A: In reference to the given scenario critically discuss the relevant pathophysiology
of acute asthma
Part A: topics to read and critically discuss:
1) What is asthma?
2) Incidence of asthma and implications of this
3) What are the common signs and symptoms of asthma?
4) Pathophysiology of asthma: relate this to your scenario
5) Pathophysiology of acute exacerbation of asthma: relate this to your scenario
6) How is an acute exacerbation of asthma defined or diagnosed: BTS guidelines?
7) Treatment guidelines for acute exacerbation of asthma: BTS guidelines: relate this to the
8) Triggers for asthma: relate this to your scenario and education and information for the
patient in terms of management of asthma
8) You must relate your discussion to the scenario where appropriate
Part B: topics to read and critically discuss:
B: In reference to the given scenario critically discuss the related pharmacology and
1) Pharmacokinetics and pharmacodynamics of the 3 identified drugs: what is the action of
these drugs, how do they work, what are the side effects, how are they absorbed,
metabolised, distributed and excreted?
2) Consider some of the points from the introduction to pharmacology session, i.e. specificity
and selectivity of a drug (beta2 agonists) and the implications of this for the patient and
nurse in clinical practice.
3) Consider the onset of action and duration of action of the drugs identified: half-life
4) Why are steroids recommended in all acute exacerbations of asthma: BTS guidelines?
5) Consider how the pharmacology of the 3 drugs impacts on the nursing care of acute
asthma and relate this to the scenario
6) Adverse effects of the medications and relate this to the action of the drug and how we
care for the patient in practice
7) 6 Rs of medicines management: importance of these: WHY? And relate to the scenario
and administration of medication to this patient: Nursing and Midwifery council (NMC)
Standards for Medicines Management 2010)
8) Care and management of nebulisers in practice (equipment and infection control)
9) Patient education regarding nebulisers and specific drug therapy for this patient
10) Education and advice regarding asthma management (particularly important due to
problems highlighted with concordance and asthma): relate this to the scenario
11) Remember that oxygen is also a drug and this is mentioned in your scenario (what is the
importance of prescribing nebulisers via oxygen driven nebuliser?): British thoracic society
12) Consider any relevant legal, professional and ethical points related to the medication and
the scenario: NMC Standards for Medicines Management (2010): use the PowerPoint for
guidance on these issues.
Robert is 32 years old and has been asthmatic since the age of 7. His asthma has
been well managed for the past 3 years with the occasional use of salbutamol
(Albuterol) inhaler: Salamol: 2 puffs (100mcg/puff). He has not had an asthma
attack for a number of years.
Robert is currently in the 3
year of his environmental science degree and finding
life generally stressful at the moment. For the past month he has been using his
Salamol inhaler: 2 puffs (100mcg/puff) more frequently: up to three times a day
He has been admitted via the emergency department to a medical ward following
treatment for an acute exacerbation of asthma. He is currently stable and
prescribed the following medications:
Salbutamol (Steri-neb) 5mg four times a day, via oxygen driven nebuliser
Ipratropium bromide (Atrovent) 0.5mg four times a day, via oxygen driven nebuliser
Prednisolone 30mg, once a day, orally for 5 days
His current observations are:
: 97% on 35% humidified oxygen
Pulse: 101 bpm
Blood pressure: 143/80mmHg
RR: 28 breaths per minute