discuss the presenting problem and co-morbidities

Nursing Case study on asthma

Week 5
Respiratory Assessment
and Case Studies
Asthma case study
The tutorial will be conducted in two parts.
The tutor will:
• give an introduction to Asthma and revisit respiratory assessment
• review the clinical notes and records pertaining to Ben’s case study
• discuss the presenting problem and co-morbidities
• consider clinical terms and abbreviations
In groups students will:
• discuss what is going on here? and what does it mean?
• describe the physiology of the presenting symptoms
• outline the subjective and objective data presented
• explain physiological responses reflected by the vital signs and why they are occurring
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Common chronic inflammatory and obstructive airway disease characterised by:
• Reversible
• Bronchoconstriction
• Oedema of airways
• Mucous hypersecretion
Ænarrowing of airways leading to alveoli = air trapping/ hyperinflation of lungs = impaired
gas exchange
Triggers Risks
Drugs and chemical
Aspirin and NSAIDs
Cold air
Irritants (smoke)
Family history
History of allergies
Age (prevalent in children)
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Pathophysiology of Asthma
Airway inflammation
Excessive Mucus secretion
Bronchospasm/ Narrowing of airways
Airway muscle constriction Swelling of bronchial membranes
Immune activation
(IL-4, IgE production) Mast cell degranulation
Chest tightening
Adapted from Brown and Edwards, 2015. p 567
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• What is Asthma Video
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Lung function tests
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The Oxygen-haemoglobin dissociation curve
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Normal ABG values (Brown, Edwards, Seaton & Buckley, 2015)
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Case Study
• Ben Marshall DOB: 05/03/1993 25 Years Male
• SUMMARY OF EVENTS: Ben was out for a jog, where approximately
20 minutes into the run he developed severe shortness of breath and
tightness in the chest. An ambulance was called and transported him
to hospital.
• SOCIAL: Ben, a university graduate, lives with parents and two
younger siblings. He is a very fit, young adult male who plays
competition football.
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Asthma Videos
• Asthma attack
• Lung Sounds
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Patient Complaints:
• Severe dyspnoea
• No Loss of consciousness
• Meds: Salbutamol inhaler
• Health History: Diagnosed with asthma as a child (age 7)
• He has presented to hospital on two previous occasions for asthma
related symptoms.
• Following his last admission 2 years ago he had Pulmonary Function
Tests: FEV1/PEFR 80% of predicted, PEFR variability 30%
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On Examination
– Patient talking in single words, pursed lips
– Spontaneous, resting RR 34, severe dyspnoea
• Short shallow breathes, with use of accessory muscles Tightness in chest Dry cough Peak expiratory flow rate ?140 ml Auscultation – ?BS, with diffuse wheezes, auditory inspiratory and expiratory wheeze
• Percussion: hyperresonant
• SpO2 93% on 4L O2
– Resting PR128, BP 90/60, centrally warm and perfused
• Elevated JVP +5 cm
– GCS 15, PERL 3+
– Temp 36.7, no complaints of chest pain
– RR 34, BP 90/60, resting PR128, Patient catheterized urine output low 40mls/hour
Glucose BSL 5.9 I – Pulmonary function tests – see above ECG – Normal, no signs of ST elevation Bloods – ABG: Ph7.35, PaCO2 45mmHg, PaO2 70mmHg, HCO3 24mmol, BE +4
Chest X-ray – Normal, hyper-inflated with flattening of diaphragm
Bloods – NAD
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Glossary of terms and abbreviations
• NAD No abnormality detected
• ABG Arterial Blood Gas
• BP Blood pressure
• ET End Tidal CO2 is the amount of CO2 in exhaled gas
• GCS Glasgow comma scale
• LOS Loss of consciousness
• RR Respiratory rate
• PERL Pupils equal and reacting to light
• PMH Past or previous medical history
• PR Pulse Rate
• RR Respiratory Rate
• SOB Short of breath
• SpO2 Saturation of oxygen onto haemoglobin in arterial blood
• # Fracture (L) Left (R) Right
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Group work
• discuss what is going on here? and what does it
• describe the physiology of Bens’ presenting
• the subjective and objective data presented
• physiological responses reflected by the vital
signs and why they are occurring
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Framework for Practice Thinking
While there is a right answer now, it may be wrong tomorrow due to alterations in the information climate affecting the decisions (Siemens 2004)
What does this
What could/can be
This person, this place, this
time and with these
What should be
Personal preference
What’s going on here?
What IS
So What?
Ethical Knowing
Empirical Knowing
Personal Knowing
Aesthetic Knowing
Socio-Political Knowing
Adapted from KCAE,1984, & White,1990
Adapted from KCAE, 1984 & White 1990, Carper 1978, Munhall,1993, White, 1995, Chinn & Kramer, 2008, White 2013
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Asthma Australia (2016). https://www.asthmaaustralia.org.au/qld/about-asthma/what-is-asthma-/statistics
Brown, D., Edwards, H., Seaton, L., & Buckley, T. C. T. (2015). Lewis’s medical-surgical nursing : assessment
and management of clinical problems (Fourth Edition.. ed.): Chatswood, NSW : Elsevier Australia.
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., Brashers, V. L., & Rote, N. S. (2015). Understanding
pathophysiology (2nd edition.. ed.): Chatswood, N.S.W. : Elsevier Australia.
Farrell, M., Dempsey, J., Smeltzer, S., & Bare, B. (2014). Smeltzer and Bare’s textbook of medical- surgical
nursing (Third Australian and New Zealand edition. ed.). Sydney: Lippincott Williams & Wilkins.
Fisher, M, Lecture April 4, 2018
McCance, K., Heuther, S., Brashers, V., & Rote, N. (2010). Pathophysiology: The biologic basis for disease in
adults and children (6th ed.). St. Louis: Mosby Elsevier.
McKenna, L., Lim, A. G., & Karch, A. M. (2015). McKenna’s pharmacology for nursing and health
professionals (Second edition. ed.). Sydney, N.S.W.: Wolters Kluwer/Lippincott Williams &
Shlamovitz, G. Z. (2016). Tube Thoracostomy. Medscape; Clinical Procedures. Retrieved from
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