Running head: ASTHMA MANAGEMENT

Asthma Management

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Asthma Management

Case

J.S, a Chinese man aged 42 years, lives in Sussex and is highly allergic to pollen and

dust. He has a medical history of mild asthma which he reports to manage using traditional

medicine (herbs). His wife drove him to the emergency room after an extended period of

wheezing and being unresponsive to fluticasone/salmeterol (Advair) inhaler. Initially, the couple

used the traditional medicine to manage the symptoms but J.S condition worsened. When J.S felt

chest pains while lying down and begun to use accessory muscles to breathe, his wife made the

decision to quickly rush him to the emergency room where he was immediately started on 4 L

Oxygen through the nasal cannula and intravenous (IV) D5W at 75 mL/hr. Arterial blood gases

are sent to the laboratory while the following vital signs are noted when J.S reports experiencing

shortness of breath and anxiety:

BP = 152/84 HR = 124 bpm R = 42 Temp = 100.4 ° F

ABGs

pH = 7.31 PaCO2 = 48 HCO3 = 26 PaO2 = 55

Causes of Asthma.

Asthma is triggered by a number of factors such as pollen, fur, dust particles and some

food additives (Banasik 2019, p.476). In the case study, J.S’ asthma was triggered by dust and

pollen. The symptom that supports the diagnosis of asthma is wheezing, his medical history, he

was unable to lie down and the use of accessory muscles to breathe (Lambrecht & Hammad
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2015, p.46). The treatment provided at the emergency department is 4 L oxygen by nasal cannula

and intravenous (IV) D5W at 75mL/hr. His vitals are alarming, especially his blood pressure at

152/84.

Treatment Plan:

Pharmacologic intervention

The following are some of the medications administered on the 42-year-old man with a

recurrent asthmatic condition that inhibits him from normal function. Albuterol HFA – 2 puffs

q4-6h, 2 puffs 15 min prior to any form of strenuous physical activity (such as running)

(Lambrecht et al. 2019, p.975). Albuterol – 0.01-0.03ml/kg of 0.5% solution diluted in 2ml

normal saline if the dosage is administered through the nebulizer while the oral dosage involves

2mg tid or qid (Woo & Robinson 2016, p.922).

Albuterol functions as a bronchodilator; implying that it relaxes the muscles of the

airways and thereby widening them (Corren et al. 2011, p.1088). This allows more air to flow

into the lungs, relieving the patient off the discomfort that is brought about by the suffocation.

Specifically, Albuterol works on the beta2 receptors that function as the predominant receptors

of the bronchi’s smooth muscles.

Prednisolone – the syrup is administered in 5mg/5 ml (Pediapred) 15mg /5 ml (Prelone)

while ‘burst’ 1-2 mg/kg/d in 1-2 doses with a maximum of 40-50 mg/d (Woo & Robinson 2016,

p.925). Prednisolone serves the function of anti-inflammatory such that it functions to relieve the

inflammation of the bronchi. Prednisolone also serves an important function of soothing and

healing the delicate passageways of the lungs, which also makes them more resistant to

bronchospasm. Budesonide Inhalation suspension (Pulmicort Respules) for nebulization high

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dosage 2.0mg/d (Woo & Robinson 2016, p.925). Budesonide works by causing a reduction of

the swelling present in the airways that is caused by asthma. There is a need for it to be used

regularly so that it can result to a reduction of instances of wheezing and shortness of breath that

is common in patients with asthma.

Ipratropium bromide – 1-2 puffs q6h for the inhaler while the nebulizer is administered in

0.25mg q20min for 3 doses, then 0.25mg q6h or 0.5mg/3ml ipratropium bromide and 2.5,g/3ml

albuterol (Woo & Robinson 2016, p.924). Ipratropium functions in such a way that it causes a

relaxation of the walls of the muscles of the bronchus and as such, allows more air to pass

through them.

Assessment Tool and Healthcare Delivery

The assessment tool used in the treatment of J.S is the Early Warning Score (EWS) since

it is a quick guide that is used to determine the degree of wellness. The EWS is based on the six

cardinal vital signs that are especially applicable in client J.S above who begun to use accessory

muscles to breathe (Gerry et al., 2020). These six cardinal vital signs include temperature, blood

pressure, respiratory rate, heart rate and AVPU/GCS response (Jensen et al. 2019, p.1067). As

such, EWS is used as a method of quickly determining the degree of illness of a patient. Despite

the fact that there is wide understanding that both expense control and quality change are

essential, the connection between restorative administrations costs and quality focuses on aspects

that relate to wellness (Milshteyn & Petrov, 2007). Accordingly, improvements in quality will

require an increase in expense since diminishing the cost could decrease quality. On the other

hand, upgrades in quality could cut down costs by diminishing difficulties or readmissions made

in doctors’ facilities (Bush & Fleming 2016, p.688). In essence, the relationship between cost
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and quality probably falls between these 2 limits, so a couple of administration costs are

connected to high quality goods and services while others may be connected to low quality. The

effect depends upon the focal point of the expenses.

A visualization of the number of people with asthma by age in the UK, England, Northern Ireland, Scotland

and Wales (data from: asthma u.k)

The table above shows the prevalence of asthma against age in the UK, England,

Northern Ireland, Scotland and Wales. Accordingly, children aged 0-15 with asthma are more
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compared to individuals aged 16 and above. More than five million asthmatic cases are reported

in the UK compared to England, Northern Ireland, Scotland and Wales while Northern Ireland

report the lowest number. The conversation over the cost-quality affiliation has been generally

encircled by a couple of crucial examinations that considered geographic domains in the United

Kingdom. These examinations filed tremendous assortments in expense across over zones, with

no confirmation that greater expense zones would be appropriate to quality or wellbeing results

(Al-Muhsen et al. 2011, p.453). Both the procedures and the comprehension of these

examinations have been extensively discussed. NICE requested that an in-depth discussion is

made on the issue of geographic assortment which functions at the expense of quality (Gauthier

et al. 2015, p.660). Various examinations of the expense quality association have looked at units

other than geographic zones, for instance, recuperating centers that use various techniques and

have come to different end results (Ymeraga & Dobroshi, 2007). All things considered, there has

been no past study that would make verifications on the cost quality relationship in social

protection.

In addition to protection costs and quality, a couple of plan credits may be essential. First,

level of assessment is basic since local level examinations may yield sudden results in contrast to

provider or patient-level assessments (Boulet 2013, p.10). Second, there are various ways to

measure quality, all of which may have an unmistakable relationship with cost. For example, an

assistant, nurture staffing per understanding, will probably have different expense proposals than

higher execution on an outcome measure such as, tolerant practical status. Third, cost can be

assessed from numerous perspectives, for example, reimbursement from a wellness plan or the

amount of resources that are used by a service provider (Beasley et al. 2015, p.1076).
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Furthermore, projects may use certain approaches, especially in making proper adjustments of

the effects of wellbeing status on quality and costs.

Assessments arranged as displaying positive quality spending affiliations if greater

expense was basically associated with higher quality over all measures and mixed positively if

greater expense was completely associated with better measures. Basically, relationships that

reported greater expense were on very basic levels associated with cut down quality and as such

were delegated negative or somewhat negative responses (Milshteyn & Petrov, 2007).

Connections finding both immense for different measures and assessments of comparative

measures were checked. Those reporting no immense association were denoted no qualification

if the assessment distinctively made precise checks of a zero alliance or dubious if the

examination comes about as a result of a significant affiliation.

The pace of improvement in spending has reduced recently as per capita spending on

social protection is evaluated to be 50.10 to 200.00 percent more conspicuous than in other

financially developed countries (Brolley et al., 2007). Notwithstanding driving the world in

expenses, the United Kingdom positions twenty sixth on the planet for future and positions

inadequately on various value markers. Confirmation of the low assessment of United Kingdom

social protection has driven experts to attempt to perceive specific sources of wasteful spending.

Non-pharmacologic intervention

The non-pharmacological intervention involves other forms of approaches that do not

include the use of medicinal drugs. It is important to point out that asthma results from the

inflammation of the walls of the bronchi in the lungs (Lötvall et al. 2011, p.355). As such, it is

important for the caregiver and the patient to become aware of the agent that causes the
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inflammation so as to avoid it. In reference to the text by Woo & Robinson (2016), the authors

point out that “stress associated with frequent health-care visits, uncertain diagnosis, missed

work because of the illness, or guilt about needing to work instead of being at home with the

patient can make working with these families a challenge to the provider” (p. 931). This implies

that many spouses grow more distressful about the health of their partner who has been

diagnosed with asthma. In as much as many health practitioners shun from diagnosing patients

with asthma at very young ages (Kudo et al., 2013), the increasing concern of spouses

concerning the health of their partners necessitates a form of diagnosis. However, once spouses

are informed about their role in the wellness of their partner who has been diagnosed with

asthma, less asthmatic incidents are likely to develop. The following are some of the non-

pharmacological interventions that could be incorporated in the lifestyle of J.S that is diagnosed

with asthma so as to reduce the incidents of the asthma attacks.

Understanding the triggers of the asthmatic condition and avoiding these triggers.

In reference to the text by Woo & Robinson (2016), the authors outline a number of

factors that relate to the onset of asthmatic symptoms such as allergens, weather conditions and

physical activities (p. 918). Allergens include pollen and dust, which cause inflammation to the

bronchi and as such, lead to asthmatic attacks. The 42-year-old man can thus, learn how to avoid

allergens or be prepared by carrying medicine (such as the inhaler) when in surroundings that

may trigger the attack. Weather conditions may include during the summer or autumn when

there is a lot of pollen and dust within the surroundings while physical activities may include

running errands or working. Understanding the triggers is important as it ensures that J.S is

prepared enough during the onset of the asthmatic attacks (Paulson & Gordon 2011, p.11).

Practicing Breathing Exercises

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Breathing exercises are important since they help the individual seek alternative ways of

supplying Oxygen in the lungs. J.S may be taught how to take deep breaths whenever he is

having an attack, which helps to supply the Oxygen that is lacking in the airways that are

congested (Yang et al. 2017, p.15). The breathing exercises are similar to the ones that are

practiced during yoga sessions, where individuals are required to take in deep breaths through

their nose and exhale deeply through the mouth (Boonpiyathad et al., 2019). Breathing exercises

also help J.S to overcome any stress that he may experience during the asthma attack that is

likely to result worsening of the asthmatic condition.

Communication plan

Communication plan involves the necessary steps that would be taken by both the parent

and her son to ensure that they adhere to treatment, thereby reducing the incidents of asthma

attacks. In reference to the article by Dima et al. (2017), the authors outline that more patients

adhere to medication once they understand the function that is played by the various forms of

interventions made (p. 1289). In order to ensure that J.S’s wife administers the medication in the

required time, there was a record keeping that was followed by the presence of an alarm that was

set up in her phone (Farne et al., 2017). Furthermore, J.S was also informed about the different

forms of medication and the different forms of non-pharmacological interventions that would

prevent him from re-experiencing the asthma attacks. Teach-back methods were also

incorporated to ensure that both J.S and his wife understood the different forms of interventions

that were necessary during treatment.

Cultural and Ethical Considerations

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J.S pointed out that Chinese cultural values are deeply ingrained in him and that they

significantly contribute to his identity. The main health belief associated with people from

Chinese heritage is the attainment of harmony, also known as yin and yang (Brolley et al., 2007).

In reference to the article by Brolley et al. (2007), the authors point out that “Health may be

viewed as finding harmony between complementary energies such as cold and hot, dark and

light. These forces are called yin and yang”. This therefore means in there is a high likelihood

that people from Chinese heritage combine both traditional and western medicine and strive to

create harmony between the two disciplines, as was the case of client J.S. During the

examination, J.S explained that he had always found Western medicine too ‘strong’ and that he

believed in the power of the body healing itself. Chinese traditional medicine was his first

priority due to the significantly lower side-effects that they cause to the body. He is used to

consulting western medicine as a last resort and in most cases, it is usually after the

recommendation of a family member. He added that he was surprised at how many people from

the western culture appear to be afraid of death, even though they understand that it is inevitable.

The Chinese culture, he explained, is filled with profound insight especially in relation to caring

for one’s body and how to approach illness. This insight shapes their perception of life, which

includes their purpose and their afterlife. Furthermore, many people who come from the Chinese

heritage hold loyalty to family and friends in high regards, more than one’s personal feelings

(Brolley et al., 2007). This loyalty may cause them to oblige to some of the health

recommendations made by their family members even though they may not understand some of

their approaches, which was the case for the woman. In the Chinese heritage, the elderly are held

in high regard and respected. They play a crucial role within the family, especially in the

guidance of younger people (Brolley et al., 2007). Many people who are Chinese acknowledge
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that death is part of life though in order to prevent illness, they strive to create harmony between

yin and yang (Brolley et al., 2007). Special foods and traditional Chinese remedies are most

often used not only to prevent illness but also as ways to address the initial stages of illness

(Brolley et al., 2007). The traditional Chinese therapies include acupuncture, massage and

moxibustion. Family members’ interaction with Chinese women who are older is one that is

based on respect. It is considered rude to outrightly say no to an elder person, even though one

does not agree with what he or she may say (Brolley et al., 2007). However, one may respond by

saying yes to communicate that he or she understands what is being said. It is also common for

individuals from Chinese heritage to express themselves in the affirmative when speaking to

someone who is an authority in a specific field so as to be respectful.

Comparative Analysis

Client J.S believes that illness is caused by a disruption in the normal functioning of the

body. The Chinese believe that illness is caused by a disruption in harmony between the yin and

yang, failing to consume the right type of food, unfavorable climate or as a result of extremely

brutal psychological and physical terror (Ymeraga & Dobroshi, 2007). Furthermore, family

members play a crucial role when a person is ill, and each individual has a part to play. However,

one of the differences between the Chinese culture and the Western culture in relation to illness

is their perception. Whereas the Chinese view sickness and death as part of life, people from the

West are greatly distressed and concerned when a person falls sick, so much so that they are

alerted to make efforts to help the patient both financially and emotionally (Ymeraga &

Dobroshi, 2007). Furthermore, the Western culture believes in the use of modern medicine in

order to attain wellness. This view is evident in the article by Ymeraga & Dobroshi (2007) where

the author points out that “patient might believe that IM administered medications have a better
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effect than those administered orally…may expect to need to use medications in order to get

better” (Ymeraga & Dobroshi, 2007). This view is contrary to that of Chinese culture, which is

premised on the use of alternative forms of treatment such as acupuncture and massage as forms

of attaining wellness.

Overall, client J.S’ vulnerabilities that include his age and allergies are set to significantly

increase his likelihood of experiencing more asthma attacks. It is important to incorporate a

holistic approach to the treatment of JS specifically because of his approach to medicine, as he

strongly believes in the medicinal properties of herbal medication. In as much as client J.S

claims that the traditional medication helps to decongest his chest, they are not effective when

his condition worsens. It is also notable that the delay in seeking medical care negatively affects

the health of J.S as it worsens his condition. It is for this reason that a recommendation of the use

of fluticasone/salmeterol (Advair) inhaler especially during the onset of the asthma attacks is

made. J.S’ wife is made to understand how her husband’s age would also predispose him to more

infections due to a weakened immune system. As such, J.S would have to be more proactive in

managing his asthmatic condition.

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