This assignment is a case study of a patient who was admitted to a respiratory ward with acute exacerbation of asthma. This assignment will discuss nursing an adult patient with asthma, also it will aim to critically assess, plan, implement and evaluate the patients nursing needs using the Roper, Logan and Tierney nursing model (1980). This case study will focus on the maintaining a safe environment. It is worth noting that the activities of daily living are interlinked e.g. according to Roper et al (1980) breathing is an activity that is crucial for life therefore all other activities are dependent on us being able to breathe. The nursing management, pharmacological agents and the tools used will be critically reviewed and how they are contributed to the overall care of this asthmatic patient will be illustrated. To ensure confidentiality the name of the patient has been changed and consent obtained from both the patient and ward manager in compliance with section five of the code of professional conduct (NMC 2008).
Jane, a 25 year old, was referred to the respiratory ward by her GP she had a five day history of increased shortness of breath, a cough and an audible wheeze. Jane was diagnosed with asthma at the age of ten. There is a history of asthma in her mother’s family. Jane’s previous admission for exacerbation of asthma was March 2007 to another hospital. On arrival Jane was immediately seen for aggressive treatment of exacerbation of asthma.
Asthma is a chronic disease and its common occurrence has increased considerably over the last decade. In 2006 Asthma UK found that the UK had the highest occurrence of asthma sufferers (up to thirteen percent) from anywhere else in Europe, (Asthma UK, 2006). In the past asthmatics were treated intermittently, it was not recognised that their affliction was due to a chronic inflammatory process requiring long term management. Levy and Hamilton (1999) noted that the most important advance was the recognition of asthma as being inflammatory in nature and treated as a chronic condition.
The British Thoracic Society (2006) describes asthma as a chronic inflammatory condition of the airways. As a result of the inflammation the airways become hyper responsive and narrows easily in response to many stimuli. Asthma involves two stages; the first stage is hyper-reactivity and the second inflammatory. In the Hyper-reactive response smooth muscles in the airway constrict in reaction to inhaled allergens or irritants. It should be noted that everyone’s airways respond by constricting when exposed, but people without asthma are able breathe in deeply to relax the airways and rid the lungs of irritants).
When asthmatics, like Jane, try to take those same breaths their airways do not relax (Esmond 2001). The hyper-reactive stage is followed by the inflammatory stage. This is where the immune system responds to allergens or other triggers, by delivering immune factors to the airways i.e. leukocytes. The most important of the leukocytes are the eosinophils, others include neutrophils, microphages, and the mast cells (Levy and Hilton 1999). These inflammatory factors cause the airway to swell, fill with fluid and produce a sticky mucous. The sputum is capable of plugging small airways; however culture of this sputum rarely confirms the presence of a pathogen (Hunter 1995).
Roper et al (1980) points out that the initial assessment of a patient is vitally important but should be ongoing throughout the patients stay in hospital. The assessment must be appropriate, accurate and comprehensive in order to ensure the patient receives the treatment that is required Welch (2000). Due to Jane’s breathing difficulty, she was at risk of obstructing her air passage and having a cardiac/respirator arrest. The Roper, Logan and Tierney model (1980) classes these as potential problems. It is important that potential problems are recognised, so that...