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Explain the pathogenesis causing the clinical manifestations with which Poppy presents.
In reference to the case, Poppy, a 9-year-old female was diagnosed with acute exacerbations of asthma. The cells and stimulus involved in exacerbation underlying the inflammation of the airway depend on the type of stimulus or allergen (Sullivan et al., 2016). Inversion of allergen results to antigen presentation by the dendritic cell which leads to elevated levels of mast cells, neutrophils, eosinophils, lymphocytes and CD4. The increase in levels of these cells in the airway leads to airway inflammation, intermitted airflow obstruction and bronchial hyperresponsivenes thus leading to air restrictions. Breathing and expiration becomes labored thus causing the clinical manifestations of asthma.
a). Sit Poppy in a high Fowlers position
-How does positioning a patient with acute asthma in a High Fowlers position assist to alleviate respiratory distress?
Fowler’s position is the best position for patients with respiratory distress or shortness of breath as in the case of Poppy. The positioning of a patient in a high Fowler position helps to alleviate respiratory distress in that it facilitates the relaxing tension of the abdominal muscles and eases compression of the chest that occurs as a result of gravity thus improving intake of Oxygen.
b). Apply and titrate oxygen
i)-What oxygen delivery device will you use?
ii)-Why did you choose this device?
Hudson masks remains as one of the devices that are utilized to deliver supplemental oxygen to patients with respiratory distress like in the case of Poppy. The device has variable performance with maximum oxygen concentration of up to 60 percent. The merits of using this device is that it has side holes which are designed to allow the patient to in draw room air during respiration. According to (Levy et al (2016), when high-flow of oxygen is needed during the treatment of acute asthma, it is necessary to ensure high-flow masks such as Hudson masks are utilized as they bring the desired concentration of oxygen.
iii)-How does providing supplemental oxygen work and how will it assist Poppy?
Providing supplemental oxygen to Poppy will help her restore her homeostasis which is maintained by the respiratory system. Restoration of homeostasis balance that is gas exchange and regulation of blood ph in the body will help in the regulation of many physiological factors like pressure, temperature, and oxygen nutrient concentrations. Besides, supplemental oxygen has been evidenced to improve the quality of life and survival as it relieves the patient from shortness of breath and fatigue (Mims, 2015).
a) Salbutamol- Salbutamol belongs to a group of drugs referred to ad adrenergic bronchodilators. The drug is breathed in through the mouth to open up the bronchial tubes in the lungs (Gaugg et al., 2017).
i)-Mechanism of Action of Salbutamol
Salbutamol acts as selective beta2-adrenergic receptor agonist to relax muscles in the airway. The medication is understood to trigger beta2-adrenergic receptors on the airway which results in a rise of intracellular concentration of cyclic AMP (Gaugg et al., 2017). A rise in the concentration of cyclic AMP leads to activation of protein kinase A, thus inhibiting the phosphorylation of myosin and reducing the intracellular ionic calcium concentration which leads to the relaxation of smooth muscles in the airway.
ii)-Why your patient is receiving this medication in relation to her symptoms and diagnosis?
Prescribing salbutamol to Poppy will help in relieving her from her worsening respiratory symptoms. These symptoms include shortness of breath and wheezing. The medication will be able to relieve the symptoms by relaxing the muscles of the airways into the lungs thus making it easier for Poppy to breathe (Sullivan et al., 2016).
iii)-What is the nursing consideration for this Salbutamol via nebulizer?
The risks of any medication should be weighed against its goodness thus a doctor needs to consider various factors before administering any drug. One of the nursing considerations for salbutamol is allergy. A nurse should check whether the patient has had an allergic reaction towards salbutamol or any other kind of medication in the past. Also, the nurse should consider other medications that the patient is using as Salbutamol interacts with some medications such as amineptine resulting in advanced side effects (Hussein et al., 2018).
iv)- What clinical response do you expect? Some common side effects that aren’t dangerous that should be expected when on Salbutamol is headaches, muscle cramps, feeling shaky and faster heartbeat (Buning et al., 2017).
v) -What continuing clinical observations will you need to undertake? In some people, Salbutamol can cause dangerous adverse effects. Some adverse effects that should be undertaken include dizziness, chest pain, serious headache, or muscle weakness. Such clinical observations are serious side effects and should ask advice from the doctor.
b) Hydrocortisone IV- hydrocortisone belong to a group of drug known as corticosteroids. According to (Buning et al., 2017), the medication is utilized to cure individuals with low levels of corticosteroids by replacing steroids that are synthesized by the body. Besides, the medication is used to treat various conditions such as swelling, redness, and strengthens the immune system.
i)-Mechanism of action- It is an anti-inflammatory adrenocortical steroid. Its form of action involves the inhibition of phospholipase A2 which reduced the formation of the arachidonic acid derivative. The medication also inhibits NF-Kapp B together among other inflammatory transcription factors thus bringing its effect in the body (Buning et al., 2017).
ii)-Why your patient is receiving this medication in relation to her symptoms and diagnosis- In relation to Poppy’s symptoms, hydrocortisone Iv will help in managing her asthma condition and some of her allergic conditions. According to (Buning et al., 2017), taking hydrocortisone iv consistently plays a critical part in reducing inflammation in the airways of the lungs thus managing asthma.
iii)- Nursing consideration for hydrocortisone iv- A nurse should consider the other types of medicine that the patient is taking as hydrocortisone interacts with other medications such as vitamins and herbs which results in adverse effects. Also, a nurse should consider allergic reactions of the patient as the medication can result in severe allergic reactions such as trouble in breathing. Furthermore, the nurse should consider certain health conditions of the patient as the medication can be dangerous when used by individuals with high blood pressure, diabetes, and glaucoma (Mims, 2015).
iv)-What clinical response do you expect? The common clinical response that should be expected after taking Hydrocortisone IV includes headache, dizziness, muscle weakness, and extreme tiredness.
v)-What continuing clinical observations will you need to undertake? The serious clinical observations that need to be undertaken include vision problems, rash, shortness of breath, swelling in the stomach, and seizures (Buning et al., 2017).
C) Ipratropium Bromide via nebulizer
i) Mechanism of action- Ipratropium bromide is an anticholinergic agent which brings its effect by blocking the muscarinic receptors of acetylcholine in bronchial smooth muscles thus causing bronchodilation (Hussein et al., 2018).
ii)-Why your patient is receiving this medication in relation to her symptoms and diagnosis- In relation to Poppy’s symptoms, Ipratropium when used together with b-agonist (salbutamol), will be useful in controlling and preventing symptoms of shortness of breath and wheezing that are caused by asthma. The medication works by relaxing the muscles around the airways thus making the patient breathe without difficulties (Hussein et al., 2018).
iii)-Nursing consideration – A nurse needs to consider the history of the patient such as hypersensitivity to atropine since when used with such conditions can cause adverse effects (Mims, 2015).
iv)-What clinical response do you expect? Common side effects that should be expected when on Ipratropium bromide include trouble in breathing, dry mouth, headache, and bitter taste.
v)-What continuing clinical observations will you need to undertake? The serious clinical observations that need to be noted include breathing difficulties. If it gets worsened one should seek medical attention (Hussein et al., 2018).