Geronimo’s acute exacerbation of asthma.
Describe the probable reasons for Geronimo’s acute exacerbation of asthma.
Instructions:-
Assessment 2 – Case study 2
Due Date: Monday Week 10 (08 May 2017)
Note: This assignment must be submitted by midnight Darwin, N.T. time
Topic: Respiratory System (Topic 2)
The following is a case study with four questions. You are required to respond to all four questions.
Response to each question should not exceed 250 words and the length of the entire assignment is 1000 words.
Assignments are due at midnight. Any assignment submitted after midnight NT time incurs a
10% penalty per working day i.e. 10% penalty is incurred 5 minutes past midnight for every day it is late.
After five days (taken from midnight) the assignment receives a ‘zero’.
CASE STUDY
Geronimo is a 12-year-old boy lives in Melbourne,with asthma diagnosed at age 6. For the last 10 daysGeronimo has been experiencing an upper respiratory tract infection with unresolved cough and breathlessness.He has been taking cough syrup but this has not improved his symptoms. He also had run out of his usual asthma medication salbutamol (2 puffs per night) for three days. It was late November and There was a huge thunderstorm two days ago.
Geronimo presented to hospital with an exacerbation of asthma. On presentation, he was speaking in phrases, his heart rate was 130 beats/minute, respiratory rate (RR) was 25 breaths per minute. His SpO2 was 94% on room air and he had an audible wheeze. His FEV1 was 1.64 L (55% of predicted).
Geronimo was administered salbutamol 100 µg 10 puffs via a pressurised metered dose inhaler and spacer and oral prednisolone 0.5mg/kg.
He responded relatively quickly to the treatment; his RR decreased to 21 breaths/minute and he could talk in paragraphs. He remained tachycardic but his FEV1 improved to 2.2 L (74% of predicted value), demonstrating a significant bronchodilator response of 34%.
His mother who was also present provided a history of Geronimo’s asthma. Both Geronimo and his mother initially reported that Geronimo was well until he caught a cold. However, when probing specifically about his asthma symptoms and overall control Geronimo acknowledged that he had difficultly playing sport especially during his soccer games on Saturdays; he wheezed and coughed when laughing, he avoided running around with his mates to prevent symptoms.
His
mother reported that while he might have missed about 10 days of school in the
last 12 months, due to a bad cough when he had colds, he was otherwise well
apart from the normal cough he gets.
- Describe the probable reasons for Geronimo’s acute exacerbation of asthma.
- Based on the history provided by Geronimo and his mother, determine which classification of asthma Geronimo’s asthma fits.
- Explain the results of his spirometry test. An arterial blood gas (ABG) testing is recommend by a junior doctor forGeronimo, do you agree with this suggestion?
- Describe the different forms of asthma medication and when each should be used.
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Solution
Describe the probable reasons for Geronimo’s acute exacerbation of asthma.
Geronimo’s acute exacerbation of asthma Essay
People with asthma exhibit different symptoms when triggered by something that may provoke a body response such as irritants in the air, cold, certain medications, exercise or allergen (Nermina Arifhodzi, 2014). Based on this, several reasons may have triggered the acute exacerbation of asthma in Geronimo, one of them being cold. Two days before Geronimo was presented to the hospital, a thunderstorm had struck an indication that there was rainfall. Geronimo, therefore, may have caught a cold due to the weather condition provoking a body response to asthma.
Exercises may have been another reason for the resurgence of asthma in Geronimo. Geronimo’s mother indicated that he had difficulty in playing soccer. During exercises, people tend to breathe with their mouth open due to the increased oxygen demand by the body (Sokolovski, 2010). They, therefore, inhale drier and colder air as opposed to normal breathing where the air is moistened and warmed by the nasal passage. Geronimo may have exercised or played soccer that may have made him inhale cold air hence exercise- induced asthma.
Geronimo may have been exposed to allergens. Allergens cause no problem to some people but may cause problems such as allergic reactions to others (Abdul Wadood, & Al-Dahan, 2015). When such people are exposed to an allergen, their immune system “sees” it as a foreign substance, therefore, releasing chemicals that deal with it. Such chemicals cause asthmatic attacks to people with asthma. Asthmatic attacks mean that their respiratory tracks become constricted that they find it difficult to breathe, therefore, experiencing coughing or wheezing.
Based on the history provided by Geronimo and his mother, determine which classification of asthma Geronimo’s asthma fits.
Generally, there are two main types of asthma; that is, allergic and non-allergic asthma (Kazemi, & Malarvili, 2012). Allergic asthma is caused by exposure to an allergen such as roaches, mold, certain additives, and drugs among others. It may also be triggered by outdoor allergens such as trees, weeds, and pollen from the grass. Such allergens will set off an asthma flare-up. Non-allergic asthma is not triggered by allergens. This type of asthma is set of by an upper respiratory infection such as cold, flu or rhinovirus. This type of asthma may also be induced by stress, exercise, exposure to extreme weather, some medications, or irritants in the air.
According to the above classifications, Geronimo, therefore, automatically fits non-allergic asthma. According to the history given by his mother, Geronimo was well until he caught a cold. He also wheezed and coughed while laughing. Geronimo had difficulty in running around with his mates. He also had difficulty in playing sports such soccer. These symptoms clearly show that Geronimo’s asthma was non-allergic since it was triggered by factors other than allergens such as cold and exercises.
Apart from the two main types, there is a rare form referred to as Aspirin Exacerbated Respiratory Disease that is triggered by aspirin (Zimmerman, & Margalit, 2009). Patients have rhinitis, a runny nose, and sneezing. When they take aspirin, they develop a runny nose, which leads to wheezing and difficulty in breathing.
Explain the results of his spirometry test. An arterial blood gas (ABG) testing is recommend by a junior doctor for Geronimo, do you agree with this suggestion?
When an actual asthma attack is occurring, it becomes very difficult to speak. Asthma patients find it very difficult to complete a full sentence without having to take another breath (Szabó, et al., 2009). The justification for this is that air is required in the lungs for one to speak fluently. Asthma makes it difficult to have enough air in the lungs, therefore, making the sufferer pause for air breaths after a short sentence. This also explains the high respiratory rate of twenty-five per minute.
A normal heart rate should not increase more than a hundred and ten beats a minute (Bryant, & Knights, 2015). Geronimo’s heart rate was at a hundred and thirty beats per minute indicating something was amiss. Asthma leads to a decreased amount of oxygen in the lungs. Low amounts of oxygen in the lungs translate to low oxygen in the blood. This means the heart will work harder trying to deliver the right amount of oxygen to the body parts. It will pump blood faster leading to increased heart rate as observed in Geronimo.
Geronimo’s FEV1 was 1.64L. Asthma in itself does not cause fever (VanMeter, & Hubert, 2016). Fever may result from other inflammatory conditions exacerbating asthma. Geronimo’s SpO2 dropped from the normal 95% to 94%. Asthma attacks cause a reduced oxygen amount in the lungs, therefore, a drop in the above statistics. Asthma causes constriction of the lungs’ airways making it difficult to breathe thus too much wheezing. The arterial blood gas recommended is, therefore, good to increase blood oxygen supply in the body.
Describe the different forms of asthma medication and when each should be used.
Salbutamol is one of the forms of medication. It is a bronchodilator since it widens or dilates the airways. Salbutamol ensures the free flow of air into the lungs by opening up the passages to the lungs. Salbutamol relieves asthma and chronic obstructive pulmonary diseases such as wheezing, coughing and feeling breathless. Salbutamol should be administered only upon examination of the patient (Oviawe, & Osarogiagbon, 2012). A patient that has had allergic reactions to medicine should not be administered with this medication. The doctor should check blood sugar levels and if the patient is diabetic before prescribing this medication.
Oral Prednisolone, an oral steroid that relieves inflammation in asthma patients, may be administered to asthma patients. Prednisolone goes straight into the body, unlike inhaled steroids that go straight into the heart. This medication works by reducing the immune systems’ response, therefore, reducing symptoms such as allergic reactions and swellings, helping the patient gain better asthma control. It is only administered when the asthmatic symptoms worsen. This medication often does not require hospitalization of the patient.
In cases of severe asthma, bronchial thermoplasty may be administered. It is also a way to open the airways to the lungs. This medication shrinks the smooth muscles in the lungs that tighten during asthmatic attacks. Bronchial thermoplasty is offered in three separate sessions on a weekly basis. Each treatment does not exceed an hour and treats a different part of the heart each time.
References
Abdul Wadood, M., & Al-Dahan, Z. (2015). The Effect of Inhaled Corticosteroid on Oral Conditions among Asthmatic Children. Journal of Baghdad College of Dentistry, 27(1), 169-174. http://dx.doi.org/10.12816/0015283
Bryant, B., & Knights, K. (2015). Pharmacology for Health Professionals. 4th edition, Mosby, Marrickville
Kazemi, M., & Malarvili, M. (2012). nalysis of Capnogram Using Linear Predictive Coding (LPC) to Differentiate Asthmatic Conditions. Journal of Tissue Science & Engineering, 02(05). http://dx.doi.org/10.4172/2157-7552.1000111
Nermina Arifhodzi, I. (2014). Influence of Air Quality Conditions on Asthmatic Patient Visits in Kuwait. Journal Of Allergy & Therapy, 05(06). http://dx.doi.org/10.4172/2155-6121.1000197
Oviawe, O., & Osarogiagbon, O. (2012). Dip patterns in asthmatic and non-asthmatic children in Benin-city, Nigeria. Nigerian Journal of Paediatrics, 40(1). http://dx.doi.org/10.4314/njp.v40i1.9
Sokolovski, I. (2010). 709 Atopic Dermatitis and Family History of Allergic Diseases in Asthmatic and No Asthmatic Children. Pediatric Research, 68, 360-360. http://dx.doi.org/10.1203/00006450-201011001-00709
Szabó, A., Mezei, G., Kővári, É., & Cserháti, E. (2009). Depressive symptoms amongst asthmatic children’s caregivers. Pediatric Allergy and Immunology, 21(4p2), e667-e673. http://dx.doi.org/10.1111/j.1399-3038.2009.00896.x
VanMeter, KC, VanMeter, WG & Hubert, RJ 2016, Microbiology for the healthcare professional, Mosby, Elsevier
Zimmerman, J., & Margalit, M. (2009). W1841 Esophageal Acid Reflux and Respiratory Symptoms: Disparate Relationship in Asthmatic and Non-Asthmatic Patients. Gastroenterology, 136(5), A-737. http://dx.doi.org/10.1016/s0016-5085(09)63400-4
