Adult Nurse Case Study Acute Asthma
Learning Outcome 2 - Critically evaluate the evidence required to care for and support adults with acute health conditions (about 650 words)
Demonstrating understanding of your patient’s condition: Explain your patient’s acute condition (50 words: 3 different source references)
Patria presented with a moderate asthma attack following a forty per cent decline in peak flow measurement. Although high (130/85) mmHg, her blood pressure is not hypertensive. Her pulse rate is at the normal rate. However, she is hyperventilating, has a fever, and has a below-average pulse oximetry score (94%).
Outline and critically analyse the evidence relating to the care of your patient and their condition.
Include epidemiology (global, national and local trends), pathophysiology, nursing care, pharmacology of your case study acute condition: Asthma
Make links to NICE guidance https://www.nice.org.uk/guidance
World Health Organisation (WHO)
https://www.who.int/publications/guidelines/en/
Page, K. (Ed.). (2012). Nursing the acutely ill adult: case book. McGraw-Hill Education (UK). (Library resource)
According to (Mukherjee et al., 2016), about eight per cent of the national population has asthma. Asthma is more prevalent in children than adults (WHO, 2021). Additionally, the condition is increasingly prevalent among ethnic minorities and those in lower socioeconomic classes. Asthma’s underlying pathophysiology is airway inflammation resulting in airway narrowing. In nursing care, the severity of the patient’s asthma symptoms defines immediate care. Nursing assessment of asthma patients involves respiratory status, peak flow, breath sounds, pulse oximeter, and vital signs (Lambert, 2019). Diagnosis is characterised by impaired gas exchange, anxiety, and futile airway clearance. There are various key nursing objectives applicable in treating asthma patients, including secretions expectoration, maintaining airway patency, and declining/lack of congestion. Nurses are also involved in various asthma interventions, especially assessing respiratory status, assessing history, assessing medication, fluid therapy, and pharmacologic therapy (Mitchell & Govias, 2021).
A basic understanding of pharmacological interventions is instrumental in nursing (Page, 2012). Pharmacologic asthma therapy depends on the severity of the condition and aims to decrease the symptoms, especially inflammation and airway obstruction. The interventions restore normal lung function and inhibit exacerbations. Mitchell & Govias (2021) suggested glucocorticoids and β2?Adrenoceptor agonists be the most valuable drugs in achieving the objectives. Anticholinergics and leukotriene receptor antagonists are considered second-line pharmacologic therapy. Inhaled steroids containing β2?adrenoceptor agonists are recommended for their efficacy (Bloom et al., 2020). The recommended pharmacologic therapy in Patricia’s case was Salbutamol and Budesonide.
Outline and critically analyse the evidence relating to the care of your patient and their condition: (Here use Patricia readings into the assessments to analyse the evidence)
Relate to signs and symptoms and how you would care for this-use supporting references
The A-E assessment; Airway, Breathing, Circulation, Disability, Exposure (ABCDE) assessment-ensure to reference
Care bundles, care pathways-reference these
Typical Tests, investigations/bloods, CXR, medication, fluid balance, specimen, examinations, drips and drains, infection control etc
Documentation/record keeping as appropriate
Look at notes A to E and consider care you have delivered in the past and principles of medical and surgical nursing notes
The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is a key immediate assessment approach for Patricia’s acute condition. A clinical assessment of the patient’s airway would examine her capacity to speak. Difficulties speaking indicates a compromised airway due to inhalation of a foreign body, secretions in the airway, laryngospasm, soft tissue swelling, or blood in the airway (Atmojo, 2019). A compromised airway demands expert support. The second step would be to assess Patricia’s breathing. Tachypnoea is a common asthma exacerbations’ element indicative of a respiratory compromise. Other measures for assessing the patients breathing include reviewing her oxygen saturation, auscultating her lungs, and percussing her chest. An arterial blood gas should follow a low SpO2 score to ascertain hypoxia extent (Thim et al., 2012). Other procedures related to breathing include a chest x-ray and peak expiratory flow rate.
Thirdly, a clinical assessment of the patient’s circulation should be carried out. Such should include pulse, blood pressure, fluid balance, and capillary refill time. Tachycardia, hypotension, diminished capillary refill time, and oliguria may indicate severe concern. Appropriate procedures include intravenous cannulation and blood tests, especially CRP (Peate & Brent, 2021). A C-reactive protein test is revealing of any signs of inflammation. The fourth concept in the assessment is a disability. Hypovolaemia and hypoxia may compromise the patient’s consciousness (Atmojo, 2019), which is assessed using the AVPU scale. A drug chart review and pupils’ examination would also be revealing of her consciousness. However, the concept can be ascertained through blood glucose and ketones screening and imaging. Lastly, exposure is fundamental during the assessment while prioritising her dignity and conserving her body heat (Nursing & Midwifery Council (NMC), 2018).
Moreover, Bridgeman & Wilken (2020) acknowledged the appropriateness of the TAPES (Technique and Medication + Action Plan + Environment + Subsequent care) care bundle in nursing asthma patients. The initial bundle statement conveys the significance of acquiring an inhaler technique before discharge. The appropriate application of the inhaler enhances the outcome. Secondly, it is instrumental in examining the patient’s medication, especially concerning adherence. Additionally, the patient or their caregiver is presented with a written action plan to manage asthma symptoms. An action plan is instrumental in identifying triggers to minimise exposure and decrease recurrence (NMC, 2018). Lastly, subsequent care concerns the provision of follow-up, which should be initiated within two days following the patient’s discharge.
Learning Outcome 3 - Examine a range of health assessment strategies and tools in order to develop a person-centred care plan (about 650 words)
Examine several health assessment strategies / tools Person-centred care plan
Outline and examine health assessment strategies and tools useful for devising a person-centred care plan for your chosen patient.
Pick 3 health assessment tools would be appropriate for your patients care and why?
Health Assessment One:
ABCDE
Why is this appropriate for your patient?
The appropriateness of the ABCDE assessment approach is evident in its efficacy in dealing with critical conditions. Peran et al. (2020) suggested that the methods should be explicitly utilised following suspicion of critical illness. As such, it is effective in recognising or ruling out the existence of critical conditions. As such, the approach would be instrumental in examining the varying symptoms evident in Patricia’s case study. The suitability of the technique is further demonstrated by its capacity to facilitate interpretation of investigation results and formulating responses, which is critical in nursing (NMC, 2018).
What are the strengths of your chosen assessment tools?
ABCDE technique is widely recognised by experts in the field in various fields, including emergency technicians, traumatologists, and acute care specialists. Smith & Bowden (2017) also demonstrate its effectiveness in expediting treatment and enhancing the quality of care. Uniformity in the approved ABCDE assessment algorithms improves inter-disciplinary cooperation in treating the critically ill. Additionally, professionals with an exceptional understanding of the technique demonstrate increased confidence in implementing a care plan.
What are the weakness of your chosen assessment tools?
However, Carter (2019) identified some limitations to the applicability of the approach. The study suggested the ABCDE is not recommended in areas where a short clinical perception of the patient is required. ABCDE is also not suitable in instances where stable vital signs have been observed or when the incentives behind visiting the hospital are not reminiscent of the patient critical condition. Lastly, ABCDE is not appropriate in cases where the initial visit was carried out by a doctor.
Health Assessment Two:
Exhaled Nitric Oxide Measurements (Feno)
Why is this appropriate for your patient?
There are significant practical and theoretical aspects supporting the applicability of exhaled nitric oxide measurements (FEno) in clinical settings. Its applicability in the presented case study is as a substitute indicator of Type 2 airway inflammation (Saito et al., 2018). Additionally, given the ineffective ones of pharmacological interventions, the method can be applied to ascertain adherence.
What are the strengths of your chosen assessment tools?
In assessing Asthma, FEno test is ideal for identifying eosinophilic airway inflammation. According to research, eosinophilic and non-eosinophilic pathologies are distinguishable through FEno levels (Abe et al., 2021). The concept is especially crucial among patients with non-specific respiratory symptoms.
Additionally, Korn et al. (2019) suggested increased steroid responsiveness in the eosinophilic airway. There is immense evidence supporting the utilisation of FEno measures to monitor steroid response and steroid prerequisites. The method would enable healthcare professionals taking care of Patricia to decide on whether further inhaled steroids treatment is required.
There is an increasing availability of portable nitric oxide analysers. The devices enhance the convenience of routine testing.
What are the weakness of your chosen assessment tools?
Despite the apparent benefits, there is limited consensus concerning the diagnostic role of the test, especially concerning severe asthma (Abe et al., 2021).
FEno is also unreliable among smoking patients and inadequately sensitive to assess asthma control.
FEno outcomes are also influenced by oral corticosteroid therapy.
Lastly, the technique lacks merit among children due to its single breath method.
Health Assessment Three:
National Early Warning Score (NEWS)
Why is this appropriate for your patient?
The appropriateness of NEWS is dictated by its capacity to enhance uncovering and responding to clinical deterioration among adult patients (Scott et al., 2019). Given the acute nature of Patricia’s condition, the tool would be instrumental in facilitating her safety and promoting the health outcome. Additionally, the NHS in England has suggested the accuracy of the approach in acute settings. Numerous studies across the globe have demonstrated the incredible predictive value concerning patient deterioration. The tool’s efficacy has been attributed to its capacity to facilitate communication in healthcare settings.
What are the strengths of your chosen assessment tools?
Ehara et al. (2019) identified the various strengths of NEWS2, which are evident in its prediction value, cross-speciality applicability, influence on the community, international approval, positive impact on clinical outcomes, and interaction with various variables. The tool also presents a significant opportunity for automation.
What are the weakness of your chosen assessment tools?
However, there are various limitations to employing the tool. Some of the impediments to NEWS2 include dependency on the practitioner’s engagement, requiring clinical judgement, having an intermittent approach to recording, and requiring reaction escalation.
Additionally, confusion accredited to variances in practice may compromise the patient’s safety but can be mitigated by the utilisation of a common mechanism (Scott et al., 2019).
Lastly, NEWS2 is susceptible to user error and erroneous recording.
References
Abe, Y., Suzuki, M., Kimura, H., Shimizu, K., Makita, H., Nishimura, M., & Konno, S. (2021). Annual fractional exhaled nitric oxide measurements and exacerbations in severe asthma. TP10. TP010 CLINICAL AND POPULATION-LEVEL STUDIES OF ASTHMA. https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1432
Atmojo, J. T. (2019). Evidence for changing cardiopulmonary resuscitation guideline from airway-breathing-circulation to chest compression-airway-breathing. Promoting Population Mental Health and Well-Being. https://doi.org/10.26911/theicph.2019.05.03
Bloom, C. I., de Preux, L., Sheikh, A., & Quint, J. K. (2020). Health and cost impact of stepping down asthma medication for UK patients, 2001–2017: A population-based observational study. PLOS Medicine, 17(7). https://doi.org/10.1371/journal.pmed.1003145
Bridgeman, M. B., & Wilken, L. A. (2020). Essential role of pharmacists in asthma care and management. Journal of Pharmacy Practice, 34(1), 149–162. https://doi.org/10.1177/0897190020927274
Carter, C. (2019). Assessment of the critically ill patient. Critical Care Nursing in Resource Limited Environments, 66–76. https://doi.org/10.4324/9781315106779-10
Ehara, J., Hiraoka, E., Hsu, H.-C., Yamada, T., Homma, Y., & Fujitani, S. (2019). The effectiveness of a national early warning score as a triage tool for activating a rapid response system in an outpatient setting. Medicine, 98(52). https://doi.org/10.1097/md.0000000000018475
Korn, S., Wilk, M., Voigt, S., Weber, S., Keller, T., & Buhl, R. (2019). Measurement of fractional exhaled nitric oxide: Comparison of three different analysers. Respiration, 99(1), 1–8. https://doi.org/10.1159/000500727
Lambert, T. (2019). Management of severe eosinophilic asthma: A simulation-based assessment of physicians' practice choices. B37. NOVEL APPROACHES TO ASTHMA MANAGEMENT AND OUTCOMES. https://doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3023
Page, K. (2012). Nursing the acutely ill adult: Case book. McGraw-Hill Education (UK)
Mitchell, I., & Govias, G. (2021). Medications used in asthma management. Asthma Education, 175–221. https://doi.org/10.1007/978-3-030-77896-5_6
Mukherjee, M., Stoddart, A., Gupta, R. P., Nwaru, B. I., Farr, A., Heaven, M., Fitzsimmons, D., Bandyopadhyay, A., Aftab, C., Simpson, C. R., Lyons, R. A., Fischbacher, C., Dibben, C., Shields, M. D., Phillips, C. J., Strachan, D. P., Davies, G. A., McKinstry, B., & Sheikh, A. (2016). The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: Analyses of standalone and linked national databases. BMC Medicine, 14(1). https://doi.org/10.1186/s12916-016-0657-8
Nursing & Midwifery Council. (2018). The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: Nursing & Midwifery Council.
Peate, I., & Brent, D. (2021). Using the ABCDE approach for all critically unwell patients. British Journal of Healthcare Assistants, 15(2), 84–89. https://doi.org/10.12968/bjha.2021.15.2.84
Peran, D., Kodet, J., Pekara, J., Mala, L., Truhlar, A., Cmorej, P. C., Lauridsen, K. G., Sari, F., & Sykora, R. (2020). ABCDE cognitive aid tool in patient assessment – development and validation in a Multicenter Pilot Simulation Study. BMC Emergency Medicine, 20(1). https://doi.org/10.1186/s12873-020-00390-3
Saito, J., Kikuchi, M., Fukuhara, A., Sato, S., Rikimaru, M., Suzuki, Y., Uematsu, M., Togawa, R., Sato, Y., Nikaido, T., Tanino, Y., Munakata, M., & Shibata, Y. (2018). Comparison of fractional exhaled nitric oxide (FeNO) levels measured by different analysers. Monitoring Airway Disease. https://doi.org/10.1183/13993003.congress-2018.pa1101
Scott, L. J., Redmond, N. M., Garrett, J., Whiting, P., Northstone, K., & Pullyblank, A. (2019). Distributions of the National Early Warning Score (News) across a healthcare system following a large-scale roll-out. Emergency Medicine Journal, 36(5), 287–292. https://doi.org/10.1136/emermed-2018-208140
Smith, D., & Bowden, T. (2017). Using the ABCDE approach to assess the deteriorating patient. Nursing Standard, 32(14), 51–63. https://doi.org/10.7748/ns.2017.e11030
Thim, T., Krarup, Grove, Rohde, & Lofgren. (2012). Initial assessment and treatment with the airway, breathing, circulation, disability, exposure (ABCDE) approach. International Journal of General Medicine, 117. https://doi.org/10.2147/ijgm.s28478
WHO. (2021). Asthma. World Health Organization. Retrieved November 13, 2021, from https://www.who.int/news-room/fact-sheets/detail/asthma.
