This article intends to analyze the journal of trauma critically. It considers an article published in March 2008 by Karen Janeen George, The Systematic Approach to Care: Adult Respiratory Distress Syndrome. Karen’s article focuses on trauma patients who are suffering from Adult Respiratory distress syndrome (ADRs) and system approaches to caring for them. This article aims at analyzing the strengths and weaknesses of Karen’s article. Additionally, it seeks to suggest ways to improve and modify these systems. Overall, this article seeks to establish how effectively Karen’s approach can be implemented in a practice.
Summary of article
Karen’s article considers new nurses in the practice dealing with trauma patients suffering from ADRs. She talks of challenges that new nurse graduates face when working in the intensive care units. She adds that practice nurses dealing with multi-trauma patients with ADRS face more challenges than nurses in other practices. Therefore, Karen suggests procedures, rationales, tools, and strategies of health assessment that can be used to address these challenges to improve result outcomes and reduce mortality rates of trauma patients with ADRs.
Karen discusses the health complications for trauma patients with ARDS. She identifies “blood transfusion, resuscitation fluids and blunt chest injuries as independent factors of ARDS” (George, 2008). She adds symptoms such as dyspnea, tachypnea, and increased breathing. She attributes this to oxygenation abnormalities in people with ARDS. Additionally, trauma patients with ADRS show dismal levels of consciousness. These patients also suffer from adrenal insufficiency that leads to hypertension.
Further, Karen discusses procedures and rationales that are appropriate for nurses to follow when handling trauma patients suffering from ADRs. She suggests “activation of leukocytes, activation of inflammatory responses and release of mediators to contribute to tachycardia” (George, 2008). She adds that to stabilize consciousness nurses should prevent hemorrhagic loss as they add damage to hypoxia and hypotension.
Further, she recommends that nurses in practice help patients to avoid loss of surfactants, the influx of fluids, and debris in epithelial space as these conditions increase damage to hypoxia and hypotension. Regarding containing hypotension, she advocates for use of bacteria, increases of the proinflammatory cytokine, and use of oxygen free radicals to reduce corticosteroid receptors.
Karen uses a case presentation to illustrate the procedures, tools, and strategies that nurses should follow when handling ADRS patients. According to Karen, nurses should check the patient’s vital signs
as soon as the patient arrives. The nurses transfer the patient to an emergency room using a spine board where they attend to him.
Medical history is important to health caregivers as it supplements the information that they have. For instance, in the case presented the nurses find that the boy does not have prior chronic diseases. Therefore, Karen emphasizes the need to have historical records. Additionally, nurses should maintain, manage and follow up on medication and nursing of patients. Nurses can do this by “following the guidelines of FASTHUG and BANDAIDS as they provide opportunities in giving care to multi trauma patients with ARDS” (George, 2008).
Evaluation of article
Karen’s article is effective and can be easily understood. New nurses can follow the procedures given easily. Another impressive factor is the way she organizes the ideas in her work. This article has high readability the author captures the main points and displays them efficiently.
This article is very captivating. It manages to catch the reader’s attention because of the way it explains the content. The author balances depth and scope properly. Further, catches the reader’s attention more by using a case presentation. This helps the reader to familiarize themselves with what the article is explaining. Finally, this article is easy to use even when one has limited time, screening through the article gives the reader a perfect hint on what the author is trying to capture.
The health strategy in Karen’s article is beneficial. In addition, I would adopt it for my practice. The strategy is beneficial as it contains steps that are easy to follow and implement.
The clarity of this health strategy is fair. One can understand what the author is saying. However, this article would have been even more effective if it would be deeper and wider. For instance, at some points when reading one feel that some points have not been completely exhausted or explained.
Researchers should write many articles about this area of health assessment. This would be beneficial to the readers as they would have a wide range of sources to supplement their knowledge.
This article is mainly beneficial to individuals familiar with the medical profession. This is because of the terms used. The depth of this article does not favor the ordinary man.
Conclusion
In conclusion, I would term Karen’s article as successful in passing the content. The article is easy to understand and the organization of content is appropriate. The content in the article is relevant and logical. In addition, the content is very practical and easy to implement. Even though the article needs improvement in terms of flow and scopes, it is still efficient. Moreover, the author captures the attention of readers and comfortably achieves the goals of this article.
References
George, K. (2008). The Systematic Approach to Care: Adult Respiratory Distress Syndrome. Journal of Trauma nursing , 19-24.
Coronaviruses are enveloped viruses that contain single-stranded ribonucleic acid. There are seven known types of coronavirus that can cause various diseases in humans. Most coronaviruses cause mild respiratory infections, but fatal outbreaks of coronavirus infection have occurred intermittently over the past decades. These include SARS-CoV (severe acute respiratory syndrome coronavirus), the first case of which was reported in November 2002 in southern China, and MERS-CoV (Middle East respiratory syndrome coronavirus), which originated in Saudi Arabia in September 2012.
Nowadays, the attention of the entire world community is drawn to one common problem – the spread of the new coronavirus infection COVID-19. The first reports of cases of a new coronavirus infection appeared in the city of Wuhan in the PRC at the end of December 2019. The disease spread rapidly throughout China, and a month later, the WHO recognized an outbreak of the infection, and a pandemic was declared on March 11, 2020. In Washington state, the first case in the United States of a new type of coronavirus was recorded on January 20, 2020. The epidemic situation for COVID-19 changes daily. According to “COVID-19 Coronavirus pandemic” (2021), as of June 21, 2020, coronavirus infection was registered in more than 220 countries; the number of infected with the virus is about 179,369,956 people. The number of diseases in the United States, which are the leader from all countries in terms of the number of infections – 34,406,059 people.
The coronavirus has a relatively high infectivity rate. According to Jefferson et al. (2020), on average, one sick person will infect another two to three people. Moreover, the likelihood of contracting coronavirus is higher than the flu but less than with measles. Clinical symptoms in coronavirus can range from asymptomatic disease to severe clinical presentation. Bickerton and Maier (2020) claim that virulence varied significantly: MERS from 2012 to March 2019 – 858 cases among 2494 cases (34.4%); SARS from June 2003 to March 2021 – 774 cases among 8096 cases (9.6%). The probability of death with COVID-19 for patients under 40 years old is about 0.2%, for patients over 60 years old, it reaches 3.6%, and for those over 80 – almost 15%.
Susceptibility to the pathogen is high in all population groups. Ou et al. (2020) identified factors and risk factors for severe COVID-19. These include age over 60 years, chronic diseases of the lungs, cardiovascular system, liver and kidneys, obesity, diabetes mellitus, cancer, and immunodeficiency states. In turn, Koley and Dhole (2020) note that experts at the University of Oxford, using the Cox regression model, identified the key risk factors for mortality in coronavirus. Blacks and Asians are at higher risk of dying if diagnosed with COVID-19. Moreover, socially disadvantaged people were in the high-risk category.
The primary mechanism of transmission of coronavirus infection is aerosol. When a carrier of the virus coughs, sneezes, or speaks, droplets or microscopic particles carry the virus from the nose or mouth into the air. Anyone who is at least 2 meters away from this person can breathe these particles into their lungs. According to Jefferson et al. (2020), the coronavirus can live in the air for up to 3 hours. Furthermore, the infection can occur due to a person’s contact with various objects containing a virus on their surface. For example, a person grasps a door handle with a virus on it and then touches their face, nose and rubs their eyes with this hand. It is at this time that the virus enters the body. Thus, respiratory syndrome coronavirus is transmitted by aerosol and contact.
Outbreaks of respiratory syndrome coronavirus have a significant impact on all areas of society. They push companies to rapidly change how they operate and put the sustainability of different systems to the test. Organizations are faced with a whole host of new systemic challenges – disruption to business continuity, sudden quantitative changes, real-time decision making, productivity metrics, and safety threats. Haleem et al. (2020) state that the COVID-19 pandemic has led to the largest ever disruption to education systems, affecting nearly 1.6 billion students in over 190 countries. The closure of schools and other educational institutions affected 94 percent of the world’s student population. However, Nelson (2020) indicates some positive impacts of the pandemic on education, such as introducing new technologies into the system.
In turn, healthcare facilities are facing catastrophic financial problems associated with the COVID-19 pandemic. Kaye et al. (2020) note that the American Hospital Association estimates the economic impact of lost profits on America’s hospitals and health systems at $ 202.6 billion. Lack of preparedness has been one of the main factors in the struggles faced by medical institutions worldwide. Items such as personal protective equipment, hospital equipment, and disinfectants were in short supply. These shortcomings have been identified by COVID-19 and have prompted health organizations around the world to develop crucial new pandemic preparedness plans. Alternative strategies such as telemedicine, social distancing, wearing masks, washing hands, and quarantining have helped mitigate the impact of the COVID-19 pandemic and are likely to impact healthcare for the foreseeable future.
The Monroe County government has developed a reporting protocol in the face of the respiratory syndrome coronavirus outbreak. According to “Monroe County Government COVID-19 Updates & Resources” (n.d.), people who have symptoms characteristic of such a syndrome, or who have close contact with a patient with COVID-19, have lived or have recently arrived from an area with the continuing spread of COVID-19, must immediately inform their doctor about it. Moreover, a list of necessary resources has been compiled, including emergency cash assistance contacts for eligible families who lost their jobs due to COVID-19, emergency food services, the COVID-19 information line, and a crisis telephone line. Thus, Monroe County has resources related to the infectious disease reporting protocol.
There are strategies for preventing an outbreak of respiratory syndrome coronavirus, one of which is to control sporadic cases and foci and prevent transmission of the virus to the general public. According to WHO (2021), early diagnosis is a significant factor in containing the spread of the virus. Testing helps to identify new potential patients who have no symptoms. Furthermore, WHO (2021) affirms that isolation of the sick is an equally effective strategy. All people who have been diagnosed with the disease should be sent to a particular institution for quarantine. Thus, strategies are to identify those who are infected, track potentially infected, and isolate those who are ill.
Thus, in the 21st century, outbreaks of respiratory syndrome coronavirus occur periodically, including severe acute respiratory syndrome – coronavirus SARS-CoV, Middle East respiratory syndrome – coronavirus MERS-CoV, and new coronavirus infection COVID-19. The spread of these diseases among the population of different countries has general patterns. It is higher among males, older people, among people with impaired immunity and the presence of chronic diseases, in which the frequency of deaths also increases. These diseases leave an irreversible mark on all spheres of society, including education, healthcare, and business. Among the strategies for preventing the outbreak of respiratory syndrome coronavirus, early diagnosis of the disease and the isolation of cases are distinguished.
References
Bickerton, E. & Maier, H. (2020). Coronaviruses: Methods and protocols. Springer US.
The human body is a system that depends on coordinating all organs regarding the distribution of necessary elements throughout the structure. Oxygen is an essential component of a person’s anatomy due to its functional effect on the tissues. In this case, the insufficiency of the supply risks failure and significant damage to the appendages hence the importance of assessing the dynamic conditions that negatively affect the health index (Carpagnano et al., 2020). One factor contributing to illnesses and death is acute respiratory failure caused by heat-related diseases. The sickness fosters imminent danger to the patient since it proficiently affects the oxygenation of the protuberances, intensifying the risk of blood circulation impairment.
Main body
Distinct factors attribute the prominent intersectionality of physical, psychological, and cultural needs within a community setting. One of the requirements is the incorporation of strategies to enhance an active lifestyle against sedentary-based habits, including poor dieting. The approach influences the cultural practices that enshrine working from home with minimal exercise and increased feeding, evident from the high consumption rate (Carpagnano et al., 2020). Fundamentally, the key considerate application frameworks involve the articulation of profound initiatives that elevate the interaction among the personnel while intensifying the participation rate in sporting events.
The assessment for acute respiratory failure involves integrating different aspects of diagnosis to determine the risk and intensity levels. One of the factors entails a physical examination regarding muscle tension, body movement, skin sensitivity, head stiffness, and the dilation of the eyes. Poor oxygen supply fosters the strain of the tissues hence the importance of observing the signals showcasing the problem. Apart from the scrutinization, a practitioner inquires about the family’s medical history to incorporate crucial details based on any genetic conditions (Li & Ma, 2020). The human body is a system that enshrines the interplay of all anatomic elements to enhance healthy living. Notably, a doctor includes the historical records of any illnesses from relatives and the self to determine a pattern.
In a different spectrum, acute respiratory failure significantly affects the inhalation and exhalation process. Fundamentally, a medical practitioner uses an oximeter to measure the body’s oxygen and carbon dioxide levels. The diagnosis enhances the insight regarding the flow of oxygen within the system while indicating irregularities that risk the health index of the anatomy (Spiezia et al., 2020).
Since the body is a system, any dysfunction of a component fosters the necessary attention to justify the adaptive response to the illness. Apart from examining the carbon dioxide and oxygen levels, it is the physician’s responsibility to order a chest X-ray to observe the abnormalities within the lungs. An effective prognosis profoundly contributes to informed decision-making among clinicians under the spectral view of acute respiratory failure.
The care plan for a patient suffering from acute respiratory failure involves integrating dynamic elements that elevate the inhalation and exhalation process. One of the significant strategies entails the improvement of oxygen intake using ventilation machines, taking antibiotics, suctioning of the oral cavity, proper nutritional management, treating of causes and injuries, and establishing an examination routine for prophylaxis and barotrauma (Spiezia et al., 2020).
The primary purpose of the approach engulfs developing an aspect that intensifies the health index of the lungs and the absorption rate of oxygen in the system. As a result, the initiative focuses on empowering the lungs and heart function that contribute to the oxygenation and supply of the blood across the entire spectrum. The optimum performance of the continuum enshrines the identification and exploitation of dynamic community-based resources. These entities include the recreational park, hospital, and the facility for the social halls. These components provide venues and platforms for the persons to gather and attain wellness education and engage in sporting activities as an adaptive measure to a dynamic lifestyle.
An individual suffering from acute respiratory failure requires immediate medical attention due to the risk of death or the development of a permanent condition such as a stroke. The key objectives of the continuum of care plan encompass addressing the sedentary lifestyle among the community members. The initiative elevates the necessity of profound intersectionality regarding healthy living. One of the objectives is to enhance the increased active state among the personnel. Another goal is establishing an awareness campaign among the individuals, while the last purpose involves incorporating measures that empower medical practitioners with adequate skill sets to attend to the patients suffering from acute respiratory failure.
Conclusion
In conclusion, the dynamic community resources necessary for a safe and effective continuum of care encompass the human capital willing to assist with the health concern. The issue lies in managing the illness, that is, acute respiratory sickness mainly caused by environmental factors. Consequently, the nurses optimize on educating the members on boosting the quality-of-service delivery among the victims. An excellent example is ensuring free movement and an active lifestyle hence intensifying the societal-based sporting events. Another aspect is the introduction of an awareness campaign for optimal evaluation of the critical values attributed to the problem.
The adoption of an alternate initiative increasing proper dieting to reduce obesity and heart conditions, is an essential component of the coordination action plan. Incorporating strategies that enhance stakeholders’ involvement contributes to the profound accountability among people in alleviating the extreme consequences and occurrences of acute respiratory failure.
Spiezia, L., Boscolo, A., Poletto, F., Cerruti, L., Tiberio, I., Campello, E., Navalesi, P., & Simioni, P. (2020). COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thrombosis and Haemostasis, 120(06), 998-1000. Web.
Drug-induced repression of consciousness during procedural interventions (Fencl, 2016).
Consciously sedated patient:
Responds with verbal cues or tactile reflexes.
Protective airway reflexes.
Unimpaired cardiovascular function.
Adequate spontaneous breathing.
Considerations for a nurse (RN):
Patient evaluation & monitoring.
Knowledge of pharmacological agents & their side effects.
Proper airway management.
Sedation exists in a continuum. Producing an appropriate depth of sedation is required to avoid respiratory complications. A patient under an appropriate level of conscious sedation exhibits various purposeful responses. He/she has the ability to respond through verbal cues or tactile reflexes and can counteract airway obstruction due to foreign materials. In addition, the patient shows unimpaired cardiovascular function and spontaneous breathing. The general considerations for practitioners to avert conscious sedation-related respiratory complications include patient evaluation and monitoring competency, knowledge of pharmacology of drugs – dosing and side effects – and skills in airway management.
The patient should be in sitting position, not supinate;
Mallampati Classification visualization & ASA status (Bui & Urman, 2013).
Class I = soft palate, faucal passage, uvulas, anterior & posterior pillars – Normal;
Class II = soft palate, faucal passage & uvula – Mild disease;
Class III = soft palate & base of the uvula – Severe disease;
Class IV = soft palate not visible – possible unstable angina.
ASA class III or higher requires intubation/nasal cannula.
Lab data & NPO status.
Patient evaluation before and during the procedure is the standard practice in sedation. It entails a focused physical exam to check vitals and lung/heart auscultations, airway evaluation, a patient history review, e.g., failed sedations, identifying drug allergies, determining the preoperative NPO status, and lab tests. The Mallampati Classification determines the ASA risk of the patient. It involves comparing the size of the tongue to that of the pharyngeal. A better view of the airway passage is obtained when the patient is seated, not when in a supine position. The ASA class III and IV are indications for intubation to prevent respiratory complications, e.g., unstable angina.
Pre-procedure Preparation & Monitoring
Informed consent:
Preoperative fasting (Conway& Sutherland, 2015):
Clear liquids – 2h;
Breast milk – 4h;
Infant formula – 6h;
Milk – 6h;
Light meal – 6h.
Monitoring Procedure:
Continuous SpO2, E.C.G., HR;
Vital signs – after every 5 minutes;
Level of consciousness – after every 5 minutes;
Pain monitoring.
Post Procedure:
Continuous SpO2>95%;
Vital signs – 5 min, then 15 min until discharge.
Adequate information at an early stage regarding conscious sedation should be provided when seeking patient consent. All patients, except infants, should be fasted prior to conscious sedation. The fasting guidelines vary depending on the type of food ingested, e.g., clear liquids would require a 2-hour fasting before a radiological procedure. Pre-, intra-, and post-procedure patient monitoring and documentation is vital. Baseline data on vital signs, SPO2, and pain are obtained before the procedure. The intra-procedure stage involves monitoring the vital signs, HR, SPO2, and CO2 (capnometry) after every five minutes. The post-procedure monitoring of these parameters is done after every 15 minutes until the patient meets the discharge criteria.
Equipment Required
Manual resuscitator and mask – for pre- & post-procedure ventilation.
Capnometer – for measuring airway CO2 concentration.
Reversal agents/antagonists.
Emergency equipment – airway kit & defibrillator.
The equipment is required for monitoring of the vital signs, SPO2, level of consciousness etc. and for resuscitation. Only MRI-compatible monitoring equipment can be used in a radiology department to avoid MRI machine malfunction. The nurse practitioner must understand the monitoring equipment and parameters.
Medication Guidelines
Drugs used for conscious sedation – level 1 sedation (Ketcham, Ketcham, & Bushnell, 2013):
Meperidine (Demerol).
Morphine.
Fentanyl (Sublimaze).
Ketamine.
Diazepam (Valium) etc.
Dosages are reduced for:
Combination of sedative & hypnotics;
Elderly patients;
Patients with organ diseases;
N.B. vital signs must be checked after every 5 minutes during administration.
Reversal agents:
Naloxone: Narcotic antagonist;
Flumazenil: Benzodiazepine antagonist;
Patient must have vital signs q 15 min X 2 hr post-administration (Ketcham et al., 2013);
Observation > 2hrs in recovery.
A number of drugs are recommended for level one sedation (minimum to conscious sedation). Examples include meperidine, morphine, and diazepam. The dosages are reduced when the sedatives are combined with hypnotics and in cases involving elderly patients or those with debilitating illnesses. Antagonistic agents, such as naloxone and flumazenil, are recommended for reversing over-sedation. However, the patient must be observed for over 2 hours after taking the last dose.
Discharge Criteria
Patient discharge depends on his/her Aldrete score
A score of >10
Reversal agent – monitored for >2 hrs after the last dose;
The post-procedure discharge criteria for the patient considers his/her Aldrete score in four parameters, namely, respiration, oxygen saturation, circulation, level of consciousness and activity. Only patients with a score of more than 10 and low pain levels should be discharged.
References
Bui, A., & Urman, D. (2013). Clinical and safety considerations for moderate and deep sedation. Journal of Medical Practice Management, 29(1), 35-41.
Conway, A., & Sutherland, J. (2015). Depth of anesthesia monitoring during procedural sedation and analgesia: A systemic review protocol. Systematic Reviews, 4, 70-81.
Fencl, J. (2016). Guideline implementation: Moderate sedation/analgesia. Association of Peri-operative Registered Nurses Journal, 103(5), 501-511.
Gorospe, E., & Oxentenko, A. (2013). Preprocedural considerations in gastro-intestinal endoscopy. Mayo Clinic Proceedings, 88(9), 1010-1016.
Ketcham, E., Ketcham, C., & Bushnell, F. (2013). Patient safety and nurses’ role in procedural sedation. Emergency Nurse, 21(6), 20-24.
Additional data in the form of clinical findings is needed to confirm the diagnosis of the respiratory impairment. Firstly, the patient needs to be asked about a history of having dyspnea. In asthma, the shortness of breath is unpleasant, which differentiates it from the other forms of dyspnea, which may follow psychiatric, cardiac, or other pulmonary causes. The difficulty in breathing in asthma often accompanies the exposure to allergens, exercise, aspirin use, or it may also occur at rest without any triggers (Quirt et al., 2018). Secondly, taking a comprehensive history of cough presentation is essential before making a diagnosis of asthma. The cough in asthma mostly occurs at night or after an exercise. A detailed history taking of the character of cough and dyspnea presentation is vital in making a diagnosis of asthma.
Other clinical findings of physical examination and laboratory values are used to differentiate the type of the respiratory condition. On physical examination, auscultation of all the lung fields is imperative to gain full information on the problem. On auscultation of the lungs, expiratory wheezes are often heard at the end of breathing out. Asthma patients may also show increased work of breathing, and on percussion, there is the production of hyper resonance sounds. Additionally, according to Quirt et al. (2018), various respiratory parameters of pulmonary function test, including the forced expiratory rate, maximal mid-expiratory rate, and peak expiratory flow rate, are significantly reduced in asthmatic patients. Therefore, objective assessments help identify the type of respiratory condition.
Differential Diagnosis
Several conditions, including chronic obstructive pulmonary disease, gastroesophageal reflux disease, and congestive heart failure, have symptoms that mimic the patient’s presentation. Congestive heart failure causes the pulmonary vessels’ engorgement and pulmonary edema, which decreases lung compliance, resulting in difficulty in breathing and wheezing. However, cardiac asthma presents with nocturnal dyspnea and wheezing secondary to narrowing of the bronchus (Horak et al., 2016). Gastroesophageal reflux disease also presents with respiratory symptoms, including wheezing, sore throat, coughing, and bronchospasms. Acidic reflux may precipitate an asthmatic attack in some individuals. COPD is strongly related to active or passive cigarette smoking or environmental exposure to carbon monoxide, which leads to a progressive airflow restriction and pulmonary cell damage secondary to chronic inflammation from noxious gases from cigarette smoking. A critical analysis of the symptoms is needed for a precise cut diagnosis.
Likely Diagnosis
The likely diagnosis of the patient is asthma which is characterized by wheezing, coughing, and dyspnea. It is diagnosed using the patient’s clinical presentation plus the physical examination findings and pulmonary function test. Moreover, asthma is characterized by wheezing, productive cough, and difficulty breathing, especially at night. Asthma can commence during childhood following the patient’s exposure to various environmental triggers, including allergens like pollen grains, animal fur, dust, or strong odors. Additionally, smoking cigarettes may also cause the activation of mast cells and T lymphocytes’ production. Hence, asthma is a hypersensitive reaction of the body to ordinarily harmless substances.
Desired Outcomes
Several goals of are to be met after a treatment plan for asthma. The primary goals of treatment are to manage the symptoms, prevent complications, and improve the patient’s quality of life. Specifically, the patient is poised to have a clear airway, free from wheezes. The patient to demonstrate actions that promote the clarity of the airway, including proper coughing techniques (Quirt et al., 2018). Moreover, the client should be able to practice behaviors necessary to maintain a healthy state by reducing the number of cigarettes smoked per day and displaying an effective way of using the inhaler.
Recommended Non-Pharmacologic Therapy
Several non-pharmacologic plans are recommended for the treatment of asthma. The success of the treatment modalities is considerably improved with the utilization of non-pharmacologic options. Firstly, exercise improves the lungs and the heart’s capacities for taking up oxygen. Secondly, breathing exercises using techniques like pursed-lip breathing helps to promote easy breathing during asthmatic attacks. Thirdly, avoiding the triggering factors of asthma, including allergens like pollen grains and dust, is the mainstay of asthma management. Furthermore, researchers have found that smoking cigarette worsens asthma (Tan et al., 2020). Nicotine, tar, and other heavy metals are inhaled during smoking leading to the narrowing of the airways due to inflammatory reactions. Therefore, non-pharmacologic therapies have an additive effect on medications use in asthma.
Special Considerations in Pharmacotherapeutic Plan
The drug use for the treatment of asthma varies according to the differing physiologic status of the patients. For instance, in children, less than 12 years of age, the use of a high dose inhaled corticosteroid is preferred to taking a combination of inhaled corticosteroid and long-acting beta-agonists in treating asthma. Additionally, in children less than eight years, the inhalers should have a suitable spacer, whereas adults tend to use dry powder inhalers (Sharma, Hashmi & Chakraborty, 2021). Furthermore, adherence to the treatment plan during pregnancy results in positive outcomes at birth. In the elderly, the therapeutic value of inhaled corticosteroids is reduced. Besides, the number of inhalers is to be reduced in the aged to increase their compliance to treatment. In summary, the treatment of asthma needs to be tailored with specific individual characteristics.
Pharmacotherapeutic Plan
Effective adherence to the treatment is required for the success of therapy. All patients have to be prescribed inhaled short-acting beta 2 agonists for one month. Examples include salbutamol and terbutaline which are administered as needed in patients. Beta 2 agonists work by blocking the beta-adrenergic receptors in the bronchioles, which causes an increase in adenyl cyclase, which activates cAMP resulting in the efflux of calcium ions, causing muscle relaxation (Sharma, Hashmi & Chakraborty, 2021). Long-acting beta-agonists like formoterol can also be used, but they have a late onset of action. Anticholinergics are also used in asthma treatment and work by inhibiting the muscarinic receptors in the respiratory smooth muscles resulting in decreased bronchoconstriction.
An example is as needed inhaled ipratropium bromide. Inhaled corticosteroids reduce the inflammatory response to allergens. An example is inhaled beclomethasone 80mcg twice a day for a long period. Leukotriene receptor blockers work to reduce the proinflammatory actions of the leukotriene, reducing the mast cell degranulation. For example, per oral montelukast 10mg per day for two weeks. Combination therapy results in improved outcomes as beta 2 agonists cause symptomatic relief, whereas corticosteroids reduce exacerbations (Sharma, Hashmi & Chakraborty, 2021). It is important to monitor these drugs’ side effects, including headaches, dizziness, back pain, and earache.
Patient Education and Management of Worsened Condition
The success of treatment can be monitored through the resolution of the symptoms of asthma. Check for the reduction in wheezing, coughing, and difficulty of breathing. Furthermore, the patient displays a correct way of using the inhalers. On counseling for the patient adherence to the pharmacologic plan, the healthcare provider needs to teach the patient on the drugs’ pharmacologic actions and their associated side effects. Teach the patient to tag along with the short-acting beta-blockers for symptomatic relief. Demonstrate to the patient the correct use of inhalers and advise on quitting smoking as it worsens asthma. According to Wang et al. (2016), the treatment plan for worsening asthma needs to incorporate systemic corticosteroids and theophylline for further management. Intravenous methylprednisolone 40mg per day and oral theophylline 0.2g twice daily for three days can help alleviate the symptoms.
Quirt, J., Hildebrand, K. J., Mazza, J., Noya, F., & Kim, H. (2018). Asthma. Allergy, Asthma, And Clinical Immunology: Official Journal of The Canadian Society Of Allergy And Clinical Immunology, 14(2), 50. Web.
Tan, D. J., Burgess, J. A., Perret, J. L., Bui, D. S., Abramson, M. J., Dharmage, S. C., & Walters, E. H. (2020). Non-pharmacological management of adult asthma in Australia: Cross-sectional analysis of a population-based cohort study. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 57(1), 105-112. Web.
Wang, H., Chen, R., Xie, J., Zhang, Q., Deng, Y., Zeng, Q., Zhu, Z., Ding, M., Lai, Z., Kolb, M., O’Byrne, P., Chen, R., & Zhong, N. (2016). A 43-year-old man with cough, expectoration, and recurrent wheezing. Journal of Thoracic Disease, 8(12), 3468-3477. Web.
The respiratory system represents a network of internal and external organs that allow for the breathing function to be enacted. Moreover, in addition to the functions associated directly with the process of breathing, the respiratory system also regulates blood pH. The specified process is performed with the help of carbon dioxide that is present in the bloodstream. By examining the specified function of the respiratory system, one will be able to develop a better understanding of managing and supporting it in patients.
The connection between the levels of blood pH and the respiratory system is quite straightforward. Specifically, the extent of Ph in the bloodstream is defined by the presence of carbon dioxide (CO2) in the blood (Hughes et al., 2021). In turn, the act of breathing, namely, inhaling oxygen and its further introduction to cellular respiration, leads to the production of CO2 within the bloodstream (Hughes et al., 2021). Consequently, the functioning of the respiratory system determines the levels of Ph in a patient’s blood.
Carbon dioxide plays a unique role in acidizing processes within the bloodstream and the resulting release of carbonic acid. Therefore, it affects the levels of pH directly, with the increase in CO2 leading to an inevitable drop in pH (Hughes et al., 2021). Similarly, carbonic anhydrase plays a vital part in the specified process, contributing to the production of carbonic acid by reacting to water (CO2+H2O=H2CO3) (Hughes et al., 2021). Therefore, by removing CO2 from the equation and minimizing its amount in the bloodstream, one will reduce the extent of H2CO3 production, creating a less acidic environment and causing an increase in pH levels (Hughes et al., 2021). Finally, carbonic anhydrase also contributes extensively to blood pH levels since it serves as a catalyst for the reaction between CO2 and H2O in the bloodstream (Hughes et al., 2021). Thus, the three components in question are vital in managing pH levels in the blood.
Similarly, the breathing rate and frequency define the pH levels. Specifically, intensive breathing leads to a rise in oxygen levels in the blood, which, in turn, contributes to a faster production of CO2 (Hughes et al., 2021). Afterward, the levels of acidity within the blood rise, lowering the pH. In fact, major deviations from a regular breathing pattern will result in changes to a patient’s well-being, known as respiratory acidosis and respiratory alkalosis. The former involves a scenario in which the breath rate is reduced to the point where hypoventilation occurs. As a result, the levels of oxygenation drop, and the pH rate rises significantly.
In turn, alkalosis takes place in case a breath rate is increased substantially. Namely, it leads to hyperventilation and a subsequent drop in pH levels (Hughes et al., 2021). As a result, a patient may experience a range of adverse changes to health, ranging from lightheadedness to tachycardia (Hughes et al., 2021). Both conditions should be avoided since they represent a health risk. Admittedly, the respiratory system can compensate for the development of acidosis and alkalosis. Specifically, the described conditions lead to compensation involving decreased pH rates and increased H3CO2 levels (Hughes et al., 2021). Therefore, appropriate medications must be introduced to avoid the development of the specified complications.
By considering the connection between the performance of the respiratory system and the levels of Ph in a patient’s blood, one will be able to address the relevant health issues. Therefore, a proper understanding of the connection between the concepts in question I required. Specifically, one must be aware of the fact that a decrease in the level of carbon dioxide within the bloodstream leads to a rise in Ph, and vice versa. The specified knowledge will allow for managing the levels of blood Ph and ensuring that it remains within the established norm.
Pharmacology and medicine use the chemical properties of various natural and artificially created drugs for their treatment and development purposes. The focus of this report is the consideration of only the chemical properties of the drugs including metaproterenol sulfate, dyphylline, prednisolone, albuterol, salmeterol xinafoate, and theophylline. Metaproterenol sulfate is the generic name for corticosteroid MDI belonging to the class of rescue/reliever drugs. Dyphylline, also known as dihydroxypropyl theophylline, is rescue/reliever, it belongs to the class of “N-7 dihydroxypropyl derivative of theophylline” (Foye et al., 2007, p. 1245). Prednisolone belongs to the class of ∆-corticosteroids that display the features of anitrheumatic and antiallergenic agents and is 1-dehydro derivative of cortisone and hydrocortisone; it is rescue/reliever (Foye et al., 2007, p. 890). Next, albuterol is rescue/reliever and the drug belonging to the class of non-catechol selective β-agonists acting as the corticosteroid MDI and bronchodilator, while salmeterol xinafoate is the corticosteroid MDI and the long acting β-agonist belonging to the controller/preventer class of drugs. Finally, theophylline is also rescue/reliever drug belonging to the dimethylxanthine group (Foye et al., 2007, pp. 405; 406; 484).
Therapeutic Use
According to Foye et al. (2007) and Hernandez (2006), all the above mentioned drugs are used in pharmacology and therapy. Metaproterenol sulfate, dyphylline, prednisolone, albuterol, salmeterol xinafoate, and theophylline are bronchodilators serving as either rescue/relievers or controller/preventers in treating respiratory illnesses, and especially asthma (Foye et al., 2007, p. 1230; Hernandez, 2006, p. 205). The bulk of the drugs are administered via inhalation, while metaproterenol sulfate can also be administered orally in the form of tablets or pills.
Molecular Properties of Selected Drugs
Physical-Chemical Characteristics
Acid-Base Characteristics
The acid-base characteristics of the selected drugs demonstrate their composition of both strong and weak acids and only neutral bases. Metaproterenol sulfate consists of strong acids, H2SO4 and CH3, and neutral bases OH; dyphylline, albuterol, theophylline, and prednisolone consist of a weak acid CH2OH and similar OH bases. The composition of salmeterol xinafoate presents neutral bases OH only (Foye et al., 2007, p. 28; Hernandez, 2006, p. 37). Accordingly, the pKa values of the weak acids range from -2 to 12, while strong acids in the selected drugs have pKa values less than -2. In acid-base reactions, the pKa are the values that allow figuring out the pKb values, i. e. the base dissociation constant according to the formular ~14 – pKa. Thus, in metaproterenol sulfate, the pKa of H2SO4 is -3, so the pKb is ~14 – (-3) = 17. In prednisolone, the weak acid CH2OH has the pKa of 11.4, and the pKb is ~14 – 11.4 = 2.6.
Overall Polarity and Its Effect on Solvation (Hydration), Solubility, Dissolution, Partitioning between Phases
The selected drugs are characaterized by domination of polar molecules. Metaproterenol sulfate’s non-polar molecules include only carbon compounds like CH2 and CH3, while OH, HC, CH, HO, and H2SO4 are polar, which means that salvation, solubility, and dissolution are possible only in solvents of the same polarity, while partitioning coefficient is greater for metaproterenol sulfate with water. In dyphylline, only CH3 is non-polar, while CH2OH, OH, and H3C display polarity. Prednisolone is mostly non-polar as CH3 is in its contents, while polar molecules include only OH and HO ones. Albuterol is also characterized by domination of non-polar CH3 molecules. Only polar molecules OH, H, and N are observed in salmeterol xinafoate, while theophylline contains the bulk of polar molecules and a single CH3 non-polar molecule. These characteristics mean that drugs with dominant polar molecules have water-related salvation, solubility, and dissolution and the high partitioning coefficient, while predominantly non-polar drugs are dissolved in water-phobic substances with lower partitioning coefficients.
Similarities and Differences of Chemical Structures
The selected drugs display structures that differ by their acid-base features, polarity, and chemical geometry. The chemical structure of metaproterenol sulfate is (Flower, 2002, p. 114):
The chemical structure of dyphylline is (Foye et al., 2007, p. 1245):
The chemical structure of prednisolone is (Foye et al., 2007, p. 888):
The chemical structure of albuterol is (Foye et al., 2007, p. 405):
The chemical structure of salmeterol xinafoate is (Foye et al., 2007, p. 35):
The chemical structure of theophylline is (Foye et al., 2007, p. 484):
All the six drugs are characterized by displaying strong acids and neutral bases in their structures. The polarity is dominant in four out of six drugs, and only prednisolone and albuterol have non-polar molecules either dominant or exclusive in their structures. The geometry of the structures selected includes three linear structures (albuterol, prednisolone, and salmeterol xinafoate), a triginal planar (dyphylline), a trigonal bipyramidal (metaproterenol sulfate), and a T-shaped structure of theophylline.
The Possibility of Intra and Intermolecular Drug Binding Interactions
Covalent Bonding
The above discussed structures reveal opportunities for intra and intermolecular binding interactions on the whole and covalent bonding in particular. Thus, metaproterenol sulfate has a double bond between CH and two CH3 molecules. In dyphylline, there is a covalent binding between CH and the molecules of H2C and CH2OH. Albuterol displays a quadruple binding of carbon with three CH3 molecules and nitrogen. In theophylline the covalent bonding of nitrogen with H3C and O can be observed. Finally, only prednisolone and salmeterol xinafoate display no actual or potential covalent bindings because of their mainly linear and non-polar structures.
Electrostatic Forces
The concept of electrostatic force is hardly applicable to the selected drugs, as well as to the majority of drugs on the whole, because such a necessary condition for electrostatic bond, or ionic bond as it is also known, to form is the interaction between the two differently charged ions, one of which is the ion of a metal (Flower, 2002, p. 154). The selected six drugs do not possess any metals in their molecular structures, but mainly gases and acids, and therefore no electrostatic processes are actually possible within these drugs or between them unless any metal molecules are added to their intermolecular interactions’ process.
Stereochemical (Structural) Features
Optical Isomerism
The selected drugs also display considerable similarities in regard to their structural features and especially the stereochemical ones that illustrate the location of molecules within the structure of every particular drug. The notion of optical isomerism is applicable to the selected six drugs as the process when the similar or close chemical elements are arranged in a different way in one molecule that they are arranged in another one (Hernandez, 2006, p. 65). Thus, N, O, H, and C are obvious optical isomerism examples as they are present in all drugs’ structures but their arrangement is different from structure to structure.
Geometric & Conformational Isomerism
The presence of geometric isomerisms in the structures of the selected drugs is also obvious but no so common to all the structures and optical isomerisms are. Thus, the geometric isomerism can be observed between metaproterenol sulfate, albuterol, and salmeterol xinafoate in the symmetrical location of the double H3C/CH3 molecules. The conformational isomerisms are observed in metaproterenol sulfate, dyphylline, prednisolone, albuterol, and theophylline. Only salmeterol xinafoate displays no sings of conformational isomerism in its molecular structure.
Effect of Molecular Properties on Biopharmaceutical Features of Drugs Affecting
Drug Release, Absorption, Transport & Distribution
The above discussion reveals that molecular properties of the selected drugs affect their biopharmaceutical features in various ways. After the administration, the drug is transported by blood to the center of activity, i. e. the area of the organism in need of drug treatment. The process of metabolism transforms the drug into the necessary elements, and then the drug is distributed in the organism. After the treatment the drug or its metabolite is excreted from the organism, usually with the help of kidneys (Kadam, 2008, p. 187). As the majority of the selected drugs have high polarity, their salvation is possible only in combination with the elements of the same polarity. Accordingly, administration, absorption, and transportation of drugs depend on the compatibility of the organism with the type of the drugs discussed.
Drug-Receptor Interaction
The selected drugs, as well as the bulk of other drugs, are aimed at causing an effect on the organism, and therefore they are bound to interact with the receptors located in the areas selected drugs are used to treat. According to Foye et al. (2007), the process of drug-receptor interaction is the basic form to monitor the organism’s response to the administration of the drug, while the presence of hydrogen bonds in the drug’s structure provides for proper drug-receptor interaction (p. 484). All selected drugs display the wide variety of such bonds and hydrogen is one of their basic constructive elements, which means that these drugs are to cause proper drug-receptor interaction.
Biotransformation Pathways by Considering the Effect of Physical-Chemical Characteristics and Structural Features of Drug Molecules
There are two basic pathways of biotransformation of drugs, which takes place in the liver, including mineralization, i. e. the process resulting in formation of CO2, H2O, and NH3, and metabolism that usually results in metabolizing and excreting all other elements from the organism with the help of salvation (Hernandez, 2006, p. 291; Kadam, 2008, p. 187). The selected drugs have specific biotransformation pathways consisting of two main stages, phase I and II, under which the metabolites are first formed through the use of oxidative and hydrolytic reactions, and then are transformed into water-soluble compound elements with the help of enzymes and the process of conjugation reaction. Given the high partitioning coefficient in the bulk of the selected drugs and their predominantly high polarity, the above processes facilitate their fast and completely excretion from the organism.
Factors Influencing Drug Metabolism
The factors that influence the process of metabolism of the selected drugs are numerous and range from the race, sex, and age of the person administering the drugs to the possible pathologies of this person and his or her overall health conditions, food habits, and interaction of the administered drugs with the other drugs potentially administered simultaneously and the overall organism peculiarities. Thus, Inuit race is the most adjusted to metabolism of drugs, while African nations are the less adjusted for this (Kadam, 2008, pp. 129 – 130). Aged people, women, and children also might experience metabolism problems. Finally, the drugs administered must be compatible with the organism’s individual peculiarities and other drugs administered simultaneously (Kadam, 2008, pp. 129 – 130). Accordingly, the factors influencing dug metabolism range from racial and national to such personal aspects as age, sex, drug compatibility and organism peculiarities.
Strategies to Manage Drug Metabolism
Simply defined, metabolism is “what an organism does to the drug” (Flower, 2002, p. 89), and proper metabolism is essential for the functioning of the whole organism and avoiding the damage that drugs not excreted properly might cause to it. Therefore, to manage metabolism of the selected drugs it is necessary to first determine the genetic peculiarities of the organism and see if the drugs are compatible with them. If yes, the drugs can be used in treatment under the professional supervision. If no, alternative treatment ways should be searched. Second, it is necessary to coordinate the drugs’ use with the administration of other drugs. In case of drug compatibility, again the supervised treatment is advisable; if the drugs turn out to be incompatible alternative drugs might be prescribed. Third, proper food should accompany the use of drugs for treatment as the elements obtained with food assist with metabolism of drugs. Finally, drug-receptor interaction should be monitored to trace metabolism and make any corrections.
Pharmacological Activity
Thus completing the report of the six drug types used to treat asthma and other serious respiratory diseases, it is necessary to note that metaproterenol sulfate, dyphylline, prednisolone, albuterol, salmeterol xinafoate, and theophylline are used as bronchodilators and function as either rescue/relievers or controller/preventers of the illnesses. The administration of the drugs is carried out through inhalation and orally (for metaproterenol sulfate only in the form of tablets), which helps at first hand to reduce the spasms and fits of asthma, ease the throat muscles, and let a human being breathe freely during the time of the drug effect and up to the next asthma fit.
References
Flower, D. (2002). Drug design: cutting edge approaches. Royal Society of Chemistry.
Foye, W. et al. (2007). Foye’s Principles of Medicinal Chemistry. Lippincott Williams & Wilkins, 6th Ediition.
Hernandez, M. (2006). Basic pharmacology: understanding drug actions and reactions. CRC Press.
Kadam, S. (2008). Principles of Medicinal Chemistry. Pragati Books Pvt. Ltd.
Respiratory Syncytial Virus is a germ that is commonly found among the children who are below two years of age. It comes about seasonally and commences in the course of the fall and stretches in to the spring. Spreading of this virus is carried out by having physical contact with the infected person. Such activities as kissing, hand contact, and touching an individual who is infected with this disease facilitates the spread of the disease. The virus causing this disease can stay alive for about twenty minutes on the hands of someone. More so, it can stay alive for a period of almost five hours or more on the tops of counters and it can as well stay alive for a number of hours on the tissues that could have been used. There can be quick spreading of the disease in those places that might be busy and in the day care centers for kids.
Signs and symptoms
RSV brings about a cold in children. Sometimes, it can bring about infection that is quite fatal. In some children who have are more than five years, the symptoms may include;” a running nose, fever and a cough” (Iaennell). In the children who are younger like the toddlers as well as the infants, pneumonia can result. The severe symptoms are exhibited after a period of two to four days after infection. The common symptoms of the disease include; wheezing, worsening cough, low oxygen levels, lethargy, poor appetite, apnea, difficulty in breathing and high rate of breathing (Iannelli)
Treatment
In carrying out treatment for this disease, there is no making use of antibiotics. RSV infection which may not be serious may not call for treatment and it can vanish on its own. In serious instances among young children, they may be kept in hospital so that they can be given moistened air, oxygen as well as fluids. In some cases, there may be need for the use of a breathing machine.
Prevention
The easiest technique to offer prevention to the RSV illness is by a person washing hands before using the hands to touch the young children. It is of great importance to ensure that other people, and mostly those who give care to the children, take necessary measures to avoid passing over RSV to the young children. As a measure to prevent the transmission of this disease to one’s child or children by other people; the parent should insist that other people should wash hands using warm water with soap before they touch one’s baby. Another measure is that other people who might have had a cold are supposed to avoid touching the baby.
Kissing the baby should be avoided since it can play a role in causing the baby to be infected. A person should not smoke from inside a room where the baby might be; exposing the baby to smoke may cause this child to be at an increased risk of being infected by RSV.
Those parents who have young children that are at a higher risk of infection should avoid those areas that are crowded as a much as possible during the periods where there are RSV outbreaks. These outbreaks in most cases are reported in the local media to warn people about having their children getting infected and to take appropriate measures.
A drug that has been approved to be used in the prevention of the RSV infection is synagis. This drug has been approved to be used among those children who are less than one year old as this group is more vulnerable to the infection. Inquiry should be made from the doctor as to whether or not this drug should be given to the child at a time when the child is at a high risk of infection (Kaneshiro).
Prognosis (Outlook)
There are very minimal chances for this infection to cause death among infants, especially when it can be identified early. Amongst the young people and even among older people, this disease is quite gentle. However, it has been established that there are chances for the bigger danger of being infected with asthma in the young children who might have been infected by “RSV bronchiolitis”.
References
Iannelli, Vincent, RSV symptoms, 2009. Web.
Kaneshiro, Neil K., Respiratory Syncytial Virus RSV. Health guide, 2008. Web.
