REPLY POSTS:Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). Instructions: - For post # 1 response, also consider commenting on the following: "Beca
PEER #1 Keara
Note: For this reply, you can also consider commenting on the following: "Because frequent asthma attacks are common in children, respiratory infections are equally as common. Gern (2008) explains that viruses are almost always present in exacerbations of asthma in children."
Use at least two scholarly references per peer post. The expectation is not that you “agree” or “disagree” with your peers but that you develop a reply post with information that is validated via citations to encourage learning and to bring your own perspective to the conversation.
Keara Post: Case study: Asthma in children.
The case study that I chose was related to acute asthma in children. The case study discusses an eight-year-old child named B.J. that has had asthma for two years since he was sick with acute bronchitis. After discovering his asthma, he was tested for allergies and they determined that he had a lot of allergies he did not know about. These included animals, pollen, and molds. In addition, he has occasional asthma exacerbation when he is in the cold weather. Throughout this discussion, we will answer a number of questions related to the pathophysiology of actute asthma.
The pathophysiology that may occur if B.J. was exposed to cats and had an asthma exacerbation would be similar to any other exposure to an allergen. After B.J. is exposed to cats, he likely would inhale the allergen from the cat and his body would begin the antigen-antibody reaction. First, being that it is a child it will be extrinsic asthma pathway. Hubert and VanMeter (2018) describe the interactions as IgE reacting with the antigen and leading to the release of histamines, prostaglandins, and kinins that lead to inflammation and bronchospasms. If the allergic response continues, leukocytes are increased and chemical mediators present and cause prolonged inflammation and bronchoconstriction which can obstruct the airway and lead to various levels of hypoxia (Hubert & VanMeter, 2018). As this allergic reaction occurs, some of the signs and symptoms that may be present with B.J.'s reaction would be wheezing, shortness of breath, coughing, narrowing or airway, and chest tightness if breathing is continually difficult. The patient may also have difficulty talking (Hubert & VanMeter, 2018).
Being aware of medication interactions and allergies is important to address in an asthma patient. An an APRN, making sure that accurate allergies and medications are documented. Knowing if there is a history of allergic reactions to common medications that individuals are allergic to is important. For example, sulfa drugs, penicillin, and various anti-body therapies can often cause a reaction in an individual with asthma that has a lot of allergens. American College of Allergy, Asthma, and Immunology (2014) discuss that skin tests and drug challenges would be useful in treating and determining current drug allergies prior to using as an intervention. In addition, knowing what his current medication regimen is and if there are any new medications being used is important.
If I was the APRN treating and dealing with B.J., I would ensure that he had his bronchodilator beta 2 adrenergic rescue inhaler with him at all times and make sure that there are not any strong scents such as perfumes and cologne present in the room. Hubert and VanMeter (2018) discusses precautions and measures to take with acute attacks. If B.J. had his attack in my presence, I would assist in controlled breathing and try to assist in reducing anything that contributes anxiety to the situation. Esmailian, Esfahani, and Heydari (2018) discuss another alternative for treating an acute anxiety attack. The authors discuss the use of ketamine to open the airways in the bronchi in asthmatic patients and this medication has been useful in treating pediatric patients (Esmailian, Esfahani, & Heydari, 2018).
If B.J. has a long asthma attack that does not resolve with emergency intervention, air can become trapped in the alveoli and result in trapped air and is not able to exchange oxygen and carbon dioxide. When a person experiences trapped air in the alveoli, hypoxia can occur as a result, carbon dioxide builds up and is not eliminated through respiration, and acidosis occurs as a result of a prolonged attack. Hubert and VanMeter (2018) explains the process of severe hypoxia and acidosis as it occurs in a prolonged attack. The authors explain that respiratory akalosis is initially present because a patient often hyperventilates when an asthma attack initially begins. As air trapping becomes apparent, marked fatigue occurs and hypoxia develops due to increased lactic acid build up and narrowing of airways. Severe respiratory distress often becomes apparent and the patient begins hypoventilation which increased hypoxia and respiratory acidosis (Hubert & VanMeter, 2018). If appropriate, measuring the patients ABG's would be helpful to determine how severe the acidosis has progressed. Possible pH may show 7.30, and CO2 of 48.
As asthma attacks continue and are not relieved with intervention, status asthmaticus can occur. Status asthmaticus is a severe status asthma attack that does not respond to normal asthma interventions. Because frequent asthma attacks are common in children, respiratory infections are equally as common. Gern (2008) explains that viruses are almost always present in exacerbations of asthma in children. Common viruses such as RSV can lead to coughing, wheezing, and airway obstruction in most asthma exacerbations and mimic similar symptoms to an asthma exacerbation (Gern, 2008).
To avoid asthma exacerbations, B.J. can take many measures to reduce anxiety. Ensuring that he stays away from any potential allergen is the first step to avoiding an asthma attack. To reduce anxiety related to an asthma attack occurring, implementing anti-anxiety medications to keep anxiousness at bay and under control would be the next step to reducing an asthma attack occurrence. As stated earlier, Hubert and VanMeter (2018) explain that controlled breathing is one way an attack can be avoided. In older children and adults, infections with common cold viruses such as rhinoviruses (RV), which produce relatively mild respiratory symptoms in most individuals, can cause severe coughing, wheezing, and obstruction to airflow.
Since B.J. has a number of allergens related to his asthma exacerbations, making sure he has a rescue inhaler is important. Beta 2 adrenergic agents are helpful in treating asthma because the medication works by causing smooth muscle relaxation. This results in the dilation of the bronchioles. Hubert and VanMeter (2018) state that these medications have minimal effect on the heart. This medication is usually administered as a nebulizer or inhaler and is beneficial if it is administered right as one recognizes an attack. Children with asthma often have difficulty breathing with exercise, but in some circumstances, children cannot exercise due to immobility and injuries. Hubert and VanMeter (2018) explain have difficulty starting to regain strength in both the physical aspect and the respiratory aspect after prolonged sitting because deep breathing and coughing may be poor and cause stasis of secretions in the lungs.
Asthma is common in both children and adults. Extrinsic and intrinsic pathways exist based on whether it is a child or an adult. Asthma attacks can be acute, prolonged, and result in status asthmaticus. Treatment for asthma exacerbations are often beta-2 adrenergic medications that are inhaled right as symptoms present themselves. Educating patients on how to alleviate symptoms and manage anxiety can assist them in reducing the occurrences of asthma exacerbations and avoid other complications in the future.
References
American College of Allergy, Asthma, and Immunology (2014). Drug allergy. Retrieved from https://acaai.org/allergies/types/drug-allergies
Esmailian, M., Esfahani, M. K., & Heydari, F. (2018). The Effect of Low-Dose Ketamine in Treating Acute Asthma Attack; a Randomized Clinical Trial. Emergency, 6(1), 1–5.
Gern J. E. (2008). Viral respiratory infection and the link to asthma. The Pediatric infectious disease journal, 27(10 Suppl), S97–S103. https://doi.org/10.1097/INF.0b013e318168b718
Hubert, R. J. & VanMeter, K. C. (2018). Gould's pathophysiology for the health professions. St. Louis, MO: Elsevier Saunders.
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