EXACERBATION OF ASTHMA (SOB AND COUGH) AND NURSING MANAGEMENT (Essay Sample)

EXACERBATION OF ASTHMA (SOB AND COUGH) AND NURSING MANAGEMENT Name of Student Course Name of Professor University Date Exacerbation of Asthma (Shorttness of Breath and Cough) and Nursing Management An assessment of the exacerbation of Asthma (Shortness of Breath and cough) provides one with the necessary experience in analyzing critically ill patients and selecting the appropriate nursing management for the condition. The problem's process revolves around identifying the vital signs that explain the changes linked to the altered physiology. The analysis case refers to an assessment of Mr. M.P, who was referred to the hospital with an exacerbation of asthma (SOB and cough). Mr. M.P is a 51-year-old white male born on 8th April 1971 in Melbourne, Australia. He is a full-time engineer working at a local construction company. The patient lives with his 49-year-old wife and three children, but the wife states that her husband sleeps late at night due to job commitments. The patient was brought to the facility by his wife, who narrates the chief concern that necessitated the referral. History of Present Illness (HPI) According to the narration by the wife, upon arriving home from a job, Mr. M.P started complaining of frequent coughs, shortness of breath, and chest tightness. The wife narrates the patient had been sustaining a cough for the past week, with a wheezing sound that developed in the last three days. The wife testifies that M.P is a cigarette smoker, and the patient confirms that he smokes at least 20 cigarettes per day. The patient is allergic to pet pander or with no medical intolerances. The patient only had minor surgery on his left toe while having difficulty managing his asthma attacks. Family history reveals that his father also had asthma, while the patient has recently had an average of two hospital visitations resulting from exacerbation of asthma. The wife narrates that the patient is under inhaled corticosteroids (ICS) which he uses at the onset of exacerbations. Further analysis of the patient is essential in diagnosing and managing the condition. Review of Systems According to the wife's revelations, M.R. M.P has gained more weight over the past six months. This situation can be noted because his clothes no longer fit. The narrator states that her husband complained of fatigue with a general loss in appetite over the period when the symptoms started to intensify. Though the patient does not complain of any chronic pain, he says he has been feeling unwell lately. The patient experiences fevers and chills sometimes during the night with no case of weight loss. In regards to the vision of the patient, there are no cases of any impaired vision though eye redness can be observed in the patient. The patient does not report any double vision, eye discharge, or pain. Further analysis of the patient organ system is crucial to uncover dysfunction and disease that might be affecting the patient. An examination of the head and neck of the patient reveals lymph node enlargement. An otoscopic examination of the patient's ears reveals that the ears are healthy as the eardrum appears grayish with a translucent appearance. The patient's oral mucosa is reddened with the prevalence of nasal congestion, a runny nose, and cases of sneezing. An examination of the mouth of the patient reveals swollen gums and obvious cavities. Additionally, the patient's detention is still intact, with revelations of mild pain along the gums. A further review of the patient's pulmonary system can be undertaken through inspection or observation. A lung examination is conducted through percussion, palpation, inspection, and auscultation. An inspection of the patient shows Mr. M.P distressed with deep, irregular breathing. The tightness of the scalene muscle is vivid, with the patient appearing to lean forward while resting his hands on the knees (Basu and Perry, 2021). The patient seems to have difficulties speaking as he speaks fewer words within a sentence. Audible wheezing sounds can be noted when the patient is breathing (Chatziparasidis, Priftis, and Bush, 2018). The nail beds of the patient seem to take a blue color, while an assessment of chest excursions through palpation reveals an asymmetric lung expansion. These findings indicate the possibility of either air or fluid filling the pleural space. Careful palpation of painful areas reveals no case of rib fracture. The patient is experiencing a chronic cough with shortness of breath and a rapid heart rate. An examination of the patients gastrointestinal reveals no ulcers, black tarry tools, or hepatitis. However, the patient reports having a loss of appetite. Genitourinary/gynecological examination of Mr. M.P narrates no cases of burning sensation when urinating, frequency or urgency in urination. The patient does not report any changes in urine color or genitalia concerns. Apart from a history of a broken toe, the patient does not have any fractures, back pain, trauma, or swelling within joints. A neurological examination reveals that the patient's reflexes are not compromised. However, the patient's gait is weak as he struggles to stand upright (DerSarkissian, 2022). The patient has never had any episodes of seizure, transient paralysis, blackout spells, or syncope. Discussion of Vital Signs Upon patient presentation to the hospital, measurement of vital signs reveals a height of 180 cm while he weighed 90 kg. Therefore, the BMI of the patient is 27.8 kg/m2, indicating that M.P. is overweight (Centers for Disease Control and Prevention, 2022). The patient's oral temperature is 98.6°F, while his respiratory rate is 23 breaths/min, a heart rate of 127 beats/min, and a paradoxical pulse of 15 mmHg. The patient's systolic pressure is 134 mmHg with a diastolic pressure of 88 mmHg. Observing the patient makes it easy to note that he is in discomfort or pain. A review of the vital signs helps in discovering the health status of a patient (Sapra, Malik, and Bhandari, 2022). Vital signs provide one with a means of hurriedly quantifying the magnitude of an illness and how well the body is coping with the psychological distress. Adding weight affects the ability of an individual to control asthma and quality of life. An article by Bass (2021) reveals that adding an estimated 5 pounds has been linked to 22% self-rated asthma control. Earlier examination reveals that Mr. M.P has been experiencing weight gain as he testifies majority of his clothes no longer fit. Peters, Dixon, and Forno's (2018) study further add that obese individuals have a heightened risk of asthma. The research states that obese individuals tend to experience frequent and severe exacerbations, reduced quality of life, and decreased response to asthma medications. Being overweight is also linked with cases of shortness of breath. According to a cross-sectional population-based study by Currow et al. (2017) prevalence of being overweight has significant consequences on dyspnea. Though the physiological mechanisms of shortness of breath among overweight and obese individuals are still unclear, combinations of changes in pulmonary mechanics and ventilatory drive are some of the likely contributing factors (Agustin et al, 2017; Grassi, Kacmarek, and Berra, 2020). A further review of the patient's cardiovascular and pulmonary symptoms is critical in determining the best nursing management for the patient. The majority of the situations when a patient experiences shortness of breath mainly occurs due to lung or heart conditions. The lungs and heart are critical in transferring oxygen to the tissues and eliminating carbon (IV) oxide; any complications among these organs can affect a patient's breathing (Kaynar, 2022). Shortness of breath can result from heart failure, asthma, lung disease, obesity, or poor fitness (Mayo Clinic Staff, 2022). When a patient experiences heart failure, blood cannot fill or leave the heart efficiently. This phenomenon can result in fluid accumulation within the lungs, thus making patients experience shortness of breath (Cullinan et al, 2017). When patients are overweight, it can strain their lungs, thus making it difficult for them to breathe (Bates et al., 2021). Asthma, where shortness of breath is also prevalent, occurs when airways tend to narrow. Poor fitness due to illness or inactivity can also result in shortness of breath. Any harm to the tissues of the lungs can result in dyspnea. This situation is common among patients with tobacco smoking linked to chronic obstructive pulmonary disease (COPD). Mr. P being a tobacco smoker, is at risk of COPD. According to Verberne et al. (2017), overweight and obesity are common amongst patients experiencing milder stages of COPD (Balmain et al. 2020). The condition commonly arises from smoking or long-term exposure to lung irritants (Dharmage, Perret, and Custovic, 2019). The symptoms of COPD are similar to those of asthma. Thereby it is crucial to differentiate the two. In both conditions, swelling within the airways tends to constrict one's ability to breathe effectively. However, in asthma, the swelling is highly triggered by a given allergic reaction or physical activity (Belleza, 2022). On the other hand, COPD refers to an umbrella name given to a class of lung conditions like chronic bronchitis and emphysema (Cleveland Clinic medical professional, 2022). Emphysema occurs when the alveoli are destroyed; chronic bronchitis results when tubes that carry air to the lungs are inflamed. Differential diagnoses are significant where two conditions share symptoms. A critical review of Mr. P.M's symptoms, family, and medical history is essential; if need be, tests can be appropriate to help diagnose the patient. The patient's wife reveals that his son's friend had visited him accompanied by his pet dog. However, because Mr. M.P is a smoker, it does not necessarily indicate that it could be entirely an asthmatic attack. The patie...