Understanding Clinical Symptoms Of Asthma Discussion Paper
Asthma is a severe and chronic respiratory disease that causes specific changes in the patient’s lungs. The major changes that can be observed are “effective swelling of the lung’s inside walls”, “effective inflammation of lung tissues” etcetera. Apart from this, other changes that can be seen are “epithelial fragility”, “hyperplasia of goblet cells”, “enlargement of submucosal glands” and “angiogenesis” (Boonpiyathad et al., 2019). The effective enlargement of submucosal glands is the reason for excess mucus production. This narrows the airways and causes moderate to severe breathing difficulties. The effective swelling and inflammation of the airways make it even harder to breathe for asthma patients. The muscular inflammation creates a specific obstacle to a patient’s breathing and this forces the patient into severe coughing and wheezing. The situation gets worse during an acute asthma attack. Understanding Clinical Symptoms Of Asthma Discussion Paper
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Figure 1: Difference between airways of a normal person and an asthmatic person
(Source: Banno et al., 2020)
According to the above figure, the asthmatic airways can be observed with “swollen linings” and high mucous production. This cannot be observed in healthy airways. The narrowing of airways also results in “effective muscle tightness” during an asthma attack. On the other side, normal lungs do not show these symptoms. Apart from wheezing, coughing and shortness of breath (SOBOE), the overall respiration rate (RR) and heart rate (HR) also increase in asthma patients (Dharmage et al., 2019)Understanding Clinical Symptoms Of Asthma Discussion Paper.
In the present case study, Allira has shown Specific Clinical Symptoms which indicate asthma. Firstly her HR level is 130 which is a high HR level. It has been shown that normal HR rates of asthma patients are higher than “120 beats per minute”. HR 130 indicates that the patient might have asthma. The normal RR rate of asthma patients is higher than “30 beats per minute”. The RR of Allira is 28 beats per minute which again suggests asthmatic symptoms. The overall “blood pressure or BP” of these patients increases due to lung contraction and the case study also shows that Allira has a BP of “140/85” which is a high BP rate. The Spo2 rate in patients with moderate asthma lies between “92% and 97%”. Allira has a spo2 level of 93% which suggests that she has moderate asthma. The case study has shown that the patient has difficulty in smooth-talking and she is using “short sentences”. This suggests that the person has asthma which has created obstacles in her airways. Therefore, from the clinical symptoms of Allira, it can be stated that she is suffering from moderate asthma and this has affected her lung tissues, muscles and airways.
The drug salbutamol is effective in relieving asthmatic symptoms by reducing airway obstacles. The drug works by effective muscle relaxation of lung muscle and this reduces the obstacles by clearing the mucous. However, this is a temporary solution and provides relief to the patient temporarily. The drug is an effective β2-agonist that works as a “smooth muscle relaxer”. The drug effectively activates the β2 receptors of airways which eventually inhibits the phosphorylation of myosin and reduces the overall intracellular concentrations of Ca++ ions. This ultimately leads to “hyperpolarization” and smooth muscle relaxation of airways (Cai, Lin & Liang, 2020)Understanding Clinical Symptoms Of Asthma Discussion Paper.
The Use Of Salbutamol For Treating Asthma
Side effects: The major side effects of salbutamol are “Anxiety”, “extreme headache”, “arrhythmia” and myocardial ischemia.
Anxiety: One of the most common side effects of salbutamol is anxiety. Different studies have shown that prolonged salbutamol use triggers anxiety and other psychological problems in patients.
Extreme headache: This is another side effect that is caused by salbutamol. The headache occurs due to excess consumption of the drug
Arrhythmia: Studies have shown that salbutamol interferes with the normal heart rate of patients which sometimes leads to increased HR; a condition known as Arrhythmia.
Myocardial ischemia: Sometimes the excess muscle relaxation and prolonged use of salbutamol reduce the blood flow rate to the heart. This condition is known as “Myocardial ischemia”.
Nursing considerations: These are effective precautions and considerations taken by nurses to avoid any side effects of the drug. The main nursing considerations for salbutamol are “effective monitoring of RR”, “effective monitoring of HR”, “determining the overall oxygen saturation” and “measuring the lung sounds” after drug administration. This helps in determining the side effects of the drug.
The present case study shows that the oxygen saturation of Allira improved after the consumption of salbutamol to 96% from 93%. This shows that the airway obstruction of the patient got cleared due to the inhalation of smooth muscle relaxer salbutamol drug.
Correct use of the “Metered-dose inhaler or MDI” is essential to improve the drug efficacy. Proper inhalation of the drug helps the patient in mitigating the airway obstacle and helps in improving his condition. The correct use of MDI is shown in the following steps.
Figure 2: MDI inhalation with the help of a “holding chamber”
(Source: Usmani, 2019) Understanding Clinical Symptoms Of Asthma Discussion Paper
The above figure shows the correct way to hold the inhaler. At first, the cap should be removed effectively from the “MDI Chamber”. The contents should be effectively shaken and after the MDI should be effectively placed between the chambers in its open end. The chamber’s mouthpiece” should be effectively placed inside the patient’s mouth. The patient is then required to “breathe out” and inhale the drug after pressing the canister (once for “single pump inhalation”). The patient is required to hold his or her breath for approximately 10 to 15 seconds in order to move the medicine through the patient’s airways (Ferguson et al., 2020).
Correct use of an inhaler is very essential for a patient with asthma as it reduces the chances of side effects. Correct inhalation of the drug also reduces the risk of the absorption of the drug in blood and increases its efficacy in the patient’s lungs.
Figure 3: Use of inhaler
(Source: McCrossan et al., 2020)
The above figure also shows the steps through which an individual can effectively inhale the medication. It can be observed that on the condition the drug is not inhaled properly it can affect the other body parts and can damage other organs. Most importantly, excess absorption of respiratory drugs in the blood increases the risk of ischemia and other diseases.
Correct Use Of Metered-Dose Inhaler (MDI)
One of the major adverse effects of asthma is if it is left untreated. This “chronic condition” causes severe lung tissue inflammation and can cause permanent scarring to the lung. Moreover, the chances of permanent obstruction and “narrowing” of airways can occur on the condition that asthma is not treated. In the present case study, it has been observed that the patient Allira has a complaint of increasing asthma effects during the winter. This shows that the disease has not been treated for this patient and during the long period of 18 months there has been a significant disease progression. “Airway remodelling” is a serious condition that occurs due to effective and poor asthma management (Hough et al., 2020). This often leads to permanent lung scarring and airway narrowing. Also, this condition restricts the respiratory medicines to work effectively and often the patient suffers from severe breathing problems and other conditions. In the condition that a patient is suffering from “Airway remodelling”, the effectiveness of respiratory medicines such as salbutamol decreases as the amount of air “passing through the lungs” decreases due to excessive lung scarring and inflammation. This is a serious condition and can lead to patient death.
The “Flixotide Junior Accuhaler” is an effective preventative medicine that contains an effective drug known as “fluticasone propionate” (Rigby, 2020). This helps in limiting the dies of respiratory drugs and also helps in reducing the negative effects of respiratory medicines. These preventers help in reducing the overall “inflammation” of lung tissues and the scaring effect; thereby improving the air passage through the lungs. As the patient in the case study has reported excess “SOBOE” and other asthmatic symptoms during winters. This proves that irregular and poor asthma management has enhanced the symptoms and efficacy of the disease for the patient.
Side Effects: The preventer drug can have different side effects such as “high amount of wheezing”, “hayfever”, “effective swelling of mouth” and “breathing trouble”. These side effects can cause effective health hazards and may delay the recovery time of patients Understanding Clinical Symptoms Of Asthma Discussion Paper.
Nursing considerations: Effective nursing considerations for the preventer drug are restricting the patient from the drug consumption on the condition the patient is allergic to fluticasone propionate and milk proteins. Pregnant and lactating women cannot use this drug as it might damage the fetus (Yeung et al., 2018). The nurses are required to monitor the patient for any allergic reactions. Nurses are also required to monitor the expiry date of the drug to avoid the risk of consuming “expiry date medicines”.
The preventer drug should be used orally and should be taken daily to prevent the adverse effects of asthma. Moreover, regular use of these preventers reduces airway obstacles and lung damage. Relievers on the other side should be used effectively during asthma attacks. This should be used adequately to reduce the airway obstacle and to induce smooth muscle relaxation in a patient’s lungs. Overuse of relievers may induce adverse effects such as “Airway remodelling”.
A teach-back method is an effective method to make patients realize their health. This method is usually applied by physicians and different healthcare professionals to observe the patient’s psychological and physiological state. This method is effective in making the patients understand the relevant information that is required for them to maintain their health and wellbeing. In the present case, the teach-back method needs to be applied to the patient Allira to observe her understanding of her condition of asthma. This can be done by asking “close-ended questions’ ‘ related to the patient’s understanding of asthma, its symptoms, medication type and drug side effects. Effective questions need to be asked to observe Allira’s understanding of relievers and preventers. This would help the medical professionals in ensuring optimum safety for Allira. During her stay in “South Australia,” the patient needs to take proper medications and respiratory inhalation drugs in order to control her asthma. As the patient has moderate to severe asthma due to poor management, effective medications would help her in reducing the negative influence of the disease.
Potential Adverse Effects Of Untreated Asthma
In the teach-back method, there are five specific components that ensure a patient’s complete understanding of the disease.
Triage: This describes that the focus for this teach-back method should be asthma and its related medication. This would help patients in understanding the depth of the concept.
Tools: This demonstrates the effective use of different visual representations to make the patient understand the negative influences of the disease. In the present case study, allira needs appropriate visual representations to understand the correct method of taking relievers and preventers and also to understand the effect of asthma on airways.
Taking proper responsibility: This demonstrates the effective responsibility that the patient should take to take proper medications and in taking care of his or her wellbeing. In the present case study, the patient needs to understand the importance of taking salbutamol and “Flixotide Junior Accuhaler” on time.
Tell me: In this stage, the patient is required to explain his or her understanding of the disease to the medical care professional (Yen & Leasure, 2019)Understanding Clinical Symptoms Of Asthma Discussion Paper.
Try again: This describes the further practice of the teach-back method to ensure effective and adequate understanding of the patient.
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Excessive inhaler use can cause muscle spasms and cramps. This primarily occurs due to the drug’s side effects. When drugs such as salbutamol are taken (which is a “beta 2 agonist) it affects the different parts of the body and hampers electrolyte balance. Moreover, this drug also causes excessive neuron impulse generation. This excess neuron impulse and electrolyte imbalance often results in excessive muscle cramps. The cramps most often can be seen in the “legs and arms” of the patient.
Different strategies can be taken to reduce the efficacy of muscular cramps. This can be done by appropriate muscle stretching, taking proper medications to reduce cramps and consuming electrolytes to overcome the electrolyte loss. These methods are effective and can help Allira in reducing her muscle cramps.
Reference
Banno, A., Reddy, A. T., Lakshmi, S. P., & Reddy, R. C. (2020). Bidirectional interaction of airway epithelial https://doi.org/10.1042/CS20191309
Boonpiyathad, T., Sözener, Z. C., Satitsuksanoa, P., & Akdis, C. A. (2019, December). Immunologic mechanisms in asthma. In Seminars in immunology (Vol. 46, p. 101333). Academic Press. https://doi.org/10.1016/j.smim.2019.101333
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Hough, K. P., Curtiss, M. L., Blain, T. J., Liu, R. M., Trevor, J., Deshane, J. S., & Thannickal, V. J. (2020). Airway remodeling in asthma. Frontiers in Medicine, 7, 191. https://doi.org/10.3389/fmed.2020.00191
McCrossan, P., Mallon, O., Shields, M. D., & O’Donoghue, D. (2020). How we teach children with asthma to use their inhaler: a scoping review protocol. Systematic reviews, 9(1), 1-4. https://link.springer.com/article/10.1186/s13643-020-01430-6;
Oh, E. G., Lee, H. J., Yang, Y. L., & Kim, Y. M. (2021). Effectiveness of discharge education with the teach-back method on 30-day readmission: a systematic review. Journal of patient safety, 17(4), 305-310. doi: 10.1097/PTS.0000000000000596
Rigby, D. (2020). Practice update: COPD-chronic obstructive pulmonary disease. AJP: The Australian Journal of Pharmacy, 101(1193), 80-85. https://search.informit.org/doi/abs/10.3316/ielapa.056215692912441
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Yeung, S., Traini, D., Lewis, D., & Young, P. M. (2018). Dosing challenges in respiratory therapies. International Journal of Pharmaceutics, 548(1), 659-671. https://doi.org/10.1016/j.ijpharm.2018.07.007 Understanding Clinical Symptoms Of Asthma Discussion Paper