Introduction
The human body is made up of systems that help it to survive by facilitating necessary functions. These systems work together in synergy for the betterment of humans. One such system is the respiratory system. This system is used in the exchange of oxygen and carbon dioxide from the atmosphere. The body requires the oxygen for its cellular functions after which they release carbon dioxide. The inhalation and exhalation of these gases is done through a complex body structure known as the respiratory system (Priestly 2008).
The respiratory structure consists of a series of organs and tissues that are linked. The lungs are used for gaseous exchange while the connecting ducts convey the gases in and out of the lungs. Just like any other part of the body, the respiratory system is prone to microbe attack. Asthma is a condition that affects the exchange of gases in the process of inhalation and exhalation. The condition makes intake and exhale of gases difficult and strenuous if it is not monitored and controlled. It is a persistent lung illness that swells the air tubes causing air passages area to be slender. The enlargement makes the airways to be very sore and susceptible to diseases. Repeated periods of breathlessness, ribcage rigidity, coughing and whistle like sound occur due to asthma (Asthma 2009).
Asthma can occur at all age groups and usually starts at the childhood stage. Experts have found ways to manage the condition by use of medicine during mild attacks. It is advised that people should cure the warning signs when they are first detected. This averts increase of severity of the indicators that can front a relentless asthma bother. These problems may result in an urgent situation requiring attention and may be fatal. The condition is not curable but with modern knowledge and therapies, asthmatic people can be aided to breathe better. However, care is the best method of managing it (Asthma 2009).
Body
A forty year old asthma patient known as Bill was taken in for an ED. He had been using steroids since his infant ages to control the asthma. Bill had an exacerbation of asthma owing to a familiar allergen. His results were RR – 36, HR – 150bpm, BP 142/88 Temp. 36.2 SpO2 – 88%. Owing to his severe condition, attention had to be given to help him recover. He was given oxygen via a non re-breather at 15 liters. Salbutamol, ipratropium bromide was administered via nebulizer. The therapy outcome was as follows; ABG results were pH 7.25 Pa oxygen 60mmHg Pa carbon dioxide 55mmHg hydrochloric acid 22mmol/L BE -2. There was no improvement while being given IV hydrocortine Adrenaline through nebulizer Salbutamol as an intravenous infusion IV and normal saline at 100ml/hr. The results show that Bill’s condition required attention thus the intervention provided (Hixon, Thomas, & Hoit 2005).
The low level of Carbon dioxide in the blood was due to the asthma condition. This gas is significant for the balancing of numerous bodily tasks. The pH equilibrium in the blood is aided by the presence of the carbon dioxide in the blood. For optimum oxygen intake by tissues, the body needs 5.5 – 6.5% carbon dioxide in the lungs. Asthma patients usually have an arterial carbon dioxide pressure of 33 mm Hg. Bill showed great change as his pressure changed to the normal level. His breathing reduced to normal as the imbalance was eased. This has been aided by the muscles in his chest being relaxed as he does not feel short of breath. The process of hyperventilation was corrected and so the body did not need to activate the protection method which is the asthma. He improved in energy due to the decrease in stiffening of the pulmonary muscles. This aided his breathing as the inhalation and exhalation were done easily. The pumping of oxygen using the non re-breather added much strength in the breathing. This resulted to a decrease in the pressure in the pulmonary vents. It was helped by the easy breathing as intake and exit of air was made uniform by the therapy provided. There were great hemodynamic changes due to the therapy. The use of ipratropium combined with salbutamol increases the peak exhalation flow rate. This mixture is advised for patients with heightened relentless asthma like Bill. (Courtney-Belford 1997)
Physical aspects that manipulate pulmonary ventilation are the change in breathing sequence as it was eased. The chest pains also subsided when the balance of gases was achieved by the body. The V/Q ratio improved as a result of the therapy and the ventilation will be working at the optimum. The ratio of ventilation and combination of the pulmonary operations were well matched. This was achieved due to the sufficient supply of gas exchange. If the alveolar ventilation equals the pulmonary blood run, carbon dioxide is removed and the blood is oxygenated. This can be observed in the high levels of oxygen found in Bill’s blood. (Hixon, Thomas, & Hoit 2005).
The hemodynamic changes observed were due to the increase of oxygen and removal of carbon dioxide. The medication which is anti-cholinergic worked to obstruct the mucus receptors from releasing mucus that clogs the airways. Increase of oxygen in the blood resulted to the shift in the pH balance to normal. A high presence of carbon dioxide in the blood causes it to be more acidic. This condition creates a situation where absorption of vital solutes is made difficult due to the imbalance. Most required solutes such as sugars and other elements depend on osmosis to move into and out of cells. The alkalinity and acidity ratio is very important for these exchanges to occur. Bill developed a balance in his hemodynamic systems which caused the preload, contractility and after load to be more efficient. There is no strain in the actions of pumping blood as the efficiency is realized at all sections of the respiratory system. This was accomplished by the patient administration given to Bill. The muscarinic cholinergic receptors are hindered from producing mucus that causes the difficulty in breathing. Medication has an effect on the intracellular calcium leading to reduction in constricting of soft muscles of the airways. (Courtney-Belford 1997).
A surge in the heart rate results in improved cardiac yielding of blood flow. This however, should be checked as it can lead to failure of the heart due to over working. A body that requires lots of supply of oxygen to the cells will trigger an increase in heart beat. This is a normal system response to aid in the exchange of gases in and out of the body. Bill showed an increased heart beat rate of 150bpm instead of the normal 72bpm. There was evidence of overworking by the heart to pump blood to the body. The heart was required to work harder to supply the much needed oxygen and remove the unwanted carbon dioxide. (Courtney-Belford 1997).
In some cases a faster heart beat rate can be very helpful. In circumstances where the body is required to absorb oxygen fast for its cells to function, a faster rate is needed. Build up of carbon dioxide in the muscles creates a feeling of muscle cramps and stiffness. This is as a result of the manufacture of lactic acid by the cells during their working. In such situations an increased heart rate is required to ensure the output of blood to these parts of the body is realized. Heart rate increase can lead to cardiac failure. When the heart is over worked with a constant beating above the normal rate, the functioning can cease hence the collapse. (Martin 2009).
In order to analyze Bill’s condition after the therapy, use of the Arterial Blood Gases features can be employed to determine the working of the system. The pH is one such feature. It shows the acidity and alkalinity equilibrium of arterial blood. Since the normal blood pH is usually 7.4 and that of Bill was 7.25, it can be said his blood pH equilibrium was slightly normal/acidic and may be recovering. A shift in the pH affects the normal functioning of the body. The respiratory system is one of the two major safeguards the body uses to provide a best possible surrounding inside the body. This is realized by buffer systems, the renal and the respiratory, in an opposite fashion. When one system shifts to one bearing, the other goes in a converse manner. The stabilizing part of the respiratory system is the carbon dioxide within the blood resulting from cell activities, and is removed via the lungs. The renal system eliminates the HCO3 which is the bicarbonate via the kidneys. This aids in checking of the pH by removing hydrogen ions which interfere with the balance. (Bartlett, Roloff, Custer, et al 2000).
Looking at the level of carbon dioxide, normal gradients are between 35 – 45 mmHg. Since Bill has a carbon dioxide level of 55mmHg it can be labeled as acidic. This will require that the excess carbon dioxide be removed by the buffer systems. When an adverse asthma hits, clogging of the air passages is intense increasing the inhalation and exhalation. The blockage results to increase in carbon dioxide levels in the blood of the patient. This will reduce the amount of oxygen in the blood significantly. However, since Bill is still under management, the therapy should be continued as the body also works to balance the excess. Another component of the blood is the dissolved bicarbonate intensity. An ordinary intensity ought to be 22 – 26mol/L and Bill shows a level of 22mol/L which is normal. To establish the acid-base disarray, the pH can go with either the pCO2 or the HCO3 and if the pH and the carbon dioxide levels are acidic then the reason can be attributed to the respiratory system. In Bill’s case the pH is 7.25 which are near normal – acidic while the carbon dioxide is 55mmgHg which is acidic. Therefore, the acid-base disorder is caused by the respiratory system. It is referred to as respiratory acidosis in medical terms. A further scrutiny of carbon dioxide or bicarbonate levels and the pH can reveal the reaction of the system. Owing to the direction of the pH and the carbon dioxide as acidic while the bicarbonate is normal, it can be deduced that the renal system is reimbursing in the balance. (Anderson 2003).
The intensity of the PaO2 and oxygen saturation can also be used to interpret the recovery level on Bill’s health. Usual in a normal human, the oxygen saturation is between 95 – 100% and PaO2 80 – 100mmHg. Bill was found to have a PaO2 of 60mmHg which is below the normal levels expected. Deducing from the observation, it can be summarized that there is proof of hypoxemia. The arterial PaO2 gives useful information on sufficiency of gaseous substitution within the lungs. The use of an equation Alveolar Gas Equation to calculate the PAO2 and the measured PaO2 can be used in knowing if the lungs are conveying the oxygen effectively from the environment to the pulmonary distribution system. The variations are determined and a ratio is calculated that can be used in assessing the condition. If the relationship of PA –Pa is eminent the rejoinder is negative and if it is standard it is positive. PaO2 is one of the deciders of SaO2; other deciders are circumstances that change the arrangement of the oxygen dissociation curve to the left or right. These could be the pH and PaCo2 amounts in the blood. The PaO2 is the propelling pressure for oxygen bits inward bound to the red blood cells and fastening to the hemoglobin. The increase in PaO2 results in the increase in SaO2. The SaO2 is the percentage of all fastening sites on hemoglobin which can be low but never above 100%. (Martin 2009).
Bill had a PaO2 of 60mmHg which showed that the pressure was still to low to propel the oxygen to bind with hemoglobin in the arterial systems. The low pressure causes the oxygen solubility to be low as less gas is dissolved. An increase in the pressure can result in increased attachment of the oxygen on the hemoglobin. The pumping of oxygen using the re-breather will continue to aid Bill in his recovery by having the oxygen delivered purely. The pressure is external from the device that is used to introduce the oxygen. PaO2 is not dependent on hemoglobin content or of its nature; however, it is only the alveolar oxygen and the nature of the lung that dictates the level of PaO2. That is why Bill’s condition shows a relatively normal PaO2 level. (Martin, 2009).
Mismatch that occurs between pulmonary ventilation and perfusion can lead to the mixing of venous blood and arterial blood. This is a typical arterial hypoxemia with standard or little carbon dioxide found in the arterial blood. On the other hand, respiratory malfunction can occur due to insufficient alveolar aeration as a result of bodily processes requirements. To determine if this is the case, evidence of arterial hypoxemia can be used. The latter is experienced when illness or damage impresses a weight on the respiratory system that is larger than the force existing to perform the respiratory function. Bill’s case can be interpreted as the second type of respiratory problem where the weight on the gaseous exchanges system exceeds the push he has in his respiratory system. (Anderson 2003).
The immunity system interference by use of salbutamol and ipratropium bromide combination is not yet known. The medication works to heal the smooth muscles aligning the air passages. This will aid the body in its normal functions and increase its fitness. An increase in oxygen uptake will result in multiplication of the number of red blood cells. Consequently, the white blood cells, which are the defense cells, will also multiply as they are interlinked in proportions. Ultimately, there will be a strong immune system due to the therapy. The body systems work in synergy and the malfunction of one of the components leads to a disabled body. Bill’s respiratory system must have had an effect on the other body systems including the immune organization. The developing of blood composition due to the therapy will aid the recovery of Bill’s health. Although slight differences are observed in the carbon dioxide levels, continued therapy will make the situation better. The immune system is comprised of numerous tissues and organs working in correlation. The blood composition should be held constant to sustain a vibrant defense system. The lymph nodes and other sites used by the defense system will be less troubled if the body is well. Bill’s health will improve if he continues on the regiment provided. (Bartlett, Roloff, Custer, et al 2000).
When Bill used steroid to ease his asthma attacks, he was endangering the defense system of his body. Steroids are chemicals that stimulate cells in the body hence the name steroids. They can be taken to target a certain ailment and in the process interfere with the balance of body systems. The immune system is not spared by the entry of steroids in the body. The chemicals are manufactured in the laboratory which makes them synthetic. The body cannot break down the steroids and hence prolonged use poses danger to the body. Bill was prone to immune system and other system breakdown. The defense system is called upon to handle any foreign element in the blood. The presence of the steroid will trigger a response from the defense system. This will result in over working and may lead to the collapse or weakening. (Martin, 2009).
When observing Bill’s presentation it can be noted that the levels of body conditions are abnormal. The increased heart rate, high blood pressure and high body temperature can be attributed to Bill’s uneasiness. These however, can be reduced by relaxation and psychological comfort. Advice on the foods taken can also help reduce the increased production of mucus. Foods that are cold should be avoided as they aggravate the production of mucus. A systematic elimination of food stuffs from ones diet to distinguish which particular food prompts mucus build up. The medication should be kept within reach at all times incase of alarm. Bill should continue with the medication taking precaution in what he takes as food. (Bartlett, Roloff , Custer , et al 2000).
The use of depressants such as cigarettes and caffeine can interfere with the healing process. These depressants alter the arterial blood gases balance causing a disturbance in normal operations of the body. Certain food stuffs should be avoided out rightly as these cause the nasal system to produce mucus. Responsibility of the management of a patient’s asthma is mostly put on the patient. If the patient understands the reasons as to why the asthma has to be taken care of, the better for him or her and their families. (Anderson 2003).
Conclusion
Asthma is a disease that has no known cure yet. Patients are advised to manage the conditions that can lead to an asthma attack. The disease is developed as a result of sliming of lung air passage ways making air movement difficult. The treatment requires a widening agent in the form of medication. The use of oral or inhaled method reverses the difficulty in breathing by dilating the muscles of the air ways. The use of salbutamol combined with ipratropium bromide as a bronchodilator helps in the management of asthma. Emergency cases require the introducing of oxygen via a non re-breather to facilitate the inflow of pure oxygen into the lungs of the patient. Continued monitoring of patients reaction to treatment is also advised for better management. Some patients might develop resistance to certain medicines requiring a change in the prescription. The arterial blood gases are a good way to monitor the patient’s progress under medication. Usual levels are used to compare the developments in patient health.
Things that can aggravate the asthma could be sudden alteration in temperature or moisture in the air. These situations should be avoided and if need be, precaution should be taken such as to dress warmly. Allergies, stress, smoke and lack of exercise among others can also trigger the asthma in a patient. People with asthma should be well advised on the danger of neglecting to take precautionary measures. The condition is very dangerous to the human health and can lead to death. However, patients should not be given or advised to use steroids due to the side effects of the chemicals. Prolonged use of steroids destroys other body tissues and organs as the body cannot breakdown the chemicals.
List of References
Martin, L 2009, PaO2, SaO2 and Oxygen Content.
Asthma 2009, what is Asthma.
Priestly, AM 2008, Respiratory Failure.
Courtney-Belford, R 1997, Healthy breathing” Australian wellbeing
Hixon, J. Thomas and Hoit 2005, Jeannette Evaluation and Management of Speech Breathing Disorders, Arizona: Bedington Brown
Anderson MR 2003, Update on pediatric acute respiratory distress syndrome. Respir Care, no 48, pp261-276
Bartlett RH, Roloff DW, Custer JR, et al 2000, extracorporeal life support: the University Of Michigan experience. JAMA, vol 283, no7 pp 904-8