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Asthma

Discuss about the Asthma Disease.

Asthma and inflammatory disease are chronic disease of respiratory system and gastrointestinal system respectively. There are different problems associate with these diseases. In this essay, specific interventions for each disease are discussed. Also, medications useful for treatment of these diseases are discussed.  

Asthma is a chronic allergic, inflammatory and immunological disease. Asthma is a type 1 hypersensitivity reaction. Asthma is mainly associated with symptoms like insufficient breathing, wheezing and coughing (Mims, 2015).  

Problems associated with asthma are insufficient breathing, coughing, insufficient airway clearance fatigue, depression and Imbalanced nutrition.

Problem

Intervention

Rationale

Insufficient breathing

Person should be placed in upright sitting posture and proper body alignment.

Patients should be encouraged to take deep breathing – Slow inhalation, holding end inspiration for some time and prolonged exhalation.

Encourage patient for diaphragmatic breathing.

Upon consultation with doctor, respiratory medications and supplemental oxygen should be provided.

Evaluate potential exercise programme in patient and encourage patient to perform exercise according to patient’s requirements. 

Education – Patient should be educated for pursed-lip breathing, abdominal breathing, relaxation techniques, use of inhaler, scheduling daily activities by considering fatigue and rest period.

Encourage patient to take small quantity meals with frequent intervals.

Nurse should stay with patient during acute exacerbations of asthma.

Proper sitting position allows maximum lung excursion and chest expansion.

Deep breathing facilitates slow respiration, aids augmented oxygenation, and prevents air trapping.

Useful in the relaxation of muscle and augmentation of oxygen saturation level.

Β2 adrenergic agonists medications relax airway smooth muscle and produces bronchodilation, which facilitate passage of air through airways.  Supplemental oxygen would compensate for low oxygen saturation.

Exercise improves patient’s working ability of respiratory muscle and give patient sense of well-being.

All these activities would be helpful in maintaining proper health and improving ventilation.

Avoid full stomach and facilitate proper ventilation.

It can reduce anxiety in the patient which would be helpful in reducing anxiety (Chow et al., 2015; Janssen et al., 2012).  

Imbalanced nutrition

Recording of body weight on regular basis.

Collection of nutritional history of patient.

Physical and vital signs of patient should be checked on regular basis.

Provision of good environment and proper position for meals to the patient.

Provide company while taking meals.

Provision of high energy protein and liquid supplements.

Caffeinated and carbonated beverages should be avoided.

Useful in assessment of food consumption.

Diet plan for patient can me made accordingly.

Patients with less nutritional intake are fatigued and demonstrate sluggishness. There is also possibility of tachycardia and raised blood pressure.

It affords comfort and reduces stress for consumption of meals.

Socializing the patient can improve food consumption in the patient.

Protein supplements provide high calorie and liquid supplements are easy to consume.

Caffeinated and carbonated beverages reduce hunger and give false sense of satiety (Chow et al., 2015; Janssen et al., 2012).

Anti-inflammatory and bronchodilator medicines should be administered in the patients with asthma. Prednisolone acts as both anti-inflammatory and immunosuppressant drug. It exhibits it action by binding to the glucocorticoid receptor (Olin & Wechsler, 2014). Salbutamol can be used as bronchodilator in patients with asthma. Salbutamol is as short acting β2 adrenergic receptor agonist (van Buul, 2015).       

External agents like cold air, exercise, pollen and viruses are responsible for the occurrence of asthma. Genetic factors and drugs such as aspirin and β blockers are also responsible for the occurrence of asthma (Mims, 2015). Imbalanced nutrition and ineffective breathing are important problems associated with asthma. Glucocorticoid receptors gets activated and produces transactivation and transrepression. Transactivation comprises of upregulation of the anti-inflammatory genes like lipocortin I, p11/calpactin binding protein, secretory leukoprotease inhibitor 1 (SLPI), and mitogen-activated protein kinase phosphatase (MAPK phosphatase). Transrepression comprises of suppression of the expression of proinflammatory proteins in cytosol. It prevents translocation of transcription factors like NF-κB in the nucleus from cytosol (Olin & Wechsler, 2014). β2 adrenergic receptors, upon activation releases adenyl cyclase enzyme in the bronchial smooth muscle of the lung. Adenyl cyclase acts as catalyst for the formation of adenosine-mono-phosphate (cyclic AMP) from adenosine-tri-phosphate (ATP). This increase in the cyclic AMP level produces relaxation of the bronchial smooth muscle. Increase in the cyclic AMP level inhibits release of histamine and leukotreine, which are necessary for bronchoconstriction (van Buul, 2015).     

Inflammatory bowel diseases (IBD) are group inflammatory diseases comprise of Crohn's disease and ulcerative colitis. IBD affects small intestine, large intestine, mouth, esophagus, stomach and the anus. IBD is a class of autoimmune disease. In autoimmune disease, body’s own immune system attacks digestive system (Cohen, 2011).

Problems of IBD include diarrhea, risk of deficient fluid volume, anxiety, acute pain, imbalance nutrition and deficient knowledge.     

Problem

Intervention

Rationale

Diarrhea

To find out beginning and pattern of diarrhea.

Observation and recording of stool frequency, quantity and characteristic of diarrhea.

Observation of related factors like fevers, chills, bloody stools, physical exertion, abdominal pain, emotional upset and cramping.

Encourage bed rest and provision of bedside commode.

Removal of stool quickly from the room and provision of deodorant in the room. 

Identification and restriction of foods which acts as precipitating factors for diarrhea.

Provision of oral fluids immediately and on regular basis. Avoidance of cold fluids.

Counseling for emotional stability to relieve stress.

Evaluate etiology of diarrhea.

Facilitate diffenrtial diagnosis of disease and assessment of severity of disease.

Assessment of causative agents and etiology.

Rest reduces intestinal motility. Rest decreases metabolic rate in complications like infection and hemorrhage. Urgency defecation can occur without word of warning and it can be uncontrollable. In case of commode at a distance, may lead to fall of the patient. 

It helps in removal of noxious odors and avoidance of patient of embarrassment.

Avoidance of intestinal irritants reduces intestinal motility.

Avoidance of intestinal irritants reduces intestinal motility. Consumption of liquids can prevent cramps and recurrent episodes of diarrhea. Consumption of cold fluids may increase intestinal motility.

Diarrhea can lead to anxiety and stress in patient which can aggravate condition (LeMone et al., 2015; Gulanick and Myers, 2011).

Acute Pain

Patient should be encouraged to report pain.

Patient should be assessed for abdominal cramp and pain. Detection of pain location, duration and intensity of pain. Study alterations in the pain patterns.

Evaluation of non-verbal cues for pain like restlessness, reluctance to move, abdominal guarding, withdrawal, and depression.

Implementation of necessary dietary modifications for example, step wise shifting of diet from liquids to the solids.

Assess and record abdominal distension, pyrexia and low blood pressure.

Assessment of ischiorectal and perianal fistulas.

Encourage patient to take comfortable position.

Assessment of factors responsible for the alleviation of pain.

Many patients may tolerate pain instead of consuming analgesics.

Colicky pain is a common feature of inflammatory bowel disease.

Non-verbal cues in addition to the verbal cues can be useful in assessing the severity of pain.

Bowel rest can result in reduction of pain and cramping.

Indication of intestinal obstruction due to inflammation, edema and scarring.

Erosion and fragile intestinal bowel wall can lead to development of fistulas.

Reduces abdominal tension and gives feeling of control on pain.

Nursing intervention can be directed in that direction (LeMone et al., 2015; Gulanick and Myers, 2011).

Aminosalicylates like sulfasalazine can be administered to reduce symptoms of ulcerative colitis. Exact mechanism of action of aminosalicylates has not been established however it can act as scavenger of oxygen-free radicals and inhibitor of leukotrienes. Aminosalicylates can act as both anti-inflammatory and immunosuppressive medications (Bayless and Bayless, 2014). Immunosuppressive drugs like azathioprine, mercaptopurine, methotrexate and cyclosporine can also be administered in inflammatory bowel disease patients (Wiseman, 2016).

IBD comprises of different phases of chronic inflammation and periods of remission spread with acute inflammation episodes. Genetic factors are also responsible for the development of IBD (Cohen, 2011).Diarrhea and acute pain are two important problems associated with IBD. Aminosalicylates can be administered through oral route and in enema or suppository from (Bayless and Bayless, 2014). Azathioprine and mercaptopurine act as purine analogue and inhibitor of DNA synthesis. Methotrexate binds to dihydrofolate reductase and prevent synthesis of tetrahydrofolate. Cyclosporiene act as inhibitor of activation of T cells and its immune response (Wiseman, 2016).

Conclusion:

Asthma and IBD are inflammatory and immune medicated disease. Provisions of nursing care for insufficient breathing and nutritional imbalance are important in asthma patients are important to improve overall quality of life in asthma patients. Provision of nursing care for diarrhea and acute pain are important in case of IBD patients to improve comfort level of patients. Anti-inflammatory and bronchodilatory medications should be administered in case of asthma patients. Aminosalicylates and immunosuppressive medications should be administered in patients with IBD. In summary, provision of specific nursing care to patients would be definitely helpful in improving condition of the patient. 

References:

Bayless, T. M., and  Bayless, T. M. (2014). Advanced Therapy of Inflammatory Bowel Disease: Ulcerative Colitis. PMPH-USA.

Chow, L., Parulekar, A.D., and Hanania, N.A. (2015). Hospital management of acute exacerbations of chronic obstructive pulmonary disease. Journal of Hospital Medicine, 10(5), 328-39.

Cohen, R. D. (2011). Inflammatory Bowel Disease: Diagnosis and Therapeutics. Springer Science & Business Media.

Gulanick, M., and Myers, J. L. (2011). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.

Janssen, D.J., Engelberg, R.A., Wouters, E.F., Curtis, J.R. (2012). Advance care planning for patients with COPD: past, present and future. Patient Education and Counseling, 86(1), 19-24

LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., and Reid-Searl, K. (2015).  Medical-Surgical Nursing. Pearson Higher Education AU.

Mims, J.W. (2015). Asthma: definitions and pathophysiology. International Forum of Allergy & Rhinology, 5(l), S2-6.

Olin, J.T., & Wechsler, M.E. (2014). Asthma: pathogenesis and novel drugs for treatment. British Medical Journal, 349, g5517. doi: 10.1136/bmj.g5517.

van Buul, A.R, & Taube, C.  (2015). Treatment of severe asthma: entering the era of targeted therapy. Expert Opinion on Biological Therapy, 15(12), 1713-25.

Wiseman, A. C. (2016). Immunosuppressive Medications. Clinical Journal of the American Society of Nephrology, 11(2): 332–343.

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