An assessment of the exacerbation of Asthma (Shortness of Breath and cough) provides one with the necessary experience in analyzing critically ill patients and selecting the appropriate nursing management for the condition. The problem’s process revolves around identifying the vital signs that explain the changes linked to the altered physiology. The analysis case refers to an assessment of Mr. M.P, who was referred to the hospital with an exacerbation of asthma (SOB and cough). Mr. M.P is a 51-year-old white male born on 8th April 1971 in Melbourne, Australia. He is a full-time engineer working at a local construction company. The patient lives with his 49-year-old wife and three children, but the wife states that her husband sleeps late at night due to job commitments. The patient was brought to the facility by his wife, who narrates the chief concern that necessitated the referral.
History of Present Illness (HPI)
According to the narration by the wife, upon arriving home from a job, Mr. M.P started complaining of frequent coughs, shortness of breath, and chest tightness. The wife narrates the patient had been sustaining a cough for the past week, with a wheezing sound that developed in the last three days. The wife testifies that M.P is a cigarette smoker, and the patient confirms that he smokes at least 20 cigarettes per day. The patient is allergic to pet pander or with no medical intolerances. The patient only had minor surgery on his left toe while having difficulty managing his asthma attacks. Family history reveals that his father also had asthma, while the patient has recently had an average of two hospital visitations resulting from exacerbation of asthma. The wife narrates that the patient is under inhaled corticosteroids (ICS) which he uses at the onset of exacerbations. Further analysis of the patient is essential in diagnosing and managing the condition.
Review of Systems
According to the wife’s revelations, M.R. M.P has gained more weight over the past six months. This situation can be noted because his clothes no longer fit. The narrator states that her husband complained of fatigue with a general loss in appetite over the period when the symptoms started to intensify. Though the patient does not complain of any chronic pain, he says he has been feeling unwell lately. The patient experiences fevers and chills sometimes during the night with no case of weight loss. In regards to the vision of the patient, there are no cases of any impaired vision though eye redness can be observed in the patient. The patient does not report any double vision, eye discharge, or pain. Further analysis of the patient organ system is crucial to uncover dysfunction and disease that might be affecting the patient.
An examination of the head and neck of the patient reveals lymph node enlargement. An otoscopic examination of the patient’s ears reveals that the ears are healthy as the eardrum appears grayish with a translucent appearance. The patient’s oral mucosa is reddened with the prevalence of nasal congestion, a runny nose, and cases of sneezing. An examination of the mouth of the patient reveals swollen gums and obvious cavities. Additionally, the patient’s detention is still intact, with revelations of mild pain along the gums. A further review of the patient’s pulmonary system can be undertaken through inspection or observation. A lung examination is conducted through percussion, palpation, inspection, and auscultation.
An inspection of the patient shows Mr. M.P distressed with deep, irregular breathing. The tightness of the scalene muscle is vivid, with the patient appearing to lean forward while resting his hands on the knees (Basu and Perry, 2021). The patient seems to have difficulties speaking as he speaks fewer words within a sentence. Audible wheezing sounds can be noted when the patient is breathing (Chatziparasidis, Priftis, and Bush, 2018). The nail beds of the patient seem to take a blue color, while an assessment of chest excursions through palpation reveals an asymmetric lung expansion. These findings indicate the possibility of either air or fluid filling the pleural space. Careful palpation of painful areas reveals no case of rib fracture.
The patient is experiencing a chronic cough with shortness of breath and a rapid heart rate. An examination of the patients gastrointestinal reveals no ulcers, black tarry tools, or hepatitis. However, the patient reports having a loss of appetite. Genitourinary/gynecological examination of Mr. M.P narrates no cases of burning sensation when urinating, frequency or urgency in urination. The patient does not report any changes in urine color or genitalia concerns. Apart from a history of a broken toe, the patient does not have any fractures, back pain, trauma, or swelling within joints. A neurological examination reveals that the patient’s reflexes are not compromised. However, the patient’s gait is weak as he struggles to stand upright (DerSarkissian, 2022). The patient has never had any episodes of seizure, transient paralysis, blackout spells, or syncope.
Discussion of Vital Signs
Upon patient presentation to the hospital, measurement of vital signs reveals a height of 180 cm while he weighed 90 kg. Therefore, the BMI of the patient is 27.8 kg/m2, indicating that M.P. is overweight (Centers for Disease Control and Prevention, 2022). The patient’s oral temperature is 98.6°F, while his respiratory rate is 23 breaths/min, a heart rate of 127 beats/min, and a paradoxical pulse of 15 mmHg. The patient’s systolic pressure is 134 mmHg with a diastolic pressure of 88 mmHg. Observing the patient makes it easy to note that he is in discomfort or pain. A review of the vital signs helps in discovering the health status of a patient (Sapra, Malik, and Bhandari, 2022). Vital signs provide one with a means of hurriedly quantifying the magnitude of an illness and how well the body is coping with the psychological distress.
Adding weight affects the ability of an individual to control asthma and quality of life. An article by Bass (2021) reveals that adding an estimated 5 pounds has been linked to 22% self-rated asthma control. Earlier examination reveals that Mr. M.P has been experiencing weight gain as he testifies majority of his clothes no longer fit. Peters, Dixon, and Forno’s (2018) study further add that obese individuals have a heightened risk of asthma. The research states that obese individuals tend to experience frequent and severe exacerbations, reduced quality of life, and decreased response to asthma medications.
Being overweight is also linked with cases of shortness of breath. According to a cross-sectional population-based study by Currow et al. (2017) prevalence of being overweight has significant consequences on dyspnea. Though the physiological mechanisms of shortness of breath among overweight and obese individuals are still unclear, combinations of changes in pulmonary mechanics and ventilatory drive are some of the likely contributing factors (Agustin et al, 2017; Grassi, Kacmarek, and Berra, 2020). A further review of the patient’s cardiovascular and pulmonary symptoms is critical in determining the best nursing management for the patient.
The majority of the situations when a patient experiences shortness of breath mainly occurs due to lung or heart conditions. The lungs and heart are critical in transferring oxygen to the tissues and eliminating carbon (IV) oxide; any complications among these organs can affect a patient’s breathing (Kaynar, 2022). Shortness of breath can result from heart failure, asthma, lung disease, obesity, or poor fitness (Mayo Clinic Staff, 2022). When a patient experiences heart failure, blood cannot fill or leave the heart efficiently. This phenomenon can result in fluid accumulation within the lungs, thus making patients experience shortness of breath (Cullinan et al, 2017). When patients are overweight, it can strain their lungs, thus making it difficult for them to breathe (Bates et al., 2021). Asthma, where shortness of breath is also prevalent, occurs when airways tend to narrow.
Poor fitness due to illness or inactivity can also result in shortness of breath.
Any harm to the tissues of the lungs can result in dyspnea. This situation is common among patients with tobacco smoking linked to chronic obstructive pulmonary disease (COPD). Mr. P being a tobacco smoker, is at risk of COPD. According to Verberne et al. (2017), overweight and obesity are common amongst patients experiencing milder stages of COPD (Balmain et al. 2020). The condition commonly arises from smoking or long-term exposure to lung irritants (Dharmage, Perret, and Custovic, 2019). The symptoms of COPD are similar to those of asthma. Thereby it is crucial to differentiate the two. In both conditions, swelling within the airways tends to constrict one’s ability to breathe effectively. However, in asthma, the swelling is highly triggered by a given allergic reaction or physical activity (Belleza, 2022). On the other hand, COPD refers to an umbrella name given to a class of lung conditions like chronic bronchitis and emphysema (Cleveland Clinic medical professional, 2022). Emphysema occurs when the alveoli are destroyed; chronic bronchitis results when tubes that carry air to the lungs are inflamed. Differential diagnoses are significant where two conditions share symptoms.
A critical review of Mr. P.M’s symptoms, family, and medical history is essential; if need be, tests can be appropriate to help diagnose the patient. The patient’s wife reveals that his son’s friend had visited him accompanied by his pet dog. However, because Mr. M.P is a smoker, it does not necessarily indicate that it could be entirely an asthmatic attack. The patient does not appear to have clubbed nails; however, a simple Carbon (IV) Blood test reveals levels of 30 mmol/l (Shroff, 2022). These results reduce the chances of hypercarbia, where carbon (IV) oxide levels are high in the blood. A CT scan of the patient’s chest does not reveal any damage to the alveoli.
A review of the patient’s past medical and family and various vital signs and symptoms depicts that Mr. M.P is suffering from an exacerbation of asthma. Exposure to pet pander triggered the patient’s asthmatic symptoms. According to findings of a survey conducted by Gergen et al. (2019), 44.2% of asthma attacks resulted from exposure to pet allergen. Research by Tiotiu et al. (2021) further reveals that tobacco smoking is linked with asthma exacerbation. Cigarette smoking in asthma patients is associated with increased doctor visits and hospital admissions due to poor asthma control (Silverman et al., 2017). Determination of the key condition affecting the patient helps choose the best nursing management regime and management strategy for the patient.
A spirometry measurement of the patient’s forced expiratory volume in 1 s (FEV1) of less than 50% predicts a severe obstruction. Though the patient is under inhaled corticosteroids (ICS), the treatment does not help him manage the exacerbations. The patient seems to be experiencing severe asthmatic attacks based on recent hospitalizations. The primary treatment intervention in an acute asthmatic attack is the provision of supplementary oxygen (Ruangsomboon et al., 2020; Rochwerg et al., 2017). The saturation levels should remain above 92% to relieve hypoxemia and alleviate shortness of breath. According to research by Geng et al. (2019), oxygen therapy has short promise in alleviating symptoms of severe asthma complications (Sage, Chomberg and Hart, 2017). The therapy enables better airflow and reduced breathing rate, normalizing the patient’s body pressure, heart rate, and shortness of breath (Penninga, Lorentzen, and Davis, 2020). A study by Maselli and Peters (2018) reveals that some patients might not respond adequately to standard therapies like the use of inhaled corticosteroids (ICS). Nursing management approaches like oxygen therapy are critical in alleviating progressive symptoms of cough, shortness of breath, and wheezing.
Besides oxygen therapy, patient positioning offers another strategy to manage the patient’s condition. The prone positioning technique is a treatment strategy that involves placing patients with breathing complications on their stomachs (De Jong et al., 2020; Hadaya and Benharash, 2020; Ponseti et al., 2017). This technique will help Mr. M.P breathe better due to his body weight. This position is essential as it ensures less lung compression and better gas exchange efficiency within the lungs. Additionally, the strategy enhances the functioning of the heart and its ability to deliver oxygen within the body. Investigations by Haday and Benharash’s (2020) and Scholten et al., (2017) reveal that the prone positioning of patients with severe asthmatic attacks also helps the patient better drain a secretion produced within the lungs if they were diseased.
The goals of asthma management revolve around the need to attain effective control of the symptoms and maintain normal activity levels for the patient. The nursing management strategy also aims at minimizing future risks of asthma exacerbations for the patient. Nurses play a critical role in reviewing and evaluating whether a certain patient adequately manages the asthma condition. An analysis of the areas of concern that need to be corrected by the patient is essential for any nurse managing a patient with asthma. Important support and advice to Mr. M.P and his wife ensure that the patient stays away from the asthmatic triggers.
Most importantly, the patient needs to avoid smoking as the behavior is linked significantly with asthma exacerbations. Smoking for individuals with asthma intensifies the risk of severe attacks that might be fatal if proper intervention is delayed (Schneider, 2017) Additionally, there is a need for the patient to reduce weight; it increases the risk of developing shortness of breath, body fitness, and heart failure (Galante, 2022). Finally, the patient must attend the relevant appointments to ensure his health is well monitored to manage the condition effectively. Mr. M.P is at risk of developing pulmonary complications that might result due to his body weight and lifestyle. Next to clinical appointments needs to examine the patient’s cardiac health to reduce the risk of developing cardiac failure or other complications that result from being overweight and smoking habits.
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