ESSAY NUR300 Nursing Transition

NUR300 Nursing Transition

Answers:

Answer 1

The other signs and symptoms that the nurse might note during the assessment of Mrs. Hogan’s condition includes the presence of cough in her chest. Sometimes, cough might also trigger asthma exacerbation in some patient (He et al., 2020). The nurse should also examine whether Mrs. Hogan is feeling any kind of chest pain which can cause uneasiness in her.

Answer 2

The nurse should place Mrs. Hogan in supine sleep position. This sleeping position has been reported to be effective for the reduction of symptoms of asthma for the patient. Patient sleeping in supine position were found to have reduced awakening episodes at night, reduction of consumption of anti-asthma medicine along with work limitation of the for the patient (Shahunja et al., 2021).

Answer 3

The five signs and symptoms that would indicate that Mrs. Hogan is not responding to the treatment and is likely to develop asthmaticus are:

She is facing difficulty while speaking with other people or describing her condition.
She is facing difficulty while breathing along with an audible wheezing sound that is associated with a respiratory distress (He et al., 2020).

Another symptom is that might indicate development of asthmaticus is feeling of shortness of breath. She reported that she could not catch her breath (He et al., 2020).

She felt chest tightness which is also a sign of the situation getting worse with time.
Another major indication of developing asthmatics is that although she has taken albuterol as well as vanceril, but these medications could not improve her condition (He et al., 2020).

Answer 4

Albuterol is an agonist at the Beta 2 receptor that are located in smooth muscles of bronchus and blood vessels. For contraction of the smooth muscles phosphorylation of the myosin is required (Ganley et al., 2021). The albuterol prevents the phosphorylation of myosin which inhibits contraction along with the promotion of relaxation of the smooth muscles. This relaxation of the smooth muscles dilates the airways thus allowing the air to pass through the airways (Ganley et al., 2021). The beclomethasone is the glucocorticoid with the anti-inflammatory as well as immunomodulating properties and is produced synthetically. It enters nucleus receptor and cause alteration in the gene expression which inhibits the production of proinflammatory cytokine in the body (Rogliani et al., 2020).

Answer 5

There are certain side effects of using albuterol nebulizer treatment that might be faced by Mrs. Hogan. Sometimes the patient might feel chest discomfort or pain along with cough that is associated with mucus (Ganley et al., 2021). The heart beat of the patient sometimes increases and becomes irregular. Albuterol nebulizer treatment is frequently associated with shaking of some body parts. Nausea, vomiting, diarrhoea, loss of appetite and dizziness are associated with such nebulizer treatment (Ganley et al., 2021).

Answer 6

During an asthma attack, there are mainly three changes that might be observed in the lungs of Mrs. Hogan. The mucous in the airways is increased which reduces the passage of the airways. Mucous is produced when the airways get inflamed and irritated. The cells responds against such condition by producing more amount of mucous. The deposition of the mucous blocks the airways which prevents the normal flow of air through them (Arismendi et al., 2020). Another alteration observed in the lungs is the swelling and the inflammation of the airways during asthma attack because it narrows the passage of the airways. The other major change that usually occurs is the tightening of the muscles. Smooth muscles in airways tightens due to contraction which makes the passage smaller (Arismendi et al., 2020).

Answer 7

In order of priority, the three-nursing diagnosis that are appropriate during Mrs. Hogan’s asthma exacerbation includes:

Ineffective airways clearance – the Ineffective airways clearance which is associated with asthma causes over production of several antibodies along with release of chemicals in blood. This riggers the tightening of the smooth muscles, a condition also termed as bronchospasm (Ariyanti, Nursalam & Yuwono, 2020).
Ineffective breathing pattern – nursing diagnosis for the asthma can be due to presence of mucous in airways which blocks the air passage.

Impaired gas exchange – nursing diagnosis of asthma relates with decreased amount of air which is exchanged during respiration (Ariyanti, Nursalam & Yuwono, 2020).

Answer 8

The three-outcome goal for Mrs. Hogan’s diagnosis of the Ineffective Breathing Pattern includes:

Her oxygen saturation level would increase to normal level and she would not require administration of oxygen externally (Mulvey et al., 2021).
She would be able to speak properly without any breathing difficulty.

She would get relief from chest tightness and shortness of breath (Mulvey et al., 2021).

Answer 9

The other questions that the nurse might ask for assessing the cause of Mrs, Hogan’s asthma exacerbation includes:

Is this your first-time experience of asthma exacerbation or have you experience asthma exacerbation previously as well?

She may or may not have a history of asthma exacerbation and it needs to be recorded for intervention purpose (Khusial et al., 2020).

Did you have any kind of allergies that might have triggered asthma attack?

This is because dust allergies triggers asthma attack (Khusial et al., 2020).

Answer 10

The other questions to Mrs. Hogan include:

Did you feel that your asthma was difficult to manage in the first place?
Did you take inhaler when you had asthma attack in the first place? (Khusial et al., 2020)

Answer 11

The steps that are of concern to the nurse include:

Hogan described that while breathing slowly she takes a puff of the inhaler. However, this is not the right way to take the puff. After releasing the air from the lungs, she has to put the mouth piece inside her mouth and puff one dose of the inhaler (Kimel, 2022).
She breaths out like blowing out of candle. However, she should blow out the air slowly.

Answer 12

Three nursing intervention includes:

Evaluation of the breathing pattern of Mrs. Hogan (Chew et al., 2020)
Monitoring peak expiratory flow rate of Mrs. Hogan

Monitoring of heart beat, pulse, oxygen saturation and respiratory rate (Chew et al., 2020)

References

Arismendi, E., Bantulà, M., Perpiñá, M., & Picado, C. (2020). Effects of obesity and asthma on lung function and airway dysanapsis in adults and children. Journal of Clinical Medicine, 9(11), 3762. https://doi.org/10.3390/jcm9113762

Ariyanti, H. R., Nursalam, N., & Yuwono, S. R. (2020). The Development of Nursing Diagnosis-based Indonesian Nursing Diagnosis Standard on Clinical Clinical Pathway among Patients with Stroke Infarction. International Journal of Nursing and Health Services (IJNHS), 3(2), 261-266. https://doi.org/10.35654/ijnhs.v3i2.196

Chew, S. Y., Leow, J. Y. L., Chan, A. K. W., Chan, J. J., Tan, K. B. K., Aman, B., … & Koh, M. S. (2020). Improving asthma care with asthma-COPD afterhours respiratory nurse at emergency (A-CARE). BMJ Open Quality, 9(2), e000894. Improving asthma care with Asthma-COPD Afterhours Respiratory Nurse at Emergency (A-CARE) | BMJ Open Quality

Ganley, J. W., Serrailh, S., Silva, L., Farias, G., Farrow, D., Pinto, S., … & Shur, J. (2021). Predicting the regional deposition and systemic exposure of albuterol sulfate formulated with low global warming potential propellants. In Respiratory Drug Delivery (pp. 4-7). Ganley-2021.pdf (nanopharm.co.uk)

He, Z., Feng, J., Xia, J., Wu, Q., Yang, H., & Ma, Q. (2020). Frequency of signs and symptoms in persons with asthma. Respiratory Care, 65(2), 252-264. DOI: https://doi.org/10.4187/respcare.06714

Khusial, R. J., Honkoop, P. J., van der Meer, V., Snoeck-Stroband, J. B., & Sont, J. K. (2020). Validation of online asthma control questionnaire and asthma quality of life questionnaire. ERJ Open Research, 6(1). DOI: 10.1183/23120541.00289-2019

Kimel, L. S. (2022). Assisting Students With Asthma Inhaler Technique and Knowledge. NASN School Nurse, 1942602X211073747. https://doi.org/10.1177%2F1942602X211073747

Mulvey, C., MacHale, E., Greene, G., Lombard, L., Walsh, J., Plunkett, S., … & Costello, R. W. (2021). Patient-selected treatment goals in severe asthma. The Journal of Allergy and Clinical Immunology: In Practice, 9(7), 2732-2741. https://doi.org/10.1016/j.jaip.2021.01.041

Rogliani, P., Matera, M. G., Facciolo, F., Page, C., Cazzola, M., & Calzetta, L. (2020). Beclomethasone dipropionate, formoterol fumarate and glycopyrronium bromide: synergy of triple combination therapy on human airway smooth muscle ex vivo. British journal of pharmacology, 177(5), 1150-1163. https://doi.org/10.1111/bph.14909

Shahunja, K. M., Sly, P. D., Begum, T., Biswas, T., & Mamun, A. (2021). Family, neighbourhood and psychosocial environmental factors and their associations with asthma in Australia: a systematic review and Meta-analysis. Journal of Asthma, (just-accepted), 1-18. https://doi.org/10.1080/02770903.2021.2018707