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In: Nursing

Jackson Smith, a 18 year-old male, was admitted to the Emergency Department at 9pm with severe...

Jackson Smith, a 18 year-old male, was admitted to the Emergency Department at 9pm with severe breathlessness. His family informed you that the patient has a history of Asthma that had been diagnosed when he was two years old. On admission to the Emergency Department the clinical manifestations were:

Severe dyspnoea, inability to speak sentences in one breath
Respiratory rate of 32 breaths/minute
SpO2 94%, on room air
Pulse rate of 130 beats/minute
Auscultation of lungs identifies diminished breath sounds and widespread wheeze
Chest x-ray shows clear and hyper-inflated lung fields

A provisional diagnosis of Acute Severe Asthma is made.

This is the case, and how would you explain or describe the clinical manifestation and the pathogenesis causing the clinical manifestations with which Mr Smith presented.

Expert Solution

Provisional diagnosis: Acute severe Asthma

Asthma:

Asthma is a long term respiratory condition in which the airways may unexpectedly and suddenly narrow, often in response to an allergen, cold air or emotional stress . It is characterised by shortness of breath, wheezing , coughing and Chest tightness.

Etiology and risk factors:

* genetic predisposition and family history

* Exposure to allegen such as cold air, air pollution, pollens, certain food items etc

* emtional stress

* smoking

* Obesity

* viral infections of respiratory tract.

Pathogenesis to manifestations:

Due to etiology and risk factors

? ( leads to)

Environmental triggers such as pollen , ait pollution, cold air irritates respiratory mucosa

?

Hyperresponsiveness of airways by inflammatory reactions ( release of interleukin by mast cells, histamines from basophils are the main inflammatory mediators as a result of allergic reactions (antigen - antibody reactions)

?

over production of mucous and constriction and congestion of airways

?

Bronchospasm and difficulty in airflow, due to over secretion of mucous and congestion of airways.

?

Shortness of breath, coughing, obstruction of airways and other symptoms of Asthma.

During acute exacerbation, allergic reactions and resultant inflammatory mediators such as histamines, leukotrines, prostaglandins from mast cells, produces smooth muscle contraction, resulting in bronchoconstriction and severe breathlessness.

Clinical manifestations:

* Difficulty in breathing

* Chest tightness or pain

* wheezing during expiration

* breathlessness while talking

* sleeplessness due to dyspnoea or coughing.

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