Category: Asthma

Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of asthma in children and adults. Frontiers in Pediatrics, 7, 1-15. Web.

This article summarizes the findings from the investigation of the relationship between genetic and environmental determinants in asthmas high-risk groups. The role environmental exposures play in the development of asthma has not been explored well, even though the environmental factors resulting in the disease have been identified in both children and adults. Childhood asthma reduces maximally attained lung function and impairs airway development. Among adults, asthma accelerates the lungs function, which increases the risk of obstructed fixed airflow. Thus, the management of asthma needs to focus on improving both short-term symptoms and long-term health outcomes. This article is valid and reliable because the authors have a rich educational and occupational background in asthma and other respiratory conditions. They have also conducted a detailed review of the literature on asthma among children and adults.

Ferrante, G., & La Grutta, S. (2018). The burden of pediatric asthma. Frontiers in Pediatrics, 6, 1-7. Web.

This research article investigates the burden and prevalence of asthma among children. In many healthcare systems globally, asthma has posed a consistent challenge, and this condition is more prevalent among low- and middle-income regions. This burden has been proven to reduce with the implementation of strategies such as early detection of asthma among children and access to proper health attention. The article outlines the risk factors for asthma, identified environmental exposures as the leading cause of asthma among children, and discusses lifelong outcomes, morbidity, and mortality. This resource is valid and reliable because the authors have conducted comparative studies on asthmas global trends among children.

King, G. G., Farrow, C. E., & Chapman, D. G. (2019). Dismantling the pathophysiology of asthma using imaging. European Respiratory Review, 28(152), 1-15. Web.

This article analyzes the current evidence concerning the pathophysiology of asthma. However, King et al. (2019) acknowledge the inadequacy of the measurements of this conditions physiological processes. The research attempts to use imaging to demystify the pathophysiology of asthma. In the past decade, there has been widespread asthma imaging, including ventilation magnetic resonance imaging (MRI), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and high-resolution computed tomography (HRCT) (King e al., 2019). Computed tomography (CT) imaging has made it easier to understand asthma, enabling physicians and scientists to see airways. This resource is valid because it provides facts, figures, and data on the various technological imaging successes in diagnosing asthma. It is a reliable source because the authors carried out a detailed literature review to arrive at their conclusions.

Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: Reshaping the concept of asthma management. Allergy, Asthma & Clinical Immunology, 16(1). 1-11. Web.

Treatment strategies for asthma have been developed and keep changing over the years. Papi et al. (2020) researched and presented their findings on how to manage asthma. Airway inflammation can be reduced by asthma control medications, for example, inhaled corticosteroids. However, according to Papi et al. (2020), a pharmacological approach was proposed in 2017, and it was based on a controller treatment. In case the controller failed, short-acting beta-agonists (SABAs) were introduced to cause relaxation of the airways smooth muscles. Since 2019, the anti-inflammatory approach was suggested and adopted, but there have been challenges of non-adherence (Papi et al., 2019). This resource is valid and reliable because it provides a chronological development of asthma treatment strategies and its authors have an educational and practice background in asthma research and treatment.

Tesse, R., Borrelli, G., Mongelli, G., Mastrorilli, V., & Cardinale, F. (2018). Treating pediatric asthma according to guidelines. Frontiers in Pediatrics, 6, 1-7. Web.

The guidelines for treating asthma among children are specific, and they depend on the risk factors exposing the child to the respiratory condition. Tesse et al. (2018) conducted a study of the clinical guidelines on pediatric asthma diagnosis and treatment. Some of the asthma management documents include National Institute for Health and Care Excellence asthma guideline consultation, the British Thoracic Society, and the Global Strategy for Asthma Management and Prevention. Among children, experts recommend non-pharmacological interventions for the management of asthma (Tesse et al., 2018). These interventions include avoiding food or drug triggers, environmental tobacco smoke, and indoor or outdoor irritants. However, Tesse et al. (2018) suggest that clinicians critically evaluate asthma management options among children based on the recommended best practices. This resource is valid and reliable because the authors make cross-reference with many evidence-based practice experiences and comparative analyses of the universally agreed documents on pediatric asthma managements clinical guidelines.

Introduction

Asthma is a highly prevalent disease among the U.S. population, especially in the case of school-age children. According to Magzamen and Tager, it is the main reason for non-injury hospitalization and missing school (583). Asthma is considered to be a spectrum disease due to the multiplicity of its manifestations. Not only the symptoms but also, the severity of asthma can differ significantly. The problem is, however, that not only the symptoms vary, but also etiology can be different.

The disease can be caused by genetic, allergic, or environmental factors. The truth lies in the fact that some population groups experience a higher risk of asthma morbidity than others. Magzamen and Tager claim that the chances are consistently higher among poor, urban black children (583). Therefore, the investigation of factors predicting asthma is essential for future prevention practices.

The projects primary objective is to identify the links between different factors and the risk of asthma morbidity. That is why the project will endeavor to answer two research questions relating to the predictors of asthma prevalence and the emergency department visits. First, the project is going to identify what individual and environmental factors best predict asthma prevalence. To answer this question, a set of such variables as gender, race, economic status of a family, or home location will be investigated.

Secondly, the project is going to answer what factors best predict ER visits and whether these factors are the same that predict asthma prevalence. For this purpose, the very variables used in question 1 will be tested again to identify the differences. It is expected that the derived information will shed light on asthma etiology and the main risk factors for the American children.

The current survey study is based on the data regarding the population of American middle school children. Data collection was conducted in Oakland, CA, based on 20 middle schools from the Oakland Unified School District (OUSD). A total of 4,017 have completed a short self-reported survey about the presence of the diagnosis or symptoms of asthma and treatment experience. Additionally, they were requested to fill the information on their grade, sex, race/ethnicity, language spoken at home, the language of survey (English or Spanish), and home address (Magzamen and Tager 584).

Geolocations of the self-reported addresses were mapped to obtain additional variables like NO2 concentration at home location and whether the home is located near a freeway. Other demographic variables were derived from census data to identify physical environmental or demographic predictors associated with asthma morbidity.

Proposed Methods

As there are numerous independent variables, it is suggested to use a machine learning algorithm that will select those variables that will be included in a multiple regression analysis. First, it is necessary to concatenate the census data and the survey data, using addresses to match up data points. Likely, some addresses will not have matches because of the mistakes of data entry. That is why these data points should be omitted. This step of data sorting is especially challenging, as the addresses in the census and survey data are in different orders. Thus, all the rows need to be rearranged appropriately during the data concatenating process.

After the data are cleaned and organized, the H2O automatic machine learning package in R will be utilized to find the most related predictors of asthma prevalence separately. H2O is chosen for this task as it can adjust the parameters automatically to produce the most relevant model. Further, the list of the significant variables will be extracted and analyzed in a multiple regression analysis. Additionally, the best predictors of emergency room visits for children with asthma will be identified.

Multiple regression models will be used to determine the importance of each predictor. Then it is needed to find out how well the lists of predictors for asthma prevalence and ER visits can be compared and identify whether a significant difference between the two tables can be found. For each of the predictors, the regression with different response variables should be analyzed to determine which predictors differ/are the same for asthma prevalence and ER visits.

As the list of data includes some variables that are redundant or missing, the machine learning algorithm will be used both with and without these variables to determine how different the results are. Then it will be decided whether they should be included in the final model or should be omitted. After the H2O Auto ML package analysis is completed, the best suitable algorithms for the current data will be selected.

These models will then be provided to the researcher. For this purpose, the codes of one or several of the best suitable machine learning algorithms from H2O will be handed to the researcher. It is also necessary to supply the codes with comments on how to apply the model so that they can reproduce the analysis in the future if needed.

The outcome of the project will include the ranged list of predictors of asthma prevalence as well as the ER visits. The predictors will be ranged according to their importance for both response variables. Additionally, there will be conclusive statements on the comparison of the same list of predictor variables for both responses. Additionally, the researcher will be provided with the codes and methods for using machine learning algorithms. They can be used for the possible follow-up study to test the changes in asthma prevalence and ER visits in case of the shift in predictor variables.

The results of the study will include the correlations between the control and independent variables. For question 1, the response variable is the presence of asthma [0(no asthma), 1(asthma)]. The list of potential predictors will be analyzed to identify their impact on the control variable. Many scholars identify demographic, economic, environmental, and healthcare-related factors as those of increased importance for asthma morbidity prediction (Hansel et al. 797).

Therefore, the variables analyzed for this question will include the following: Race, household income, language spoken at home, parents education degree, family composition, parents employment status, healthcare access, housing construction type, renter/owner-occupied, location near the highway, heating type, and the exposition to the pollutants. For question 2, the response variables will be the ER visits due to wheezing for the last 12 months [1 (ER visit), 2 (No ER visit)]. As one of the objectives of the research includes the comparison of these predictors, the variables should be the same as in question 1.

The regression model outputs will be used to identify the correlation between each variable and asthma morbidity. This information will help to answer the research questions, and also will provide the grounds for ranging the predictors according to their importance. It is expected that the relevant interactions will be identified between income levels, race, and asthma prevalence, as reported in the research (Magzamen and Tager; Hansel et al.).

Additionally, living conditions contribute to the severity of the disease, increasing the rate of ER visits. However, parents education and healthcare accessibility will also have a significant impact. The obtained analytical conclusions can be utilized for the prediction of the epidemiologic situation and early prevention practices.

References

Hansel, Nadia N., et al. Predicting Future Asthma Morbidity in Preschool Inner-City Children. Journal of Asthma, vol. 48, no. 8, 2011, pp. 797803.

Magzamen, Sheryl, and Ira B. Tager. Factors Related to Undiagnosed Asthma in Urban Adolescents: A Multilevel Approach. Journal of Adolescent Health, vol. 46, no. 6, 2010, pp. 583-591.

Despite the intentions to improve the quality of life and create the best control and treatment approaches, asthma remains a significant problem in the United States. Statistical data from various credible sources show that about 10% of American children (7 million) have asthma as a diagnosed chronic disease (Johnson et al., 2017; Papadopoulos et al., 2019). In addition, children may suffer from asthma-related problems like fatigue, uncontrolled blood pressure, and repeated visits to hospitals. Pediatricians, therapists, and nurses continue working to understand how to reduce readmission rates among asthma patients and develop new follow-up programs to involve children and their families.

Problem

There are many problems around the topic of pediatric asthma in the modern world of health care and nursing. Papadopoulos et al. (2019) underlined the importance of an increased focus on childhood asthma in terms of its definition (distinguishable from adult asthma), guidelines for a specific treatment, and follow-up management. The problem is that even the most professional medical workers cannot control the burden of asthma, and asthma-related revisits are observed in approximately 40% of children within the next 12 months (Johnson et al., 2017). As a rule, much attention is paid to the way of how children must be diagnosed and treated. The role of nurses and their possible contributions to the problem solution is still unclear.

Significance of the Problem

The significance of the problem lies in the necessity to improve the existing statistics and provide children and their families with a possibility to control asthma and its related issues. Childrens health is the promotion of well-being in people from conception through their adolescence. It is a responsibility not only for a pediatrician but for nurses, parents, and other caregivers. Children are vulnerable to a number of environmental factors, and they can hardly control or understand their health problems. Asthma is not only a serious health or family burden but a social and economic concern that results in school absence, impaired quality of life, and increased costs on medication (Papadopoulos et al., 2019). Therefore, the reduction of readmissions among asthmatic children cannot be ignored, and new solutions have to be developed.

Purpose of the Research

The primary purpose of this research is to reduce readmissions in pediatric patients who have already been hospitalized and diagnosed with asthma. It is expected to underline the worth of nurse participation in follow-up care. The goal is to understand in nurse phone calls may contribute to improved parental awareness of asthma and predict their childrens revisits to hospital with the same problem. Postdischarge phone calls have already been investigated as a part of a patient- and family-centered care approach for children with nephrosis, acute renal failure, or urinary tract infection (Flippo, NeSmith, Stark, Joshua, & Hoehn, 2015). Now, the potential worth of nurse phone calls and communication with parents will be discussed directly in regard to pediatric patients with asthma.

Research Questions

The problem of readmissions among asthmatic children covers many spheres, including the recognition of the disease, treatment effectiveness, and follow-up care. To clarify if phone calls organized by nurses can be effective in prevention revisits, several research questions should be answered:

1. Are nurse phone calls to families with asthmatic children would reduce the number of readmissions with the next year?
2. Will nurse-parent communication increase the awareness of asthma-related complications in families?
3. Would one call per week be effective in reducing a childs revisits to a hospital? Or is it necessary to change (increase/diminish) this frequency?

Masters Essentials

The role of nurses in the research under consideration is integral, which underlines the importance of nurse knowledge in this field. In nursing education, there are nine essentials according to which nurses must develop their skills (American Association of Colleges of Nursing, 2011). Several conditions can be aligned with the topic of this research project. Essential III about quality improvement and safety helps recognize the responsibilities of nurses in their abilities to meet the standards of care and demonstrate a high performance (American Association of Colleges of Nursing, 2011). Essential V covers the role of informatics and healthcare technologies in nursing care. Nurses must learn how to choose the most effective communication technologies and support patients and their families. Finally, Essential VIII tells about clinical prevention for improving health (American Association of Colleges of Nursing, 2011). A phone call intervention as a service to reduce readmissions in asthmatic children is an excellent example of how population health is managed and improved.

Conclusion

The idea to help children and their families in predicting asthma-related readmissions turns out to be a serious topic for research. Phone calls have already been proved as an effective communication tool between nurses and parents for disease control. This project is characterized by narrowed sample (pediatric patients with asthma), an apparent intervention (phone calls), and particular participants (doers) of the intervention (nurses and parents, or other caregivers). Asthma continues changing the quality of a childs life, and the role of a researcher is to investigate as many aspects of the problem as possible and predict the growth of readmission rates in hospitals.

References

American Association of Colleges of Nursing. (2011).The essentials of masters education in nursing. Web.

Flippo, R., NeSmith, E., Stark, N., Joshua, T., & Hoehn, M. (2015). Reduction of 30-day preventable pediatric readmission rates with postdischarge phone calls utilizing a patient-and family-centered care approach. Journal of Pediatric Health Care, 29(6), 492-500.

Johnson, L. H., Beck, A. F., Kahn, R. S., Huang, B., Ryan, P. H., Olano, K. K., & Auger, K. A. (2017). Characteristics of pediatric emergency revisit after an asthma-related hospitalization. Annals of Emergency Medicine, 70(3), 277-287.

Papadopoulos, N. G., ustovi, A., Cabana, M. D., Dell, S. D., Deschildre, A., Hedlin, G.,& Phipatanakul, W. (2019). Pediatric asthma: An unmet need for more effective, focused treatments. Pediatric Allergy and Immunology, 30(1), 7-16.

Introduction

Despite advances made in the field of medicine, asthma remains to be one of the most widespread and chronic lung conditions affecting most children while still at their tender ages. It is alarming that out of every fifteen children picked at random, one of them is most likely to be an asthma patient. Besides, these statistics do not deviate much among adults. In North America for instance, more than five percent of adults are victims of asthma. Current demographic facts reveal that nearly one million Canadians in addition to fifteen million North Americans have been diagnosed with asthma. According to Sandra (14), it is unfortunate that new asthma infections have been reported to be on the rise. Further estimates reveal that asthma-related cases have gone up by at least thirty percent in the last two decades. This paper attempts to give an in-depth analysis of both the intrinsic and extrinsic causes of asthma as well as the perturbing yet underlying effects of this chronic respiratory condition.

Definition and Overview

Asthma is a long-term condition in which the bronchial tubes are inflamed which then results in constriction of the tubes which allow air passage (Peacock 8).

Consequently, breathing is hindered considerably making it cumbersome for the patient to breathe with ease. Once the air passage tubes have been narrowed, it is cumbersome to reverse them back to normal even with proper diagnosis and treatment. In other words, the condition may be permanent. The inflamed tubes may also develop allergies to certain allergens (Peacock 9). The airways may equally become sensitive and extremely reactive to allergic conditions. Medical records do not stipulate any specific age group or gender when it comes to bronchial hyperreactivity; there is a possibility of every human being suffering from this intermediate condition.

Causes of Asthma

In retrospect, there is no real known cause of asthma. Nevertheless, medical experts present more or less the secondary factors which are associated with asthma, namely genetics and environmental triggers. The severity after attack is dependant on the nature of the cause. According to National Institute of Health (par.1) environment plays a key role in the cause and development of asthma. Beyond human control is the genetic factor in which asthma can be transmitted from a parent to the offspring. Scientists believe that there might be other causes of this breathing which have not been discovered yet. Beneath the genetic and environmental causes, the air passage plays a crucial role in being extra sensitive in identifying the possible threats entering the lungs and thereby narrowing down to protect the lungs (Kaliner, Barne & Persson 27). A has argued that environmental triggers consider our body defense system as a real enemy. For instance, dust particles and other airborne pollutants are very significant in aggravating asthmatic condition. If these pollutants would be alleviated, then severe asthma cases would equally reduce.

Transmissible genes within a family tree as far as the cause of asthma is concerned cannot be avoided hence patients are only advised to keep off risk factors within their surrounding (Levy, Weller and Hilton 30). Some of the environmental triggers include smoke from tobacco and poor quality air due to pollution or extra ozone levels. Recent data reveal a very close link between childhood asthma and polluted air especially from automobiles. The research statistics show that the aggravation of asthma among children is mainly due to external pollution from dirty air.

Caesarean sections and asthma are also related in the sense that about twenty per cent of babies born from Caesarean section have a higher prevalence to asthma than those delivered normally. It is being suggested that this is due to bacterial exposure during Caesarean section which interferes with the normal body defense. In vaginal birth, the bacteria do not interfere with the immune system hence lower chances of an infant developing asthma.

In the study of genes, nearly one hundred genes are linked with asthma. Medical experts, however, still believe that several studies need to be conducted to ascertain genetic connection to asthma to discard any doubt of chances in the earlier studies. Most of these genes attached to asthma are believed to interfere with the immune system. Once the system has been modified or simply weakened, the victim is more likely left to the mercy of asthma attack (National Institute of Health par.2). In addition to separate genetic and environmental causes of asthma, these two factors can also interact and degenerate into a third cause of asthma. There are research suggestions that it is possible for certain genes to combine with environmental factors and cause or aggravate asthma. For instance, the CD14 genes and endotoxin exposure are good example of gene-environment fusion linked to asthma. Endotoxin can originate from farm waste, animals like dogs and smoke fumes from tobacco.

Conclusion

In summing up this paper, it is imperative to note that the genesis of asthma has remained to be a puzzle since its invention hundreds of years ago. In essence, medical experts have conclusively come to a consensus that asthma has no known particular cause. Of great concern is the biology behind asthma which is still a mystery despite frantic efforts to study the condition and administer its cure. Due to this uncertainty, the condition can only be managed by keeping off some possible environmental triggers which are mainly caused by air pollution which. Consequently, the patient experiences episodes of short breaths as if there is less air supply in the lungs.

All age groups can develop asthmatic. Nevertheless, research studies show that asthma prevalence rate in boys is higher than in girls while at the same time there are more female adults who are asthmatic than males. Asthma can be caused by two major factors namely environmental allergies and genetics. In some cases, the environmental-gene interaction has been suggested as another cause. Asthma has no cure. Rather, it can be treated by controlling the symptoms and risk factors like allergies and endotoxiins.

Works Cited

Kaliner A. Michael, Barne J. Peter and Persson C. G. A. Asthma: its pathology and treatment. New York: Marcel Dekker, 1991.Print

Levy Mark, Weller Trisha and Hilton Sean (4^th ed). Asthma: Your Fingertips Guide, UK: Class publishing London, 2006. Print

National Institute of Health. What Causes Asthma? National Heart Lung and Blood Institute, 2010. Web.

Peacock, Judith. Asthma. Minnesota: Capstone press, 2000. Print

Sandra J Jordan. Attacking Asthma. Current Health. 33.7 (2010): 14-16

Common Symptoms

Asthma is a specific and rather severe condition that is determined by airways swelling, narrowing, and sometimes producing extra mucus. Some patients see this disease as a minor nuisance, but others have more serious symptoms and deal with a major issue that can lead to life-threatening asthma attacks and interfere with daily life. The common signs of asthma include trouble sleeping because of wheezing, coughing, or shortness of breath, chest pain or tightness, and wheezing when exhaling (Mayo Clinic Staff, 2020). All these symptoms may become worse due to respiratory viruses like the flu.

Types of Asthma

It is possible to distinguish several types of asthma according to the circumstances of this condition. First, there is exercise-induced asthma that can worsen if the physical exertion is sudden or the air is dry and cold (Mayo Clinic Staff, 2020). Second, workplace irritants like dust, gases, and chemical fumes may trigger occupational asthma. Finally, allergy-induced asthma can appear because of some airborne substances, including pet dander, cockroach waste, mold spores, and pollen.

Etiology

As mentioned above, asthma signs and symptoms can be caused by exposure to a number of different substances and irritants that trigger allergies. Such causes may vary significantly and typically include gastroesophageal reflux disease, preservatives and sulfites added to beverages and food, stress or strong emotions, and specific medications (Mayo Clinic Staff, 2020). Moreover, air pollutants or cold temperature, physical activity, respiratory infections, and airborne allergens are also added to this list and may be considered the most common causes.

Treatment

Unfortunately, asthma cannot be cured completely, but it does not mean that nothing may be done to ease the situation. Proper treatment proposed by a medic can control the signs and make everyday activities more comfortable. Typically, each patient, together with his or her doctor or nurse, creates an individual plan based on the symptoms, type of asthma, and other circumstances. Moreover, a special device called an inhaler lets a person breathe in particular medicine and makes the condition more manageable.

Reference

Mayo Clinic Staff. (2020). Asthma. Mayo Clinic. Web.

Asthma is a major health issue in Australia, prevalence and death rates are high by international standards even though there has been a decline. The prevalence in children remains high however the mortality rate has reduced compared to the previous years. This paper will look at asthma in the Aboriginal and Torres Strait Islander Australians who have a high prevalence rate. Critically discuss the relevant social determinants of health and why smoking is still high in this group. In addition the paper will critically discuss the current health promotion and education activities and the evidence to support them and relevant outcomes that support these.

Asthma is the second among the illnesses that are reported by this indigenous population. The prevalence is high among the elderly, young children and people who dwell in non-remote areas. The mortality rate in this group is mostly caused by asthma, more people are hospitalised due to asthma (Marks, Poulos, Ampon & Ann-Marie, 2008).

People living in advantaged areas have a less chances of dying from asthma compared to those living in poverty-stricken areas (Valery, Chang &, Shibasaki, 2001). When one is infected with asthma their physical function is reduced dramatically. This means they are not able to engage in economical activities fully which reduces their income. Thus they are not in a position to seek medical assistance as they cannot afford it. The little money they make is used to buy food. Consequently, more people are likely to die from asthma complications in this group. Another important thing to note is that even though there is a national guideline for managing asthma that has been around for nearly twenty years few use it. This is especially true for the people living in remote localities. They have no way of accessing the guidelines. Moreover they have low immunisation levels and smoking rates are very high (Peat & Veale,1996). About 10% of adult asthma occurs because they are exposed to triggering agents in their working places. They work in poor conditions and this puts them at a greater risk of contracting the diseases. Peat and Veale Say that evidence shows that many indigenous people suffering from asthma have symptoms of an infectious nature rather than allergic origins (2009).

The indigenous populations of Australia have poor health compared to the non-indigenous population. Dawson (2004) says this is because they have less access to health services as some live far away from the health facilities. Transport is also a problem in the remote areas where most reside, some do not speak English and thus communication is hindered again there is the unavailability of same-sex indigenous health workers. The poverty rate among the indigenous populations is about three times higher than in the non-indigenous populations. In 1986 half of the children were living in poverty (Dawson, 2004)

Smoking is higher in this group the rate is almost twice that of other Australians. This means that children are exposed to passive smoke and this affects their health as they are exposed to the passive smoke before they are born and after they are born. Studies say about 11% of children suffer from asthma (Torzillo & Chang, 2001). They are said to be from homes where smoking takes place. Smoking among the people with asthma according to Marks et al (2008) remains the same as those without asthma. This is despite the peoples knowledge of the adverse effects of smoking. It triggers asthmatic symptoms and may lead to lung failure especially where there is under treatment of asthma. The smoking habit is higher in the younger people who suffer from asthma than the older people suffering from the same. This group continues to smoke because some are not aware of the effects due to their poor quality of life. Thus they lack information on important health matters.

Smoking has been found to be higher among those who live in poor areas. Jenkins (2007) observed that 40% of children with asthma live with smokers. In this indigenous group smoking rate is very high and about 50% of the adult population are smokers. More worrying is the smoking trend among pregnant women which is very high. It increases the chance of their children contracting asthma.

Asthma has both direct and nondirect costs to the community. The direct cost includes hospital services, medicines, devices and medical consultations which cost the government about $700 million years according to financial data of the year 2000-2001. The largest chunk of this money goes into treating children with asthma. The indirect costs are incurred by the community and family. People suffering from asthma have reduces social activities, they have high absenteeism rate thus reducing their productivity in their work places. The children spend a lot of time away from school and this affects their academic performance (Kritikos & Vickyn.d).

Researchers estimate that the cost of asthma could be saved by 45 %. This would go a long way in improving the life of individuals and their productivity as well as saving the community. Asthma was declared a national concern and many initiatives started to improve asthma management. The initiatives have been in asthma education, community based projects, school projects and improvement in management in hospitals as well as follow-up.

Therefore it is important that asthma is managed to avoid the negative impacts. The practice in asthma management has not achieved its objective because the practices are suboptimal and the mortality rate is still high. The challenge is higher among adolescent sufferers. They have issues of self image, they do not adhere to drugs and denial therefore self management is very vital for this group (Kritikos & Vickyn.d)). Management practices in rural areas in Australia are poor and thus mortality rate is higher compared to metropolitan areas (AIHW, 2008). There is a chronic shortage of health services and the burden lies with the primary sector. The indigenous populations must be involved in the asthma management programmes. The health care givers should educate them about asthma through proper education.

Due to the high cases of new borns being infected with asthma the NAPS Project was founded in 1998. It was a pilot project to give information to women during ante-natal care to warn them on the dangers of smoking. The information was given about how passive smoke affects the fetus and their infant life. The project was successful and more projects were initiated as phase two in July 2000 to December 2001. The success led to phase three called The Newborns Asthma and Parental Smoking Project between 2002 and 2005. The project become so successful that two more years of funding by Heathway commenced in 2005 to March 2007 (Newborns Asthma n.d).

The Indigenous Womens Project was formed and it was funded by the Health Department of the Government of Western Australia. The project gives free Brief Intervention training to health workers working with indigenous pregnant women. The project also has grants that can be used by the health professionals and other organizations (Newborns Asthma n.d).

In 2002 The Australian Centre for Asthma Monitoring was started to deal with accurate and updated records as well as publications concerning the social and economical impacts of asthma in the society. The Asthma Cycle of Care is a programme that helps health providers in dealing with the management of asthma. The caregivers are and especially the nurses need to get a chance to practice by interviewing patients and making decisions about the kind of treatment they need (Crips, Potter,&Perry, 2005: 189-205) It carries surveys on the severity of the disease, medical reviews, individual management education, and write a plan for dealing with hospitalized patients with severe or mild asthma. The project aims to improve asthma care and the lives of the infected.

The asthma Partnerships Programme was started to encourage behavior change. There is evidence that patients beliefs about diseases have a major impact on outcomes. Many studies have shown that patients have different beliefs concerning inhalers. This shows the there is a difference between self management of asthma and real behaviour. Moreover doctors have often shown to have poor view of the attitudes exhibited by patients towards treatment. This leads the physicians to think that the patients will adhere to the treatment. In case there is no commitment to the treatment the effectiveness of the treatment is undermined however good it may be.( Busse& Holgate, 2000:66-68) in the background of this, the program aims to equip the physicians with the tools necessary to win over the patient to adhere to treatment. This helps them to identify what the patients think to be able to help them change their behavior for the better. They are able to break barriers that exist between the physician and the patient. When the patient-physician relationship is established the patient gets involved in the responsibility of getting outcomes from the treatment.

Treatment of asthma should involve all the stakeholders. There is importance in changing management practices in asthma. The local people should be involved in the management so that they do not feel as if ideas are being imposed on them. The physicians should be open-minded to understand their patients and be willing to accommodate new ideas. Support should be given to the care providers to encourage them in their practice.

Bibliography

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Kritikos & Vicky Innovative Asthma Management by Community Pharmacists In Australia. Web.

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Stanhope, M. (2004). Community and Public Health Nursing, (6th ed.), St. Louis: Mosby.

Tomlins, R. & Fardy (2001). Practical Strategies to Improve Asthma Management and Health Outcomes in rural Australia. Web.

Torzillo PJ, Chang AB. Infection, wheezing and Aboriginal children. Medical Journal of Australia 2001; 175: 4-5.

Veale AJ, Peat JK, Tovey ER, Salome CM, Thompson JE,Woolcock AJ.(1996). Asthma and Atopy in Four Rural Australian aboriginal communities. Medical Journal of Australia 165: 192-196.

Valery PC, Chang AB, Shibasaki S(2001). High prevalence of Asthma in Five Remote Indigenous Communities in Australia. European Respiratory Journal 17: 1089-1096.

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Wright, L. (2005). Nurses and Families: A Guide to Family Assessment (6th ed.), Philadelphia:F.A. Davis.

Introduction

Some of the materials covered in this course include the respiratory system and its diseases, such as asthma. When I was young, I had a friend called Brian, who always walked with the asthma inhaler. Other children used to make fun of him when he had asthma attacks, and I felt sorry for him. Besides, he could not join us in playing football as exercising would worsen his illness. By then, we were young and did not understand what Brian was experiencing. I chose this condition to understand the etiology, symptoms, and how best Brian would have managed the ailment.

Asthma is a chronic inflammatory disease of the airways, making people experience breathing difficulties and have challenges in performing some physical activities. According to the Centers for Disease Control and Prevention [CDC] (2020), there are over 24 million asthmatic cases, and there is a higher prevalence in females. In terms of ethnicity, there is a higher prevalence of the condition among African Americans. It is hard to tell if someone has the illness, especially for children under five years (CDC, 2020). Therefore, it is advised that one should go for a medical checkup to be sure.

Etiology of Asthma

The illness can be grouped depending on the causative agent. Allergic or extrinsic asthma is triggered by common allergens such as pollen, dust, food, pet dander, and mold. Nonallergic or intrinsic asthma is due to irritants present in the air, and they include perfumes, air fresheners, cigarette smoke, air pollution, cold air, burning wood, or household cleaning reagents. Occupational asthma happens at workplaces, and dust, gases, fumes, animal proteins, rubber latex, industrial chemicals, and dyes activate it. Exercise-induced asthma is due to vigorous undertakings such as going to the gym. It ensues within a few minutes after starting an exercise and can last up to 15 minutes after the workout. Aspirin-exacerbated respiratory disease (AERD) is a severe form of asthma triggered by nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen. Another type is nocturnal asthma, which is due to heartburns, dust mites, and pet dander.

Pathophysiology

The inflammatory response is central in the pathophysiology of asthma, and there are early and late asthma responses. On exposure to the trigger, the resident airway mast cells are triggered, causing the formation of crosslinks of immunoglobulin E (IgE) on the mast cell surface. This stimulates histamine production, which prompts the release of leukotrienes and prostaglandins, among other enzymes. Mast cells also release cytokines, which signal other inflammatory cells to the lungs. Histamine binds to the H1 receptors present on the smooth muscles of the bronchi, leading to bronchospasm and, eventually, wheezing (Lumb & Thomas, 2020). It also binds to other H1 receptors to increase vascular permeability. Mucous secretion is increased when histamine acts on H2 receptors. These events occur within minutes of exposure to the allergen; hence, it is referred to as the early asthmatic response.

The late asthmatic response occurs after several hours, and the delay is because of the presence of inflammatory cells and the continued inflammatory response. The important inflammatory cells in this phase are the T helper cells. The allergen antigen activates these cells, and they secrete several cytokines responsible for maintaining and enhancing the inflammatory response. Besides, the released cytokines attract other inflammatory cells such as eosinophils and master cells, which also produce cytokines, and consequently, augment the cellular and inflammatory response.

The pathophysiology is a bit different in patients with exercise-induced bronchoconstriction (EIB) without asthma, and it is related to inhalation of cold air. The air has a low moisture content, and when it reaches the bronchi, it absorbs water from the bronchial wall, leading to dehydration. The airway surface cells become hyperosmotic and draw water from the surrounding cells (Aggarwal et al., 2018). The changes in cell volume stimulate the inflammatory response. In asthma cases, there is increased ventilation of airways when a patient is exercising, and water is lost via evaporation. It causes dehydration of the airway surface, and consequently, the smooth muscles start to contract. The osmotic changes trigger mast cell degranulation, which releases inflammatory mediators.

Signs and Symptoms of Asthma

Patients common symptom is wheezing, whereby there is a production of a scratchy sound when breathing. Other symptoms are pain in the chest, chest tightness, shortness of breath, chronic cough, and sleeping difficulties. These symptoms are referred to as asthma attacks because, at one point, the patient is fine, and on exposure to the trigger agents, the symptoms flare up. The symptoms vary and can be moderate or severe and may happen daily or occasionally.

Several tests can be done to confirm if the symptoms are a result of asthma. Pulmonary function tests determine the rate of inhalation or exhalation at maximum effort. Broncho-provocation tests determine the response of the airways to specific substances. The fractional exhaled nitric oxide (FeNO) tests measure nitric oxide levels in a patients breath; increased levels indicate inflammation of the lungs. Most of the tests can be done during spirometry, and results are obtained within a short time. Besides, imaging techniques such as x-rays help identify abnormalities in the respiratory system and their magnitude and inform the extra tests (Harrison & Fauci, 2009). However, this technique is not sufficient to provide a specific diagnosis.

Treatment

Prevention

There is no method of preventing a person from developing asthma. However, asthmatic patients can circumvent asthma attacks through several means. First, they should identify the allergens, which they respond to, and evade them. This is because, without the trigger, a person cannot experience asthma flare-ups. Second, they should adhere to the doctors prescribed asthma action strategy as asthma is a persistent illness, and the approach will decrease needless healthcare use (Zahran et al., 2018). Moreover, the patients should be vaccinated against diseases such as influenza, which can initiate asthma. The patients should be in a position to identify and treat the ailment as early as possible. Also, they should immediately stop the activity they were engaged in as it may have been the trigger.

Diet and Health

Asthma patients do not require a special diet, but some foods may increase their lung function and better respond to asthma attacks. Obese patients are at a high risk of developing asthma, and it is difficult to treat asthma in overweight persons. Therefore, a person should have a healthy, balanced diet and maintain a good body weight for management ease. Patients should also take foods rich in vitamin A, D, and magnesium. Bananas are rich in potassium and antioxidants; hence they improve lung function. However, they should avoid allergic foods such as animal proteins, wheat, treat nuts, and shellfish. Also, foods producing or causing gas should be avoided as the gas presses on the diaphragm, leading to chest tightness and eventually triggers asthma flare-ups.

Medication

Besides following the prevention steps, medication is necessary to control the symptoms. There are several medications, and each has a different mechanism of action, targeting a specific point of the asthma pathophysiology. The drugs can be either quick-relief medications or long-term treatments. Short-acting beta-agonists such as albuterol and levalbuterol are inhaled and act within minutes to ease the symptoms of an asthma attack. Anticholinergic agents such as tiotropium and ipratropium are also quick-acting. They prevent acetylcholine from excreting high amounts of mucus and from causing contraction of smooth muscles. Oral and intravenous corticosteroids help to relieve the inflammation, but they have side effects when used for long.

Long-acting drugs include inhaled corticosteroids such as fluticasone propionate. These drugs are administered twice a day for several weeks to attain maximum benefit. They can be used in high doses in cases of severe asthma attacks. Another medication is theophylline, a pill taken daily to relax the bronchial smooth muscles and keep the airway open. It is not a common drug, and its downside is that it requires regular blood tests. There are also immunomodulatory drugs such as Omalizumab, which prevent IgEs from binding to mast cells; hence there is no inflammatory response. The drug is administered via the subcutaneous route every two to four weeks.

In conclusion, asthma is a chronic condition affecting many children globally, and it is triggered by allergens such as dust, pollen, animal proteins, among others. Persons with chest pains, difficulties in breathing, and producing wheezing sounds are highly likely to suffer from asthma and should visit a doctor for a checkup. The condition can be prevented by avoiding the asthma triggers, maintaining a healthy lifestyle, and observing the doctors asthma action plan.

References

Aggarwal, B., Mulgirigama, A., & Berend, N. (2018). Exercise-induced bronchoconstriction: Prevalence, pathophysiology, patient impact, diagnosis, and management. NPJ Primary Care Respiratory Medicine, 28(1), 1-8. Web.

Centers for Disease Control and Prevention. (2020). Most recent national asthma data. Web.

Harrison, T. R., & Fauci, A. S. (2009). Harrisons manual of medicine. McGraw-Hill.

Lumb, A. B., & Thomas, C. R. (2020). Nunns applied respiratory physiology eBook. Elsevier.

Zahran, H. S., Bailey, C. M., Damon, S. A., Garbe, P. L., & Breysse, P. N. (2018). Vital signs: Asthma in childrenUnited States, 20012016. Web.

Appendix A

National Demographic Information of 2018 for CDC (2020) s Asthma Data

Introduction

An African American girl aged 8 years, was diagnosed with asthma, which in the recent past has been controlled using a rescue inhaler. She is being admitted to the emergency department after the escalation of the disease to an acute exacerbation, and she is receiving oxygen per nasal at 2 L. The prescribed medication for her is DuoNeb treatments every 4 hours and methylprednisolone sodium 10 mg IV every 12 hours. Additionally, there is an order to start giving her an IV of D51/2 NS at 100mL/hour. If her condition improves or she recovers after these treatments within 24 hours, the girl will be weaned off oxygen and discharged home. Where another prescription of rescue inhaler and prednisolone orally for 5 days will be administered while making follow-up with a pulmonologist in one week. However are scared about the treatment procedures, and should be taught clearly about the etiology of asthma, its symptoms, triggers, the use of a peak flow meter, and a spacer dose inhaler.

Assessment

On observation, the patient was looking restless when provoked and she was aggravated. The airways were swollen, with contracting muscles. She had difficulty in breathing and speaking, wheezing sound when breathing, and at times breathing very fast. The childs mother explained that the disease has been recurring in the recent past occasionally. Further, tests revealed anxiety and depression in the child, and she looked emotionally and physically drained.

The interview with the mother portrayed a family that is deeply rooted in religious beliefs, they have faith in miraculous spiritual healing. Their child who is in the fourth developmental milestone seems to be much inclined to these beliefs but is beginning to explore more interactions in social life beyond her parents. The child is in the process of discovering new things, and understanding competencies. Thus, she needs encouragement to build her confidence in her abilities (Chery, 2021). At this stage, the child thinks logically, and organized, on issues; she understands that her views might not be the same as other peoples (Chery, 2020). However, chances are that she can also be rigid if things are not explained well to her.

Diagnosis

The patient has ineffective breathing patterns; and the airway clearance is poor due to bronchospasms, increased pulmonary secretions, or ineffective cough. The girl has also developed anxiety which could be due to Change in the environment or change in health status. She showed signs of fatigue which could be as a result of either Increased work of breathing, hypoxia, or respiratory distress. There was an indication of interrupted family processes necessitated by the childs sickness and emergent hospitalization. Lastly, the family seemed to be in need of information about preventive measures and behavior changes.

Nursing interventions

Firstly, the nurse will assess the childs vital signs like increased BP, RP, and HR which occur during hypoxia and when it is severe BP, and HR drops leading to respiratory failure. Then check her respiratory rate, depth, and rhythm to see what could be the cause of anxiety; assess breath sounds and adventitious sounds such as wheezes and stridor, since wheezing happens due to bronchospasm, and reduced wheezing and irregular breath sounds suggests that respiratory failure is about to occur. Monitor oxygen saturation, peaked expiratory flow rates and forced expiratory volume (Belleza, 2021). Normal oxygen levels (95-100%), and the severity of exacerbation are measured through peak expiratory flow rate generated by a forced maneuver with inflated lungs.

Explain to the family members that asthma is a very sensitive disease that is easily triggered by exposure to cold things, tobacco smoke, dry air, vigorous exercises, upper respiratory infections, and allergens like pollen grain, mold, and dust. Persuade the through kind and simple reasoning not to expose the child to these triggers while at home. Through counselling, let them see the importance of keeping the child safe from the triggers. Practically, demonstrate slowly, to the child and the family procedure on how to use the peak flow meter and a spacer dose inhaler, to help them while at home.

Therapeutic Interventions

Create a period of rest between activities, to reduce fatigue which is normally high when ineffective breathing patterns increases, and so it increases metabolic rate and oxygen requirements. The patient should have her head placed on an elevated bed, to allow maximum lung expansion which assists in breathing. Conduct psychological therapies on both the patient and family so as to influence them to positively change their behaviors and beliefs, help reduce the disease symptoms (Belleza, 2021). Having identified that the childs family believes in spiritual healing and that it affected the patient medication patterns before, educate them by reinforcing that healing indeed comes from God. Incorporate praying sessions, each and every time before the patient is attended to either at home or in the hospital. Perform cognitive therapy to the family members to help repair their thoughts, perceptions, helplessness state, and wrong fear they have developed about asthma which may trigger the disease.

Further, symbolic plays graphic arts which includes drawing, coloring, or working with clay in the child is the ideal activity. It requires buying artificial clay from the shops, which the child can use to mold different shapes, like cars, houses, all sorts of electronics, and even animals. Symbolic play is excellent in helping children learn to express themselves and explore nature, technology, and the world in general through different experiences, ideas, and emotions which build their confidence in their abilities.

Medication

Ensure she is receiving oxygen per nasal at 2 L for the next 24 hours until her normal oxygen levels (95-100%) are back. Make sure together with the mother to administer to the patient DuoNeb treatments every 4 hours and methylprednisolone sodium 10 mg IV every 12 hours. Explain to the family and the girl that an additional drug called IV of D51/2 NS at 100mL will be given to her after every one hour. At every interval of drugs administration, allow the family members or their church leader whom they may invite to pray before the procedure is executed. For the next 24 hours monitor the patients progress and if her condition stabilizes, wean off oxygen and recommend discharge to home.

Conclusion

Discharge the patient after 24 hours, and together with colleagues ensure to follow them at home to confirm if they are following procedures on how to manage asthma. While at home the child must always carry the inhaler just in case of an attack, let the parents take the active role as caregivers, and administer the drugs to the child. Review continuously to confirm if the child has maintained an optimal breathing pattern.

References

Chery, K. (2021). Eriksons Stages of Psychosocial Development. Web.

Cherry, K. (2020). The 4 Stages of Cognitive Development. Web.

Belleza, R. N. M. (2021). Asthma Nursing Care Management. Web.

An assessment of the exacerbation of Asthma (Shortness of Breath and cough) provides one with the necessary experience in analyzing critically ill patients and selecting the appropriate nursing management for the condition. The problems process revolves around identifying the vital signs that explain the changes linked to the altered physiology. The analysis case refers to an assessment of Mr. M.P, who was referred to the hospital with an exacerbation of asthma (SOB and cough). Mr. M.P is a 51-year-old white male born on 8th April 1971 in Melbourne, Australia. He is a full-time engineer working at a local construction company. The patient lives with his 49-year-old wife and three children, but the wife states that her husband sleeps late at night due to job commitments. The patient was brought to the facility by his wife, who narrates the chief concern that necessitated the referral.

History of Present Illness (HPI)

According to the narration by the wife, upon arriving home from a job, Mr. M.P started complaining of frequent coughs, shortness of breath, and chest tightness. The wife narrates the patient had been sustaining a cough for the past week, with a wheezing sound that developed in the last three days. The wife testifies that M.P is a cigarette smoker, and the patient confirms that he smokes at least 20 cigarettes per day. The patient is allergic to pet pander or with no medical intolerances. The patient only had minor surgery on his left toe while having difficulty managing his asthma attacks. Family history reveals that his father also had asthma, while the patient has recently had an average of two hospital visitations resulting from exacerbation of asthma. The wife narrates that the patient is under inhaled corticosteroids (ICS) which he uses at the onset of exacerbations. Further analysis of the patient is essential in diagnosing and managing the condition.

Review of Systems

According to the wifes revelations, M.R. M.P has gained more weight over the past six months. This situation can be noted because his clothes no longer fit. The narrator states that her husband complained of fatigue with a general loss in appetite over the period when the symptoms started to intensify. Though the patient does not complain of any chronic pain, he says he has been feeling unwell lately. The patient experiences fevers and chills sometimes during the night with no case of weight loss. In regards to the vision of the patient, there are no cases of any impaired vision though eye redness can be observed in the patient. The patient does not report any double vision, eye discharge, or pain. Further analysis of the patient organ system is crucial to uncover dysfunction and disease that might be affecting the patient.

An examination of the head and neck of the patient reveals lymph node enlargement. An otoscopic examination of the patients ears reveals that the ears are healthy as the eardrum appears grayish with a translucent appearance. The patients oral mucosa is reddened with the prevalence of nasal congestion, a runny nose, and cases of sneezing. An examination of the mouth of the patient reveals swollen gums and obvious cavities. Additionally, the patients detention is still intact, with revelations of mild pain along the gums. A further review of the patients pulmonary system can be undertaken through inspection or observation. A lung examination is conducted through percussion, palpation, inspection, and auscultation.

An inspection of the patient shows Mr. M.P distressed with deep, irregular breathing. The tightness of the scalene muscle is vivid, with the patient appearing to lean forward while resting his hands on the knees (Basu and Perry, 2021). The patient seems to have difficulties speaking as he speaks fewer words within a sentence. Audible wheezing sounds can be noted when the patient is breathing (Chatziparasidis, Priftis, and Bush, 2018). The nail beds of the patient seem to take a blue color, while an assessment of chest excursions through palpation reveals an asymmetric lung expansion. These findings indicate the possibility of either air or fluid filling the pleural space. Careful palpation of painful areas reveals no case of rib fracture.

The patient is experiencing a chronic cough with shortness of breath and a rapid heart rate. An examination of the patients gastrointestinal reveals no ulcers, black tarry tools, or hepatitis. However, the patient reports having a loss of appetite. Genitourinary/gynecological examination of Mr. M.P narrates no cases of burning sensation when urinating, frequency or urgency in urination. The patient does not report any changes in urine color or genitalia concerns. Apart from a history of a broken toe, the patient does not have any fractures, back pain, trauma, or swelling within joints. A neurological examination reveals that the patients reflexes are not compromised. However, the patients gait is weak as he struggles to stand upright (DerSarkissian, 2022). The patient has never had any episodes of seizure, transient paralysis, blackout spells, or syncope.

Discussion of Vital Signs

Upon patient presentation to the hospital, measurement of vital signs reveals a height of 180 cm while he weighed 90 kg. Therefore, the BMI of the patient is 27.8 kg/m2, indicating that M.P. is overweight (Centers for Disease Control and Prevention, 2022). The patients oral temperature is 98.6°F, while his respiratory rate is 23 breaths/min, a heart rate of 127 beats/min, and a paradoxical pulse of 15 mmHg. The patients systolic pressure is 134 mmHg with a diastolic pressure of 88 mmHg. Observing the patient makes it easy to note that he is in discomfort or pain. A review of the vital signs helps in discovering the health status of a patient (Sapra, Malik, and Bhandari, 2022). Vital signs provide one with a means of hurriedly quantifying the magnitude of an illness and how well the body is coping with the psychological distress.

Adding weight affects the ability of an individual to control asthma and quality of life. An article by Bass (2021) reveals that adding an estimated 5 pounds has been linked to 22% self-rated asthma control. Earlier examination reveals that Mr. M.P has been experiencing weight gain as he testifies majority of his clothes no longer fit. Peters, Dixon, and Fornos (2018) study further add that obese individuals have a heightened risk of asthma. The research states that obese individuals tend to experience frequent and severe exacerbations, reduced quality of life, and decreased response to asthma medications.

Being overweight is also linked with cases of shortness of breath. According to a cross-sectional population-based study by Currow et al. (2017) prevalence of being overweight has significant consequences on dyspnea. Though the physiological mechanisms of shortness of breath among overweight and obese individuals are still unclear, combinations of changes in pulmonary mechanics and ventilatory drive are some of the likely contributing factors (Agustin et al, 2017; Grassi, Kacmarek, and Berra, 2020). A further review of the patients cardiovascular and pulmonary symptoms is critical in determining the best nursing management for the patient.

The majority of the situations when a patient experiences shortness of breath mainly occurs due to lung or heart conditions. The lungs and heart are critical in transferring oxygen to the tissues and eliminating carbon (IV) oxide; any complications among these organs can affect a patients breathing (Kaynar, 2022). Shortness of breath can result from heart failure, asthma, lung disease, obesity, or poor fitness (Mayo Clinic Staff, 2022). When a patient experiences heart failure, blood cannot fill or leave the heart efficiently. This phenomenon can result in fluid accumulation within the lungs, thus making patients experience shortness of breath (Cullinan et al, 2017). When patients are overweight, it can strain their lungs, thus making it difficult for them to breathe (Bates et al., 2021). Asthma, where shortness of breath is also prevalent, occurs when airways tend to narrow.

Poor fitness due to illness or inactivity can also result in shortness of breath.

Any harm to the tissues of the lungs can result in dyspnea. This situation is common among patients with tobacco smoking linked to chronic obstructive pulmonary disease (COPD). Mr. P being a tobacco smoker, is at risk of COPD. According to Verberne et al. (2017), overweight and obesity are common amongst patients experiencing milder stages of COPD (Balmain et al. 2020). The condition commonly arises from smoking or long-term exposure to lung irritants (Dharmage, Perret, and Custovic, 2019). The symptoms of COPD are similar to those of asthma. Thereby it is crucial to differentiate the two. In both conditions, swelling within the airways tends to constrict ones ability to breathe effectively. However, in asthma, the swelling is highly triggered by a given allergic reaction or physical activity (Belleza, 2022). On the other hand, COPD refers to an umbrella name given to a class of lung conditions like chronic bronchitis and emphysema (Cleveland Clinic medical professional, 2022). Emphysema occurs when the alveoli are destroyed; chronic bronchitis results when tubes that carry air to the lungs are inflamed. Differential diagnoses are significant where two conditions share symptoms.

A critical review of Mr. P.Ms symptoms, family, and medical history is essential; if need be, tests can be appropriate to help diagnose the patient. The patients wife reveals that his sons friend had visited him accompanied by his pet dog. However, because Mr. M.P is a smoker, it does not necessarily indicate that it could be entirely an asthmatic attack. The patient does not appear to have clubbed nails; however, a simple Carbon (IV) Blood test reveals levels of 30 mmol/l (Shroff, 2022). These results reduce the chances of hypercarbia, where carbon (IV) oxide levels are high in the blood. A CT scan of the patients chest does not reveal any damage to the alveoli.

A review of the patients past medical and family and various vital signs and symptoms depicts that Mr. M.P is suffering from an exacerbation of asthma. Exposure to pet pander triggered the patients asthmatic symptoms. According to findings of a survey conducted by Gergen et al. (2019), 44.2% of asthma attacks resulted from exposure to pet allergen. Research by Tiotiu et al. (2021) further reveals that tobacco smoking is linked with asthma exacerbation. Cigarette smoking in asthma patients is associated with increased doctor visits and hospital admissions due to poor asthma control (Silverman et al., 2017). Determination of the key condition affecting the patient helps choose the best nursing management regime and management strategy for the patient.

A spirometry measurement of the patients forced expiratory volume in 1 s (FEV1) of less than 50% predicts a severe obstruction. Though the patient is under inhaled corticosteroids (ICS), the treatment does not help him manage the exacerbations. The patient seems to be experiencing severe asthmatic attacks based on recent hospitalizations. The primary treatment intervention in an acute asthmatic attack is the provision of supplementary oxygen (Ruangsomboon et al., 2020; Rochwerg et al., 2017). The saturation levels should remain above 92% to relieve hypoxemia and alleviate shortness of breath. According to research by Geng et al. (2019), oxygen therapy has short promise in alleviating symptoms of severe asthma complications (Sage, Chomberg and Hart, 2017). The therapy enables better airflow and reduced breathing rate, normalizing the patients body pressure, heart rate, and shortness of breath (Penninga, Lorentzen, and Davis, 2020). A study by Maselli and Peters (2018) reveals that some patients might not respond adequately to standard therapies like the use of inhaled corticosteroids (ICS). Nursing management approaches like oxygen therapy are critical in alleviating progressive symptoms of cough, shortness of breath, and wheezing.

Besides oxygen therapy, patient positioning offers another strategy to manage the patients condition. The prone positioning technique is a treatment strategy that involves placing patients with breathing complications on their stomachs (De Jong et al., 2020; Hadaya and Benharash, 2020; Ponseti et al., 2017). This technique will help Mr. M.P breathe better due to his body weight. This position is essential as it ensures less lung compression and better gas exchange efficiency within the lungs. Additionally, the strategy enhances the functioning of the heart and its ability to deliver oxygen within the body. Investigations by Haday and Benharashs (2020) and Scholten et al., (2017) reveal that the prone positioning of patients with severe asthmatic attacks also helps the patient better drain a secretion produced within the lungs if they were diseased.

The goals of asthma management revolve around the need to attain effective control of the symptoms and maintain normal activity levels for the patient. The nursing management strategy also aims at minimizing future risks of asthma exacerbations for the patient. Nurses play a critical role in reviewing and evaluating whether a certain patient adequately manages the asthma condition. An analysis of the areas of concern that need to be corrected by the patient is essential for any nurse managing a patient with asthma. Important support and advice to Mr. M.P and his wife ensure that the patient stays away from the asthmatic triggers.

Most importantly, the patient needs to avoid smoking as the behavior is linked significantly with asthma exacerbations. Smoking for individuals with asthma intensifies the risk of severe attacks that might be fatal if proper intervention is delayed (Schneider, 2017) Additionally, there is a need for the patient to reduce weight; it increases the risk of developing shortness of breath, body fitness, and heart failure (Galante, 2022). Finally, the patient must attend the relevant appointments to ensure his health is well monitored to manage the condition effectively. Mr. M.P is at risk of developing pulmonary complications that might result due to his body weight and lifestyle. Next to clinical appointments needs to examine the patients cardiac health to reduce the risk of developing cardiac failure or other complications that result from being overweight and smoking habits.

Reference List

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Rochwerg, B., Brochard, L., Elliott, M., Hess, D., Hill, N., Nava, S., Navalesi, P., Antonelli, M., Brozek, J., Conti, G., Ferrer, M., Guntupalli, K., Jaber, S., Keenan, S., Mancebo, J., Mehta, S. and Raoof, S., 2017. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. European Respiratory Journal, 50(2), p.1602426.

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Patient Initials: JK Age: 9 years Sex: Male

Complaints: The patient reported to clinic complaining of a heavy cough, shortness of breath, and audible wheezing. The patient was also having difficulty breathing when sleeping and complains of regular chest congestion. In addition, the patient regularly suffers chest pain. The patient has a previous medical history of asthma and has been using an albuterol nebulizer. The inhaler, however, has not helped alleviate current symptoms. Before reporting to the clinic, the patient was having difficulty completing sentences without stopping to catch a breath. Patient was also finding it hard to use stairs at home.

Subjective Data

Family History Patient was born in the United States and has three sisters and one brother. Patient is the youngest in family and attends primary school. His mother suffered from asthma as a child but it stopped without any medical intervention. His father and siblings have never been diagnosed with asthma. Father is a heavy smoker but he does it outside the house. Occasionally, when he comes near patient after smoking, patient finds it difficult to breath and has to use nebulizer before regaining normalcy.

Health History Patient was born healthy, weighing 3.7Kgs. Until three years ago, when he was diagnosed with asthma, patient was healthy and rarely fell ill. Patient is active and does not have any physical challenges. Enjoys playing soccer and video games. Patient has healthy appetite and feeds well.

Past Medical History Patient was first diagnosed with asthma three years ago. At the time, the patient was having difficulty breathing when playing with friends. He was also experiencing regular bouts of bronchitis and other respiratory problems. The asthma diagnosis was confirmed after successful treatment was noted using asthma medication. Patient regularly sees his physician but in two years the prescription has not changed.

Surgical History-Patient got eight sutures on the head three years ago after falling down while playing and sustaining a deep cut. No other surgical procedure has been performed on patient.

Allergies-Patient suffers no known allergies

Medications-Patient uses albuterol inhaler.

Patients locus of control and readiness to learn: The patient a child accompanied by both parents. The parents are both highly educated and are willing to learn more about their childs illness. The parents form a good support system, which will help in implementation of the plan.

Differential Diagnoses

1. Allergic Rhinitis
2. Bronchiolitis
3. Airway Foreign Body

Objective data

Physical Examination-Patient was nervous during the assessment but was ready to have tests done.

Vital Signs: Blood Pressure: 144/77 right/sitting, T: 37⁰C; P: 80 and regular; R 33, non-labored; Wt: 74#; Ht: 51.

• Frequent coughing episodes
• Wheezing sound when breathing out
• Shortness of breath
• Chest congestion or tightness
• Chest pain-Patient kept complaining of chest pain
• Chest x-ray showed clear lungs and trachea.

Advanced practice nursing intervention plan

1. Investigate the patient for all presenting symptoms and clerk parents for additional information on history of illness.
2. Assess for asthma validity, guided by the Asthma Symptom Utility Index.
3. Review the medication currently being used for efficacy. Where necessary, prescribe additional medication.
4. Refer to pulmonologist for pulmonary function test.
5. Educate patient and guardians on proper management of disease.

Goals

There are four goals that will guide the treatment process of this patient. These are:

1. To properly control the symptoms
2. To restore normal lung function
3. To restore activity levels to normalcy
4. To treat the illness using as few drugs as possible. If possible, only drugs with the least side effects should be used.

Patient has been on asthma medication and this assessment has confirmed the diagnosis as severe persistent asthma. Inhaled corticosteroids should be prescribed as the first line of treatment. Inhaled corticosteroids have been shown to have better effect in reducing the need for asthma exacerbations (Klaasen et al., 2012).

A long-acting bronchodilator, such as salmerol or formetrol, should be combined with the inhaled corticosteroid. This combination is known to alleviate the symptoms of asthma fast.

The use of systemic corticosteroids and inhaled bronchodilators are widely accepted as cornerstones of effective treatment for acute exacerbations of asthma (Debley et al., 2012).

Long-term use of inhaled corticosteroids has been a subject of debate, particularly in terms of the side-effects they could have on the patient. However, many scholars have confirmed that even when used for long periods, inhaled corticosteroids do not have clinically important side effects (Debley et al., 2012). Szefler et al. (2012) showed that use of inhaled corticosteroids had no effect on the growth of children. However, the goal of this treatment plan is to use the least amount of drugs.

A nebulized solution is popularly used in the administration of asthma medication because it requires little skill to deliver. However, the nine-year-old patient is old enough to use an inhaler. Having used an inhaler for the past two years, the patient has developed proper technique and manages to deposit as much medication in the lungs as would have been administered using a nebulized solution. However, the new inhaler he will be given should have an aerochamber. Inhalers with aerochambers are more effective in delivering the medication to the lungs (Klaasen et al., 2012).

The symptoms that brought the patient to the clinic can be managed without the need for admission. The patient will be given enough medication to control the symptoms and then discharged after careful observation.

Referral

The patient will be referred to a pulmonologist, who will conduct further tests to rule out the other diseases pointed out in the differential diagnosis. Patient also needs to see an otolaryngologist to completely rule out presence foreign body in the airway.

Rationale

The patient came in into the clinic complaining of a heavy cough, shortness of breath, and audible wheezing. Patient was also having difficulty in breathing when sleeping and regularly suffered chest pain.

Differential diagnosis includes Airway Foreign Body, Allergic Rhinitis and Bronchiolitis. Aside from natural causes, the fact that patients father is a heavy smoker influenced the list of differential diagnoses.

Airway Foreign Body was considered a possibility because it normally presents with difficulty in breathing. It is also common in households where there is a smoker. It was, however, ruled out because the chest X-ray that was take did reveal anything impacted in the airways and lungs.

Allergic Rhinitis was ruled out because patient did not have other symptoms of the disease. Normally, Rhinitis symptoms show up seasonally, depending on the presence of a particular allergen. Rhinitis was considered a possible diagnosis because of the realization that when patients father comes close to him after smoking, he gets breathless. However, complete investigation of both the nasal and sinus mucosa confirmed that they not inflamed as would have been the case with Allergic Rhinitis.

Bronchitis normally presents with a mild fever, a symptom which the patient did not have. Patients temperature and other vital signs were within normal ranges.

Patient should be examined by a pulmonologist in order to rule out other pulmonary complications not identified among differential diagnoses.

Education and Counseling

The patients parents should be properly educated on the treatment plan with emphasis being placed on compliance. They need to understand why it is important for the patient to take the medication as prescribed and the dangerous symptoms to watch out for. Any unusual symptom should be immediately reported to the doctor.

Foods and drinks that may complicate the situation should be discourage, especially cold fizzy drinks, such as soda. The patient should always be warmly dressed and if possible stay away from areas with a lot of smoke and/or dust.

The patients parents should be taught to regularly evaluate the patient and report any strange symptoms. If possible, his teachers should also be informed by the healthcare provider to constantly monitor the patient and get him medical attention immediately something unusual is noted. The parents need to encourage the patient so that he does fall into depression for always being the sickly one among his friends. Parents should also monitor patient during play, and ensure that he does not partake in strenuous activities prematurely

Follow up should be done within two weeks to re-assess the symptoms and the effectiveness of the administered drugs. If possible the patient should be reviewed by the nurse and doctor who attended to him on first visit.

References

Debley, S., Cochrane, S., Redding, J., & Carter, E. (2012). Lung function and biomarkers of airway inflammation during and after hospitalization for acute exacerbations of childhood asthma associated with viral respiratory symptoms. Ann Allergy Asthma Immunol, 109(2), 114120. Web.

Klaassen, M., Kant, D., Jobsis, Q., Hovig, S., Schayck, C., Rijkers, G., & Dompeling,E. (2012). Symptoms, but not a biomarker response to inhaled corticosteroids, predict asthma in preschool children with recurrent wheeze. Mediators Inflamm, 202(2), 162-163. Web.

Szefler, J., Wenzel, S., Brown, R., Erzurum, S., Fahy, J., Hamilton, R.,&Minnicozzi, M. (2012). Asthma outcomes: biomarkers. J Allergy Clin Immunol, 129(1), S9S23. Web.