Question

Rocco Smith is a four (4) year old with a history if asthma. Rocco’s Father has rushed Rocco to the Emergency Department with acute shortness of breath, tachypnoea and an audible wheeze after playing soccer in the backyard with his older brothers. Rocco’s Father tells you he gave Rocco his salbutamol puffer at home but it didn’t work as well as it usually does so he rushed him to the Emergency Department.

You conduct a primary survey which reveals the following:

Airway – Patent.

Breathing – RR 48, speaking in single word sentences, increased work of breathing, accessory muscle utilisation, audible wheeze.

Circulation – HR 125, pale, cool peripheries.

Disability – Alert and responsive.

Choose one (1) abnormal assessment finding from the case study. Link this finding to the underlying pathophysiology of asthma by explaining the disruptions to normal physiology at the cellular, tissue and systemic levels that result in your selected abnormal assessment finding.

Answer 1

1) ans) Asthma is a common pulmonary condition defined by chronic inflammation of respiratory tubes, tightening of respiratory smooth muscle, and episodes of bronchoconstriction The Centers for Disease Control and Prevention estimate that 1 in 11 children and 1 in 12 adults Asthma may cause difficulty breathing, chest pain, cough and wheezing. The symptoms may sometimes flare up.

Asthma:
a respiratory condition marked by attacks of spasm in the bronchi of the lungs, causing difficulty in breathing. It is usually connected to allergic reaction or other forms of hypersensitivity

Rocco Smith is a four (4) year old with a history of asthma. Rocco’s Father has rushed Rocco to the Emergency Department with acute shortness of breath, tachypnoea and an audible wheeze so here abnormal assessment findings was noted down clearly

following:

Airway – Patent.

Breathing – RR 48, speaking in single word sentences, increased work of breathing, accessory muscle utilisation, audible wheeze.

Circulation – HR 125, pale, cool peripheries.

Disability – Alert and responsive.

audible Wheezing :
Wheezing is a relatively high-pitched whistling noise produced by movement of air through narrowed or compressed small airways. It is a symptom as well as a physical finding.

Pathophysiology:

Airflow through a narrowed or compressed segment of a small airway becomes turbulent, causing vibration of airway walls; this vibration produces the sound of wheezing.

Wheezing is more common during expiration because increased intrathoracic pressure during this phase narrows the airways and airways narrow as lung volume decreases. Wheezing during expiration alone indicates milder obstruction than wheezing during both inspiration and expiration, which suggests more severe airway narrowing.

By contrast, turbulent flow of air through a narrowed segment of the large, extrathoracic airways produces a whistling inspiratory noise

Shortness of breath

Dyspnea in acute asthma reflects both uncoupling of inspiratory effort from inspiratory flow (airway narrowing) and hyperinflation. Both uncoupling and hyperinflation are promptly relieved by treatment. Subsequently in stable subjects, lung function is no longer a major determinant of dyspnea

Pathophysiology:

Dyspnea may be defined as an uncomfortable sensation of breathing. The sense of respiratory effort, chemoreceptor stimulation, mechanical stimuli arising in lung and chest wall receptors, and neuroventilatory dissociation may all contribute to the sensation of dyspnea. Different mechanisms likely give rise to qualitatively different sensations of dyspnea. In most patients, dyspnea is probably due to a combination of mechanisms. For example, in asthma, a heightened sense of effort, neuroventilatory dissociation, and vagal stimuli arising from bronchoconstriction and airway inflammation may all play a role. Patients with different disorders and different mechanisms of dyspnea use different phrases to describe their breathing discomfort. Hence, the language patients use to describe their dyspnea may provide clues to the etiology of their symptoms

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