Acute Asthma  Mr. Jefferson who is aged 30 years old walks into your clinic. You already are aware that he has asthma since this is not his first time at the clinic. He goes no to inform you clearly that in the last two or three weeks, he has had sleepless nights and is constantly awakened by coughs. Due to this intensified coughing, he has had to increase the use of his salbutamol inhaler every day.  His peak flow has also increased especially in the morning and at night. Mr. Jefferson has also been transferred at work and he now operates mostly in the open which could be an exposure to allergens or cold weather. Psychophysiology of Asthma Following Exposure to Cold weather In a case of acute asthma, the exacerbation comes about due to the contraction or else the bronchoconstriction of the smooth muscles of the bronchiole. When this happens, the airways are narrowed in a response to certain agents. These agents are stimuli and are either irritants or allergens (VanMeter and Hubert 2014). The exposure to these stimuli triggers allergies in the system of a patient and hence portraying the symptoms and signs of an asthma attack. Early Signs of Acute Asthma Attack Being a chronic illness, the effect of asthma on a patient’s body are long-lasting and hence it makes the control of the disease a process. The infection affects the airways and also the lungs. The airways become narrowed and inflamed occasionally. The patient then experiences wheezing due to bronchoconstriction. There is also the production of thick mucus which in turn causes coughing and leads to improper breathing. The short breaths are brought about by poor oxygen supply. There is also tightening of the chest. All these are signs that Mr. Jefferson has experienced. Significant Medical and Drug History Questions As a medical personnel, it is important to know exactly the record of the patient you are dealing with since the onset of the asthmatic attacks to his current state. This will enable you to plan, updates and also to provide the best medical advice possible to the patient. You should ask questions such as; if he has commenced on any medication?  Is there any medication that he has stopped since the last meeting? Has he noted any new allergic responses since the last meeting? When was the last asthma attack and how long did it last? What his feeding habits? The medical history of his family and whether they have a history of asthma attacks? And many more relevant questions that will help you get the right medication for the patient. Precautions in Treatment The most important factor that one is to consider while providing the appropriate medication for any asthma patient, is to provide a process that will reduce the severity of asthma attacks to prevent more damage on the patient’s respiratory organs (Sun 2017). The patient should also be given precautions to avoid things and activities that may trigger their asthma attacks. Items such as colognes, perfumes and smokin.

1. Acute Asthma
Mr. Jefferson who is aged 30 years old walks into your clinic.
You already are aware that he has asthma since this is not his
first time at the clinic. He goes no to inform you clearly that in
the last two or three weeks, he has had sleepless nights and is
constantly awakened by coughs. Due to this intensified
coughing, he has had to increase the use of his salbutamol
inhaler every day. His peak flow has also increased especially
in the morning and at night. Mr. Jefferson has also been
transferred at work and he now operates mostly in the open
which could be an exposure to allergens or cold weather.
Psychophysiology of Asthma Following Exposure to Cold
weather
In a case of acute asthma, the exacerbation comes about due to
the contraction or else the bronchoconstriction of the smooth
muscles of the bronchiole. When this happens, the airways are
narrowed in a response to certain agents. These agents are
stimuli and are either irritants or allergens (VanMeter and
Hubert 2014). The exposure to these stimuli triggers allergies in
the system of a patient and hence portraying the symptoms and
signs of an asthma attack.
Early Signs of Acute Asthma Attack
Being a chronic illness, the effect of asthma on a patient’s body
are long-lasting and hence it makes the control of the disease a
process. The infection affects the airways and also the lungs.
The airways become narrowed and inflamed occasionally. The
patient then experiences wheezing due to bronchoconstriction.
There is also the production of thick mucus which in turn causes
coughing and leads to improper breathing. The short breaths are
brought about by poor oxygen supply. There is also tightening

2. of the chest. All these are signs that Mr. Jefferson has
experienced.
Significant Medical and Drug History Questions
As a medical personnel, it is important to know exactly the
record of the patient you are dealing with since the onset of the
asthmatic attacks to his current state. This will enable you to
plan, updates and also to provide the best medical advice
possible to the patient. You should ask questions such as; if he
has commenced on any medication? Is there any medication
that he has stopped since the last meeting? Has he noted any
new allergic responses since the last meeting? When was the
last asthma attack and how long did it last? What his feeding
habits? The medical history of his family and whether they have
a history of asthma attacks? And many more relevant questions
that will help you get the right medication for the patient.
Precautions in Treatment
The most important factor that one is to consider while
providing the appropriate medication for any asthma patient, is
to provide a process that will reduce the severity of asthma
attacks to prevent more damage on the patient’s respiratory
organs (Sun 2017). The patient should also be given precautions
to avoid things and activities that may trigger their asthma
attacks. Items such as colognes, perfumes and smoking should
be avoided at all costs. The patient in this case should also
avoid going out into the cold while dressed inappropriately. He
should always protect his own health first by keeping warm and
avoiding the cold.
Effects of Prolonged Asthma Attack
With more asthma attacks that are uncontrollable, the patient is
at high risk of losing their life. This is due to conditions known

3. as acidosis and hypoxia which may lead to other fatal
conditions such cardiac arrhythmias (Tello et al 2019). These
frequent attacks can be terminal and may weaken one for life
until they succumb to the condition.
Measures to reduce Anxiety
The signs and symptoms of asthma can be frightening especially
to young people. The inability to breath or breath well is a very
scary ordeal that may lead to someone with acute asthma
developing other conditions. It may lead to severe cases of
anxiety that is further detrimental to the general health and
well-being of a patient. The patient should therefore avoid
factors that may trigger any asthma attacks.
Inhalers and Their Use in the Control of Acute Asthma
When you get to look at his PMH, it shows a maintenance of 2
puffs of salbutamol MDI and beclometasone 100 MDI also
2puffs a day. He has also been on antihistamines for a while.
The immediate care protocol to ensure that he receives include;
stopping his use of the beclometasone inhaler in order to reduce
the inhalation of steroids and to explain that he needs to ensure
that he is using his inhaler as prescribed and also following the
set procedure such as cleaning his mouth and brushing after
using the inhaler (VanMeter and Hubert 2014).
Likelihood of Frequent Respiratory Infections
A patient such as Mr. Jefferson who has asthma is at a very high
risk of infection from other illnesses caused by mostly virus and
bacteria (Doshi et al 2017). Their bodies are weakened and
hence the risk of infection from these organisms is increased.
Being a topic condition, asthma increases a patient’s
susceptibility to both non-respiratory microbial and respiratory
infections.

4. Dental Procedure Concerns
Medical reports and research has proven and shown that dental
material may be a cause for further exacerbation in cases of
acute asthma. These concerns include; tooth enamel dust,
dentifrices, fissure sealants, fluoride trays and cotton rolls. One
is, therefore advised to always have supplemental oxygen
during the treating of an asthmatic patient just in case of an
exacerbation.
Nutrition
Cases of acute asthma can be either increased or reduced by the
different diets as taken by a patient. Patients who feed on food
that is loaded with Vitamin C and E, magnesium, selenium and
omega-3 fatty acids have a decreased rate of asthma attacks.
Most of the nutritious value of these substances provide
antioxidants which are very essential for the protection of cells
and ensuring minimum damage. Asthmatic patients should also
avoid cow’s milk, soy, wheat, eggs, tree nuts and fish
(VanMeter and Hubert 2014).
Aspects of Immobility
Patients with acute asthma such as Mr. Jefferson just like any
other with respiratory conditions develop an increased rate in
their mobility with time as the exacerbations affect their ability
to move with time. This is mainly due to weakened muscles due
to less and less activity. Most of them are usually aged and
hence their movement is highly reduced.
Respond with 8-9 sentences , 2 APA Schorlay citataions

5. Influenza A
Mrs. A.H. had an acute episode of influenza A, complicated by
pneumococcal pneumonia. She lives in a senior apartment
building where a number of residents have had influenza in the
past month.
Causes of influenza and its effects on the lungs
Influenza is a caused by the influenza virus, and is highly
contagious. There are three groups of the influenza virus; type
A, B and C. Type A is the most prevalent of the three types.
Influenza may affect both the upper and lower respiratory tract
(Huber and VanMeter, 2018). The hemagglutinin (HA) molecule
adheres to the respiratory epithelium and generates infectious
virus particles. Transmission occurs when a susceptible host is
exposed to virus particles through aerosol or other surfaces
contaminated by an infected person. Influenza causes
inflammation in the lungs, they become compromised secondary
to the viral infection in the respiratory epithelium in
conjunction with the inflammation caused by the immune
response activated to fight off the infection (Kalil and Thomas,
2019).
The normal mechanism that defend against infection in the
respiratory tract
The normal mechanism that that defend the lungs against
infection is mucociliary clearance. In the respiratory mucosa the
epithelium is covered with cilia and globlet cells that secrete
mucous. This forms a thin layer of mucous, that traps pathogens
and inhaled particles, while the cilia propel them up and out of
the respiratory tract. A cough or sneeze is stimulated by

6. excessive mucous or foreign particles in the respiratory tract
resulting in further expulsion and prevention of entry into the
lungs (Huber and VanMeter, 2018).
Susceptibility
It can be expected that a number of residents in a senior
apartment building would be affected by the influenza for a
number of reasons. The first being that influenza virus is highly
contagious. Also because of its incubation period which is 1-4
days, this means that the virus can be passed on one day before
symptoms develop and for up to five days after (Hubert and
VanMeter, 2018). These elderly residents have increased
susceptibility as a result of their age, they are elderly usually
over the age of 65 years; this age group is high risk.
Additionally, resident in senior apartment building tend to
participate in shared activities, they share facilities, and
transportation.
Precautions to avoid being infected
The single best way to for the residents to avoid being
infected is by getting vaccinated against the influenza virus
yearly. The residents will have to be vaccinated yearly against
influenza because the influenza viruses are constantly mutating.
As a result, effective immunity does not last for a long period
of time (Hubert and VanMeter, 2018). Apart from being
vaccinated the resident can follow some basic practices such as
good hand hygiene, cover their noses and mouths when
coughing or sneezing, skipping group activities if they are sick,
avoid contact with other residents who are sick, drink plenty of
fluids, eat plenty of fruits and vegetables especially those rich
in vitamin C.
Precautions to reduce the risk of respiratory infections in the
professional environment

7. To reduce the risk of respiratory infection in the
professional environment the single most important precaution
would be to get vaccinated against the influenza virus. Keeping
your immune system boosted by consuming citrus fruits, and
other foods that boost the immune system, staying hydrated,
getting at least 6-8 hours of sleep, and taking a vitamin
supplement, are all precautions that can be taken to reduce the
risk of infection in the work environment. Additionally,
practicing good hand hygiene and staying home from work if
infected, if unable to say home, another option would be to wear
a surgical mask.
Effect of antibacterial drugs on influenza
Antibacterial drugs also known as antibiotics, are not
effective for treating influenza, because the influenza is caused
by a virus. Antibiotics should be prescribed for bacterial
infection. Prescribing antibiotics unnecessarily leads to
increased antibiotic resistance which could result in death
(Imanpour et al, 2017). If the patient develops a bacterial
pneumonia, then antibiotics may be prescribed at this time.
Predisposition to pneumonia
Mrs. A.H. is predisposed to pneumonia because of her age,
there may also be structural and functional changes in her
respiratory systems that put her at risk by reducing he host
defenses. Chest wall mobility and lung compliance is decreased
and reduced respectively and may lead to the elderly not being
able to clear the secretions in their lungs completely which lead
to an increase in the workload of the respiratory muscles.
Because Mrs. A.H. was infected by the flu her mucociliary
function which is her defense against pathogens was already
impaired.

8. Case summary: Mrs. A.H. was admitted to the hospital after she
developed severe chest pain, and appeared confused to friends.
Diagnostic test with rationale
The appropriate diagnostic test for Mrs. A.H. would
include, blood work including an arterial blood gas, sputum
culture, chest x-ray (CXR). A complete blood count is drawn to
see if the patient has a leukocytosis, neutrophil and bands this
show the presence of the infection and the inflammatory
process. Blood chemistry to see if the patient is dehydrated,
also the electrolytes and bicarbonate level to ascertain if the
patient is at risk for acidosis. The arterial blood gas is drawn to
ascertain the oxygen content in the arterial blood. The lung
consolidation decreases the oxygen exchange in the lungs as the
alveoli are filled with exudate as a result of the inflammation
and vascular congestion. Sometime supplemental oxygen is
necessary to keep the oxygen saturation up. A CXR performed
to show the distribution of the consolidation as more than one
lobe may be affected. The more lobes that are affected the lower
the oxygen saturation leading to hypoxia. Sputum is collected
and sent for culture and sensitivity to identify the organism and
the appropriate antibiotic that the organism is susceptible to
(Hubert and VanMeter, 2018). Urine antigen test is also sent to
the laboratory for check for Streptococcus pneumonia (Henig
and Kaye, 2017).
Probable cause of chest pain and confusion
Chest pain that increases with cough and inspiration is referred
to as pleuritic chest pain. In pneumonia pleuritic chest pain is
caused by the inflammation of the lung and adjacent parietal
pleura. The parietal pleura has somatic nerves, the inflammation
triggers the pain receptors resulting in pleuritic pain (Reamy et
al. 2017). A probable cause of the patient’s confusion could be

9. hypoxia. The patient has consolidation in the lungs that can be
affecting more than one lobe. This consolidation is caused by
the exudate in the alveoli, it decreases the oxygen exchange,
and the blood flow in the affected lobes. During infection the
metabolic rate is higher than normal and there is a greater
demand for oxygen. The demand for the oxygen can not be met
due to hypoxia this results in metabolic acidosis which leads to
confusion in the especially in the elderly (Hubert and
VanMeter, 2018).
Probable signs and symptoms as pneumonia develops
As the pneumonia develops the patient would probably
experience other respiratory and systemic signs and symptoms.
These systemic signs and symptoms include fever, chills may
occur, fatigue, tachycardia, and leukocytosis. Fever and fatigue
occur as a result of the infection and the inflammatory process.
The white blood cells are also elevated as a result of the
immune response and inflammation. The white blood cells
release pyrogens that circulate in the blood resulting in the
hypothalamic control being reset to a higher level. Because the
hypothalamic control has reset to higher than normal, the body
tries to increase the body temperature by shivering, the heart
rate is also increased resulting in tachycardia (Hubert and
VanMeter, 2018). The respiratory signs and symptoms include
dyspnea, tachypnea, rales, diminished breath sounds, and
productive cough with rust colored sputum. The patient
experiences a dyspnea because of the exudate and consolidation
in the lungs that interfere with the gaseous exchange across the
alveoli, this increases the work of breathing resulting in
tachypnea. The productive cough occurs in an effort to remove
the build-up of inflammatory exudate that is in the lungs. The
rust color is as a result of the red blood cell and found in the
alveolar exudate (Hubert and Van Meter, 2018).
Arterial blood gases

10. Mrs. A.H. is at risk for both respiratory acidosis and
metabolic acidosis. In metabolic acidosis, the arterial blood gas
in the early stage of pneumococcal pneumonia for Mrs. A.H.
because she has two lobes involved the pH may be normal at
first but in the advance stage the patient can experience
metabolic acidosis resulting in a pH that is less than normal.
The oxygen saturation in the early stage would be slightly
decreased but as the infection progress and the inflammation
and exudate the hypoxia increases and oxygen saturation greatly
decreased, she would also have a low bicarbonate level as the
patient experiences metabolic acidosis
ABG: pH 7.30 PaCO2 42 PaO2 50 HCO3 23
Mrs. A.H. can compensate to maintain a normal pH by deep
rapid breathing, more acid will be excreted by the kidneys and
the bicarbonate absorption will be increased.
Causes of dehydration and its associated complication in
pneumonia
Mrs. A.H. may become dehydrated secondary to high fever,
hyperventilation and inadequate fluid intake. Dehydrations
cause dry mucous membranes, dry skin, low blood pressure,
weak pulse, mental confusion and fatigue. A severe
complication of dehydration is acute renal failure (Hubert and
Van Meter, 2018).
Treatment and mobility
The treatment for pneumonia for Mrs. A.H. would include
intravenous hydration to help reduce the fever prevent any
further dehydration. Intravenous antibiotics to kill the
microorganism causing the infection serving to lessen the
effects of the infectious process. Supplemental oxygen is also

11. needed to keep the oxygen saturation greater than 92 %.
Respiratory treatment may also be ordered to help Mrs. A.H.
move her secretion in order to prevent any further
complications. Incentive spirometry could also be used to help
aerated her lungs. Elderly patients like Mrs. A.H. should be
ambulated daily while in the hospital this helps increase the
work of breathing and improve the lung expansion, to prevent
pooling of secretions which could lead to further complications.
Ambulating these elderly patients also prevents them from
becoming deconditioned which causes increased weakness.
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