Health Ethics - Asthma Patient in APA Style - Article Example

Case Study With Health Ethics in case of an Asthma Patient In APA Style Author: University: Abstract This is the case study of a female asthma patient admitted to emergency ward with tachypnoea and shortness of breath due to acute asthma attack. The treatment given to her taking into consideration the health ethics is mentioned in the paper according to her condition and improvement. The course of treatment, the drugs and IV fluids administered and the decisions the team took in the course of treatment are presented in an analytical manner that explains an ethical based treatment that brings a patient from emergency ward condition to a healthy and normal situation. 1. Patient Rights While considering the treatment to any patient Health Ethics play a major role in treating the patient properly and with minimum suffocation. The diagnosis should be accurate to give e relevant medicines and diet. While treating this patient to relieve her from asthma and tachypnoea related problems, the toxins and waste products emitted by bacteria and the examination their effect on asthma patient is necessary. Considering health ethics, bringing her to hospital in ambulance reduces initial stress during acute asthma attack.1 The paramedical staff should understand the severity of asthma and should warrant ambulance paramedic assistances. The staff should pre-empt complications as the patient is suffering with acute asthma attack. As the Asthma is a form of allergy, the prescription chart needs the enquiry of adverse reactions if any. As the patient is using Cromlyn Sodium and Ventolin at home, that usage should be noted in the prescription chart as a reference that is helpful in prescribing medicines in the course of treatment. The patient is suffering with shortness in breathing and tachypnoea. Keeping in view this problem, the paramedical staff should be ready with oxygen supply and other emergency equipment. As mentioned earlier, asthma is a type of allergy; the drug reactions after 30 minutes of injecting the drugs should guide nursing observations. The breath sounds; both inspiratory and expiratory are less, the anaphylaxis nature of the airway obstruction need to be examined. 2 2. Treatment and Diagnosis 2.1. Culture and Background: The culture and background of the patient is important to diagnose and treat a patient suffering with acute Asthma. The aspects like the work environment and the place he lives is utmost important while starting to treat an asthma patient. In some geographical locations like Merrimack valley (Northwest of Boston) American Lung Association in 2001 observed that the pediatric asthma is in epidemic proportions between Cambodians but not in other communities. The work place environment of the patient may also result in acute asthma suffering. This finding suggests enquiring about culture and background of the patient in case of critical treatment. For example, in this case, the patient has doses of ventolin at home and it may show no effect in hospital if administered before other treatment. 3 2.2 Accessory Muscle Use: Along with accessory muscle use, the patient is emitting small amounts of white sputum despite use of ventolin and Cromolyn Sodium at home. This demands initiation of oxygen at approximately 2 liters/minute to reduce the suffocation in breathing and to increase RR from 40 to normal. This reduces even heart rate and thus helps in reducing accessory muscle use. 4 2.3 Inspiratory and expiratory wheezing: As asthma is an upper airway disease, auscultation during a wheezing is helpful in characterizing the patient’s breathing problem. In the case of present asthma patient, the inspiratory and expiratory wheezing is due to air trapping as seen generally in asthma patients. This is occurring while expiration and monotonic wheezing at the level of larynx indicating the upper air - way obstruction. As laryngeal edema is diagnosed here, racemic epinephrine can be used in the treatment. As part of the temporary solution, the heliox can be used to resolve the event in order to follow the definitive therapy. The intravenous antibiotics also help in treating the soft tissue infection observed in the present case. As there is no information about the vaccine for type B Haemophilus influenza in this patient, the incidence of epiglottitis cannot be overruled. In the course of treatment for inspiratory and expiratory wheezing in this case, team decided to administer intravenous antibiotics. After that, it preferred the endoscopic evaluation. The patient is examined to determine the amount of positive airway pressure needed to relieve the obstruction.5 2.4 Coughing up white sputum: The coughing up of white sputum by the patient indicates the excess production of mucus. This results in swelling of tissue due to excessive accumulation of fluid (edematous) thus narrowing the airway and resulting in shortness of breath. This situation demands the maintenance of airway initially by keeping him in comfortable and calm position. Further treatment is to increase the oxygen flow and auscultation to assess air movement through the lungs. Administration of intravenous line with 0.9% is suggestible to improvise hydration and thin secretions. When situation suits the use of albuterol, the anti-inflammatory drugs are also suggestible. 6 2.5 HR and RR measurements before, during and after treatment: After the above treatment, the patient can be admitted to medical/surgical unit for continued fluids and antibiotics. The monitoring of respiratory status is a continuous process here to obtain ABG values. This involves SpO sub 2^ and general condition. The results of this monitoring evaluated the effectiveness of treatment and reduction of hypoxia. 7 3 Doses 3.3 . Administration of 0.5cc Ventolin with 3.0 cc normal Saline: As mentioned in above chapter before the administration of Ventolin the Solu-Medrol can be administered through I.V method. As the patient is suffering with acute asthma attach and suffering with shortness of breath with RR 40, it is advisable to order 500mg of ampicillin every 6 hours to treat respiratory infection. When the RR is less than 30 and the patient is taking rest with lesser suffocation in breathing then the further treatment is suggestible. When she is relieved of acute symptoms, then the Ventolin can be advised, as she is now using accessory muscles to a lesser extent. 3.4 Conflict of Opinion: Conflict of opinion may arise when one member of the team wants to administer ventolin despite the no effectiveness of it at home when used by the patient. At this context, the conflict regarding administration of ventolin can be avoided by following ethics that enquire about the medication taken before coming to hospital. 8 4 Auscultation 4.3 Expiratory wheezing and better airflow: At the time of admission, the patient is experiencing shortness of breath and wheezing. The wheezing is continuous as it is observed for more than 250ms. The duration and intensity of wheezing is severe, the above treatment decreased the intensity initially, and then auscultation detected the duration. This situation demanded the administration of antibiotics. 9 4.4 Administration of 0.5cc Ventolin with 3.0 cc normal Saline When wheezing has been reduced after administration of IV fluids, an aerosol treatment with 0.5cc of Albuterol and 3.0cc of normal saline worked well to reduce the pressure in the airway. The simultaneous administration of ipratropium (Atrovent) of 0.5mg has been given in 2.5 ml NS q1-2h until the peak flow meter has shown a reading greater than 200-250L/min. 10 4.5 Peak flows before and after treatment: The peak flow before initial treatment was 125 and after that, they are more than 200 and less than 250. After the excessive liquid in the form of sputum is removed by the use of nebulizer and at the end of second treatment, the peak flow of around 350 is observed. 5. Effect of policy on actions in the Absence of Ethics The policy of the hospital or the treatment team in diagnosing and treating the patient is important and plays important role in curing the patient. The health ethics encourage enquiring about background and culture of patient before starting treatment. In the absence of ethics, it depends on policy of the hospital in making those queries. If the policy coincides with ethics, the course of treatment will be safer and comfortable. If not, it may result in problems like use of ventolin in the present case as the patient used it before coming to hospital and it may be of no use if used initially. 6. Conclusion While discharging doctor and paramedical staff need to assess the patient’s knowledge of asthma and should encourage her to participate in the treatment. The emphasis of significance of recognizing signs and symptoms of worsening airway obstruction early, which enables her to prevent and treat exacerbations is important. The team should explain the use of peak flow meter to the discharging patient and explain about the care regarding work exposure if her working environment is allergenic due to chemical atmosphere. Some cases may necessitate the job change also. References: 1. Peninsula Online, 10th July 2006, Monash University, Volume 4, issue 10, Retrieved on 5th April 2008 from http://www.monash.edu.au/campuses/peninsula/news/peninsula_online/issue10_06.html 2. Janet Dullaghan. 26th April 2006, Anaphylaxis Policy for Acute and Community Areas, Huntingdonshire NHS, Volume information not available, Retrieved on 5th April 2008 from http://www.huntspct.nhs.uk/documents/Publications/Policies/Clinical/Anaphylaxis_Policy.pdf?preventCache=18%2F07%2F2006+15%3A13 3. Chiocca, Ellen, Russo, Lisa, July 1997, Actionstat: Acute asthma attack, Bnet, Volume information not available, Retrieved on 6th April 2008 from http://findarticles.com/p/articles/mi_qa3689/is_199707/ai_n8768444 4. Michael J Morris, 13th February 2007, Asthma, e-medicine, Volume 13, Retrieved on 6th April 2008 from http://www.emedicine.com/med/topic177.htm 5. Francisco J. Soto, Kalpalatha K. Guntupalli, 2008, All That Wheezes Is Not Asthma: Diagnosing the Mimics, Emergency Medicine, Volume 9, Retrieved on 6th April 2008 from http://www.emedmag.com/html/pre/cov/covers/111501.asp 6. N. Meslier, G. Charbonneau, J-L. Racineux, 1995, Wheezes, ERS Journals Ltd, volume information not available, Retrieved on 7th April 2008 from http://www.erj.ersjournals.com/cgi/reprint/8/11/1942.pdf 7. Paul D. Chan, MD, 2005, Current Clinical Strategies, Current Clinical Strategies Publishing, Volume information not available, Retrieved on 7th April 2008 from http://www.umsha.ac.ir/Vice%20Chanceilor/research%20chanceilor/e-books/Dakheli%5CMedicine%20-%20Current%20Clinical%20Strategies.pdf 8. Susan Reece et al, 2002, Cultural Interpretations of Asthma: Exploring Explanatory Models of Families, Key Informants, and Health Care Providers within the Cambodian Community, CITA, Volume Information not Available, Retrieved on 12th April 2008 Read More