Asthma Pathophysiology: Etiology and Risk

Asthma Pathophysiology: Etiology and Risk School nursing is one of several traditional roles for community health nurse. Providing health care for schools placed for a number of reasons. In the first place, school environment it self may create hazards which students must be protect from. Beside, children need to be healthy to learn effectively .similarly vital reason is, maintaining the health of children today produce healthy adults in years to come. Subsequently, protect and promote the health of overall community. Jocelyn Elders a former U.S surgeon stated you can not educate a child who isnt healthy and you cant keep a child healthy who isnt educated this common says teaches us the importance of keeping school child healthy as well as the necessity of school nurse (Clark, 2008). An estimated 7 million U.S. kids under age 18 have been diagnosed with asthma and more than 13 million days of school are missed each year because of the condition, as indicated by the American Academy of Allergy, Asthma, and Immunology (KidsHealth,2011) . According to my week rotation in Tareq Bin Ziad primary school, I have notice that asthma ranked the 2nd highest disease among the school children based on the statistic done by the school nurse. Therefore, I have chosen asthma as a topic of my written assignment. This paper aims to identify literature review about asthma definition, pathophysiology, causes, risk factor and sign and symptoms, diagnosis and treatments. Secondly, it will clarify community health nurse strategies including comprehensive assessment, intervention and prevention. Definition and statistics Asthma is a disease that involves periodic episodes of severe but reversible bronchial obstruction in person with hypersensitive or hyperresponsive airway. Accordingly, a significant rise in episode of acute asthma requiring immediate hospitalization in children has occurred during the last 2 decades. On the contrary, frequent repeated attack of acute asthma may lead to irreversible disease in the lung and development of chronic asthma. It was proven that, in the age group 5 to17 years about 140 per 1000 persons have been diagnosed with asthma. However the number of attacks peaks in school children in September, often associated with increase in incidence of common cold (Gould,2006). Although asthma is considering COPD group, likewise it is more common, more serious and more manageable than it is generally though. As asthma known to be chronic with some individuals so, it consider long live condition and might lead to death if not well managed in acute episodes . In UK, asthma kills about 1600 adults and 20 children annually (Hough, 2005). Pathophysiology, Etiology and Risk factor Asthma may be classified in different ways. It may be acute or chronic, acute referring to single episode where as chronic referring to long-term condition. A recently developed system rates a case of asthma on a clinical scale ranging from mild, intermittent, severe and persistent (Gould, 2006, P.393). Mater of fact there are three phases of response take place in asthmatic patient. Firstly, sensitization stage, which occurs in atopic people via exposure to allergens in fetal or early life, stimulates production of excess immunoglobulin -E (IgE) antibodies in the serum. IgE becomes fixed to mast cells, which then react to antigens by releasing bronchoconstrictor mediators such as histamine. Serum IgE is five times greater in people with asthma than in those without. Once allergic asthma has developed removal from the allergen does not always prevent continuing asthma, it might delay it only. Second stage called hyperreactive stage, what special about this stage it can occur with or without allergic component. Continued exposure to allergens or response to other stimuli leads to mast cell degranulation and release of inflammatory cytokines such as eosinophils . Also it releases bronchoconstrictor mediators such as histamine and extra mucus. Besides, chronic inflammation damages the surface of epithelial layer causing hyperreactivity of bronchial smooth muscle. Thirdly, bronchiconstrictors mediators and hyperreactive bronchial smooth muscle lead to exaggerated bronchoconstriction .These triggers might be food such as diary products, egg and acidic drink .pets, balloon, smoking, cold whether, indoor condition (dust) , some drugs, gastroesophageal reflux disorder and emotions such as depression and frustrated chest infection and exercise (Hough, 2005,P.366). Another facts associated with asthma pathophysiology are Impaired mucocilary function, edema formation, vascular congestion, increase vascular permeability, production of thick tenacious mucus, thikining of ai rway wall (McCance Huether, 2006). There is no single cause of asthma, but certain factors may increase the likelihood of developing it. These factor can be categorized as genetic and environmental factors including: A family history of asthma or other related allergic conditions (known as atopic conditions), such as eczema, food allergy or hay fever. Having bronchiolitis as a child (a common lung infection among children) and being born prematurely (especially if you needed a ventilator). Developing another atopic condition such as a food allergy and being exposed to tobacco smoke as a child particularly if your mother smoked during pregnancy. As well as being born with a low birth weight less than 2kg or 4.5 pounds (Asthma, 2010). Additionally causes are viral upper respiratory infection, sedentary life style, poor ventilation and increased air pollution (Gould, 2006). Few risk factors related to asthma including gender, obesity, smoking and population differences. Before puberty asthma occurs more often in males while after adolescence, it appears to be more common in females. Some experts argue that excess weight pressing on the lungs may trigger the hyperreactive response in the airways typical of asthma. Others believe that asthma leads to obesity by inhibiting physical activity, although several studies have found no difference in activity levels between people with or without asthma (health central, 2011). Sign and symptoms and Diagnoses The sign and symptoms of asthma vary from person to person and in any individual from time to time. Some of theses are Shortness of breath (especially with exertion or at night), Wheezing sounds, coughing may be chronic (worse at night and early morning) , sweating , bluish color to the lips and face , anxiety and chest tightness (Medicine Net, 2011). Similarly important symptoms including : Pulling in of the skin between the ribs when breathing (intercostal retractions), Abnormal breathing pattern, tachycardia, hypoxia, tick tenacious or sticky mucus ,chronic dry cough in some and others have productive cough (Copstead Banasik, 2010) Actually, there is no simple test to diagnose asthma. Nevertheless, general partitions normally diagnose asthma by asking about the symptoms, what trigger it, how often and what settle it down. Coupled with some questions about medications patient use, life style, occupational and home and work environment. Other test are spirometry, to assess how well your lungs work and Peak expiratory flow rate test which defined as a small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath (Medicine Net, 2011). Further more, asthma can be diagnosed based on physical finding, sputum examination, pulmonary function test, and blood gases analysis and chest radiography. Complete blood count can show an elevate number of white blood cells with increased eosinophils. Equally important test is skin testing and inhalation test to determine type of allergens. Conversely, skin testing is usually more helpful in young patient who have extrinsic asthma. Arterial blood gases may be normal in mild condition but as long as it become severe respiratory alkalosis and hypoxia will be shown (Copstead Banasik, 2010). As it is mentioned previously, asthma classified as mild, intermittent, severe and persistent. Other classifications are status asthmaticus and it characterized by prolonged attack more that 24 hours, leading to dehydration. Asphyxia asthma, this attack leads to arrest within hours or minute. Another one is nocturnal asthma, related to asthma at night and it considers symptoms free in the day. Besides, occupational asthma, usually seen in adults and attribute to substance in work place. in addition to drug induced asthma , aspirin intolerance occurs in about 10% of asthmatic people because it reacts with in hours after ingesting it .one more is premenstrual asthma, it present as particularly severe monthly asthma attack during the 5- 10 days leading up to menstruation. As well as, exercise induced asthma; this is common in children and adolescents. Bronchospasm often occur within three minute after the end of exercise and resolve in 60 minute (Hough, 2005). Prevention and treatment Minimizing the number and severity of acute attacks is crucial to prevent permanent lung damage, reduce risk of infection and to prevent chronic lung disease such as asthma. General measures to reduce asthma include avoidance of common triggering factors, doing skin test to determinate the stimuli casing allergy and avoid it. Good ventilation at home and school area, regular swimming sessions are of great benefit for school age children to strengthen chest muscle. Administer prophylactic medication as children go back to schools and at first sign of cold. During acute attack many individuals carry inhalers so they can self administer bronchodilator, usually beta adrenergic agent such as (ventolin). This medication can be also used prior to exercise or known stimuli to avoid attack happening. Controlled breathing techniques and a reduction of anxiety often decrease the severity of attack. When chronic inflammation develops it is recommended to use glucocorticoids such as (Beclovent) b ecause this medication is more effective in reducing the second stage of inflammation in the airway. In cases like status asthmaticus hospital care is essential because patients do not respond to bronchodilators. In chronic condition prophylaxis is given to the patients such as Cromolyn sodium; a prophylatic medication administer by inhaler on a regular daily basis. The drug inhibits the release of chemical mediators from sensitized mast cell and decreases the number of esenophils, thus reduce hyperresponsiveness (Gould, 2006). Assessment Physical assessment for asthma patient includes examine nose, mouth, throat, sinuses, ears, chest and skin. Community health nurse is responsible for this assessment by examine patient nose for signs of increased nasal drainage, swelling inside the nose, check throat for signs of drainage, indicating inflammation and infection in the sinuses .Listen to child chest for wheezing, indicating blockage of airflow in the airways. Observe chest muscle for breathing and examine patient skin for signs of an allergy (Essig, 2011) Moreover, asthma can cause tiredness and weakness therefore child lacks energy and unable to perform simple tasks ( Haines Clarke, 2009). Asthma can be affected by psychological aspect such as stress, anxiety, sadness and can be provoke by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders (Lehter,Feldman, Giardino, Song Schmaling, 2011). Regarding social assessment nurse can found that asthmatic child tend to stay alone always because of feeling embarrassed about their condition and medication taking in school or in public area( Essig, 2007) . Due to asthma some children lose their self -esteam ; others may fear oh having asthma attack if they are at school or around friends ( Roberts , 2010). Children with asthma who live in economically deprived urban areas tend to have more-severe asthma and poorer outcomes over the course of the illness. Frankly there is evidence that in some low-income children with asthma, parents have problems with treatment compliance and adhering to home management guidelines factors that clearly affect the course of the illness in children (Nelson , Awad, Alexander Clark , 2009). To perform environmental assessment nurse need to collect information about patient area of living, home environment, work environment and school environment. Importance of this assessment is to reduce irritant and allergens in the sittings where asthmatic patient spends more time. Tobacco smoke and air pollution are the mainly two respiratory irritant that asthma patient suffer from ( NHLBI , 2011) Prevention and Intervention Primary prevention asthma patient are mainly education and awareness about the condition. It is recommended to avoid smoking and exposure to environmental tobacco smoke, particularly during pregnancy and early childhood. About infant regular and exclusive breast feeding reduce risk for asthma. Let the patient be aware about all risk factor associated with developing asthma such as allergen from food, animal, infection and bad life style (Arshad , 2005). Secondary prevention of asthma defined as intervention for child or patients who are at high risk for the development of asthma but who have not yet developed asthma symptoms or signs. Beside those who are at initial development of the disease. Theses patients have family history of allergic disease or atopic conditions. Secondary prevention of asthma falls in to three phases: pharmacological treatment, control of environmental allergy and allergen -specific immunotherapy which reduced the progression of asthma and prevented an associated increase in bronchial hyperreactivity.( Canadian medical association, 2005) Tertiary prevention is the stage where patient already have the disease however community health nurse role is to decrease attacks and reduce complications. Patient with allergic asthma , ezema and atopic dermatitis must reduce exposure dust and animal such as dogs and cats. Thus, improve system control and prevent excecerpation. Also pharmotherapy is very important in this stage (WHO, 2002). There are many nursing intervention for asthmatic patient like Maintain respiratory function and relieve bronchoconstriction while allowing mucus plug discharge. Let the patient have enough rest and relaxation. As ordered, administer oxygen by nasal cannula breathing and to increase arterial oxygen saturation during an acute asthma attack. Place the patient in semi-fowler position and encourage diaphragmatic breathing. Reassure the patient during an asthma attack and stay with him .Encourage the patient to express his fears and concerns about his illness. Encourage regulate exercise as a part of asthma treatment; promote good nutrition and good hygiene. Demonstrate the proper use of metered dose inhaler properly. Educate client (recognize triggers: smoke, dust, mold, weather changes, and animals). Administer drugs and I.V. fluids as ordered (Nursing file, 2009). Conclusion Asthma is a chronic condition characterized by obstructing the bronchial airway. Usually it developed in childhood and symptoms decrease while grow up. Number of asthmatic children is increasing yearly due to the environmental factors. Simply asthma happened when inflammation of airway occurs, bronchospasm of airway muscle, edema of air way and increase mucus secretion. Many factors can cause asthma like environmental factor, family history, infection and allergy. Main sign and symptoms are wheezing sounds, coughing, more secretions and chest tightness. It can be diagnosed by asking patient about the symptoms, pulmonary function test, sputum examination, blood gasses analysis and chest X-ray. In treating asthma ventolin , beclovent and prophylaxis like cromolyn sodium are common . Physical, phychological, economical, environmental and social assessment is needed to done for asthmatic patient. Prevention of asthma categorized in to primary, secondary and tertiary. Nursing intervention for asthmatic patient vary. Some of these interventions are maintain respiratory rate, let patient complete rest and administer medications and oxygen. What is Fashion? What is Fashion? What is Fashion? For centuries individuals or societies have used clothes and other body adornment as a form of nonverbal communication to indicate occupation, rank, gender, sexual availability, locality, class, wealth and group affiliation. Fashion is a form of free speech. It not only embraces clothing, but also accessories, hairstyles, beauty and body art. What we wear and how and when we wear it, provides others with a shorthand to subtly read the surface of a social situation. Fashion as a Sign System Fashion is a language of signs, symbols and iconography that non-verbally communicate meanings about individuals and groups. Fashion in all its forms from a tattooed and pierced navel, to the newest hairstyle, is the best form of iconography we have to express individual identity. It enables us to make ourselves understood with rapid comprehension by the onlooker. Fashion as a Barometer of Cultural Changes How we perceive the beauty or ugliness of our bodies is dependant on cultural attitudes to physiognomy. The accepted beautiful female form that Rubens painted is subliminally undesirable nowadays, if we are to be thought beautiful in a way that the majority accepts in the 21st century. Today an inability to refashion and reshape our bodies whilst constantly monitoring the cultural ideal leaves us failing the fashion test. Those that pass the fashion test invariably spend their lives absorbed in a circle of diet, exercise, cosmetic surgery and other regimes. This includes the rigors of shopping in search of the ultimate garb. The Need for Tribal Belonging Our reluctance to give ourselves a regular makeover through diet, exercise, and consistently conscious use of specific dress styles infers that we have the personality flaws of a weak willed human. We become in the eyes of fashion aficionados somewhat inadequate and imperfect in the fashion stakes. Thus we strive to keep a culturally satisfying appearance so that we feel better, whereas in fact we are striving to stay in the tribe, whatever type of tribe that may be. Group affiliation is our prime concern with regard to fashion. As long as some group similarity is identified within the group, our personal fashion whether current or dated can belong to any tribe. It is the sense of belonging marked by how we fashion ourselves that gives us the tribal connection. Roles An innate characteristic of human beings is the desire to strive for differentiation. The removal of Sumptuary Laws and rigid dress codes has enabled the individual to use fashion as a means to identify clearly the many different roles that a person plays in any one day. Sociologists borrowed the word role from the theatre because, like actors individuals play many parts and each part has to be learnt. Roles are continually learned and rehearsed and relearned. They are also shared, because like the actors on a stage, fluid interaction only occurs if all the performers know the behaviour expected. Class Stratification The Edwardians were experts in the art of role play. They had had sufficient time to readjust to the new patterns of behaviour established by the Victorians. The Edwardians were socially stratified into those who wore tailor made clothing down to those who wore other peoples cast offs. The poor simply looked poor, because their raiment betrayed them. Whilst the rich and nouveau riche displayed their wealth through an iconography of signs and symbols that enhanced their body image in the eyes of those that saw themselves as socially inferior. Role Set Roles and activities are closely linked to what people wear. People are affected by their role-set, which includes boyfriends, girlfriends, sisters, brothers, friends, husbands, lovers, mothers, fathers, grandparents, relatives, employers, customers, clients, work mates, business colleagues, peer and age groups. The people with whom a purchaser interacts affects the final purchase and this applies to any fashion dominated item from interior furnishings to choice of cars. Likewise the purchase of fashionable clothes, fabrics, or accessories becomes a visual currency and speaks volumes silently. The tools of fashion provide the signs and symbolism that function as an information service for the role-set. People are so aware that others make judgements about them through their clothes and accessories that many run up huge debts to appear to belong to a particular lifestyle. Frequently the rest of their role-set are doing likewise. Members of the role-set often encourage them. Only individuals with a strong sense of self identity stick their necks out and admit to wearing items that others might consider dubious or passÃÆ' ©. Occupation, Status and Purpose of Clothing Those with high status occupations will wear the clothes they think others expect them to wear. They will not wish to experience role conflict by wearing the incorrect clothing. It is from the clothes a person wears that we get our first impression of personality. They provide mental clues to a persons status and occupational role, as well as being a means of conforming to peer group expectations. Clothes also have the utilitarian function of providing both protection from the extremes of the elements, keeping us warm or cool or safe. They also act as an aid to modesty or immodesty as the wearer so desires. The state of a persons clothes is synonymous with self respect and is a sign of respectability. It also adds another sign that the person has sufficient status in society to maintain at the cost of time and money, laundering, dry cleaning and repair. To be respectable some expense has to be incurred in the maintenance of cleanliness and neatness. Veblens The Theory of the Leisure Class Thorstein Veblen the US economist who wrote the book The Theory Of The Leisure Class in 1899 maintained that Dressing for status as an outward expression of wealth is indeed functional, by the very fact that such clothes prevent the wearer from engaging in manual labour. Also because of their restrictive design they need the assistance of others to dress the wearer and keep clothes in pristine condition. Veblen devoted a whole chapter of his book to Dress As An expression Of The Pecuniary Culture. He wrote our apparel is always in evidence and affords an indication of our pecuniary standing to all observers at first glancedress, therefore, in order to serve its purpose effectively should not only be expensive, but it should also make plain to all observers that the wearer is not engaged in any kind of productive labour Foremost in Veblens mind must have been the fashions of the 1890s a decade that gradually favoured increasing conspicuous consumption by the rich. A century later the vogue for power dressing in the 1980s saw excessive indulgence and conspicuous consumption in fashion. Fashionable behaviour was the epitome of conspicuous waste, but the purest form of relief in a stressed, angst ridden society. Status Symbols One of the most favoured forms of semiotic distinction is fashion, because fashionable clothes, accessories and body adornment are easy for others to observe at glance. Incidental items, particularly branded specific handbags footwear, jewellery, accessories and new hairstyles act also as important status symbols. First a fashion is approved by others. Then it is copied because of competition. Finally it is replaced as it becomes commonplace and has ceased to fulfill its function of being distinctive. The status fashion can be anything from a particular jewel such as solitaire diamond stud earrings or the latest fad for long drop gold earrings to a brand logo pair of jeans in a particular style and colour. The ability to decode trends that are not deliberate and obvious is limited to a small group who adopt consumer items early. Wearing a Uniform Some people instinctively know how to appear respectable to the majority through their clothing. Others are less obviously successful in attaining consistently reliable grooming. The rise of the Corporate Uniform adopted by banks and similar institutions in the 1980s reinforced power dressing. It indicated how important the uniform is as a means of distinguishing one person from another instantly. Uniforms provide us with mental clues. Occupational Uniform Wearing an occupational uniform puts an employee in the position of being a visual metaphor. We learn quickly to associate different uniforms with different role conceptions and different role expectations. We connect the policeman or security guards uniform with authority, law, order and help. Likewise we associate the nurses or paramedics uniform with help, care, protection and mothering. By contrast the jaunty overall and hat of the ice cream vendor with the promise of pleasure. When people put on a uniform they adopt what they think it symbolises, but even people who dont wear a specific occupational or leisure uniform tend to know vaguely what to wear. Those who adapt their wardrobe to â€Å"fit in† with their company, succeed much faster in terms of upward job mobility. Mass Youth Uniform Young people in particular adopt the uniform of their peer group. However the uniform must be the peer groups uniform, not one imposed on them by adults. Fashion in the form of a mass youth uniform can create a sense of belonging to the peer group and a feeling of identity as the adolescent personality reaches maturation. For the majority, an old status symbol, be it a brand, a logo or attitude accessory is old-fashioned the moment is loses favour within the group. An up to date status symbol cries out to some I must have it now. The mobile phone as a belt accessory was a perfect example of this. As new products develop, last years non WAP mobile phone version is passÃÆ' ©. It is essential to have the latest fashion accessory, to gain instant peer approval Mass Production and New Textile Technology Between the first and second World Wars mass production of clothing truly developed. But it was not until clothes rationing was introduced in the UK that production methods became more streamlined. Rationing of cloth and haberdashery, along with strict specifications ensured manufacturers created garments in a speedy, efficient, economic manner whilst attaining a certain standard of quality control. By the 1950s increasing numbers of women abandoned the little dressmaker and bought from the increasing majority of chain stores. Department stores like Debenhams continued to move with the times experimenting with new fabrics and new looks. By the 1990s were using designers like Jasper Conran to design ranges with style and flair. A whole range of exciting yarns, new fashion fabrics, protective materials and engineered fabrics became widely available after 1960. New materials and fabric finishing techniques are at first exclusive and expensive. Initially they are offered to the world of Haute Couture. A couple of years later they filter to the mass market. Youth Cult in the Global World The youth cult of the teenager in the 1950 s became a major force in the1960s. Other contributing influences were the glamour of the cinema, the television in ordinary homes and a change in attitudes and values after the introduction of the female birth pill. Global coverage of the mood of society was absorbed from the cinema, television and fanzine magazines. The world had instant access to the latest trends and fashions as fast as the picture could be transmitted. Today what people see in their homes on television or when surfing the Internet soon becomes accepted very quickly as normal and everyday. In the comfort of ones own home the television monitor scales down the stark newness of an idea, especially the impact of a fashion concept and this makes it easier for us to accept more quickly when worn by others even if we cant see ourselves wearing a similar item. Fashion Cycles The young have not always been dominant in fashion history. Until the Victorian Era a fashion look took between 10 and 15 years to permeate country areas. Once rail travel improved mass communication between country and city, the cycle of fashion speeded up so fast, that by the Edwardian Era in 1901, fashion was moving in a yearly cycle. Emancipation of Women and the contribution of all classes of women to the 1914 1918 war enabled and encouraged women to adopt more practical clothing and to try out new styles in fashion, hair and beauty. By the millennium everyday changes in lifestyle included fitness and health pursuits, car and air travel and centrally heated environments in homelife. All created a need for clothing fashion designed for the way we live now. How we perceive our persona and what we want to say to society in a very visual camera obsessed culture, is still expressed through our bodies, the way we wear clothes, jewellery and body art. Today fashion and beauty can be affordable for everyone. There is always a range such as Avon that provides quality beauty, make up and accessory products at a prices most can afford.