Health Variations 3- Acute Exacerbations Of Chronic Conditions

Learning outcomes

In this age, the intensity of disorders are increasing at a rapid pace within the individual and due to this, the death rate is augmenting significantly. Among many others, the most noteworthy ones are respiratory infections or asthama that results in stress and varied allergic symptoms and many others. Therefore, to minimise these aspects, proper treatment need to be used by the patients.  

Acute severe asthma triggers from viral respiratory infections, nonadherence to therapies, smoking, exposure to allergens and other drugs. However, based on the situation of Jackson significant assumptions can be established due to the cause of his attack through his clinical manifestations. The pathogenesis that is causing the clinical manifestations as presented in the case of Jackson Smith is highly critical. The symptoms that have been observed in Jackson includes severe dyspnoea, lower respiratory rate, lower blood pressure rate, lower pulse rate as well as auscultation of lungs that highly inflated.  There is a huge possibility that the causes of dyspnoea initiated form the allergens primarily originated in the cardiac or respiratory region, (Edmonds et al. 2012). Also, based on the medical history of Jackson it has been analyzed that he was diagnosed with severe acute asthma at the age of 2 which states that the inflammation of such critical manifestations initiated at that age. On the other hand, the viral respiratory infections including bronchoconstriction can be a significant cause of such manifestations.

Furthermore, the narrowing down of airway due to muscle contraction in response to exposure of stimuli incorporating irritants or allergens could its primary cause. Later the pathogenic process initiated with the lower respiratory rate of 32 breaths per minute. This is the reason behind the inability to speak sentences in one breath along with severe dyspnoea case due to allergens, (Farah et al. 2012).  The lower blood pressure of 150/85 mmHg is also caused due to lymphocytes due to development of airway inflammation caused by overproduction of IgE based on the increased production of eosinophils which critically suppressed the breathing. Also, this led to diminished breath sounds as well as a widespread wheeze. The hyper-inflated lungs that were analyzed from the X-ray also revealed that the respiratory infections triggered the asthma attacks that were faced by Jackson at the age of 2. Also, the airway inflammation was caused due to response therapy, intensity as well as the cellular pattern.

Also, as he was prescribed under some medications due to asthma attacks, there is a huge possibility that he did not follow up routine checkups or continued the medicine. This, in turn, led to both functional and structural changes, (Green & Pavord, 2012). The structural changes that would be possible based on the clinical manifestations include angiogenesis, sub-basement fibrosis, smooth muscle hypertrophy, mucus hypersecretion as well as injury to epithelial cells. Also, the viral respiratory infections caused due to allergens can be the primary cause of such structural challenges.  On the other hand, the functional changes include loss of lung function which resulted highly inflamed as well as shortness of breaths. The lymphocytes could also disrupt the airway function. Also, the pulmonary function might also be declined due to heavy smoking activities along with environmental factors including allergens. At the age of 2 declines in lung function cannot be anticipated however at the age of 18 such declinations can be observed which resulted in airflow obstruction leading to such a critical situation. Also, Anticholinergics led to bronchodilation by lowering the intrinsic vagal tone of the airway, which was the major reason behind Jackson’s inability to speak. The neutrophils, dendritic cells as well as macrophages have been possible to be activated due to allergens which resulted in airway functional changes causing such manifestations, (Holt & Sly, 2012). The inflammatory mediators including cysteinyl-leukotrienes also affected the lung functions that led to such critical symptoms in the patient. Hence, the major pathogens causing such condition of Jackson is due to lung infection as well as a respiratory infection that led to shortness of breath as well as such clinical manifestations that have been identified.

Causes and diagnostic procedures

To mitigate such criticality in Jackson as well as manage it efficiently, significant nursing strategies are required to adopt. The first strategy that can be significantly adopted based on nursing to manage the situation of Jackson is administering occasional exercises under continuous supervision, (Watts & Chavasse, 2012). As Jackson is suffering through shortness of breath and his respiratory rate was also affected, exercises along with continuous supervision are highly required. Also, to achieve the oxygen saturation above 90%, it is highly required exercises which would certainly reduce pulmonary vasoconstriction, as well as supplementary oxygen, must be kept ready. Also, exercising appropriate techniques needs to be provided as it would assist stimulate receptors in airways smooth muscles which would relieve bronchoconstriction that would reduce the resistance to airflow and would enhance the process of breathing, (Kennedy et al. 2012). Herbal medicine should be prescribed to Jackson to relieve the acute episodes and enhance the mechanism with strong doses of medicines. Acupuncture can also be used to aerosolize the routes which would reduce the tension in the lung tissues by monitoring the initial response of Jackson. In case the attack becomes much more critical then ventilation is required as it could be effective for treating the cause efficiently. Breathing exercises and techniques would also assist in Jackson’s case that led to bronchodilation which would enhance the ability to speak a complete sentence.

The 2^nd strategy that needs to be administered is systematic diets and clean room atmosphere that would reduce the inflammation caused in the airway. It is a significant system that would assist to treat a patient for moderate to severe asthma attacks, (Tsai et al. 2012). Also, such a dietary system and clean environment must be prescribed and must be administered during the initial stages after observing the situation. Also, constant supervisions by creating an enhanced atmosphere with effective care can also be administered that would certainly enhance the situation of Jackson and would decrease the need for mechanical ventilation and any other nebulizers, (Lim et al. 2012). This kind of therapy would assist to manage airway secretions and treat issues of lungs and respiratory infections extensively. By administering these two nursing strategy based on the situation of Jackson and clinical manifestation could highly make the situation at ease. Furthermore, it would also give him relief and smooth flow of air without any inflammation in the lungs. On the other hand, as this case relates to highly acute severe asthma, it would reduce the severe need of medication as each of the strategies has its own positive impacts that would certainly improve the condition of Jackson extensively.

Implications for nursing practice

As continuous nebulized Salbutamol and nebulized Ipratropium bromide (4/24) and IV Hydrocortisone 100mg (6/24), these medications have a significant impact on Jackson as well as their mechanisms are highly distinct.  Nebulised Salbutamol works as quick-relief medications. Also, as the condition of Jackson states that he is suffering through severe acute asthma, short-acting beta2 agonists like nebulized Salbutamol is highly recommended. It would also relieve the bronchoconstriction due to such acute episodes. It assists in the airway for smooth muscles and decreases the resistance to airflow. On the other hand, in case it would be provided through the process of inhalation or aerosolized routes, it might not reach the lower airways as well as the lung tissue of Jackson. This in would highly disrupt the airflow and reduce tidal volume extensively, (Papadopoulos et al. 2012).

Anticholinergics are a critical issue that has been observed in Jackson’s case that led to bronchodilation by lowering intrinsic vagal tome of the airway. For such treatment, the mechanism of nebulized Ipratropium bromide (4/24) has been prescribed as it produces bronchodilation as well as enhances the pulmonary function of Jackson. Also, the adverse reaction to cardiovascular is also minimized. On the other hand, the adverse reaction of nebulized Ipratropium bromide is its impact on the cardiovascular system. However, in this case, it is assumed to be minimal due to which such implications would be managed efficiently, (Silvio Torresa et al. 2012).

IV Hydrocortisone 100mg is a kind of corticosteroids that assists to suppress the airway inflammation by restricting inflammatory migration of cells and activation. Also, it assists to block late e phase reactions to the allergens. It reduces hypersensitivity, edema as well as secretions, (Powell et al. 2012). It should be administered for 3 to 10 days and in the case of Jackson 5 to the 10-day course is significant as it would enhance the condition suffered due to severe acute asthma. On the other hand, these doses have negative nursing implications as well if not held continuous supervisions including relapse that would critically worsen the situation, (Pavord et al. 2012). Hence, nebulized Salbutamol and nebulized Ipratropium bromide (4/24) and IV Hydrocortisone 100mg (6/24) medications must be provided to Jackson under effective supervision to mitigate the negative nursing implications associated with it. Based on the clinical manifestation, these medications would enhance the present situation of Jackson by therapeutic care is highly required for reducing the chance of its occurrence again.

Conclusion

Conclusively, it may be mentioned that proper clinical manifestation is essential in order to mitigate any sort of infections hampering the health of the human beings. Failure to do so, might prove extremely harmful for the individual to retain the life in the future in an effective way.

References

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Green, R. H., & Pavord, I. (2012). Stability of inflammatory phenotypes in asthma.

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Silvio Torres, M. D., Nicolás Stucco, M. D., Juan José Boscha, M. D., Tomás Iolstera, M. D., Alejandro Siabaa, M. D., Rivarolaa, M. R., & Schnitzlera, E. (2012). The effectiveness of magnesium sulfate as initial treatment of severe acute asthma in children, conducted in a tertiary-level university hospital. A randomized, controlled trial. Arch Argent Pediatr, 110(4), 291-296.

Tsai, C. L., Lee, W. Y., Hanania, N. A., & Camargo Jr, C. A. (2012). Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008. Journal of Allergy and Clinical Immunology, 129(5), 1252-1258.

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