the Pediatric Intensive Care Unit

Sample Solution

Respiratory Alterations: Asthma

Pathophysiology of Asthma

Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or early morning. These symptoms are caused by airway hyperresponsiveness, which leads to bronchoconstriction, increased mucus production, and mucosal edema.  

The pathophysiology of asthma can be summarized as follows:

1. Inflammation: The airways become inflamed due to the infiltration of inflammatory cells, such as eosinophils and mast cells.
2. Airway Hyperresponsiveness: The airways become overly sensitive to triggers, such as allergens, irritants, and cold air, leading to bronchoconstriction.
3. Bronchoconstriction: The muscles surrounding the airways contract, narrowing the passages and making it difficult to breathe.
4. Mucus Production: The airways produce excess mucus, which can further obstruct airflow.
5. Mucosal Edema: The lining of the airways becomes swollen, further narrowing the passages.

Source: National Institutes of Health (NIH). (2023). Asthma. National Heart, Lung, and Blood Institute.

https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates

Full Answer Section

Factors Related to Asthma

1. Cultural Implications:

• Beliefs and Practices: Cultural beliefs and practices can influence the perception of asthma, its management, and adherence to treatment plans. For example, some cultures may attribute asthma to supernatural causes, leading to alternative or complementary treatments that may not be effective.
• Stigma: In some cultures, asthma may be stigmatized, leading to feelings of shame or embarrassment among individuals with the condition. This can affect their willingness to seek help or adhere to treatment plans.

Source: World Health Organization (WHO). (2019). Asthma. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/asthma

2. Financial Implications:

• Access to Care: The cost of asthma medications, medical appointments, and specialized care can be a significant financial burden for families. This can lead to undertreatment or non-adherence to treatment plans.
• Economic Impact: Asthma can have a significant economic impact on individuals and families, as it may lead to missed work or school days, reduced productivity, and increased healthcare costs.

Source: American Lung Association. (2023). Asthma and Finances. American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma  

3. Environmental Implications:

• Exposure to Allergens and Irritants: Exposure to allergens (e.g., pollen, dust mites, pet dander) and irritants (e.g., air pollution, tobacco smoke) can trigger asthma attacks. Environmental factors, such as air quality and housing conditions, can also play a role in the development and management of asthma.
• Climate Change: Climate change may exacerbate asthma symptoms by increasing the frequency and severity of allergic triggers, such as pollen and air pollution.

Source: World Health Organization (WHO). (2019). Asthma. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/asthma

Priority Nursing Interventions

1. Monitor respiratory status: Continuously monitor Elliot's respiratory rate, oxygen saturation, and lung sounds to assess the effectiveness of treatment.
2. Administer medications as ordered: Ensure timely administration of bronchodilators and corticosteroids to alleviate bronchoconstriction and reduce inflammation.
3. Provide oxygen therapy: If necessary, administer oxygen to improve oxygenation.
4. Promote rest and comfort: Create a calm and restful environment to minimize stress and promote healing.
5. Educate the family: Provide education about asthma management, including trigger avoidance, medication administration, and early recognition of symptoms.

Labs and Diagnostic Testing

• Complete blood count (CBC): To assess for signs of infection or inflammation.
• Basic metabolic panel (BMP): To evaluate electrolyte balance and kidney function.
• Pulmonary function tests (PFTs): To measure lung function and assess the severity of airway obstruction.
• Chest X-ray: To rule out other conditions that may be causing respiratory symptoms.
• Allergy testing: To identify potential allergens that may trigger asthma attacks.

Critical indicators:

• Respiratory rate: A rapid respiratory rate may indicate worsening asthma.
• Oxygen saturation: A decrease in oxygen saturation may indicate hypoxemia.
• Lung sounds: Wheezing or decreased breath sounds may indicate airway obstruction.

Source: American Lung Association. (2023). Asthma Tests and Procedures. American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/symptoms-diagnosis

Interdisciplinary Team Members

• Pulmonologist: A specialist in respiratory diseases who can provide expert guidance on asthma management.
• Respiratory therapist: A healthcare professional who can assist with respiratory treatments and monitoring.
• Dietitian: A healthcare professional who can provide nutritional advice to help manage asthma symptoms and promote overall health.
• Social worker: A healthcare professional who can help address the social and emotional needs of the patient and family, including financial assistance and support services.
• Psychologist or counselor: A healthcare professional who can help manage stress, anxiety, and other psychological factors that may contribute to asthma symptoms.

Source: National Institutes of Health (NIH). (2023). Asthma. National Heart, Lung, and Blood Institute.

https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates