Assessing And Managing Asthma In Patient Lucy

Importance of Patient History in Asthma Assessment

Discuss about the Clinical Reasoning Cycle, In Relation To A Case Study Of Lucy.

The patient Lucy has been suffering from asthma since her childhood, and recently works as a cleaner at a private aged care facility. Although daily inhalation of beclomethasone has helped in reducing severity of her asthma conditions, she is currently facing several problems that have led to the occurrence of respiratory distress and dyspnoea. With the aim of collecting information about the patient and formulating an appropriate care plan, her context and situation will be initially considered, followed by collecting information about all the vital cues, which in turn will facilitate patient assessment. Gaining a deeper understanding about her social background and the community in which she lives, is integral to the process of clinical reasoning, as it will provide exhaustive information on the risk factors that might have increased her susceptibility to the disease (Shaban 2015, p.5). Moreover, there is a need to record appropriate information about the medical history of Lucy, and the crucial role that her social and cultural life might have played on the onset of asthmatic symptoms (Chawla & Davis 2013, p.661). Conducting an exhaustive review of her family history is essential, due to the fact that the patient suffers from asthma since her childhood. Assessment of family history is also needed because her father also suffered from asthma, and died at 40 years of age. Moreover, asthma has also been recognised as one of the diseases that are common in higher social classes (Stephens & Townsend 2013, p.129). This can be correlated with a need to investigate her social background. Initially, a vital signs assessment will be conducted to note abnormalities in the temperature, respiration rate, pulse rate, and blood pressure.

Any deviation from the normal ranges would indicate the state of Lucy’s essential body functions (Storm?Versloot et al. 2014, p.41). This can be directly be correlated with her presenting symptoms of dyspnoea, tightness in the chest and wheezing cough. Hence, conduction of an assessment of the major vital signs, will act as an evidence for presence of any respiratory difficulties. This assessment will also help in gaining a deeper understanding of the underlined pathophysiology that might have led to obstruction and inflammation of the airways, and subsequent development of asthma. This will also be followed by conducting a respiratory assessment that will involve counting the breathing rate of the patient, followed by auscultation, where sounds from the lungs and heart will be heard by a stethoscope.

Significance of Vital Signs Assessment in Asthma Diagnosis

Most medical encounters often combine health promotion and problem oriented approaches, in order to extract answers from the patients that display their hidden concerns, about specific health abnormalities or symptoms. At times, it is necessary for noting down exactly what the patient intends to mean by particular statements. Hence, formulating appropriate questions, while maintaining the privacy and dignity of the patients, is imperative in clinical assessment (Lin, Watson & Tsai 2013, p.169). All forms of data related to the patient history form a crucial aspect of health assessment, since they facilitate the process of obtaining information about previous allergy, illness or any surgeries that have been conducted on the patients. This is turn facilitates nurses and other healthcare professionals to understand about probable risk factors that might have contributed to development of certain symptoms in the patient. Hence, identification of the patient history is considered of utmost importance, and a major priority while delivering optimal health care services (Frank, Basch & Selby 2014, p.1513). With the aim of collecting relevant information that pertain to patient history, developing appropriate communication skills is necessary. These skills initiate a patient centred communication that provides assistance to understand and illicit the perspectives of the patient, which includes their ideas, expectations, concerns, feelings, needs, and functioning (White & Danis 2013, p.2325). Patient centred communication also helps to understand the unique cultural and psychosocial aspects of the patients, and also facilitates the process of reaching a shared understanding of the problems and treatment practices that will confirm with the values and beliefs.

An initial establishment of rapport is followed by asking questions that relate to the patient history, such as, “have you been diagnosed with any other illness since childhood, apart from asthma?”, or, “did you undergo any major surgery ever?”, or “do you have allergies towards any medication, food or external agents?”.  Questions that relate to presence of pets or close contact with pet dander and hair will also be formulated. This can be correlated to the fact that exposure to pet dander have often been found to increase risks of asthma. Other questions will focus on past medications such as, “do you remember the medicines that you used to take in childhood for asthma?”, or “what medicines are you currently on?”.  Questions related to social background and family history will also be asked for obtaining a positive diagnosis of asthmatic symptoms. Responses to these questions will facilitate the formation of a close association between the presenting complaints and the past history, thereby facilitating the process of nursing care.

Role of Respiratory Assessment in Managing Asthma

Health assessment refers to the comprehensive plan of care that identifies the specific preferences of the patients and how they will be addressed by the healthcare professionals or skilled nursing staff.  Therefore, health assessment can be defined as the evaluation of patient health status by performing a thorough physical examination, after obtaining relevant information regarding the patient history (Komenaka et al. 2014, p.378). Based on the responses that will be obtained for the aforementioned questions, followed by conduction of the health assessment, such as, vital signs measurement and respiratory trouble assessment, the findings will be analysed and correlated with each other. An extensive study of the patient history suggests that Lucy has been suffering from asthma since her childhood, which can be considered hereditary due to presence of similar symptoms in her father that eventually resulted in his death.  This suggests that development of asthmatic symptoms, such as, tightness in the chest and wheezing breath can be attributed to heredity, since the disease runs in her family (Lajunen, Jaakkola & Jaakkola 2013, p.179).  A range of environmental and genetic factors play an important role in increasing susceptibility of an individual towards development of asthma. Family history has often been considered as a risk factor, with 25 genes being identified that have a close relationship with asthma in more than 6 populations.  Some of these genes are IL10, GSTM1, LTC4S, and IL4R (Meyers et al. 2014, p.410).

Furthermore, environmental factors such as, smoking during pregnancy, pollution and exposure to indoor volatile organic compounds have also been recognised as triggers for asthma. The process of presenting questions to the patient will therefore help in gaining information about probable environmental triggers as well that might have contributed to the disease. Questions will be formulated that pertain to the nature of work that she is expected to perform at the private aged care facility. Owing to the fact that she has the job of a cleaner at the workplace, the likelihood of getting exposed to a range of pollutants and allergens are quite high, which might lead to an exacerbation of asthma attack. Exposure to allergen, pollutants, and viral infection has been found to worsen asthma.

The vital signs assessment was initially conducted to determine all forms of abnormality in the normal physiology parameters. An analysis of this assessment states that her pulse rate was 115, temperature 38 °C, respiratory rate 32, blood pressure 160/90, and SaO₂ 91%. A study of these vital signs help in establishing links between presence of severe respiratory distress in Lucy, due to the fact that the pulse rate and respiratory rate are  beyond the normal levels.  Furthermore, an elevated blood pressure also suggests presence of hypertensive symptoms in the patient.  However, the oxygen saturation falls within normal limits, which indicate lack of need to deliver or implement oxygen therapy. Evidences have established strong association between hypertension, increased breathing rate and high pulse rate, with asthma (Horeczko & Wintemute 2013, p. 179).  Hence, conduction of the vital assessments and respiratory assessment helps in drawing conclusions about the major physiological abnormalities presented by Lucy. Narrowing of the airways, due to an inflammation of the bronchi and bronchioles, often led to the development of symptoms such as, wheeziness, tightness in the chest and shortness of breath, all of which were observed in the patient. An increase in respiratory rate can be attributed to the action of neutrophils, eosinophils, and cytokines (Schleich et al. 2013, p.11).

Importance of Communication Skills in Asthma Diagnosis

Failure to strike a balance between Th1 and Th2 cells often lead to inflammation of the airways, thereby blocking the respiratory passage (Ji et al. 2014, p.78). This results in limitation of airflow and subsequent respiratory distress in the patient. Owing to the fact that Lucy was dyspnoic, and suffered from laboured and difficulty breathing, immediate medical attention should be provided. Sudden drop in her oxygen saturation rate to 88% that is much lower than the normal range of 95-100% also indicates the need of providing immediate healthcare services for reducing respiratory trouble. This calls for the need of delivering supplemental oxygen for preventing a worsening of symptoms (Martin & Grocott 2013, p.434). Conduction of a respiratory assessment that also involved auscultation suggested the presence of wheezing or continuous whistling and course sounds during breathing (Bohadana, Izbicki & Kraman 2014, p.747).  This can be attributed to the fact that the patient uses her accessory muscles during respiration, which in turn contributed to laboured breathing. An inflammation of the bronchi and bronchioles, due to exposure to allergens might have resulted in development of that sounds.  Hence, narrowing of the airways can be considered as the primary physiological abnormality that led to the development of asthma symptoms, subsequently obstructing air flow and producing courses sounds during breathing (Zhao, Lloyd & Noble 2013, p.335).

An evaluation of the results and drawing conclusions from the reports of the patient facilitates the procedure of understanding the underlying pathophysiology that might have contributed to a range of health abnormalities, manifested by the patient. Gaining information on the patient history suggests that genetic predisposition can be considered as a major risk factor that made the patient want susceptible to asthma. Extracting relevant information about the medical and social history of the patient was gained by asking specific questions that pertained to the patient. This in turn enhanced the objective of formulating an appropriate diagnosis, and providing optimal medical care to the patients. Moreover, an analysis of the present situation and context of the patient related to her job, also helped in getting sufficient information on the triggers that might have led to the condition. Hence, the patient answers established strong evidences for the asthmatic condition to be hereditary. Documentation of subjective and objective data also suggested that the workplace might have exposed her to various environmental triggers such as, allergens and pollutants that lead to an exacerbation of her symptoms (Pult & Riede-Pult 2013, p.25). While, the subjective data helped in understanding the patient’s point of view and perceptions about the presenting complaints, the objective data involved all health parameters that were observed or measured.

Environmental and Genetic Factors Contributing to Asthma

Physical examination assisted in recognizing the presence of labored breathing symptoms, accompanied by wheezing sounds (Noble et al. 2013, p.1465). On the other hand, the vital signs assessment indicated presence of high blood pressure, high temperature and increased respiratory rate, all of which have been linked with an increase in severity of asthma symptoms. Drop in oxygen saturation levels at a later period also confirmed the presence of acute inflammation in her bronchi and bronchioles, thereby suggesting the need of gaining an understanding of the aetiology that might contribute to such diseases. Salbutamol is the most commonly used drug for treating asthma, owing to its effects in opening up the airways present in the lungs (Patel et al. 2013, p.33). However, the common side effects of salbutamol include increased heart rate, dizziness, anxiety and headache. The nursing care plan will also take into consideration the fact that the patient Lucy’s health condition showed deterioration upon administration of the medicine salbutamol.

This refers to the documentation process that will encompass the set of actions that will be implemented, for resolving or supporting accurate nursing diagnosis that have been identified by nursing assessment. The nursing care plan will help in recording the interventions and will also enable conducting an assessment of their effectiveness. This will facilitate a standardized, holistic and evidence-based care.

Diagnosis	Objective	Intervention	Rational
Respiratory distress	To relieve the patient Lucy from wheezing and laboured breathing that she is suffering from.   To facilitate her easy recovery and bring back the respiratory rate within normal ranges To increase oxygen saturation levels	Conducting an assessment of the vital signs of the patient, measuring the respiratory death and the heart rhythm. Conducting an auscultation to hear the breathing sounds and determining any abnormality such as, a whistling or coarse sound. Measuring the pulse rate of the patient Delivering supplemental oxygen to restore the saturation level Administering anti-inflammatory medications such as, vancenase, pulmicort and twisthaler Administering anticholinergic medications such as, ipratropium bromide that will act as bronchodilators	Vital signs assessment will help in noting abnormal physiological patterns. Auscultation will determine presence of inflammation in the bronchi or obstruction of the airways Pulse rate will give a direct measure of dyspnoea or laboured breathing Supplemental oxygen therapy will help in enhancing or bringing back the oxygen levels to normal, and will also reduce risk stuff for the health complications (Martin & Grocott 2013, p.434) Corticosteroids will reduce inflammation of the airways and will also prevent flare-up of asthma (Wenzel et al. 2016, p.35) The bronchodialators will open the obstructed airways of the lungs, thereby reducing laboured breathing (Van Sickle et al. 2013, p.e55335).
Airflow obstruction	To reduce blockage of the airways, due to chronic inflammation of the bronchi and bronchioles Decrease contractibility of the smooth muscles.	Investigating any colour changes in the nails, skin and lips. Determining the colour viscosity and order of cough or sputum Assessing the rates of oxygen saturation by using pulse oximetry Conducting an x-ray of the chest ABG test	Blue colour in the lips, nails or skin will indicate presence of psychotic symptoms and low oxygenation (Soto-Ramírez et al. 2013, p. 402) Analysis of the sputum will also help in determining presence of any secondary infection in the throat or lungs (Yap et al. 2013, p.49) Pulse oximetry will directly monitor the oxygen saturation in the blood and any changes in blood volume flowing through the skin (Addison et al. 2015, p.114). The chest x ray will produce images of the airways, heart and lungs, and will also help in diagnosing for the complications Arterial blood gas test will also monitor the acid base balance in the blood (Sun et al. 2014, p.59)
Fever	To return the body temperatures to normal level	Administration of plenty of fluids Administration of medicines such as, ibuprofen and acetaminophen	The fluids will restore the electrolyte balance of the body and keep the body hydrated (Kularatne, et al. 2015, p.130) The medications will act as antipyretics and lower the elevated temperatures (Teagle & Powell 2014, p. 701).
Hypertension	Reduce the blood pressure within normal range	Conduct an assessment of the blood pressure and pulse rate	Blood pressure assessment will help in noting abnormality Calcium channel blockers or diuretics will be used either singly or in combination, to reverse the blood pressure values to normal levels (Zamponi et al. 2015, p. 823)

 

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Physiological Abnormalities Observed in Patient Lucy

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