Case Study of Amelia Suffering through Asthma Free Sample

Question: Introduction State an Overview of the Patients condition and Identify the Two Priority Nursing Problems. Give a brief plan for the Essay topics. Answer: Introduction: Amelia is suffering through Asthma. Asthma is common problem in children. Amelia is exhibiting, signs and symptoms related to the Asthma. These signs and symptoms include increase in respiratory rate, less oxygen saturation, cough and wheezing. Amelia is also exhibiting rhinorrhea. Amelia is prescribed with medications like prednisolone as anti-inflammatory drug and salbutamol as bronchodilator. Supplemental oxygen also supplied to Amelia. Restricted airway and inflamed airway are the two problems identified in Amelia. These two problems occur in Amelia due to cascade of events comprised of allergy, inflammation, secretions of mediators, bronchoconstriciton and insufficient breathing. In the essay, these problems are correlated with the signs and symptoms of Amelia. For each problem, two interventions are discussed. These interventions would be helpful in improving condition of Amelia. Restricted airway problem: Amelia is having restricted airway problem. In asthma allergen induced and IgE dependent immune mechanism occurs. As a result, there is release of different mediators like histamine, leucotrines and prostaglandins. These mediators produce contraction of the airway smooth muscle. As a result there is occurrence of airway narrowing and bronchoconstriction. Airway inflammation is the predominant causes of the restricted airway. Due to restricted airway, there can be insufficient airway clearance, insufficient breathing, increased respiratory rate, hypoxia and decrease in the oxygen saturation level (Bonini and Usmani, 2015). In Amelia also there is evidence of increased respiratory rate. In children Amelias age respiratory rate should be between 20 30 breaths per minute. However, in case of Amelia respiratory rate was 34 breaths per minute. Oxygen saturation should be between 95 100 % in children. However, in case of Amelia it was 90 %. Amelia is associated with moist cough and this t ype of cough is called as productive cough. In productive cough phlegm is expelled from the respiratory tract. As a result, infective agents and foreign particles can be expelled out from the respiratory tract. Rhinorrhea is also observed in case of Amelia. Rhinorrhea is the condition in which there is considerable amount of mucus in the nasal cavity. Inflammation in the airways leads to secretions of different mediators in the respiratory tract (Patadia et al., 2014). These secretions get accumulated in the nasal cavity. Restricted airway and accumulation of these secretions in the airways and nasal cavity lead to the insufficient airway clearance. Insufficient airway clearance leads to insufficient breathing. Due to insufficient breathing there is less exchange of oxygen at the alveoli-capillary interface. As a result, there is less amount of oxygen in the blood, which need to be supplied to tissues and organs. Amount of oxygen carrying by blood is termed as the oxygen saturation level. In Amelia, this oxygen saturation level is less as compared to the normal level. It reflects her blood is carrying less amount of blood. As a result there is less supply of oxygen to the tissues and organs. Lung has compensatory mechanism for this insufficient oxygen. Lung starts breathing at faster rate to supply more amount of oxygen to the tissues and organs. Hence, increased respiratory rate was observed in Amelia (Mims, 2015). Sitting up posture intervention: For restricted airway problem, sitting up posture as a nursing intervention should be provided. This nursing intervention facilitates breathing in Amelia. Sitting up position can increase stretching of lungs and increase in surface area of lungs for gas exchange. In this position, lungs are flexible and chest expands to take more amount of air in. Goal of this nursing intervention is to facilitate maximum respiratory function in Amelia. By sitting up, maximum respiratory function can be achieved in Amelia without much physical efforts and by providing comfortable positioning (Kim et al., 2012). Pillow can be used to support back of the Amelia. More number of pillows should not be used because there is possibility of sink in the pillows. This can lead to restriction of chest movements. Slight movement of the foot of Amelia on the bed can be helpful in preventing her from going into the sleep. Comfortable position can be provided to Amelia by making her to sit on the edge of the bed or in an armchair. She can also seat on the table with her hands inclined towards the front side. Heels, ankles, sacrum and elbows are the pressure points in the body. Amelia should not give much stress on these parts of the body while sitting. Maximum expansion of the chest can be achieved by adjusting inclination against the wall, resting head on the raised arm and inclination over banister (Melam et al., 2014). Implementation of this nursing intervention is difficult in case of children. Children always try to keep sliding on the bed. In the literature, it is evident that, positioning of children in sitting upright position improved oxygen saturation level in adjuvant with standard asthma therapy. Sitting up in the upright position can be improved in children by educating Amelia and parents about importance of sitting up position. Salbutamol: Salbutamol was used in case of Amelia as a beta adrenergic agonist and bronchodilator. Salbutamol is the 2 adrenergic stimulant and it is having effect in long tem. Salbutamol produces its action by inhibiting release of mast cells. In restricted airway problem of Amelia, salbutamol can be effectively used because it produces bronchodilation effect and improves drainage of mucus in the airways (van Buul and Taube, 2015). Assessment of effect of salbutamol in case of Amelia should be evaluated within approximately 1 2 hours after administration of salbutamol. Assessment can be performed by tests like arterial blood gas (ABG) analysis and pulmonary function test (PFT). Nurse should perform evaluation of respiratory parameters in Amelia prior to after administration of salbutamol. Based on the outcome of after administration of salbutamol, modifications in the dose and frequency should be done. Nurse should monitor for the central nervous system (CNS) stimulation in Amelia because in children between age 2 6, there is possibility of CNS stimulation. CNS stimulation includes hyperactivity, excitement, nervousness and insomnia. Nurse should also monitor Amelia for signs and symptoms of fine tremor in figures, tachycardia and gastrointestinal tract (GI) symptoms. Nurse should educate Amelia and her parents about use of inhaler. Nurse should instruct them to avoid contact with eye. Nurse should advise them not to increase frequency of inhalations without consultation of the doctor. Salbutamol can induce dizziness or vertigo, hence precautions should be taken while taking salbutamol (Neininger et al., 2015). Inflamed airway problem: Second problem in case of Amelia is inflamed airway. Asthma is mainly disease of airway inflammation. In case of asthma, inflammation is the bodys reaction to allergens. Due to inflammation, bronchial tubes become swollen and narrowed. Inflammation also leads to release of different inflammatory mediators. Different inflammatory cells are responsible for inflammation in asthma like Th2 lymphocytes, mast cells, eosinophils, dendritic cells, epithelial cells, macrophases and resident cells of airway. Th2 cytokines such as IL-4, IL-5 and IL-13 are responsible for inflammation in asthma (Kim et al., 2016). There is also occurrence of edema of in bronchial tube as a result of progressive inflammation. There is more release of mucus in airways which results in the deposition of mucus plugs in the airways. This deposition of mucus in nasal cavity is termed as rhinorrhea which was observed in Amelia. This leads to the limitation of air passage through bronchial tube. This can result in dyspn ea and less oxygen saturation. In case of Amelia also, less oxygen saturation was observed. Deposition of mucus can produce cough in Amelia. This cough is for expelling deposited mucus. In case of Amelia also, moist cough observed. In acute stage, inflammation would not cause narrowing of bronchial tube, however persistent and chronic cough can lead to the narrowing of the bronchial tube. This narrowing of bronchial tube can be exaggerated by external stimuli like dust or cold air (Erjeflt, 2010). Trigger of inflammation lead to the cascade of events which lead to the dysfunctioning of the lung. Narrowing of the bronchial wall lead to insufficient breathing as a result there is rapid rate of breathing. In Amelia, rapid breathing rate was observed. Narrowing of bronchial tube leads to difficulty in the air passage. This leads to forcibly passage of air through narrow and constricted airways. This forceful passage of air gives whistling sound of exhaled air which is known as wheezing. Wheezing was also observed in case of Amelia (Chawes, 2011). Hydrocortisone: Hydrocortisone is a short acting steroid with both glucocorticoid and mineralocorticoid propertiese. Hydrocortisone can perform different functions like antiinflammation and immunosuppression. In case of Amelia, occurrence of asthma is mainly due to the inflammation. Hydrocortisone can be useful in treating this inflammatory phase of asthma. In asthma, Th2 medicated immune mechanisms can occur. Hydrocortisone can also be helpful in treating immune system disturbance in Amelia. Hydrocortisone can be useful in treating asthma in Amelia by stabilizing leukocyte lysosomal memebranes and inhibiting release of allergic substances. Hydrocortisone produces immunosuppression activities by modifying immune response to diverse stimuli, reducing antibody titers and suppressing hypersensitivity reactions. Hydrocortisone should be initiated in Amelia within one hour of occurrence of symptoms like cough and wheezing. Prednisolone, which is a corticosteroid, should be used in Amelia (Olin and Wechsl er, 2014). Prednisolone should be initiated with single 2 mg/kg dose. Maximum dose of prednisolone should 50 mg per day. In subsequent days, 1 mg/kg twice a day can be administered (Kravitz et al., 2011). If Amelia is suffering through acute severe wheezing, prednisolone should not be administered in Amelia to avoid its over use. Nurse should monitor blood pressure, weight, fluid and electrolyte balance and glucose level. Nurse also should monitor platelet count and white blood cells differential count in Amelia. Nurse should monitor her for hypocalcemia. Nurse should monitor Amelia for chest pain and fractures of long bones. Nurse should assess Amelia for susceptibility of infection. Nurse should advise family members of Amelia to supply high protein, calcium and vitamin D rich food. Nurse should monitor Amelia for behavioral and psychological aspects. There is possibility of mood changes and depression due to long term consumption of hydrocortisone. If Amelia is subjected to certa in stress due to surgery or injury, the nurse should adjust dose of hydrocortisone. Nurse should perform ophthalmic examination in Amelia, in case of long term administration of hydrocortisone. The 2015 Global Initiative for Asthma (GINA) guidelines identified hydrocortisone through inhalation route as the preferred treatment for Asthma (Zhang et al., 2014). Education as intervention: Another nursing intervention for inflamed airways of Amelia is education to Amelia and her parents. This intervention is important for Amelia and her parents because they might not have enough knowledge of Asthma. Nurse should tell Amelia about correct way of breathing and coughing. Nurse should tell her to take deep breath and cough for 2 3 times in a sequence. Nurse should tell her to use abdominal muscle for coughing. The nurse should tell her to change her position continuously during coughing. Nurse should tell Amelia and her parents to maintain hygienic condition. Because patients with Asthma are more susceptible for infection. Nurse should advise Amelia to wash her hands properly before eating. Nurse should also advise Amelia to wear gloves and facemask (Klok et al., 2015). Nurse should advise Amelia to keep herself away from the dust and allergens. Dust and allergens may exaggerate inflammation of airways. Nurse should advise Amelia to take more amounts of fluids. This fluid intake would be helpful in thinning mucus and its expulsion would be easy. Nurse should warn Amelia and her family members about the decrease in food intake. Hence, she should take food with more calories. This decrease in food intake might be due to continuous coughing and change in food taste due to inhalation of medications. Nurse should ask her to rinse her mouth after taking inhalation. Nurse should educate Amelia and her family members about proper consumption of prescribed medications. Parents should take care that Amelia should not miss single dose of medications. Nurse should educate Amelia and her parents about use of inhaler. Nurse should advise Amelia and her parents, not to change dose of inhalation without doctors consultation (VanGarsse et al., 2015; Young, 2011). Conclusion: Amelia is diagnosed with Asthma. Amelia exhibited symptoms related to the respiratory system. Form the symptoms exhibited by Amelia; it can concluded that, there is decline in lung function in Amelia. Restricted airway and inflamed airway are the two common problems associated with decline in lung function. Inflamed airway occurs due to the exaggerated response to allergens and restricted airway may occur due to augmented release of secretions in inflammation. Both these problems results in the insufficient breathing and dyspnea in Amelia. Sitting-up posture and salbutamol administration are the two interventions provided in case of restricted airway. Sitting-up posture helped Amelia for easy breathing and salbutamol was used as bronchodilator. Bronchodilators can reduce narrowness of restricted airway. Hydrocortisone administration and education to Amelia and her parents, are two interventions provided for inflamed airway. Hydrocortisone such as prednisolone was administered to Amel ia to reduce inflammation. Education was provided to Amelia and her parents to manage consequences of inflamed airway. In summary, identification of the problem and provision nursing intervention would be helpful in improving condition of Amelia. References: Bateman, E.D., Reddel, H.K., van Zyl-Smit, R.N., and Agusti, A. (2015). The asthma-COPD overlap syndrome: towards a revised taxonomy of chronic airways diseases? Lancet Respiratory Medicine, 3(9), 719-28. Bonini, M., Usmani, O.S. (2015). The role of the small airways in the pathophysiology of asthma and chronic obstructive pulmonary disease. Therapeutic Advances in Respiratory Disease, 9(6), 281-93. Chawes, B.L. (2011). 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