusive dressings should be used with caution; rigid or plastic diapers covering the affected region will improve systemic absorption.

Avoid extended usage, especially close to the eyes, genital and rectal regions, forehead, and skin creases.

Peter was given hydrocortisone to shorten the length of an exacerbation. This is because inhaled corticosteroids at elevated doses decrease airway irritation and increase airway responsiveness, thus reducing an exacerbation period for the patient such as Peter in the case study.

Mechanism of action

Ipratropium bromide performs as an antagonist to acetylcholine by inhibiting muscarinic cholinergic receptors (Kumar et al., 2016). By inhibiting cholinergic receptors, cyclic guanosine monophosphate synthesis is reduced (cGMP). Reduced airway diameter in the lungs results in reduced smooth muscle contraction. Ipratropium acts by hampering secretions from the mucous and salivary gland and enlarging bronchial smooth muscle.

Intranasal ipratropium induces a parasympathetic reflex in the nasal mucosal glands, thus alleviating rhinorrhea symptoms (allergic or non-allergic).

Peter had an inspiratory and expiratory wheeze as some of the symptoms. He has prescribed Anticholinergic Ipratropium bromide (Atrovent) 500ug 4/24. The purpose of ipratropium bromide is to treat and alleviate the effects of wheezing and breath shortness. It works by soothing the muscles around the airways, allowing them to loosen up to allow easier breathing.

Nursing Consideration

Atropine, soybeans, and peanuts hypersensitivity; sudden bronchospasm, narrow-angle glaucoma, prostatic hypertrophy, urinary neck obstruction, breastfeeding. Peter was given ipatropium bromide to improve lung function and reduce hospital readmissions, considering that asthma is a chronic condition.

References

Chamberlain, J. M., Teach, S. J., Hayes, K. L., Badolato, G., & Goyal, M. K. (2016). Practice pattern variation in the care of children with acute asthma. AcademicEmergency Medicine, 23(2), 166-170. https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.12857

DeBaun, M. R., & Strunk, R. C. (2016). The intersection between asthma and acute chest syndrome in children with sickle-cell anaemia. The Lancet, 387(10037), 2545-2553. https://www.sciencedirect.com/science/article/pii/S0140673616001458

Denholm, R., van der Werf, E. T., & Hay, A. D. (2020). Use of antibiotics and asthma medication for acute lower respiratory tract infections in people with and without asthma: retrospective cohort study. Respiratory Research, 21(1), 1-12. https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-019-1233-5

Fergeson, J. E., Patel, S. S., & Lockey, R. F. (2017). Acute asthma, prognosis, and treatment. Journal of Allergy and Clinical Immunology, 139(2), 438-447. https://www.sciencedirect.com/science/article/pii/S0091674916308004

Kim, C. K., Callaway, Z., & Gern, J. E. (2018). Viral infections and associated factors that promote acute exacerbations of asthma. Allergy, Asthma & Immunology Research, 10(1), 12. https://synapse.koreamed.org/upload/SynapseData/PDFData/0166aair/aair-10-12.pdf

Kumar, R. K., Herbert, C., & Foster, P. S. (2016). Mouse models of acute exacerbations of allergic asthma. Respirology, 21(5), 842-849. https://onlinelibrary.wiley.com/doi/abs/10.1111/resp.12760

Powell, C. V. (2016). Acute severe asthma. Journal of Paediatrics And Child Health, 52(2), 187-191. https://onlinelibrary.wiley.com/doi/abs/10.1111/jpc.13075?casa_token=_oJ2CkZ6VyEAAAAA:stlDsVadMTo6ed_Rj7r0R86wO9yMiq5UW-i_cOYDw98LNbQQOEOBjwS_g5fRvxdyGb5NA5ks1ItUgKul

Ullmann, N., Caggiano, S., & Cutrera, R. (2015). Salbutamol and around. Italian Journal of Pediatrics, 41(2). 

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