(6NU520) Nursing assignment critiquing the care and treatment of an asthamatic person

Question

Task: You are supposed to describe and critique the care and treatment of a person living with asthma, using current evidence to support your discussion in your nursing assignment. You should link theory and practice and demonstrate how undertaking this module has influenced your practice. You should provide a case study of an individual who is living with asthma as an appendix on which to base your critical discussion, ensuring the case study enables you to meet the module learning outcomes.

Answer

Introduction
“Asthma” is a health condition that adversely affects the respiratory system of humans (Deeks et al. 2018). It usually results from inappropriate contraction and expansion of "airways", leading to breathing trouble. Asthma often initiates "coughing" and 'shortness of breath" among people due to unfavourable conditions. Moreover, smoke, pollution, medication and emotions are the causes of severe asthma among people.

The nursing assignmenthas elaborated on the professional management of asthma for people living with asthma. Further, the care treatment necessary for people living with asthma has been discussed in the nursing assignment. The effectiveness of professional asthma management has been evaluated in the nursing assignmentwith reference to a case study.

Discussion in the nursing assignment
Description of asthma management
Asthma often results from allergies which obstruct "inhaling and exhaling", resulting in breathing troubles (Deeks et al. 2018). It is necessary for professionals to ensure appropriate care treatment for people living with asthma in order to alleviate their pain and prevent severe respiratory issues. Views of medical practitioners analyzed for the nursing assignmentpresent that treatment for asthma is either “relief or control”. It is essential to control and relieve people from asthma attacks in order to avoid severe health conditions. According to international guidelines, the primary goal of asthma management is to control asthma (Bleecker et al. 2020). It has been observed in the nursing assignmentthat several patients can be assisted in asthma control with the aid of “inhaled steroids''. On the contrary, other asthma patients suffer from severe asthma attacks despite multiple “asthma therapy”.

Figure 1: Treatment for Asthma
(Source: Self-created)

The nursing assignmentcase study presents that the lady has been suffering from “uncontrolled severe asthma” despite asthma treatments (Refer to appendix). The patient has been later diagnosed with benign carcinoid intrabronchial tumour (Ncbi.nlm.nih.gov, 2011). The lady had undergone surgery wherein the tumour was removed. According to Bleecker et al. (2020), "systemic corticosteroid", which is often used for uncontrolled asthma management, often leads to adverse health impacts. It is an "anti-inflammatory" drug that is provided to people suffering from asthma in order to relieve their breathing trouble. The lady in the nursing assignmenthad been suffering from asthma earlier; however, it has been controlled through effective medication.

According to Papi et al. (2020), asthma management necessitates the use of "anti-inflammatory" drugs; however, repeated use of such medication is likely to lead to "treatment side effects" including tumours in the lungs, respiratory tract, bronchioles and cardiovascular effects. It has been stated that asthma management mandates "comprehensive treatment" in order to reduce the "risk of adverse events". It can be observed in the nursing assignmentcase study that the lady has been subject to medication for years in order to control asthma. However, the lady developed complexities in recent years due to the tumours (Ncbi.nlm.nih.gov, 2011). It can be observed from the nursing assignmentthat the surgery has been effective in avoiding the recurrence of asthma for the lady. It has been stated that "oral corticosteroids" often result in "infections, osteoporosis and psychiatric disorders" among people with asthma. It has been observed that severe cases of asthma resulting from obstructions in the lungs, bronchioles and respiratory tract can be treated with surgery to alleviate the pain of patients.

On the other hand, Menzies-Gow et al. (2020) argued that asthma is a "chronic respiratory disease" which is related to "morbidity, increased mortality and risk of hospitalisation due to exacerbations". In addition, it has been stated that care treatment for asthma is associated with high costs of medication and hospitalisation. The disease is common worldwide among all strata of society irrespective of economic background. However, difficulties in affording cost-intensive treatment for asthma often lead to severities among patients. It has been stated in the nursing assignmentthat "uncontrolled asthma", in addition to "comorbidities", results in adverse health conditions among people living with asthma.
It can be observed in the nursing assignmentcase study the lady has been financially efficient to afford cost-intensive asthma treatment for several years. Further, she has been able to afford high hospitalisation costs, wherein she could undergo surgery in order to manage her asthma. In addition, Cloutier et al. (2020) stated that external interventions by professionals are necessary in order to ensure effective asthma management. It has been stated that it is essential to assist people living with asthma with expert guidelines in order to improve "asthma-related quality of life". People living with asthma need to be provided appropriate medical assistance in accordance with the severity and ranking of asthma symptoms. It has been stated that an "Expert Panel" of asthma management presented that patients might not be likely to follow the recommended course of action as proposed by experts. However, a "shared decision-making" process can be effective for people suffering from asthma and their caregivers. It has been stated in the nursing assignmentthat the inclusion and participation of asthma patients in "decision-making processes" can be effective in improving asthma management and care treatment.

It has been observed that the lady living with asthma (case study) has been participative and cooperated with the medical practitioners in the hospital while undergoing treatment for asthma management (Ncbi.nlm.nih.gov, 2011). As a result, she could undergo surgery to cure asthma. On the other hand, the non-cooperation of the lady would have created hindrances for the medical practitioners leading to ineffective asthma management. It is necessary to include "shared decision-making" in asthma management in order to provide appropriate treatment with the aid of medical professionals.

According to Deeks et al. (2018), general practitioners and pharmacists play an important role in asthma management. It has been stated in the nursing assignmentthat people living with asthma often consult general practitioners to alleviate their pain. In order to improve asthma management, general practitioners engage with asthma patients to provide care treatment recommendations. Elaborating on the "prescribed guidelines, effective utilisation of asthma care action plan, guiding on medicine doses" are common roles played by general practitioners in improving asthma management.

It has been stated in the nursing assignmentthat general practitioners and their assistance is essential in care treatment for people living with asthma. It has been observed from the nursing assignmentthat improved care treatment through strict adherence to guidelines is effective in improving the "quality of life" of people suffering from asthma. It acts as an asthma control initiative in asthma management and helps to reduce spending on the health system. It has been observed that the lady (case study) has been undergoing medication for asthma over the years, which initially controlled her disease (Ncbi.nlm.nih.gov, 2011). It indicates that strict adherence to guidelines has been effective in controlling her disease initially. However, she developed severities due to the intrabronchial tumour, which resulted in complex asthma symptoms.

Critical analysis of the care treatment of a person living with Asthma
The leading cause of Asthma is airborne allergies such as dust, spores, particles, pollen and more. The effective treatment of this disease is consuming long-term medicines and inhalers to control breathing problems. On the other hand, one of the most effective treatments for preventing this disease is "Bronchial thermoplasty", and this treatment can be effective for acute asthma patients(Asthma, 2022). It has been found from the nursing assignmentreport of Pharmacytoday.org (2022), FDA has given licenced Tezepelumab-ekko, which is the best medicine for asthma patients who have been suffering from acute problems. Tezepelumab-ekko is a developed biological treatment which can be effective for all severe asthma patients.

On the other hand, as stated by Krings et al. (2019), the treatment is based on control-oriented procedures, which can be a part of a repetitive medication cycle. It has been found from the nursing assignmentcase study that a 48 years old woman has been suffering from this disease for 12 long years, and proper medication has controlled her asthma symptoms. On the other hand, effective prevention, as well as long-term cure, have been used to control Asthma. It has been found from the nursing assignmentthat the 48 years old woman has controlled her asthma attack for 12 long years by consuming "formoterol” medicine, and this woman has faced severe asthma attacks after 12 years due to the wrong dosage of medicines. As per the view of Krings et al. (2019), in the case of asthma patients, drugs are entirely dependent on the age as well as the symptoms of patients. On the other hand, many asthma patients have been using inhalers for quick relief. It has been identified from the nursing assignmentcase study that oral steroids have been given to that woman for treatment which can lead to an increase in her asthma symptoms. According to Krings et al. (2019), patients have to consume medicines for long periods of asthma control and have to contact doctors for routine check-ups regularly. Asthma patients need to consume corticosteroid medicines to control asthma attacks. As stated by Asthma (2022), corticosteroid consists of “fluticasone propionate, budesonide, beclomethasone, mometasone as well as fluticasone furoate”.

On the other hand, as per the view of Krings et al. (2019), the efficacious biological therapy named Omalizumab is one of the essential biological therapy for asthma patients. It is found in the nursing assignmentthat most asthma patient has been suffering from allergy, and IgE has been used to control Asthma. On the other hand, inhales such as "fluticasone-salmeterol, budesonide-formoterol, formoterol-mometasone along with fluticasone furoate-vilanterol” can be effective for asthma patients to prevent severe symptoms (Asthma, 2022). Moreover, the main objective of the treatment of Asthma is to reduce the chances of inflammation by consuming appropriate drugs which can control inflammation. Theophylline is another medicine which can help to relax muscles from the circumstances of airways (Asthma, 2022).

Treatment for non-severe asthma patient
As stated by Chiner et al. (2022), patients who have been suffering from no acute asthma disease can be treated with repetitive medicine, such as consuming inhales with mild dosage. Patients who have not been suffering from critical asthma problems need to consume medication effectively on a daily basis by following the instructions of doctors. On the other hand, as per the view of Asthma (2022), “Agonists” is another significant medicine for asthma patients to control Asthma. As per the nursing assignmentthe oral steroid also can be effective for asthma patients to prevent acute problems. Moreover, as stated by Chiner et al. (2022), patients can consume "oral glucocorticoids" in case of mild asthma symptoms, and this medicine can effectively diminish the probability of relapses. "Oral glucocorticoids" can effectively reduce the side effects of "agonist" medicines as well. Controlling Asthma can involve focusing on avoiding the attacks suddenly for anyone (Bleecker et al. 2020). Quick relief medicines control can be helpful in determining the asthma attacks and controlling the medicines. It is important to exercise, and a proper diet can be helpful in decreasing the asthma rate on a regular basis. It can be focused on developing, disengaging the control and medical development, and it doesn't have any side effects for the patients. It is important to ensure the medical history is clear to reduce asthma attacks. Additionally, it is important to ensure that medicines and other remedies can be helpful in controlling Asthma. It can be said in the nursing assignmentthat side effects should be avoided in controlling the diseases, and quick relief medicines should not be used more to reduce the side effects (Chiner et al. 2022).

Social Cognitive Theory
According to Schiavo et al. (2019) "social cognitive theory" is effective in improving self-management of health care treatment through the "reciprocating cognition and behaviour" of humans. It has been stated in the nursing assignmentthat "coping with self-efficacy" plays an important role in the "psychological feedback system for human adaptation to challenges and uncertain situations". The social cognitive theory states that "an individual's health behaviour" is guided by their "experience, actions of associated individuals and environmental factors".

Figure 2: Social Cognitive Theory
(Source: Self-created)

In addition, Rhee et al. (2018) stated that adolescents with asthma often defy their medical guidelines and adherence to medical action plans. Lack of experience due to age leads to cognitive barriers among this age group of the population. It has been stated in the nursing assignmentthat a lack of self-management, including non-adherence to appropriate medication, results in the severity of asthma among adolescents. It has been further observed that self-management is driven by self-efficacy to achieve "desired behaviour". Moreover, "punishment of behaviour" among others is significant in influencing the actions of individuals as highlighted in the social cognitive theory.

It has been observed from the nursing assignmentthat adolescents have been subject to the complexities of asthma due to ineffective asthma management (Rhee et al. 2018). However, individuals with effective self-management, self-efficacy and care treatment through adherence to medication and action plan observed better control over asthma. Further, the perception of barriers resulting from situational factors often affects asthma management adversely. It has been stated in the nursing assignmentthat individuals who are willing to overcome barriers indicate a higher level of social cognition and are effective in the self-management of asthma.

Moreover, Lycett et al. (2018) stated that a lack of self-management has resulted in increased mortality among people living with asthma. Self-management of asthma requires "self-monitoring of symptoms, adhering to treatment and medication and controlling environment factors". However, it has been observed that adherence to "asthma treatment" has been significantly low, whereby asthma prevalence among 235 million people worldwide has been observed (Lycett et al. 2018). It has been stated in the nursing assignmentthat digital intervention can be effective in asthma management. "Electronic monitoring" and "short message programmes" are likely to be beneficial in initiating behavioural changes based on social cognition among people living with asthma. It is necessary to present the experiences, actions and outcomes of others in order to influence the behavioural aspects of people suffering from asthma. Based on social cognitive theory, individuals are likely to undertake actions and effective self-management initiatives when influenced by others' actions.

On the contrary, Lau and Tarlo (2019) presented that prevention and control of asthma is the primary method of treatment for people living with asthma. It has been stated in the nursing assignmentthat asthma often results from stress at the workplace, which is termed "occupational asthma". However, self-management based on others' actions can be effective in controlling chronic disease. The co-workers can influence the person living with asthma to adhere to medications and action plans in order to influence behavioural aspects. According to social cognitive theory, individuals' actions are influenced by the actions of associated individuals. Hence "occupational asthma" can be controlled through support from peers and effective self-management initiatives. Moreover, it is necessary to control "occupational asthma" in order to improve the quality of life at workplaces.

According to Holguin et al. (2020), "The European Respiratory Society or American Thoracic Society's task Force" recommended the use of "inhaled tiotropium" for adolescents and adults with "severities and uncontrolled asthma" followed by "macrolide therapy". It has been stated in the nursing assignmentthat non-adherence to medication results in severities. According to social cognitive theory, an individual's experience influences actions and hence severities of asthma need to be treated with effective medication to help the patients cope with "psychological feedback". Effective medication is likely to alleviate the pain and improve psychological conditions, thereby preventing adverse behavioural outcomes.

It has been highlighted by Di Genova et al. (2018) that obesity and asthma adversely affect the psychological aspects of individuals, thereby leading to lower cognitive abilities. However, "therapeutic strategies" can be effective in preventing severe asthma among children. Moreover, it acts as an "optimal asthma management" strategy that improves the health conditions of people living with asthma. It is necessary to initiate self-management factors to prevent complexities among people living with asthma. It has been stated in the nursing assignmentthat self-management not only prevents the disease but also helps to develop self-efficacy that drives their behaviour. The social cognitive theory highlights that self-efficacy is integral to "health behaviour" in order to improve health conditions. It has been stated that self-efficacy can help individuals to overcome perceived barriers thereby improving the quality of life for people living with asthma.

Evaluation of asthma management
According to Ramsahai et al. (2019), "acute exacerbation of asthma" is one of the significant challenges faced by medical practitioners. As a result, prevention and control of asthma are emphasised by medical practitioners and expert panels. It has been observed in the nursing assignmentthat the lady in the case study has been living with the chronic disease of asthma. However, effective self-management and adherence to medications have helped her to control the disease until recent times. It can be observed that "self-efficacy" has been one of the significant factors that helped the lady cope with the disease and prevent other morbidities. According to social cognitive theory, experience is one of the important indicators of behaviour (Schiavo et al. 2019). The lady's past experience has been effective in driving her behaviour in the later years when she was admitted to the hospital due to "wheezing and dyspnea". It can be observed from the nursing assignmentthat her cognitive abilities helped her to adhere to the medications and treatment at the hospital, whereby her intrabronchial tumour was detected.

On undergoing surgery and removal of the tumour, there has been no recurrence of her asthma. It can be evaluated that she expressed a positive "health behaviour" to prevent the complexities of asthma. At this level, her asthma has been uncontrolled and resulted in severe outcomes (Ncbi.nlm.nih.gov, 2011). However, her uncontrolled asthma resulted from the tumour and not due to ineffective self-management. It has been stated in the nursing assignmentthat uncontrolled asthma management requires advanced clinical intervention and cannot be treated with preliminary pharmaceutical assistance and self-management (Schiavo et al. 2019). The lady's condition could, however, be attributed to side effects of "systemic steroids" for asthma control which results in adverse health conditions.

On the other hand, Spray et al. (2021) stated that caregivers play an important role in preventing and controlling asthma through effective management. Moreover, professional guidance is essential to follow the appropriate medication, action plan and treatment. Professional medical practitioners prescribe the medication, while caregivers are responsible for helping patients adhere to them. Moreover, caregivers are entitled to help people living with asthma initiate self-management practices in order to cope with "psychological feedback". It has been observed from the nursing assignmentthat treatment options vary based on the acuteness of asthma and the type of tumour in the concerned case. Nevertheless, it is important to consider a "shared decision-making" approach while determining the course of treatment (Schiavo et al. 2019). It has been observed that "shared decision-making" has been integral in order to make the lady undergo surgery (Ncbi.nlm.nih.gov, 2011). Patients' consent and inclusion in decision-making help them to adapt to challenges, thereby showing positive behaviour towards asthma treatment and management. It has been observed from the nursing assignmentthat “uncontrolled asthma” necessitates clinical intervention and hence “diagnosis confirmation” is integral prior to “expensive treatments”. Further, it is essential to prevent and control asthma in order to avoid cost-intensive treatments. Patients need to be conveyed adequate information and effective self-management techniques in order to prevent and control asthma. Self-management is an important approach to care treatment for people living with asthma (Schiavo et al. 2019). The lady in the nursing assignmentcase study has been "adherent to her asthma therapy" during her hospitalisation period which resulted in effective treatment to alleviate her pain. Her adherence helped her to avoid mortality and her disease could be prevented from recurrence. It is evident from the fact that the lady had "no recurrence of asthma for 2 years, and her asthma is presently well controlled" (Ncbi.nlm.nih.gov, 2011). Even though she observed an asthma attack within eight months of the initial surgery due to obstruction in her airways, medical tests revealed no abnormalities, and thereafter she observed no recurrence of her asthma.

One of the main symptoms of asthma patients is coughing and issues with breathing.Such symptoms can be found in a patient while doing physical work. Medical workers use several test procedures to identify whether a patient has Asthma or not by examining the patient nose, and throat along with past medical records (Krings et al. 2019). It is observed in this nursing assignmentthat at the beginning of Asthma, a patient can be found having a cough twice a week. In the second stage, a patient can feel issues in breathing as well as coughing three to four days a week.

As per the view of Agache et al. (2020), the final stage of Asthma can be severe for a patient as it can cause breathing issues, coughing and wheezing sounds while breathing. In several scenarios in the final stage, a patient can be seen with issues while sleeping due to shortness of breath.on t either hand, doctors, mainly use Spirometry tests to diagnose a patient and its stage to offer treatment (Langan and Goodbred, 2020). Such tests are mainly used to identify Asthma within an age group of 5 to 11 years. Tiredness while doing physical jobs can be a symptom. Most of the time, a patient uses an inhaler to reduce shortness of breath. Several years ago, most doctors have seen Asthma as only a lung disease due to obstruction in the lungs. However, modern science has discovered that Asthma can be a cause of pathogens, which is known as "chronic cellular inflammation". It has been found from the nursing assignmentreport of Chiner et al. (2022), that inflammation can be the cause of many mites, cockroaches and moulds, which mainly get into airways. Hence, it has been evaluated in the nursing assignmentthat continuous treatment, as well as proper medicatianl, is the best way to control Asthma.

Conclusion
In the above context, it can be concluded from the nursing assignmentthat medical practitioners prioritise the prevention and control of asthma to avoid severe health conditions. Further, adherence to medication, action plans and prescribed treatment can be an effective approach to asthma management by controlling asthma. Self-management is crucial for the care treatment of asthma in order to help people living with asthma to cope with psychological aspects which reflect in their behaviour. It can be concluded from the nursing assignmentthat adherence to medication and "shared decision-making" is essential in order to control asthma and improve the quality of life of the patients.

Asthma is a non-curable disease, and patients who have been suffering from this disease need to follow proper medication on a daily basis. In this nursing assignment, a case study of a 48years old woman has been discussed, and it has been identified that this woman has been suffering from Asthma for 12 years. It has also been found that the wrong medication treatment is dangerous for asthma patients. In this study, a brief discussion on asthma management has been highlighted. Besides, from the critical analysis, it has been found that asthma patients have to follow appropriate medications as per their requirements. Hence, it can be concluded from the nursing assignmentthat if an asthma patients can follow a proper medicinal chart, they can control their severe asthma problem.

References
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Theory
Appendix