Acute Care: Diagnosis And Management Of Asthma And Chest Pains

Introduction to Acute Care for Patients with Asthma and Chest Pains

Discuss about the Analysis of Helen Johnson’s Case Study.

Acute Care refers to the provision of short-term urgent medical care to the patients (Salimi et al., 2017). The treatment mode is active as it targets a severe ailment such as Asthma. The method of care involves the management of evaluation of the clients with acute conditions. Afterward, nurses prepare the patients for discharge. Moreover, the care providers train the patients on preventing further infection by the disease. The acute care nursing skills enable the nurses to improve the quality of care. The technique starts with diagnosis followed by management of the emergency condition.

Helen Johnson is a 32 years old suffering from Asthma and chest pains. The paper looks at the patient’s history. Additionally, the paper discovers Helen’s diagnosis and past medical records. The two complications are involved since they require a series of consistent medical attention. Moreover, they are epidemic and have numerous risk factors. Appropriate nursing management is necessary for managing the two scenarios. Furthermore, there are strengths and weaknesses of the scenes. This paper looks at the diagnosis, management, best practice guidelines, and areas for improvement in Asthmatic attack and chest pain.

The family members of Helen brought her into the emergency department of Avenue hospital with chest pain and asthmatic attack.  Helen had been complaining of asthmatic in her chest. After one day, she started experiencing chest pain. The week before, Helen had been wheezing and complained about her inability to breathe correctly. After few hours, she began to feel severe pain in her chest area. Helen also says that she feels occasional flare-up emotions.

Helen admits that she has encountered gases and dust particles both at home and at the workplace. Her medical history indicates, breathing complications, tightness in the chest, and persistent coughing. However, Helen states occasionally experience difficulties when sleeping due to the breathing complications. Her records indicate that she had been complaining about pulmonary and lung infections.

During the diagnosis process, the physician has to conduct random physical tests. The physician should ask the patient about the signs and symptoms (Salimi, Henderson, Morgan, Jalaludin, & Johnston, 2017). The physicians conducted both pick flow and spirometry tests on Helen (Salimi et al., 2017). The pick flow determines the ease of breathing of the patient. Low pick flow readings indicate difficulty in breathing. However, high reading suggests low asthma attacks. Helen has shallow interpretations implying that she has asthma. She should avoid crowded places to improve her breathing capacity. Spirometry test checks on the circumference of the bronchioles (Beasley et al., 2016). Asthmatic conditions narrow the boundary hence restricting gaseous exchange between the lungs and the atmospheric air (Beasley et al., 2016). Helen has restricted airspace thus causing a restriction in the amount of air that she breathes.

Patient History and Diagnosis

Asthma is a complex disease due to the nature in which it manifests itself in the body system. The condition interferes with the air track hence complicating the process of breathing (Gibson, & McDonald, 2017). The contraction level of Asthma is elementary but complicated in such a way that its stops inhalation. The disease results into blocking of the free movement of atmospheric air into the lungs (Kelly et al., 2017). The signs and symptoms include coughing and wheezing (Bell, 2017). Afterward, the patient feels that their chest is tight. Additionally, breathing becomes difficult for the patients (Bell, 2017). The victims later develop acute chest pain.

St. Ann’s hospital carries out a consistent treatment for the chest pain and Asthma patients.  The health facility prescribes anti-inflammatory drugs to the asthma patients. The facility continually checks on the progress of the patients. The hospital also supports the patients in looking after their health status. The health center also trains the patients on the correct usage of the inhalers (McLaughlin, Kable, Ebert, & Murphy, 2016). Patients obtain the knowledge of the causative agents of asthma from the facility. Every Australian health facility has an obligation of supporting and encouraging the Asthmatic patients. The support enlightens the patients about the causes of chest pain and asthma.

A proper management strategy encourages the patients to assume a significant role in solving their medical conditions. The patients can now monitor and adequately take medications. Moreover, the patients can lead a happy life despite the complications. The health facility delivers tutorials on the causes, prevention, and treatment of asthma. The learning sessions emphasize on avoiding of the causative agents and consistent uptake of medicine. Moreover, the health center sensitizes people on the need to use the inhaler in the proper manner (Whitehead, 2017). The Staff of St. Ann also carries out regular awareness tours of the neighboring communities. The campaigns sensitize the people on the medication of asthma and chest pain. Additionally, the nurses teach the society about the prices of the drugs.

The health facility also provides affordable services that support the patients. Additionally, the health center offers relevant information about the disease to the citizens. The hospital staff encourages the family members to monitor the patients and ensure that they take their drugs. The hospital also enhances literacy as far as asthma is concerned (Brown, Edwards, Seaton, & Buckley, 2017). The hospital staff educates the public on the causative agents of Asthma. Moreover, the nurses enlighten the patients on the available treatment regimens. Furthermore, the hospital trains the patients on the techniques of using the inhaler. The facility also implements the plans of action in asthma treatment (Whitehead et al., 2017).

Treatment and Best Practice Guidelines

Strengths

The education on the proper usage of inhalants enables them to command their rehabilitation programs. The patients can avoid causative agents such as dust and pollen grains after schooling from the nurses. Additionally, the clinicians expose the patients on the various treatment options. As a result, the patients make informed choices about the treatment plan that suits their cultural beliefs. The support channels such as specific asthma management departments assist in the treatment procedure (Elaro et al., 2016). The constant monitoring of the symptoms enables the nurses to manage the disease. The public also gets the knowledge about the manifestation of the disease and can report to the hospital in case of a symptom.

Weaknesses

The education plan can be less effective with the disabled patients. Communication barriers hamper communication between the health practitioners and the illiterate patients. Moreover, the program of ensuring equal distribution of resources is expensive to achieve. The treatment options may contradict the preferences of the patients (Reddel, Ampon, Sawyer, & Peters, 2017). Additionally, patients may experience difficulties in learning how to use the inhalants.  There are family members who are unsupportive and do not monitor the patients when taking the drugs. The indifferent culture of the aboriginals complicates the treatment process for that group of patients. The indigent patients cannot afford the medications hence suffer in silence.

In comparison with inhalants, oral medications have a narrow index of therapy (Becker, & Abrams, 2017). Due to the low action, a patient must continuously take the drugs for a long time to manage asthma. Long-term use of oral medication can cause severe damage to the body such as fracturing of the bones (Elaro et al., 2016). However, oral administration of asthma drugs deals with severe complications in a better manner compared to inhalants. The oral medicine does not have an undesirable impact on the patients (Reddel et al., 2017). Inhalants act immediately to correct asthma whereas the action of oral medication takes an extended period.

The inhalants are small in size and light in weight. Therefore, patients can carry them around to any destination.  Patients apply the inhalants that have adequate instructions with ease. The portability of the inhalants makes them vulnerable to misplacement.  Inhalation challenges a select group of people when it comes to application (Reddel et al., 2017).  The senior citizens, children, and individuals with mental diseases find it challenging to use the inhalants. An aspiratory pathway must exist for proper inhalation process. The use of inhalants affects the people surrounding the individual. Unlike the oral medication, the person next to the patient must notify the user of an inhalant.

Strengths and Weaknesses of Asthma and Chest Pain Management

The St. Ann’s hospital uses methacholine to diagnose asthma (Abramson, Perret, Dharmage, McDonald, & McDonald, 2014). The methacholine triggers asthma. The inhalation of the drug leads to airways constrictions to a small extent. Patients who show a reaction to the medication has asthma. Clinicians apply the diagnosis process when the tests of the lung are negative. The diagnosis is also through the use of nitric oxide gas. Individuals having elevated levels of the gas are having asthma. X-rays and CT scans can also reveal the presence or absence of asthma and chest pains (Abramson et al., 2014).

When the nose and the airways have abnormality or inflammation, then the individual has asthma. Individuals who are allergic to numerous items can also have asthma and subsequent chest pains. The range of things that an asthmatic patient can be allergic to include: pollen grains and pets. Additional items are dust and molds (Fawcett, Porritt, Campbell, & Carson, 2017). During diagnosis, the physician exposes the individual to either of the things. If the items trigger a reaction out of the patient, then they have asthma. Such individuals need immediate immunotherapy to correct the allergic reactions. Eosinophils test also checks for asthma (Fawcett et al., 2017). The physician takes saliva or mucus sample from the individual. Individuals who have eosinophils have asthma.

Beta medications are essential in managing asthmatic and chest attacks. The patient inhales them to produce the desired effect.  The drugs include formoterol and salmeterol (Fawcett et al., 2017). The medications assist in clearing and opening the air track. When taken in isolation, the Beta medicine can result in chronic asthmatic conditions. Therefore, the patients should take the drugs together with glucosteroids (Fawcett et al., 2017). The drugs are only applicable for mild attacks. However, acute cases must combine the two remedies otherwise beta medicine is not appropriate. Proper management of asthma combines inhalants and oral medication both in the long and short term to bring the healing effect.

Combination remedy can contain a mixture of salmeterol and fluticastrol. (Fawcett et al., 2017) Another combination entails formoterol and budesonide (Fawcett et al., 2017). Moreover, a combination of mometasone and formoterol can also arrest asthmatic attacks and chest pains (Fawcett et al., 2017). All the blends have a beta effect and corticosteroid components. However, the presence of the agonists in the combination remedies can lead to an asthmatic attack and chest pains. Theophylline is another medication which can arrest chest pain and Asthmatic complications (Fawcett et al., 2017). The patient takes the drug in an oral form on a daily basis. The medication assists in opening the bronchioles.

Comparing Oral Medication to Inhalants

Theophylline dilates the muscular mass of the alveoli (Fawcett et al., 2017). The nurses in the past century preferred this drug as compared to the present day nurses (Fawcett et al., 2017). The current practice uses ipratropium in the management of asthmatic attack (Fawcett et al., 2017). The drug clears and opens wide the air tracts. Therefore, the medication eases the gaseous exchange between the lungs and the alveoli. Patients having bronchitis and emphysema usually use the drug to correct their complications. Apart from inhalation, corticosteroids can be in the form of oral tablets (Yang et al., 2017). The drugs get rid of inflammatory effects of asthma and chest pains.

Australian health department recommends the drugs that the paper has discussed earlier on. The instructions resonate with the current management practices and recommendations for asthma management. The Australian government is training the asthma patients and the physicians on the best medication for the complication. The education strategy focuses on the variety of asthma medication that exists in the health sector. The government is teaching the general public on the oral and inhalation medications (Watkins et al., 2016). Additionally, the exposure enables the patients to use the inhalers properly. Moreover, the system states the various strengths and weaknesses of current treatment strategies.

The Australian government is carrying out a campaign on asthma awareness. The campaign targets both clinicians and people with asthma. The drives explain the usage of the drugs and their costs. The recognition addresses the false beliefs that people have concerning asthma complications and the resultant treatment methods. The government is continually equipping the hospitals with asthma drugs (Boulet, FitzGerald, & Reddel, 2015). The health department considers patients who speak correctly and walk appropriately to have Mild asthma. However, patients who cannot talk properly have the acute asthmatic conditions. The severe asthmatic patients cannot breathe appropriately and have low saturation rates of oxygen.

There are asthma patients who have very chronic conditions. Such individuals usually collapse when walking and also feel dropsy. Moreover, the critically ill asthma patients have low respiratory actions. The patients also have low levels of saturated oxygen. The mild patients require bronchodilators as the first regiment. If their symptoms persist, the physicians should add ipratropium in their medication (Lee, Maggiore, & Chung, 2018). The severe asthma patients should begin their treatment with an appropriate bronchodilator. Furthermore, the patient should take ipratropium and corticosteroids. In case of no change, the patient should see a nearby doctor.  The patient should consider an additional dosage of bronchodilators.

Diagnosis through Methacholine and Nitric Oxide Gas

St. Ann’s hospital is currently carrying out sensitization campaign within the locality of the hospital. The facility should broaden the spectrum to cover a large population. The hospital is not accepting insurance cards from certain insurance firms. The hospital should modernize its operation to allow insurance in their treatment processes (Basheti, Hammad, & Bosnic-Anticevich, 2017). Australian guideline practices emphasize on educating the patients on proper usage of inhalants (Zwar et al., 2017). The health facility should consider other means of treatment apart from the oral medication. The best guidelines also urge the health facilities to invest in supporting the patient to manage their conditions. St. Ann should borrow from the instructions and monitor the symptoms of the patients. Moreover, the facility should ensure that patients regularly take the prescribed dosage.

The current diagnosis and treatment strategies by the Australian Commission of safety and quality are appropriate. Additionally, the existing facilities employ the best approaches to treat both mild and severe asthma patients. The two bodies have an excellent plan for the management of the disease (McDonald et al., 2017). However, the approach of management should follow a given procedure. The physicians should assess the intensity of the asthma complication before commencing treatment. The physicians should prescribe an appropriate bronchodilator to any patient regardless of the stage of infection.

Conclusion

For future asthma diagnosis and treatment, a few issues should change to ensure a seamless process. Physicians should start taking allergy treatment seriously. They can fist run immunotherapy to detect the presence of allergy. There are clinical shots that can help to reduce the violent allergic reactions that asthma patients undergo regularly. The clinicians should give patients the shorts regularly to reduce their allergic reactions. Moreover, physicians should embrace omalizumab medication in the future. The drug is in the form of an injection. The injection should target patients having acute asthma and allergies. The drug manipulates the immunity of the patient. Additionally, the immune system fails to detect allergies hence preventing hypersensitive reactions.

References

Abramson, M. J., Perret, J. L., Dharmage, S. C., McDonald, V. M., & McDonald, C. F. (2014). Distinguishing adult-onset asthma from COPD: a review and a new approach. International journal of chronic obstructive pulmonary disease, 9, 945.

Basheti, I. A., Hammad, E. A., & Bosnic-Anticevich, S. Z. (2017). Economic Impact of Inhaler Misuse in Australia and Jordan: Checklist Guided Patient Education can Reduce Pharmaceutical Expenditures. Jordan Journal of Pharmaceutical Sciences, 10(2).

Trigger Factors and Allergies Associated with Asthma

Beasley, R., Hancox, R. J., Harwood, M., Perrin, K., Poot, B., Pilcher, J., … & Thayabaran, D. (2016). Asthma and Respiratory Foundation NZ adult asthma guidelines: a quick reference guide. The New Zealand Medical Journal (Online), 129(1445), 83.

Becker, A. B., & Abrams, E. M. (2017). Asthma guidelines: the Global Initiative for Asthma about national guidelines. Current opinion in allergy and clinical immunology, 17(2), 99-103.

Bell, J. (2017). Over the counter: Act on asthma!. PS PostScript, (May 2017), 30.

Boulet, L. P., FitzGerald, J. M., & Reddel, H. K. (2015). The revised 2014 GINA strategy report: opportunities for change. Current opinion in pulmonary medicine, 21(1), 1-7.

Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.

Elaro, A., Patel, M. R., Shah, S., Armour, C., Kraus, K., Farris, K. B., & Bosnic-Anticevich, S. (2016). A Comparative Analysis Of The Management Of Paediatric Asthma In Community Pharmacy In The USA And Australia. In A63. PEDIATRIC ASTHMA: PREDICTORS AND OUTCOMES (pp. A2156-A2156). American Thoracic Society.

Fawcett, R., Porritt, K., Campbell, J., & Carson, K. (2017). Experiences of parents and carers in managing asthma in children: a qualitative systematic review protocol. JBI database of systematic reviews and implementation reports, 15(3), 657-665.

Gibson, P. G., & McDonald, V. M. (2017). Management of severe asthma: targeting the airways, comorbidities and risk factors. Internal medicine journal, 47(6), 623-631.

Kelly, A. M., Keijzers, G., Klim, S., Graham, C. A., Craig, S., Kuan, W. S., … & TANDEM Study Group. (2017). An observational study of dyspnea in emergency departments: Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (TANDEM). Academic Emergency Medicine, 24(3), 328-336.

Lee, F., Maggiore, P., & Chung, K. (2018). Self-Management of an Inferior ST-Segment Elevation Myocardial Infarction. New England Journal of Medicine, 378(10), 960-962.

McDonald, V. M., Maltby, S., Reddel, H. K., King, G. G., Wark, P. A., Smith, L., … & Gibson, P. G. (2017). Severe asthma: Current management, targeted therapies and future directions—A roundtable report. Respirology, 22(1), 53-60.

McLaughlin, K., Kable, A., Ebert, L., & Murphy, V. (2016). Midwives? perception of their role in providing antenatal asthma management in Australia–A qualitative study. Midwifery, 35, 11-16.

Reddel, H. K., Ampon, R. D., Sawyer, S. M., & Peters, M. J. (2017). Risks associated with managing asthma without a preventer: primary health care, poor asthma control and over-the-counter reliever use in a cross-sectional population survey. BMJ Open, 7(9), e016688.

Salimi, F., Henderson, S. B., Morgan, G. G., Jalaludin, B., & Johnston, F. H. (2017). Ambient particulate matter, landscape fire smoke, and emergency ambulance dispatches in Sydney, Australia. Environment international, 99, 208-212.

Watkins, K., Trevenen, M., Murray, K., Kendall, P. A., Schneider, C. R., & Clifford, R. (2016). Implementation of asthma guidelines to West Australian community pharmacies: an exploratory, quasi-experimental study. BMJ Open, 6(8), e012369.

Whitehead, L. (2017). Vitamin D for the management of asthma: A Cochrane Review Summary. International journal of  nursing studies, 73, 105-106.

Yang, I., Brown, J., George, J., Jenkins, S., McDonald, C., McDonald, V., … & Dabscheck, E. (2017). COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update. Medical Journal of Australia, 207(10), 436-442.

Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell Davies, G., & Hasan, I. (2017). A systematic review of chronic disease management.