Analysis of Common Complaint – “Shortness of Breath”

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Table of Contents

Diagnosis: Asthma (adult patient)
Rationale
Compare and Contrast Two Different Clinical Guidelines for Asthma
Evidence-Based Diagnostic Plan
Evidence-Based Action Plans
Evidence-Based Management Plan
Patient/Caregiver Education in Evidence-Based Management Plan
References

Diagnosis: Asthma (adult patient)

Brief Description of the Common Complaint Selected “Shortness of Breath”

Shortness of breath is a condition where a person manifests uncomfortable breathing difficulties. Some people may experience this problem over sudden attacks while others may be affected over for several weeks or more (Dharmage et al., 2019). A person with breath shortness has increased number of breaths per minute meaning the person experiences trouble when breathing or getting enough oxygen (Dharmage et al., 2019). Other physical signs comprise color changes where a bluish color is seen around the mouth of the patient, on the fingernails and inside of the lips.

Differential Diagnoses Related to the Common Complaint

Bronchitis;
Pneumothorax;
Asthma.

Rationale

Bronchitis

This is the swelling of the bronchial tube also known as bronchi. Bronchitis can be either chronic or acute; acute bronchitis is a common condition that develops as a result of cold or other infections affecting the respiratory system (Dharmage et al., 2019). Therefore, this inflammation makes breathing very difficult because of the narrowing of and irritation of the airways

Pneumothorax

This is a condition that caused by leakage of air between the lungs and chest wall. The air presses the outer side of the lungs causing them to collapse (Brown et al., 2020). A lung collapsing can be life-threatening on certain occasions (Brown et al., 2020). The treatment of pneumothorax is done by inserting a needle between the ribs to get rid of excess air.

Asthma

Asthma occurs because of airway swelling that makes them narrow. As a result, breathing becomes difficult and flow of air is interfered with (Dharmage et al., 2019). This causes coughing, wheezing, and shortness of breath (Dharmage et al., 2019). Since asthma changes over time, patients have to meet with the medical practitioner regularly to track the signs and symptoms and adjust to treatments as required.

Compare and Contrast Two Different Clinical Guidelines for Asthma

Medications

These are medicines designed to keep asthma symptoms under control. For instance, medicines taken for long-term control are meant to reduce airway inflammation that causes asthma. Tiotropium bromide is taken by asthmatic people for long-term control. An adult person uses this medication once daily as a long-term asthma treatment. Long-term medications are vital for asthma treatment because they decrease chances of developing asthma attacks (NHLBI, 2012). The highly recommended long-term control therapy drugs are corticosteroids (ICSs).

Bronchial Thermoplasty

Bronchial thermoplasty is a type of treatment for severe asthma. It is not widely available or applicable for every person. When bronchial thermoplasty is being administered, the medical professional heats the inside of the airways in the lungs using an electrode. The purpose of the heat supplied is to decrease the smooth muscles inside the airways thus decreasing chances of developing asthmatic attacks.

The most appropriate method of managing asthma is through prevention and long-term control. This mechanism normally entails learning to determine the asthma triggers, taking appropriate steps of avoiding triggers and tracking breathing system to ensure that the medications taken are always in control of the symptoms. However, in case of an asthma flare-up, one might opt using a quick inhaler.

Evidence-Based Diagnostic Plan

Spirometry

This test can be used by doctors to diagnose asthma in adult people. In helping determine the effectiveness of the lungs, a person takes a deep breath and forcefully exhales out into a tube connected to a spirometer (Çolak et al., 2019). The amount of exhaled air is recorded as well as the strength of exhaling (Çolak et al., 2019). If some measures are below the norm for an adult person, this might signify that asthma has narrowed the airways.

Evidence-Based Action Plans

When Patient is Doing Well

Working in a relationship with the healthcare practitioner is important to create an effective evidence-based plan that is efficient in controlling asthma attacks. For instance, when the patient is doing well, there is breathing difficulties, chest tightness, coughing or wheezing (Çolak et al., 2019). The patient can perform her daily chores, and peak flow recording is above 80 percent, When there are such indicators, the patient should continue taking medicines for long-term control of asthma.

When Asthma Starts Worsening

When asthma starts to worsen, the patient experiences difficulties breathing, coughing, chest becoming tight, and wheezing. The patient wakes up at night because of asthma attacks; experiencing difficulties when doing certain activities that one use to perform on a daily basis (Çolak et al., 2019). Finally, the peak flow recording indicates half to three-quarters of the best flow after checking with the flow meter.

Medical Alerts

The patient is required to seek medical intervention when; there are extreme breathing difficulties; there is no help provided by the quick relieve medicines; when the patient become unable to perform some of the activities they used to perform earlier. Additionally, patient should seek medication when peak flow measurements indicate less than half of the chest peak flow (Çolak et al., 2019). The current symptoms never get better and it is possible to reach or go to hospital. Therefore, performing peak flow measurement is the fastest method to measure how air flows from the lungs.

Evidence-Based Management Plan

Pharmacology

Asthma therapy is based on a stepwise approach depending on the severity of the condition. The primary goals are minimizing the signs and symptoms resulting from airway obstruction and inflammation, preventing exacerbations, and maintaining the normal functioning of the lungs (Murphy et al., 2019). Glucocorticoids and β₂‐adrenoceptor agonists are currently the recommended drugs used for eliminating airway obstruction and inflammation (Dharmage et al., 2019). Other drug options include anticholinergics, leukotriene receptor antagonists, and theophylline.

Patient/Caregiver Education in Evidence-Based Management Plan

Appropriate self-management can considerably improve patient’s quality of life. However, patients are not equipped with the relevant asthmatic knowledge; they can use medical devices incorrectly and struggle to comply with recommended asthma management strategies (Lowey, 2020). Therefore, nurses should ensure that patients and caregivers are equipped with appropriate health education.

Follow-up and Referrals

Follow-up is the act of making contact with a patient or a caregiver at a specified later date. Follow-ups will create opportunity for medical practitioner to assess asthma control and determine whether there is need to adjust therapy being provided to the patient. During follow-ups lungs measurements will be obtained by spirometry for at least after every 1-2 years; and more frequently if asthma is not well controlled (NHLBI, 2012). Asthma highly varies over time and, thus, the patient needs to see the doctor after 1-2 weeks while gaining control, and 1-6 months later to monitor control. Patient transfer is to a written order from the primary care doctor (Lowey, 2020). After the patient has been discharged by the medical practitioner, the patient can refer to another healthcare facility for further care and follow-up.

Role of Culture

The cultural beliefs and behaviors of a patient might conflict with biomedical healthcare practices and values, which may result in non-adherence with asthma treatment regimes. Cultural competency and health literacy primer offer educational tools that improve cross-cultural communication skills, delivery of culturally and linguistically services (Brottman et al., 2020). They also help create programs and policies that decrease cost of healthcare to the patient due to low ability to pay. Therefore, medical practitioners ought to understand and be sensitive to these cultural beliefs and behaviors and discuss the appropriate asthma management plan with the patient.

Algorithm for Patient Care

There are four steps that one needs to know as asthma first aid. First, sit the patient upright; second give the patient four puffs of blue relieve puffer and shake the puff before administering. Put one puff into a spacer at a time and make the person take four breaths of each puff through the spacer (Brottman et al., 2020). Third, if there is no improvement after four minutes, give the patient more puff as in step two. If still there is no improvement, call for an ambulance.

Case Study

The 55-year-old female patient was presented to the clinic with a medical history significant for asthma. She has been using albuterol rescue inhaler 3 times a week for the past year. All this time the patient has been experiencing asthma symptoms 2 times monthly. Because of these symptoms, spirometry was done showing a forced expiratory volume in the first second (FEV1) of 78% predicted. The patient was then prescribed with a low-dose corticosteroid, fluticasone 44 mcg at two puffs twice per day. Nevertheless, she remained symptomatic and continued using her inhaler 3 times per week. Therefore, she was switched to a combined inhaled steroid and long-acting beta-agonist (LABA) (fluticasone propionate 250 mcg and salmeterol 50mcg, one puff twice a day) by his primary care doctor.

References

Çolak, Y., Nordestgaard, B. G., Vestbo, J., Lange, P., & Afzal, S. (2019). Prognostic significance of chronic respiratory symptoms in individuals with normal spirometry. European Respiratory Journal, 54(3).

Brottman, M. R., Char, D. M., Hattori, R. A., Heeb, R., & Taff, S. D. (2020). Toward cultural competency in health care: A scoping review of the diversity and inclusion education literature. Academic Medicine, 95(5), 803-813. Web.

Brown, S. G., Ball, E. L., Perrin, K., Asha, S. E., Braithwaite, I., Egerton-Warburton, D.,… & Beasley, R. (2020). Conservative versus interventional treatment for spontaneous pneumothorax. New England Journal of Medicine.

Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of asthma in children and adults. Frontiers in pediatrics, 7, 246. Web.

Lieberman, J. A., Zhang, J., Whitworth, J., & Cavender, C. (2018). A randomized, double-blinded, placebo-controlled study of the use of viscous oral cromolyn sodium for the treatment of eosinophilic esophagitis. Annals of Allergy, Asthma & Immunology, 120(5), 527-531. Web.

Lowey, S. E. (2020). Management of severe pain in terminally ill patients at home: An evidence-based strategy. Home healthcare now, 38(1), 8-15.

Murphy, J. A., Heisser, J. M., & Montgomery, M. (2019). Evidence-based review of smartphone versus paper asthma action plans on asthma control. Journal of Pharmacy Technology, 35(3), 126-134. Web.

National Heart, Lung, and Blood Institute (NHLBI) (2012). Asthma care quick reference: diagnosing and managing asthma. U.S. Department of Health & Human Services. Web.

Petsky, H. L., Cates, C. J., Kew, K. M., & Chang, A. B. (2018). Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): A systematic review and meta-analysis. Thorax, 73(12), 1110-1119. Web.

Wang, Z., Pianosi, P., Keogh, K., Zaiem, F., Alsawas, M., Alahdab, F.,… & Murad, M. H. (2017). The clinical utility of fractional exhaled nitric oxide (FeNO) in asthma management. Web.

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