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Case study:

Jackson Smith, a 18 year-old male, was admitted to the Emergency Department at 9pm with severe breathlessness. His family informed you that the patient has a history of Asthma that had been diagnosed when he was two years old. On admission to the Emergency Department the clinical manifestations were: 
– Severe dyspnoea, inability to speak sentences in one breath 
– Respiratory rate of 32 breaths/minute 
– SpO2 90%, on room air 
– BP 150/85 mmHg 
– Pulse rate of 130 beats/minute 
– Auscultation of lungs identifies diminished breath sounds and widespread wheeze 
A chest x-ray was performed and showed a clear and hyper-inflated lung fields. 
A blood gas was taken: 
pH : 7.35
 PaO2: 60mmHg 
PaCO2: 50mmHg 
HCO3: 25mEq/L 
Lactate: 1 
SaO2 90% 
A diagnosis of Acute Severe Asthma was made.

Question

1. Explain the pathogenesis causing the clinical manifestations with which Jackson Smith presented with. 

2. Discuss two high priority nursing strategies to manage Jackson and provide evidence-based rationales for these strategies.
 
3. Three of the drugs that were given to Jackson were continuous nebulised Salbutamol and nebulised Ipratropium bromide (4/24) and IV Hydrocortisone 100mg (6/24). 
a. Discuss the mechanism of action of these drugs, and relate to the underlying pathogenesis of an Acute Severe Asthma. And, 
b. Describe the nursing implications (monitoring for and responding to adverse effects, and evaluating therapeutic effect) when administering these drugs to a patient with an Acute Severe Asthma.
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