Case Study About the Patient With Asthma

Paper Info
Page count 8
Word count 2223
Read time 10 min
Topic Health
Type Essay
Language 🇬🇧 UK

Mrs. Smith is a 38-year-old woman who was diagnosed with asthma in her childhood, but the symptoms gradually resolved in her teens. Currently, she is discharged from the hospital after an asthma attack. According to Nursing and Midwifery Council (NMC) confidentially terms, the name of the patient was changed to keep her data and personality protected. Mrs. Smith’s broad geographical location may be identified as the UK, and she works in the office. This paper will provide a detailed assessment of the patient based on the international and local guidelines such as the Global Initiative for Asthma (GINA) and the Scottish Intercollegiate Guidelines Network / British Thoracic Society (SIGN/BTS), respectively (Boulet et al. 2012). In particular, the patient’s current asthma status, the disease factors, pharmacological and non-pharmacological management options, the patient and her family education, an asthma action plan will be discussed in this essay. Among the other key professionals involved in patient management, there are her general practitioner (GP) and nurses.

First, it is essential to evaluate the patient’s current asthma status to provide further assessment and treatment options. Mrs. Smith’s key health indicators are as follows: heart rate – 152, respiratory rate – 33, blood oxygen level (SpO2) – 92 percent on a fraction of inspired oxygen (FiO2) 0.22, mild intercostal retractions and breath sounds indicate amplified expiratory wheezes throughout all lung fields. Reddel et al. (2015) consider that the severity of asthma status is a dynamic or variable condition that can be modified by therapy, patient education, and the elimination of triggering factors. The general control of asthma consists of two components – current monitoring and long-term risks. If current monitoring refers to the symptoms and the functional status of the patient at the given time, then the future risks imply the threat of exacerbations, instability of the disease (repeated episodes of loss of control), and permanent deterioration of the pulmonary function. Mrs Smith’s current status is post-acute, since she was hospitalised as a result of the shortage of breathing and then discharged with stable condition. However, it should be noted that there is the future risk for her health that is associated with her working area. According to the asthma assessment scale proposed in the GINA manual, control categories for asthma include the following points: controlled, partially controlled, and uncontrolled ones (Global Initiative for Asthma – GINA 2017). Considering the patients’ health indicators, it is possible to note that her disease is partially controlled. Mrs Smith is aware of her disease and uses inhalers, yet she lacks knowledge on how to handle her disease symptoms and facilitate them. The current status decreases the quality of the patients’ life, since she has to experience wheezing and breathlessness as well as the risk of health complications.

Speaking of the factors contributing to the current state of the disease, it is important to note that environment and genetics are the two key factors that cause asthma in the patient. Mrs Smith’s sister and grandmother also suffer from this disease that tends to deteriorate in them. The patient reports that in her childhood, asthma was detected by health providers, yet her family paid no attention to this fact because of the lack of symptoms in her teenage period. Therefore, it is possible to suggest that the lack of attention and monitoring led to such severe consequences. Another aggravating factor relates to environment. As claimed by Custovic et al. (2012, p. 302), “childcare arrangements, pet ownership, and changes to housing design and indoor allergen exposure” are the main factors that may cause asthma, allergy, and atopy. The patient’s current workplace is the office in a converted barn that previously served as a stud farm for horses. The mentioned place is, probably, have some level of mould, dust, and other dangerous components, since the building was not initially built for people. The significant increase in the incidence of asthma as a result of exposure to harmful environmental factors was detected in the recent study by TingTing et al. (2013). It can be hot or cold air, its contamination by various small dust particles, chemical compounds, and vapours.

Even though there are triggering factors that may aggravate the current situation, Mrs Smith tries to strictly adhere to the prescriptions made by her doctors. For example, she inhales prednisolone once a day that helps her to control asthma attacks. Consistent with Bårnes and Ulrik (2015), prednisolone is corticosteroid the process of treatment by which starts with high doses of the drug and ends with low ones in accordance with the “step down” principle. The initial high dosage is appointed with the aim of handling the disease as quickly as possible, namely, to minimise seisures and reduce the severity of the course of the disease. Therefore, one may state that the patient’s current adherence to the given treatment is the beneficial factor. However, the patient lacks proper inhaler technique and forgets to use it timely.

There are both pharmacological and non-pharmacological management options that the patient currently has and also those that can be implemented in the future. In most cases, as argued by Chung (2015), only adequate drug therapy is able to provide control over the manifestations of asthma, while the principles of its selection should be based on the assessment of the severity of the disease and its clinical and pathogenetic form. When achieving the stable therapeutic effect, it is advisable to limit the drug correction to the minimum required level. Among the pharmacological options for the given patient, there are stabilisers of cell membranes, corticosteroids or bronchodilators (adrenomimetics, m-cholinolytics), and auxiliary means (antihistamines, mucolytic agents) (Price et al. 2014). Speaking of non-pharmacological set of options, one should outline such issues as herbal remedies, breathing techniques, and relaxation strategies. The most famous non-traditional methods of treatment involve acupuncture, homoeopathy, herbal medicine, and Ayurvedic medicine. For example, according to the recent study by Joshi et al. (2017, p. 117), “Ayurvedic treatment showed improvement in Asthma symptoms in mild to moderate asthmatics”. These methods can be useful for some patients and their families, but they have not been sufficiently studied, and their effectiveness has not been proven. Some substances used in such medicine (for example, grasses such as comfrey) are known as potentially dangerous. Others, on the contrary, can be helpful. Nevertheless, non-pharmacological options should be used only as a supplement to the treatment recommendations set out by the doctor.

The long-term cooperation between the patient and the doctor is necessary as training of the patient is mandatory for the realisation of the principle of self-education. The patient should know what to do regularly and how to act during an attack. In addition, the constant monitoring of the patient’s condition is required in order to adjust the treatment measures and management plan. It is of great importance to educate the patient and her family on how to properly use the inhaler device as it can save her life by helping to control breath. It should be especially emphasised that correctly conducted breathing in asthma helps to drain the bronchial tubes, clean them from accumulated microbes, strengthen the muscles of the chest, normalise blood circulation, and improve immunity and metabolism in the body (Harnett et al. 2014). As a result of the regular training the following changes will occur in the patient’s body: the elasticity of the blood vessels will increase, which in turn will lead to the reduction in the risk of stroke and other haemorrhages. Further, the walls of the vessels will be cleared of cholesterol plaques, the activity at the cellular level and immunity will increase, blood microcirculation will be restored, and metabolic processes will be enhanced (Harnett et al. 2014). Most importantly, the patient awareness of the mentioned treatment option is the core goal of her education.

Since patient education is an essential part of an integrated program for the treatment of patients with asthma, Mrs Smith received the basics of self-control. She was explained that to adequately control this disease, the patient needs to be aware of his or her illness and the possibilities of modern medication. One of the best and most effective forms of training is systematic study, it was suggested to the given patient (Watkins et al. 2016). Namely, Mrs Smith was taught correct perception of an objective assessment of the severity of asthma in combination with a subjective interpretation of the key symptoms of the disease. It seems significant to emphasise the fact that she was also given some basic information regarding what medications should be taken continuously, and which ones – only if necessary. The list of measures of treatment and prevention, including the intake of inhaled and systemic corticosteroids, oxygen therapy, and medical examination as well as the written guidance on self-assessment and self-management, both with prolonged therapy and in the treatment of exacerbations were given to the patient.

To prepare asthma management plan, it is critical to remember that the treatment of asthma requires the exclusion of triggers and the choice of appropriate medications to prevent the development of symptoms (Watkins et al. 2016). Also, it is necessary to prescribe medications to quickly relieve symptoms and stop seisures, if they appear. An attack can be the event that will cause the patient to seek medical help and begin treatment of the disease. For the treatment of asthma in the given patient, inhalation preparations present the most preferred option, since it has the highest therapeutic effect compared to tablets or syrups (Wong et al. 2017). This is due to the fact that inhaled drugs in high concentrations are injected directly into the bronchial tree, providing a powerful therapeutic effect and preventing significant systemic side effects. It should also be stressed that the need for regular medication intake worsens the quality of life of asthmatics. If the pill can be drunk unnoticed, then to properly do the inhalation, the patient will need time and skill, while trying to hide this procedure is extremely difficult. As a result, Mrs Smith is likely to limit contact with relatives and acquaintances or cancel business meetings and trips, especially during periods of exacerbation of the disease.

All of the above confirms the social status of the patient’s asthma requires special attention. It is recommended to intake drugs that directly dilate the lumen of the bronchi (bronchodilator) such as salbutamol for coping with an attack of asthma and its aggravation. By continuing prednisolone intake, the patient will ensure the long-term breath control. Such non-pharmacological means of treatment of asthma as inhalations, respiratory exercises, psychotherapy, acupuncture, qigong therapy, reflexotherapy, diet therapy, etc. may be used a complementary treatment (Wlasiuk & Vercelli 2012). They significantly improve the effect of the drugs taken, accelerate recovery, and prevent the progression of the disease and the occurrence of sudden attacks of suffocation.

Of particular importance is the preventive treatment, which is considered the most relevant after recovery or relief of an emergency. Its purpose is to prevent the onset of exacerbation of the disease in the future. If this cannot be avoided, then ease the course of the disease, smooth the seisures, and promote faster recovery. In this connection, climatotherapy may be recommended to strengthen the whole body, adjust immunity, and help it to fight asthma. Wlasiuk and Vercelli (2012) consider that farm effect may address asthma attacks due to its natural impact. Even though the life of farmers and village is not so interesting and eventful as in the city, this lifestyle has its advantages, since it protects against allergies and asthma for many years. Mrs Smith may be recommended to re-consider her current location of job and housing with the aim of moving to more favourable environment.

Compliance with the asthma action plan is the key to achieving the reduction of symptoms and their severity, as stated by Bundy and Murphy (2014). To help the patient in her self-care and education, it is possible to use the electronic means of the modern technology. For example, Kuhn et al. (2015) propose the use of electronic health record (EHR) in managing asthma. This method is based on the electronic tracking of the patient’s key health indicators and the subsequent notification that, in its turn, is likely to help in providing timely and appropriate care for the patient as well as stimulate her self-care.

Summing it up, it is essential to point out that Mrs Smith’s asthma was assessed as post-acute and partially controlled. According to the detailed evaluation, it was revealed that she works in the unfavourable environment and has the genetic predisposition to asthma. The patient shows the basic skills of self-care and disease awareness, yet her knowledge needs to be improved. The suggested asthma action plan identifies both pharmacological (prednisolone) and non-pharmacological treatment for the given patient (breathing techniques, acupuncture, etc.). More to the point, it was recommended to consider job and location change along with proper inhaler techniques. It was proposed that the team of experts, including her GP, nurses, and her pulmonologist should monitor her health status and implemented any changes, if required. In general, Mrs Smith is likely to make every effort to improve her health, she looks interested in her ability to live fully and prevent asthma attacks in the future. The patient was suggested to visit her GP regularly and adhere to his or her prescriptions, thus contributing to the treatment effectiveness.

Reference List

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