Pathophysiology of Asthma – Essay

Exam Case Scenario Pathophysiology of asthma attack Asthma is a chronic lung disease characterized by episodes in which the bronchioles constrict due to oversensitivity. In asthma, the flight paths (bronchioles) constrict making it difficult to get air in or out of the lungs. Breath littleness is the main symptom. The bronchi and bronchioles change state inflamed and constricted. Asthmatics usually fight back to triggers. Triggers argon substances and situations that would not normally trouble an asthma free person. Asthma is either extrinsic or intrinsic.Extrinsic is when the agitation in the airline business is a result of hypersensitivity reactions associated with allergy (food or pollen). Intrinsic asthma is linked to hyper antiphonary reactions to otherwise forms of stimuli like infection. Or they drive out nurture a conspiracy of both. The bronchi and bronchioles contain smooth muscle and argon lined with mucus-secreting glands (goblet cells) and ciliated cells (push the mucus towards the throat). Next to the airways melodic line supply in that location ar lots of mast cells.Once they become stimulated the mast cells release a number of cytokines (chemical messengers), which cause physiological changes to the liner of the bronchi and bronchioles. Three such protein cytokines are histamine, kinins and prostaglandins (leukotrienes) which cause smooth muscle contraction, increase mucus production and capillary tube permeability. The airways soon narrow and become deluge with mucus and fluid leaking from the blood vessels. Airflow becomes obstructed resulting in a wheeze.As the airways become obstructed the uncomplaining of depart become fatigue and their respiratory effort becomes weak and inadequate causing hypoxaemia and hypercapnia. Airway Assess the airway. If the uncomplaining is talking this means they have a patent (clear) airway accordingly they are breathing and have brain perfusion. Look and listen for signs of airway obstruct ion. A partial obstruction is often noisy, and in complete airway obstruction there are no breath sanitarys. Maintain and observe the airway and report some(prenominal) changes. If the airway does become compromised suction or sit the diligent up.If the patients level of conscious has alter carry out the query tilt and chin lift. If you have had airway management training insert an oropharyngeal or nasopharyngeal airway. vivacious Count the respiratory enjoin over 1 minute. The normal jog is between 14 20 resps per min. A spicy respiratory rate (tachypnoea) indicates that the patient is unwell and that the patient is struggling to breath. Evaluate the rate, rhythm and prudence of the breathing. Make sure the patients chest is moving every bit on both inclines (symmetrical), if not this could indicate a pneumothorax.Observe to see if the patient is using his or hers accessory muscle to breath (if the patient feels they are having difficulty getting enough oxygen, their body begins to clench these muscles every succession they breath in an attempt to acquire to a greater extent air) as this could be a sign of respiratory distress. Monitor the peripheral oxygen strength (SpO2) using a flash oximeter. A low SpO2 reading can indicate that the patient is in respiratory distress. Give oxygen as prescribed using a venturi mask. Check the rubric of the patients lips and tongue, central cyanosis indicates lack of oxygen to the skin.Listen to the patients breathing, breath sounds are normally quite. each abnormal sounds such as wheezing suggest that there could be a fluid build up in the lungs. Circulation Palpate the radiate pulse, assessing for the rate, quality and rhythm. The normal range for this is between 60-100 beats per min. An elevated pulse rate can be due to the patient organism in pain, fear or a sign of an infection. sexual conquest the patients blood pressure and insure that this is at bottom the normal range (100/60 140/90 mmHg) . Look at the patients colour in their hands and fingers, and check if the patient feels warm or cool. flyer the capillary refill time (CRT). Apply pressure to a fingertip, held at a level of the heart, for 5 seconds so that the skin becomes blanched and then(prenominal) release. Measure how long it takes for the colour to return. The normal capillary refill time is less than 2 seconds, anything over indicates reduced skin perfusion. Ask the patient if they have any chest pain, if so begin a ECG monitoring. Take the patients temperature. The normal range for this is 36-37. 5 degrees Celsius. A high temperature can be a sign of infection.The doctor whitethorn overly like to re-take the patients Arterial Blood Gas (ABG) because previous results showed respiratory acidosis. hindrance Assessment of disability involves evaluating the patients central offensive carcass function. Assess the patients level of consciousness using the AVPU scale. public lecture to the patient if they a re alert and talking they are sort out as A. If the patient is not fully awake establish whether they respond to the sound of your voice (opening their eyes, making any sounds) if they do they are classified as V.If the patient does not respond to voice administer a monstrous stimulus (gently rubbing the sternum bone). If they respond they are a P on the AVPU scale. And finally if they do not respond to any of the preceding(prenominal) they are a U, you should then move onto the more detailed Glasgow torpor Scale (GCS). You go out assess the patients pupils (eyes) and motor receipts (arms and legs) among other things to contact the patient a score out of 15 (15 being the highest). A GCS of fewer than 8 is a medical emergency and you would then have to go back to assessing the patients airway.Exposure It may be necessary to undress the patient, taking care to maintain their dignity at all time, in order to undertake a thorough head to toe check, looking out for any signs of D VT, sores or rashes. Always turn in consent before any procedure so always hold back the patient informed of what it is you are doing. Reassure the patient to reduce anxiety and try to make them as comfortable as possible. Ask the patient if they are in any pain and get the doctor to prescribe an appropriate analgesia.If the doctor has prescribed the patient antibiotics ensure that blood cultures are done prior to giving the patient their antibiotics, this will give an holy result from the lab. Give the patient any other due medicament making sure to ask if they have any known allergies. unfluctuating peak flows should be done on the patient pre and post medication, this will tell us if the medication being given to the patient is operative or not. Spirometry test will show how well the patient breathes in and out and it is to a fault used to monitor the severity of some lung delimitates, and their response to word.Take a mid stream urine sample from the patient and twilight stick, depending on the results send down to the lab. The doctor might also require a chest x ray from the patient. Complete all the germane(predicate) chance assessment such as the Waterlow score (patients are classified according to their risk of developing a pressure sore), the MUST score (screening tool to identify adults who are malnourished or at risk of malnutrition), falls risk assessment (what the chances are of the patient falling) and Moving and use (if the nurses are required to use any equipment on the patient).And the patients hygiene needs must be assessed and if necessary an appropriate nursing plan must be put into place. Start the patient on a fluid chart, making sure to write down any IV fluids that they have. The cannula site must be checked and the patient must have a VIP score to make sure there are no signs of phlebitis. A sputum sample must also be collected and sent to the lab. Carry out a blood glucose test to ensure that the patients blood glucose l evels are within normal ranges (4-7 mmol/l). A referral should be made to the respiratory nurse who will provide support to patients who suffer from chronic respiratory diseases.Give patient advice to keep off any triggers that they are aware of, advice on medication and if relevant give advice on smoking cessation. Symbicort combination inhaler containing budesonide and formoterol Inhalers are used to renounce drugs to relieve or stay fresh the symptoms of asthma. Budesonide Corticosteroid drug used in an inhaler to prevent attacks of asthma but will not freeze an existing attack. Budesonide is used by patients whose asthma is not controlled by bronchodilators alone. Budesonide controls symptoms by reducing inflammation in the swollen inner layers of the airways.By subdueing airway inflammation they reduce the swelling (oedema) inside the bronchioles. There are fewer side effects to the drug when inhaled because it is absorbed by the body in practically littler quantities th an when it is taken orally. Budesonide is usually taken twice a daylight and normally lasts between 12 to 24 hours. Asthma prevention is the condition for which prolonged use may be required. There may be a small risk of glaucoma, cataracts, and effects on bone with high doses inhaled for a prolonged period.Side effects include a cough, sore throat Formoterol Bronchodilators are prescribed to widen the bronchioles and improve breathing. Bronchodilator drugs act by relaxing the muscles surrounding the bronchioles. Formoterol is from the sympathomimetic group which is mainly used for the fast relief of breathlessness. Sympathomimetic drugs interfere with nerve signals passed to the muscle through the autonomic nervous arrangement. Because sympathomimetic drugs stimulate a branch of the autonomic nervous body that controls the heart rate, the patient may sometimes feel palpitations or trembling.People with heart problems, high blood pressure or an overactive thyroid gland will ha ve to be extra cautious. Salbutamol inhaler/nebuliser Salbutamol is a sympathomimetic bronchodilator that relaxes the muscle surrounding the bronchioles. It is used to relieve symptoms of asthma. Inhalation is considered more effective because the drug is delivered directly to the bronchioles, thus giving rapid relief, allowing smaller doses and causing fewer side effects. Compared to some similar drugs it has little stimulant effect on the heart rate and blood pressure, making it safer for tribe with heart problems.Salbutamol is usually taken 1-2 inhalations 3-4 times a day, usually starts operative within 5-15 min and can last up to 6 hours. The closely common side effect of salbutamol is fine tremor of the hands also anxiety, tension and restlessness may occur. Prednisolone A powerful corticosteroid used to reduce inflammation and suppress allergic reactions and immune system activity. Corticosteroid drugs reduce inflammation by blocking the action of chemicals called prosta glandins that are responsible for triggering the inflammatory response.These drugs also temporarily depress the immune system by reducing the activity of certain types of white blood cell. Because corticosteroids suppress the immune system, they increase susceptibility to infection. They also suppress symptoms of infectious disease. IV Hydrocortisone Hydrocortisone is a corticosteroid used in the palmment of a variety of allergic and inflammatory conditions. Hydrocortisone is chemically very(a) to the hormone cortisol, which is produced by the adrenal glands. Prolonged high dosage may cause diabetes, glaucoma, fragile bones and thin skin.Aminophylline Aminophylline is a bronchodilator used to dainty bronchospasm (constriction of the air passages) in patients suffering from asthma. It can be used to treat acute attacks. Slow-release formulations of the drugs produce beneficial effects lasting for up to 12 hours, they are also useful taken at night to prevent night-time asthma and early morning wheezing. Side effects are headaches and nausea. green goddess and alcohol increase excretion of xanthines from the body, reducing their effects.