Pathophysiology of Asthma
According to the Global Initiative for Asthma [GINA], 2023, asthma is a chronic inflammatory illness of the airways that is defined by a range of recurrent and fluctuating symptoms, restriction of airflow, and hyper responsiveness of the bronchi. Airway remodeling and inflammation are the result of intricate interplay between hereditary and environmental variables in the pathophysiology.
Allergens, irritants, or respiratory infections can cause an increased immune response in people with asthma. In reaction, inflammatory mediators such histamines, leukotrienes, and prostaglandins are released as a result of mast cell, eosinophil, and T lymphocyte activation (Kumar et al., 2021). The broncho constriction, increased mucus production, and airway epithelial enlargement brought on by these mediators result in the classic symptoms of wheezing, coughing, tightness in the chest, and shortness of breath.
Factors Related to Asthma
- Cultural Implications: Cultural ideas and practices can profoundly influence asthma management. According to Cohen et al. (2022), certain cultures have a preference for traditional cures over Western medicine, which could result in a low level of adherence to prescription medications or inhalers. For education and support to be effective, it is imperative that these cultural differences are understood.
2. Financial Implications: The expenses associated with asthma can be high and include those for prescription drugs, recurring physician visits, and emergency treatment (Reddel et al., 2021). Low-income families might find it difficult to pay for long-term care, which could worsen the illness and increase the need for medical attention.
Environmental Implications: According to Brunekreef & Holgate (2020), environmental variables are a major cause of asthma exacerbations. These factors include exposure to allergens (such as dust mites and pollen), air pollution, and tobacco smoking. Urban children may be more exposed to these triggers than other children, therefore minimizing their effects may need focused efforts.
Priority Nursing Interventions
- Administer Bronchodilators: Ensure the prompt administration of short-acting beta-agonists (SABAs) to relieve acute bronchospasm.
- Monitor Respiratory Status: Continuously assess respiratory rate, effort, oxygen saturation, and lung sounds to identify changes in the patient’s condition.
- Provide Oxygen Therapy: Administer supplemental oxygen as needed to maintain oxygen saturation levels above 92%.
- Educate Family: Involve the family in understanding the condition, recognizing early signs of exacerbation, and the importance of medication adherence.
- Positioning: Encourage the patient to sit upright or in a position of comfort to facilitate easier breathing.
Labs and Diagnostic Testing
- Pulmonary Function Tests (PFTs): These tests help assess lung function and can be crucial for diagnosing asthma severity. A reduced forced expiratory volume in one second (FEV1) indicates obstruction (National Heart, Lung, and Blood Institute [NHLBI], 2020).
- Arterial Blood Gases (ABGs): ABGs help assess the patient’s oxygenation and carbon dioxide levels, which are critical during severe asthma exacerbations.
- Complete Blood Count (CBC): A CBC may show eosinophilia, indicating an allergic component to the asthma.
- Allergy Testing: Skin or blood tests can help identify specific allergens contributing to the patient’s asthma.
Interdisciplinary Team Members
- Respiratory Therapist: To provide specialized care in managing respiratory distress and administering respiratory treatments.
- Pharmacist: To optimize medication regimens, ensure proper dosing, and monitor for drug interactions.
- Nutritionist: To offer dietary advice that can help reduce inflammation and improve overall health.
- Social Worker: To assist the family with financial resources, access to care, and support for managing chronic conditions.
- School Nurse: To ensure a comprehensive asthma management plan is in place when the child returns to school.
Conclusion
Effective asthma management requires an integrated, multidisciplinary approach, especially in a critical care situation. For children like Elliot, healthcare providers can greatly enhance outcomes by focusing nursing treatments and taking into account cultural, economical, environmental, and pathophysiological aspects.
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Pathophysiology
Asthma is a respiratory disease characterized by obstruction of the airway typically caused by an external stimulus that triggers inflammation of the lung lining (Banasik, 2022). Asthma is a common disease occurring in around 7-14% of the U.S. population and is usually diagnosed during childhood and early adulthood. There is a higher incidence of asthma diagnoses in African American children, children who were born prematurely, and those who live in highly populated cities (Banasik, 2022).
Cultural Implications
It is reported in the literature that African American and Latino children have the highest incidence of asthma cases in America compared to white children (Koinis-Mitchell et al., 2010). It is reported that this increased incidence could be a result of more African American and Latino families living in bigger cities where air quality is poor (Koinis-Mitchell, 2010). It is important to use this information to provide culturally competent care to patients who may be in these situations.
Financial Implications
In 2019, the annual direct and indirect cost of asthma in the U.S. totaled around $56 billion (Banasik, 2022). Most patients with asthma require multiple medications to control their symptoms. Medications like rescue inhalers, maintenance inhalers, and nebulizers are common treatments that contribute to the costs of asthma (Banasik, 2022). Although most medications for asthma treatment is covered by commercial insurance, there are many other expenses that cannot be covered. Many patients with asthma purchase additional home air purifiers and humidifiers which pose an additional expense.
Environmental Implications
The environment is an important factor in the lives of patients with asthma. Some of the environmental factors that can trigger an asthma attack are allergens, smoke, and cold climate (Banasik, 2022). It is important for patients with asthma to control the air quality of their environment as much as they can.
Priority Nursing Interventions
If I were a nurse in the PICU where Elliott was being treated, I would use the ABC’s of emergency medicine (airway, breathing, and circulation) to direct the interventions I would do for him. First, I would assess his airway to ensure patency (Makic et al., 2023). I would also get a set of vital signs to make sure that he is adequately breathing and moving oxygen around his body. Secondly, I would assess his levels of anxiety because increased anxiety could hinder his ability to breathe (Makic et al., 2023). I would provide therapeutic communication to make him feel better about being in the hospital. Thirdly, I would teach and encourage Elliott to use deep breathing positions and exercises to make breathing easier for him (Makic et al., 2023).
Laboratory and Diagnostic Testing
Arteriole Blood Gas (ABG) testing would be an important lab test for patients with asthma to determine if there are any acid-base imbalances and hypoxemia (Banasik, 2022). A chest x-ray would also be an important diagnostic tool to visualize any obstructions or abnormalities within the lungs Banasik, 2022). Peak expiratory flow rate (PEFR) is an important test to obtain to measure how effectively the lungs are able to function (Banasik, 2022). Some critical indicators I would be looking for from these tests are respiratory alkalosis, chronic narrowing of the airway, and a PEFR value of less than 80 liters per minute (Banasik, 2022).
Interdisciplinary Team Members
In order for Elliott to receive the best holistic care, many members of the interdisciplinary team will need to be part of his care (University of Rochester Medical Center, n.d.). A pulmonologist will need to be consulted to direct the plan of care related to his respiratory function. An allergist may need to be consulted to find any allergic causes of Elliott’s asthma. Physical therapy and occupational therapy will need to be consulted to teach Elliott how to maximize his respirations while during physical activity and performing activities of daily living. The pharmacist will dispense and adjust any medications Elliott may need. Lastly, respiratory therapy will be a part of the interdisciplinary team to administer breathing treatments and manage any oxygen delivery devices he may need.
References
Banasik, J. L. (2022). Pathophysiology (7th ed.). Elsevier.