Assessment findings to relevant pathophysiological or psychosocial theory
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Contents
Systematic assessment of the individual 4
Roper, Logan and Tierney approach 4
Nursing priorities in managing care with rationale 7
Factors that impacted the care given 8
Introduction
Care management is a potential team-based patient-centered strategy whose main purpose is to assist patients and their support networks in more successfully managing medical problems (Arnold et al., 2016). Acute care is a subset of secondary healthcare in which a patient receives active but brief therapy for a serious injury or disease, an immediate medical problem, or while recovering from surgery.
Patient scenario and Current health status
The patient I am referring to is a 60-year-old female who experienced an acute asthma attack. She had been diagnosed with asthma 12 years back, and was taking combined therapy for asthma for 5 months before attending the clinic. During winters, the patient often experiences coughing spells and eczema, and hay fever. Her father had also died from asthma, and she had been suffering from a dry hacking cough for 6 weeks after recovering from bronchitis.
bio- psycho-social information that is important to their care management and/or recovery
Systematic assessment of the individual
Roper, Logan and Tierney approach
Activity: The patient was not able to do daily activities because of difficulty in breathing and exhaustion.
Mobility: The patient had difficulty in breathing, tightness in her chest, and acute pain when her asthma got worse, and hence she was unable to move around much (McGloin & Skull, 2022).
Sleep: The patient was feeling very exhausted, so her sleeping habits were likely affected.
Personal Hygiene: There is no information on the patienta's personal hygiene habits.
The A-E approach
Pathophysiology: Asthma is a chronic inflammatory disorder of the airways, characterized by airway hyperresponsiveness, inflammation and narrowing of the airways. During an asthma attack, the airways become inflamed and narrowed due to airway constriction caused by bronchospasm, edema, and mucus secretion, which leads to difficulty in breathing and wheezing (Castillo et al., 2017).
Management: In order to improve the patient's airways, a nebuliser treatment with salbutamol and ipratropium bromide was given to reduce bronchospasm and inflammation. Additionally, oral prednisolone and montelukast were prescribed to reduce inflammation.
Pathophysiology: During an asthma attack, the body's circulation increases in order to compensate for the increased oxygen demand. This leads to an increased blood pressure.
Management: The patient's blood pressure was monitored and her condition was assessed regularly to ensure that it was within normal limits.
Pathophysiology: During an asthma attack, the body's oxygen levels decrease, which leads to a blue discoloration of the skin due to the lack of oxygen.
Management: In order to prevent further exacerbations of the patient's condition, she was advised to maintain good airway hygiene, such as avoiding exposure to allergens, dust, and smoke (McGloin & Skull, 2022). Additionally, she was advised to use her inhaler as prescribed and to keep a peak flow meter at home to monitor her condition. The patient was also provided with a written action plan to help her manage her condition and instructed on when to seek medical attention.
Nursing Management Care Priorities
Assessment findings to relevant pathophysiological or psychosocial theory
Another one is that the osmotic hypothesis defines that extreme dryness or dehydration in the airways can result in the contraction of the smooth muscles of the airways and also enhance the resistance of the airways (Lloyd et al., 2019). This might have caused dryness in the airways and thus results in bronchoconstriction, which makes the breathing process difficult for the case patient. Due to this breathing difficulty, she is getting exhausted, which further decreases her state of alertness and thus putting her in a state of confusion (Yeh et al., 2009). Relating these care priorities to relevant pathophysiological theory, it is important to understand the causes of asthma to develop an effective care plan.
Asthma is caused by inflammation of the airways and the release of various inflammatory mediators, including histamine, leukotrienes, and cytokines. These inflammatory mediators cause narrowing of the airways, leading to difficulty in breathing, wheezing, and coughing. Additionally, airway hyper-responsiveness increases, leading to asthma attacks. The release of mediators also causes an increase in mucus production, further narrowing the airways and causing more difficulty in breathing (McGloin & Skull, 2022). The inflammation also causes the airways to become swollen and increases the risk of infection.
Nursing management of the individual within a given timeframe
Nursing priorities in managing care with rationale
| Diagnosis | Expected outcomes | Interventions |
|---|---|---|
| Shortness of breath | improve the patient's breathing | The patient was given a nebuliser treatment with salbutamol and ipratropium bromide, which helps to relax the airways and make breathing easier. Additionally, the patient was given oral prednisolone and montelukast to reduce inflammation in her airways and reduce the severity of her asthma attack. The patient was also placed on oxygen therapy and monitored closely. |
| Chest tightness | The patient is no longer feeling any pain and discomfort in the chest. | Make her sit in an upright position, after 3 hours of admission. |
| Worse cough | The cough of the patient got reduced over time. | Allow the patient to drink enough water every 2 hours. |
Factors that impacted the care given
Evaluate the effectiveness of the care provided
The care provided to the patient was effective in managing her condition and alleviating her symptoms. Overall, the patient was managed effectively and her condition improved significantly. She was discharged from the hospital after 3 days with a good understanding of her condition and how to manage it.
In order to improve the care provided to the patient, it would be beneficial to provide additional education and support to the patient and her family (Gabrielli et al., 2022). This could include providing patient education materials on asthma and its management, as well as providing access to support groups and other resources. Additionally, it would be beneficial to provide the patient with access to a pulmonary rehabilitation program to help her better manage her condition and improve her overall quality of life.
Future learning
Conclusion
References
Castillo, J. R., Peters, S. P., & Busse, W. W. (2017). Asthma exacerbations: Pathogenesis, prevention, and treatment. The Journal of Allergy and Clinical Immunology: In Practice, 5(4), 918–927. https://doi.org/10.1016/j.jaip.2017.05.001
Cloutier, M. M., Schatz, M., Castro, M., Clark, N., Kelly, H. W., Mangione-Smith, R., Sheller, J., Sorkness, C., Stoloff, S., & Gergen, P. (2012). Asthma outcomes: Composite scores of Asthma Control. Journal of Allergy and Clinical Immunology, 129(3). https://doi.org/10.1016/j.jaci.2011.12.980
McGloin, S., & Skull, A. (2022). Principles of Acute Care Nursing. SAGE.
Mortimer, C. (2019). A preliminary study to determine the effects of nebulised salbutamol on blood glucose levels during an acute asthma exacerbation. Airway Pharmacology and Treatment. https://doi.org/10.1183/13993003.congress-2019.pa4243