As an advanced practice nurse your ability to apply the concepts of pathophysiology to analysis of the disease processes is fundamental because the underlying pathophysiology of disease directly correlates to the presenting signs and symptoms and severity of disease.
While presenting symptoms may be attributed to one underlying body system, cellular processes often impact multiple related body systems.
Based on the knowledge you have gained up to this point, it is time to apply your skills to complete a case study for a patient presenting with asthma exacerbation.
Review the Patient Diagnosis Case Study: Asthma.
Patient Diagnosis Case Study: Asthma
Nancy Smith, a 35-year-old female, presents with an asthma exacerbation. She has had asthma since she was a child for which she was hospitalized several times. Her asthma was well controlled until the past couple of years. She has gone to urgent care a few times over the past year (most recently 4 months ago) and was given a prescription for an inhaled steroid (she never filled), albuterol inhaler, and oral steroids. She had eczema as a child and received allergy shots for many years. Her asthma symptoms flared again 2 weeks ago, and she has been using her albuterol 4 to 5 times a day. She reports that she is very short of breath when climbing stairs or when walking to the mailbox. She has had productive nighttime coughing spells every day during the past week and has had to prop herself up on pillows to breathe. She indicates that she has had similar previous flares in the past.
Patient Health Information
Meds: Proair HFA, Claritin, Flonase prn.
Pulse ox: 93% on RA
Assessment Deliverable
Write a 700- to 1,050-word paper that addresses the following:
- Discuss the pathophysiology of asthma including the 3 underlying components occurring in the bronchial mucosa.
- Explain how Nancy’s symptoms relate to each of the 3 underlying components of disease pathophysiology.
- Describe the risk factors for asthma including genetic/genomic, pharmacogenetic, and environmental exposure.
- From a pathophysiological perspective, analyze the concept of “atopy” and how it relates to asthma, allergic rhinitis, and atopic dermatitis.
- Describe the chronic pathophysiologic changes that occur in the respiratory system with uncontrolled asthma.
- Correlate these pathophysiologic changes to asthma morbidity and mortality.
Cite a minimum of 4 scholarly resources to support your answers.
Format your paper according to APA guidelines.
Submit your assessment.
Assessment Support
- Visit these websites to find information related to concepts in this assessment:
- Centers for Disease Control and Prevention (CDC)
- National Heart, Lung, and Blood Institute
- Global Initiative for Asthma (GINA)
Patient Diagnosis Case Study: Asthma
Nancy Smith, a 35-year-old female, presents with an asthma exacerbation. She has had asthma since childhood, which was previously well-controlled but has worsened over the past couple of years. She has a history of eczema and has been using albuterol frequently due to recent symptoms including shortness of breath, nighttime coughing, and difficulty breathing when exerting herself. Nancy’s current medications include Proair HFA, Claritin, and Flonase as needed. Her pulse oximetry reads 93% on room air.
Pathophysiology of Asthma:
Asthma is characterized by chronic airway inflammation, bronchial hyperresponsiveness, and airway obstruction. In the bronchial mucosa, three underlying components contribute to these manifestations: inflammation, bronchoconstriction, and airway hyperresponsiveness.
- Inflammation: Chronic inflammation in the bronchial mucosa leads to airway remodeling, increased mucus production, and infiltration of inflammatory cells such as eosinophils, mast cells, and T lymphocytes. This inflammation contributes to airway narrowing and hyperresponsiveness.
- Bronchoconstriction: Smooth muscle constriction of the airways occurs due to the release of inflammatory mediators such as histamine, leukotrienes, and prostaglandins. This constriction leads to the characteristic symptoms of wheezing, chest tightness, and shortness of breath.
- Airway Hyperresponsiveness: Asthmatic airways demonstrate increased sensitivity to various stimuli, including allergens, irritants, exercise, and respiratory infections. This heightened response results in exaggerated bronchoconstriction and airway narrowing.
Relationship of Symptoms to Pathophysiology:
- Nancy’s shortness of breath, nighttime coughing, and exertional dyspnea are indicative of bronchoconstriction and airway obstruction resulting from inflammation and hyperresponsiveness in the bronchial mucosa.
- The need to use albuterol frequently suggests inadequate control of bronchoconstriction, highlighting the severity of inflammation and airway hyperresponsiveness.
Risk Factors for Asthma:
- Genetic/Genomic Factors: Family history of asthma and atopic conditions increases the risk of developing asthma.
- Pharmacogenetic Factors: Genetic variations may influence response to asthma medications, affecting treatment efficacy.
- Environmental Exposure: Allergens (e.g., pollen, dust mites), air pollution, tobacco smoke, occupational exposures, and respiratory infections contribute to asthma development and exacerbations.
“Atopy” and its Relation to Asthma:
“Atopy” refers to a genetic predisposition to develop allergic hypersensitivity reactions. It is closely linked to asthma, allergic rhinitis, and atopic dermatitis. Individuals with atopy have an exaggerated immune response to common allergens, leading to the production of IgE antibodies and release of inflammatory mediators upon exposure.
Chronic Pathophysiologic Changes in Uncontrolled Asthma:
In uncontrolled asthma, persistent inflammation and airway remodeling occur. Chronic exposure to inflammatory mediators leads to structural changes in the airways, including subepithelial fibrosis, increased smooth muscle mass, and hypertrophy of mucous glands. These changes result in irreversible airflow limitation and loss of lung function over time.
Correlation to Morbidity and Mortality:
Uncontrolled asthma increases the risk of acute exacerbations, hospitalizations, and mortality. Persistent inflammation and airway remodeling contribute to progressive decline in lung function and decreased quality of life. Additionally, severe asthma exacerbations can lead to respiratory failure and death, emphasizing the importance of effective management and prevention strategies.
In conclusion, understanding the pathophysiology of asthma is essential for assessing and managing patients like Nancy. By addressing underlying inflammation, bronchoconstriction, and airway hyperresponsiveness, healthcare providers can optimize treatment strategies and improve outcomes for individuals with asthma.