In: Nursing
A 15-year-old white female with a history of asthma since early childhood.
He diagnosis with asthma and Contraception initiation
Question
1. Diagnosis asthma
a. Explain the Pathophysiology of asthma
b. What is the therapeutic regimen of asthma?
c. What labs can you order for this patient?give the definition and Description of the Test. At least 2 labs
d. Significance of the Test Being Ordered for this Patient
E. What medication would give to this patient et why?
a)Pathogenesis of asthma. (A) Sensitization: Inhaled allergens (antigen) are taken up by antigen presenting cells (macrophage/ dendritic cell) and shows a TH2-dominated response favoring IgE production and eosinophil release.
(B) On re-exposure to antigen (allergen), they bind to IgE bound on mast cells and release preformed mediators from mast cells. These mediators, either directly or via vagal stimulation produce bronchospasm, increased vascular permeability, and mucus production.
(C) The recruitment of leukocytes (neutrophils, eosinophils, and basophils; lymphocytes and monocytes) signals the beginning of the late phase and a fresh round of mediator released from leukocytes, endothelium, and epithelial cells. Major basic protein, eosinophil cationic protein also causes damage to the epithelium.
b)For mild episodic asthma:Inhaled short acting beta 2 agonist at onset of each episode.
For seasonal asthma:regular low dose inhaled steroid(200-400 microgram/day) or cromoglycate given 3-4 weeks before the season until 3 weeks after the season.And for individual episodes we can give beta 2 agonist.
For mild chronic asthma with occasional exacerbations: regular low dose steroid ( 100-500 microgram/day).Alternatively give cromoglycate or oral theophylline inhalation.episode treatment by inhaled beta 2 agonist.
For moderate asthma with frequent exacerbations: Increasing doses of inhaled steroid (upto 800 micrograms/day) + inhaled beta 2 agonist. Leukotriene antagonists can be tried instead of beta 2 agonist.
For severe asthma:i) Regular high dose inhaled steroid (800-2000 microgram/day) through a large volume spacer device + inhaled long acting beta 2 agonist(salmeterol) twice daily.
ii)For refractory asthma: Hydrocortisone hemisuccinate 100 mg.i.v.stat followed by 100-200 mg 2-4 hourly infusion.
iii)Nebulized salbutamol(2.5-5 mg) + ipratropium bromide(0.5 mg) intermittent inhalations along with oxygen.
iv)High flow humidified oxygen inhalation
v)Salbutamol/terbutaline 0.4 mg im/sc may be also added.
C) i)Lung Function test: These are group of tests that measures how well your lung works, how well the lungs take in and exhale air and how efficiently they transfer oxygen into blood.It is based on measurement of volume of air breathed in and out in normal and forced respiration. It is done using spirometer.
ii)Sputum test: This is done on saliva and mucus discharged on coughing. We look for the eosinophils which becomes visible when the symptoms appear using a rose stain.
d)As she is someone who has asthmatic problems from childhood it can be due to some abnormality in her lung functioning so lung function test can be done.Sputum test is done to check if it is some kind of excercise or cold induced asthma.
e)As the asthma is controllable and not much severe it comes under mild episodic asthma ,so the most suitable medication would be: inhaled short acting beta 2 agonist on the onset of each episode.