2.4.1 Short Answer Exam based on one case study of acute life-threatening and/or traumatic complex health condition Weight: 35% Type of Collaboration: Individual Due: 3rd May Sunday Submission: Refer...

2.4.1 Short Answer Exam based on one case study of acute life-threatening and/or traumatic complex health condition
    Weight:
    35%
    Type of Collaboration:
    Individual
    Due:
    3rd May Sunday
    Submission:
    Refer to section 2.5 of the Learning Guide - General Submission Requirements
    Format:
    
Short answer questions based on a case study of an acute life-threatning and/or traumatic complex health condition.
    Length:
    1250 words
    Cu
iculum Mode:
    
Word Count
There is a word limit of 1250 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10% word count. If you exceed the word count by 10% (1375 words) the marker will stop marking.
Details
You are to answer all questions related to the case study provided. Your answers must be directly related to the clinical manifestations that your patient presents with. You must submit your work with a minimum of six references from the past 5 years including journal articles, textbook material or other appropriate evidence based resources.
Aim of assessment
The purpose of this assessment is to enable students to:
1. Demonstrate knowledge by analysing the information provided in the case study.
2. Apply the clinical information provided in the case study and describe this clinical information within a pathophys- iological and patient focused framework.
3. Discuss nursing strategies and evidence based rationales to manage a patient with an acute episode of asthma.
4. Discuss the pharmacological interventions related to the management of a patient with an acute episode of asthma.
Case study
Poppy is a 9 year old female, weight 40Kg.
She presented to ED with worsening respiratory symptoms over the past few hours. Her parents state she is unable to talk in full sentences or undertake a peak flow. In ED Poppy has been given 3 x 20 minutely nebulised Salbutamol with 6LPM of O2, IVF commenced, Stat dose of Prednisone administered, Chest X-ray shows hyperinflation of both lung fields. She was admitted to ICU due to her deteriorating respiratory function with a diagnosis of acute exace
ation of asthma.
EXCERPT OF RELEVANT ICU NOTES
Past History
Diagnosed with asthma age 2 (infrequent intermittent asthma).
Cu
ent medications: - Ventolin PRN. IUTD (immunisations up to date)
Nursing Assessment
A. Clear, speaking in single words
B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and expiratory wheeze
C. HR 160bpm, ST, peripherally warm D. GCS 14/15 (E4, V4, M6)
E. Accessory muscle use, shoulder shrugging on inspiration, tracheal tug
F. IVF NaCl 53 ml/hr G.
a. Mg- low 0.60mmol/L XXXXXXXXXX10mmol/L) all other pathology is normal.
. BGL 9.0mmol/L
c. Beta-agonist- Salbutamol
d. Anticholinergic - Atrovent
e. IV Hydrocortisone
9
Plan
f. ABG shows respiratory acidosis, (PH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, Lactate
1.4)
· Keep SpO2 92-95%%
· Beta- antagonist Salbutamol continuous via nebulise
· Anticholinergic Ipratropium
omide (Atrovent) 500ug 4/24
· Hydrocortisone 100mg 6/24
· MgSO4 6.4mmol/20 minutes
· IVF 53ml/h
· Repeat ABGs in 1hou
· Monitor BGL
· Peakflow /spirometry
Question 1
Explain the pathogenesis causing the clinical manifestations with which Poppy presents.
Question 2
1. Sit Poppy in a High Fowlers position
· How does positioning a patient with acute asthma in a High Fowlers position assist to alleviate respiratory distress?
2. Apply and titrate oxygen
· What oxygen delivery device will you use?
· Why did you choose this device?
· How does providing supplemental oxygen work and, how will it assist Poppy?
Question 3
For each medication below explain
· The mechanism of action.
· Why your patient is receiving this medication in relation to her symptoms and diagnosis?
· What are the nursing considerations for this medication?
· What clinical response you expect?
· What continuing clinical observations will you need to undertake?
1.Salbutamol via nebuliser 2.Hydrocortisone IV
3.Ipratropium Bromide via nebulise

Module 2: Asthma

Key concepts

At the end of the tutorial today, you should be able to:
 Describe the pathogenesis of asthma and its clinical manifestations especially in the context of paediatric patients.
 Clinical Manifestations of asthma and being able to recognise between nursing priorities.
 Describe how asthma effects gas exchange and what are the triggers of asthma
 Recognise treatment priorities for the management of patients experiencing acute exace
ation of asthma.
Chapter 24 & 25



Asthma Handbook
https:
www.asthmahandbook.org.au/man
agement/children





Alterations of pulmonary system
across the life span
– pages XXXXXXXXXX
https:
www.asthmahandbook.org.au/management/children
https:
www.asthmahandbook.org.au/management/children


Plan
 Mark role
 Khaoot on resp/asthma – login details go to Kahoot.com
 XXXXXXXXXXGo to login
XXXXXXXXXXUser name crook.benny
XXXXXXXXXXPassword : Surfing1
XXXXXXXXXXFind the kahoot , team mode , get the each table to share a device and play
 Read case study
 Break groups into 4 tables and define the 4 different features of asthma e.g airway hype
esponsiveness and draw a diagram
 Do the same for the cells e.g histamine
 Talk through question 3
 Question 4 – let the students look up the asthma handbook to find the answers, about diagnosis
 CXR and bloods results discus as a class






Activity 2.1.: Case studies: Hannah Fo
est presents with Exace
ation of Asthma.
A new admission has a
ived. You receive the following handover:

XXXXXXXXXXHannah is a 9-year-old female presenting with an SOB 1100 whilst at school.
S
Hannah was at school playing in the playground and started to develop some SOB whilst running in the playground. Her friends started to
notice that she had an audible wheeze and was only talking in short words and continues to cough. She presented to the school nurse who
subsequently called the ambulance.
B

History of Asthma
Uses Ventolin PRN
IUTD (Immunisations up to date)
A A-G Assessment Airway: Clear

Breathing:
 Severe shortness of
eath and coughing
 Tracheal tug and subcostal recession
 Using accessory muscles on respiration
 Unable to speak properly and is only speaking in short words
 On auscultation expiratory wheeze
 Respiratory rate 42
eaths/min
 SpO2 92% on room air
Circulation:
 Heart rate: 130 beats/min
 Temperature: 37.8

Disability:
 GCS 15, PEARTL. Equal strength X 4
Exposure:
 No
uising, wounds
 Nil cannula
 Weight: 40kg

Fluids:
No IV fluids in progress

Glucose:
 BGL: 5.2 mmol/L


R Ventolin 5mg x3 every 20mins Prednisone 1mg/kg
CXR
Bloods FBC, UEC
Keep Oxygen saturations above ~94%

Activity 2.2: Pathophysiology Review

Question 1: What is the definition of Asthma?

A clinical definition of asthma in children
Asthma is defined clinically as the combination of variable respiratory symptoms (e.g. wheeze, shortness of
eath, cough and chest tightness) and excessive variation in lung
function, i.e. variation in expiratory airflow that is greater than that seen in healthy children (‘variable airflow limitation’).
See: A working definition of asthma
There is no single reliable test (‘gold standard’) and there are no standardised diagnostic criteria for asthma. The diagnosis of asthma is based on:
history
physical examination
considering other diagnoses
clinical response to a treatment trial with an inhaled short-acting beta2 agonist reliever or preventer


The primary event in asthma is airway inflammation and that airway hype
esponsiveness and airflow obstruction are secondary and
symptomatic features of the disease. Underlying airway inflammation (which involves cellular infiltration, edema, nerve i
itation, and
vasodilation) results in constriction of airway smooth muscle, increased production of mucus, and airway hype
esponsiveness. The
airflow limitation associated with asthma is caused by a variety of changes in the airway, all of which are influenced by airway
inflammation. These changes include
onchoconstriction (
onchial smooth muscle contraction that quickly na
ows the airways in
esponse to a variety of stimuli, including allergens and i
itants), airway hype
esponsiveness (an exaggerated
onchoconstrictor
esponse to stimuli), and airway edema (hypersecretion of mucus and mucous plugs as the disease becomes more persistent, which
further limit flow). With time, remodeling of airways may occur, and reversibility of airway obstruction may be incomplete in some
persons. Possible changes in airway structure include sub-basement fi
osis, hypersecretion of mucus, epithelial cell injury, smooth
muscle hypertrophy, and angiogenesis (the growth of new blood vessels from existing blood vessels) (polgar-baily, 2017)

The key here is trying to make the pathophysiology easy to understand. I SUGGEST DIAGRAMS.
Pictures can really show the process clearly.

The pathophysiology of asthma includes
 Bronchoconstriction
 Airway odema
 Airway hype
esponsiveness
 Airway remodeling
I have included a lot of detailed just in case you asked some deeper questions from students hopefully this helps,
 Bronchoconstriction:
In asthma, the dominant physiological event leading to clinical symptoms is airway na
owing and a subsequent interference with
airflow. In acute exace
ations of asthma,
onchial smooth muscle contraction (
onchoconstriction) occurs quickly to na
ow the