International Consensus on Pediatric Asthma †MyAssignmenthelp.com

Question: Discuss about the International Consensus on Pediatric Asthma. Answer: Introduction: Acute asthma can be defined as of the gravest health care concerns, and it has served to be one adamant disease which requires critical care initiatives and management of the symptoms for the patient to be free from any danger of exacerbations. However, the medical industry provides systematic and efficient care program for diseases like asthma efficiently, which can be considered the contribution of a vast array of technological innovation and pharmacological advancements in the treatment of respiratory disorders (Orihara, Dil, Anaparti Moqbel, 2010). Along with the innovations in the medicine and pharmacology in order to combat the diseases like asthma, the innovative changes in the care planning and implementation for the patients suffering from asthma has contributed significantly as well to the improvement of the care scenario (Klok, Kaptein Brand, 2015). A clinical discussion comprises of exploration and analysis of the assessment of the patient and key findings, underlying p athophysiology of signs and symptoms, and care initiatives to be taken to address the clinical manifestations of the patient. This assignment will attempt to explore and evaluate the assessment and care planning procedure for asthma, taking the assistance of a case study as a clinical discussion report. Primary survey: This case study represents the case of a 12-year-old patient named Hannah sparks who had been admitted to the emergency department of a rural hospital with the primary clinical issues of shortness of breath. She had been diagnosed with asthma three years ago, and the only medical management that the patient had been privy to had been salbutamol inhalers, used when needed. It has to be mentioned in this context that the care of any patent presenting a series of discomfort must begin with the initial assessment phase. Many frameworks and protocols have been developed for streamlining the process of patient situation investigation and assessment of the signs and symptoms of the patient. The primary survey assessment framework can be considered the most suitable and effective first stage of the entire assessment process (Buckley Gordon, 2011). According to the Levinson et al. (2017), the primary survey assessment framework is the key process of the paramedic practice as well, as it serves the first pedestal of care planning for the patient. This framework mainly deals with the rapid process of determining the level of urgency that is needed by a particular patient. And along with that, the benefits of this specific assessment framework is extended towards understanding the quickly and systematically the critical condition of the patent and the absolute care priorities. The primary survey usually is conducted using the DRABC approach which has five step by step assessment functions, danger, response, airway, breathing and circulation assessment. The first component is danger, where the patient will need to be assessed for any immediate danger that can lead to fatal consequences for the patient. Concerning this case study, there was no immediate pertinent danger to the patient. The next element of the assessment framework is response, and it is associated with understanding the levels consciousness of the patient (Akinbami et al., 2012). In this phase the AVPU scale is utilized to check if the patient is alert, is responding to verbal stimuli, responding to any painful stimuli or is unresponsive throughout or in any of the mentioned stimuli. Concerning this case study, the patient is alert and is efficiently responding to the all the stimuli, her verbal response is limited to 2-3 word sentences. The next element of the assessment is the airway assessment, where the competence of the airways of the patient is checked for any risk of future stridors. In this case, Hannah, the patient under consideration in the case study had been dealing with audible expiratory wheezing which indicates at obstructed airways and possibilities of future stridor. The fourth element is the breathing assessment, which is done to check if the patient is breathing with an average respiratory rate and whether the patient has ade quate ventilation. Hannah had shortness of breath with audible wheezing and respiratory rate of 28 bpm, which indicates at respiratory disorders and aggravated asthma. The last element of the assessment framework is the circulation assessment which helps in determination whether the patient has an adequate pulse or circulation. In this case, the patient had a pulse rate of 125 bpm and the blood pressure of 130/70 mmHg; which indicates at the higher cardiac output and slight hypertension (Moore et al., 2010). Underlying pathophysiology with 2 abnormal assessment findings: From the primary survey assessment framework, it can be stated that the patient had been facing the onset of worsening asthma indicated by the shortness of breath, wheezing, and high respiratory rate. Now it has to be mentioned that asthma is a very common respiratory disease and it targets a vast majority of the population across differential age groups as well. This particular disease targets According to the authors, the pathophysiology of this disease is complex, and it involves a variety of different respiratory complications like airway inflammation, intermittent airway obstruction, and bronchial hyperresponsiveness. On a more elaborative note, it affects 235 million people worldwide, and despite being common in adults as well, this particular disease begins its onset in the children more commonly. It has to be mentioned that asthma is facilitated by the construction of the airways which in turn leads to inflammation and hypersecretion of mucus. Both of these factors together p romote wheezing and airway obstruction which can facilitate coughing, wheezing and shortness of breath as well (Murphy O'byrne, 2010). One of the most common phenomena in case of the asthma episodes is the onset of broncho-constriction. This process is facilitated when the inflamed airways produce a hypersensitivity reaction to the environmental triggers such as smoke, pollen, dust. This constriction then, in turn, produces excessive mucous which further blocs the already narrowed down airways and contributes to the obstruction. Elaborating more, the presence of the stimuli or allergen acts like a potent trigger in this scenario and leads to smooth muscle spasms in the bronchial airways which is soon followed by renewed inflammation and hypersecretion of the mucous in the airways leading to the infamous asthma attacks (Kaufman, 2011). Exploring the pathophysiology of the mechanism of the spasms, a bronchus functions by means of the autonomic nervous system which then functions by means of a parasympathetic reflex loop. This parasympathetic reflex loop is composed of afferent nerve endings present in the inner lining of the bronchus. The stimulation of the allergens is facilitated in the afferent nerve endings, which results into the travel of a significant impulse to the brain stem vagal centre and moves down the vagal efferent pathway and reaches back to the small bronchial airways facilitating the constriction and resultant intermittent spasms. The inflammation, on the other hand, is also facilitated by the immune response o the respiratory apparatus to the stimuli by the activation of the antigen-presenting cells (Orihara, Dil, Anaparti Moqbel, 2010). It has to be mentioned that, the two selected abnormal assessment findings from the primary survey assessment framework are the shortness of breath due to wheezing and high respiratory rate. The patient had audible expiratory wheezing and the ability to answer questions with 2-3 word sentences which indicates the severity of her airway obstruction and validates the choice of this finding. Along with that, the average respiratory rate is 18-20 breaths per minute, whereas the patient had a respiratory rate of 28 breaths per minute. Hence it had been chosen as the second abnormal assessment finding of the assignment. Considering the signs and symptoms of the patient it has to be mentioned that the stimulation by any external stimuli has resulted in the chain reaction of bronchial constriction in the patient; which has then led to airway inflammation, hypersecretion of mucous (Ozier et al., 2011). It can be the possible pathway leading to the presence of shortness of breath and wheezing in the patient due to airway obstruction, along with that the inflammation in the airways coupled with smooth muscle spasm would have resulted to increased oxygen demands in the body leading to the high respiratory rate at 28 breaths per minute. Nursing management in the first hour: Nursing priorities Nursing outcome Management interventions Rationale Shortness of breath with excessive wheezing. The patient will be relieved from the shortness of breath and the wheezing will subside. Along with that the normal relaxed breathing pattern will be facilitated in the patient. Assessment of the vital signs of the patient with assessment of respiratory rate, depth and rhythm. Assessment of the adventitious breathing sounds and oxygen saturation. Administration of airway clearance with sectioning intervention (Basole et al., 2015). Administration of necessary medication like beta 2 adrenergic drugs (albuterol, levalbuterol, terbutaline) It will help in determining the extend of the respiratory distress due to the asthma attack and the exact severity of her condition (Basole et al., 2015). Will help in understanding the severity of airway obstruction and bronchospasm. Cleared airways will facilitate better airway passage. These will serve the purpose of bronchodilation which will help in relaxing the bronchial smooth muscles, facilitating better airway passage (Papadopoulos et al., 2012). High respiratory rate and 91% oxygen saturation The patient will regain normal respiratory rate and the oxygen saturation of the patient reaches 98% Auscultation of the adventitious breathing sounds to check for wheezes or rhonchi and with effectiveness and duration of the cough (Papadopoulos et al., 2012). Entertain breathing exercises and suggest the patient to obtain recovery position to calm the patient and revive the breathing rate. Repeat airway clearance if needed and provide external oxygen masks. Encourage increased fluid uptake in the patient. Administer inhaled corticosteroids like budesonides, fluticasone, beclomethasone, and mometasone The breathing sound identification will guide the care plan to follow. The breathing exercises will serve as excellent nonpharmacological means to improve the expiration-aspiration ratio. Airway clearance will reduce obstruction and will facilitate better breathing (Bratton et al., 2012). Fluid uptake will improve renal input and output facilitating better comfort of the patient. It will help in the reducing the inflammation and reviving the respiratory rate back to normal (Halterman et al., 2011). Slightly high cardiac output due to anxiety The patient will be relieved from the anxiety and will be calm and relaxed throughout the stay. Assessment of the cardiac output of the patient along with the blood pressure. Assessment of different signs of anxiety in the patient by assessing the indicators like panic, fear, and uneasiness in the patient (Klok, Kaptein Brand, 2015). Assessment of theophylline levels in the body. Providing the means for relaxation to the patient such as calm quiet atmosphere and soft music. Encourage progressive muscle relaxation technique in the patient, diaphragmatic and pursed lip breathing and repetitive use of relaxation phrases. The assessment will provide a clear idea regarding the cardiovascular risk. Anxiety can be a cause for shallow breathing and the underlying cause identification will guide the best suited intervention plan. As excessive theophylline concentration in the body determines the levels of anxiety this assessment will determine the severity of the anxiety in the patient and its impact on the cardiac output (Morse et al., 2011). The calm environment and soft muscle will to some extent reduce the tachycardia. The relaxation exercises will help the patient overcome the anxiety and feel calm so that the cardiac output decreases further. Management of her slightly high blood pressure. The blood pressure of the patient will reduce and will revert back to the normal levels. Assessment, monitoring and recording to the blood pressure of the patient and assessing the laboratory data that is available Assessing the presence of the quality of the central and peripheral pulse of the patient as well (Moore et al., 2010). Auscultation of heart tones and the breathing sounds. Administering mild diuretics to lower the blood pressure of the patient like the chlorothiazide, hydrochlorothiazide, indapamide, metolazone, or Quinethazone. In case the patient does not retain normal blood pressure, administrating loop diuretics like the furosemide, bumetanide, torsemide. It will provide the nursing profession with the insight regarding the underlying reasons behind the hypertension. It will provide insight regarding the incidence and probability of the vasoconstriction Will determine any possibility of atrial hypertrophy in the patient. It will help in reducing the hypertension of the patient by providing slight vasodilation and reducing BP (Liu et al., 2010). It will help in providing diuresis in the patient by inhibiting resorption of sodium and chloride in the body. Conclusion: It has to be understood in this context that any disease can turn life-threatening with the lack of immediate and effective intervention applied to the scenario. The delay in the administration of the care interventions can have a significant detrimental impact on the disease progression pathway and can even lead to fatal consequences for the patient. Therefore, the only method to ensure that the patient is going to attain immediate care intervention, prompt and effective assessment is an absolute requirement. The primary assessment framework provides the excellent tool for the registered nurses to effectively and successfully complete the task of assessing the different physical manifestation of the disease the patient is suffering from. The registered nurses are benefitted exponentially by the use if the DRABC primary survey assessment framework which provides the students with the opportunity to rapidly identify and articulate immediate responses for each care priority of the patient, in turn avoiding the chances of the patient deteriorating towards life-threatening abnormalities. 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