Airway Inflammation: Diagnosis and Treatment - Essay Example

Patient Information: Jane is a 25-year-old woman

Chief Complaint: an episode of shortness of breath and chest tightness

History of Present Illness: Jane stated that she was previously well woman but presented herself to our office with complaints of episodic shortness of breath and chest tightness. She said that she has been having the symptoms on and off for over two years. Jane states that her condition has worsened lately, with episodes occurring two or three times a month. She notes that the symptoms are worse during the spring months. She has no exercise-induced or nocturnal symptoms.

Allergies: No known food or drug allergies.

Past Medical History

Allergies: No known food or drug allergies.

Past Medical History: patient denies any hospitalization and the immunization status ae up to date

Past Surgical History: patient denies any previous surgeries

Family History: her father has asthma and no other serious condition

Social History: our client is singles, stays with a roommate, and works as an administrative assistant at a high tech firm. Her roommate has a cat as a pet. Our client stated that she smokes and drinks while in the accompany of her friends.

Objective

Vital Signs: Temperature, 98 F; heart rate 88; respiratory rate, 22; blood pressure 131/86; body mass index, 27

General Appearance: our client appears to be well. However, she is anxious, conversing freely with some stops amid sentences due to respiratory distress.

Respiratory: She has mild wheezing and diffuse rales

Cardiovascular: She has a regular rate and rhythm with no gallops or murmurs.

Gastrointestinal: X4 bowel sound, and there are no bruits.

Pre-evaluation: The laboratory result shows that pancytopenia with platelets counts of 70000/mm3, hemoglobin is 8.3g, and AST 90 and ALT 112. The blood culture shows no bacterial infection or gram staining. The impression on the chest X-ray shows mild pneumonia.

Pertinent PE findings are: VS 115/80, HR 84 RR 22 T 98.6 O2 SAT 95% room air. Relevant physical examination is notable for mild end-expiratory wheezing.

Assessment

Primary Diagnosis: Asthma

Our client from the case study has symptoms that show that she is asthmatic. She has a cough, wheezing, chest tightness, retractions, mucus, and shortness of breath. Reactive airway disease or asthma affects the resistance, and the triggers include exposure to an allergen, protein, or some perfumes. Our client may have had this condition because she has been exposed to triggers that include the fur from the cat, inheritance from the family, and she has also been having the symptoms associated with asthma.

Pathophysiology:

Asthma or airway inflammation is a disease caused by an interaction of the cells and mediators with the airways resulting in a bronchial inflammation—the airflow limitation characterized by recurrent episodes of cough, wheezing, and shortness of breath. The redness may be a result of allergens induced muscle contraction, which leads to the release of histamine, and other mediators from the matt cells contract the airway smooth muscles. The response to asthma attack regardless of the type is often characterized by symptoms such as inflammation, edema, and mucus buildup along the airway leading to coughing, wheezing, and shortness of breath as presented by the patient. The three categories of provocative agents for asthma include: the allergens such as cats or pollen, Sensitizer’s agents such as proteins or dust initiate an allergic response. Other agents include the irritants, which may consist of the induced non-allergic reaction such as fumes, and the physical conditions such as exposure to cold weather or the physical exertions.

Differential Diagnosis:

Chronic cough is a significant problem and needs to be differentiated from asthma because of the tendency of being undertreated or misdiagnosed. Clinicians have to ensure that their clients are suffering from the condition itself does not mimic other diseases; for example, the pseudo-asthmatic syndrome mimicking bronchial asthma. Physicians may also miss the diagnosis of exercise-induced asthma because symptoms mainly occur after the exercise. The differential diagnosis, therefore, included: chronic obstructive pulmonary disease, vocal code congestion, gastroesophageal reflex infection, and the infrequent wheezing cases that may need to be investigated may consist of the pulmonary embolism, pulmonary infiltrates and some medications. Other tests included the X-ray scan to monitor the lungs if there could be other underlying conditions because the client is a smoker and takes alcohol.

Plan

Diagnostic Test:

We conducted the following test on the client to further the asthma condition diagnosis, and they include.

Pulmonary functional test: the test is carried to diagnose lung problems. The spirometry test is a simple breathing test used to determine the amount of air obstruction from the client.

Exhaled nitric oxide: asthma is an inflammatory process, and the exhaled nitric oxide gas from the lungs often indicates an inflammation. This test, therefore, is essential in diagnosing and managing asthma condition. Patients are asked to breathe into a small handheld machine for 10 seconds. Then the device calculates the amount of the gas in the air breathed out.

Some other tests may include the methacholine challenge, imaging test for structural abnormalities or infection, allergy testing, and provocative testing for exercise and or cold-induced asthma.

Diagnosis: Based on the test findings, the client has an asthmatic condition.

Medical Management:

Patients with asthma can be treated through medication that will provide control of the disease and quick relief of the symptoms. Some of the medicines include inhaled steroids, leukotriene modifiers, and others. While attending to patients, it is essential to understand that some medications can be used for long-term control while some are quick to relieve the symptoms. For our patient, we can use the following drugs to assist her with the condition. Cromolyn sodium drug is a safe agent for mild inflammatory effects. The drug works by inhibiting early to late phases of asthma. The patient can get this drug on a metered-dose inhaler, capsules, or oral inhalation. The patient will take 2 to 4 puffs three times daily. Even though this drug is well-tolerated, the patient needs to know the side effects such as cough, sore throat, and unpleasant taste. Other drugs include the leukotriene blocking agents such as the Accolate and Zyflo. The quick-relief medication such as short-acting inhaled beta2 will also be administered to the client to help with the relief of bronchospasm and the prevention of exercise-induced bronchospasm. Some other mechanism includes asthma therapy, which can be employed to assist with the client's situation. The therapies involve starting therapy at a consistent level with the patient's level of severity and increasing the treatment in steps to help manage the disease.

Prognosis:

Asthma patients may develop permanent lung malfunctioning, and smokers are at higher risk of developing complicated health conditions. Even though this disease has a poor prognosis, it is essential to know that patients admitted in ICU and other conditions such as brittle asthma are at higher risk of severe asthma complications. Therefore, the patient must be subject to the right treatment with inhaled steroids for better healthcare outcomes.

Follow Up Care/ Referral:

For our client, we will do a followed up every three months a year for us to achieve a favorable prognosis. The follow up is to enhance effectiveness and timely outpatient care for minimizing adverse asthma effects.

Patient education:

It is vital for the patient to complete the dosage and follow through the physician's medical recommendation. The patient should seek medication on experiencing sudden changes to the regular breathing experience. The patient should understand the triggers and prevent oneself from getting the asthmatic attack by ensuring that she is away from the pollen, cats, and other allergens.