LIVING WITH RESPIRATORY PROBLEMS: A CASE OF HELEN AND FAMILY
Name of the student
Name of the instructor
Helen is a patient with a known history of asthma, autism, learning disabilities and overweight all occurring concurrently since she was six years. She has coexisted with them for the last 10 years, having turned 16 years recently. She is on treatment, being on medical management of the asthma by a Becotide inhaler and supportive management for the autism, via a 3 day monthly visit from the social services to aid the family in behavioral management. She has a recent hand injury and is under medical management for it.
Though she lives with her family members except her father who regularly visits, her social life is much affected since she cannot form and maintain healthy social and sexual relationships. These conditions have affected other domains of her life, including self-care, since she has to be closely monitored. The effects of the condition have extended to involve family and non family members with occasional levels of being aggressive to the family and teachers.
I have had one year of contact with her as my client, as well as, her family and participated directly in her care. The health interventions given to her during the process of care include comprehensive health education on asthma touching on the aggravating factors as well as their prevention, lifestyle changes, nutritional, as well as medical care. I have also involved a linkage to other services of benefit to her health and follow up care since asthma and autism are lifetime conditions and require continued care.
The family members are now fully aware of her conditions and the role they should play in contributing to the holistic care of Helen. This case study covers the normal anatomy of the respiratory system, altered physiology in relation to asthma, the effects of asthma on Helen’s life, my involvement in her care, as well as, conclusion of interventions useful even in the future.
HYPERLINK “https://www.google.com/search?tbm=bks&tbm=bks&q=inauthor:%22Kristi+Lew%22&sa=X&ei=vA1HU4WeJ8-GhQftqIHQDg&ved=0CDwQ9AgwAg” Kristi (2009) describes the human respiratory system as a component of various organs, each playing a critical and specific function in ensuring that respiratory gases, oxygen and carbon dioxide are effectively exchanged between the body and the environment done through inhalation and exhalation. Its main structures include the nasal cavity, which is lined by a thin ciliated epithelium with an adequate blood supply. The cilia in epithelium play a key role in trapping particles inhaled together with hair, hence cleaning it. The dense blood supply to the epithelium ensures adequate moistening and warming of hair before its inhalation. It also houses bony structures known as the concha that creates air turbulence in the nose facilitating warming and cleaning (Donna, 2011).
On the posterior relation, the nasal cavity opens to the nasal-pharynx that in turn opens to the larynx, oftenly referred to as the voice box (Kristi 2009). It has vocal cords which vibrate with the aid of muscles and air passage, producing human voice. They also play a major role in airway protection. Below the larynx is the trachea, a tubular structure made of cartilage and muscles. It Conducts air into to the lungs. The inner lining of the trachea has a thin epithelium with cilia and mucus for trapping of foreign bodies inhaled together with air. It branches into two main branches, namely the left and right primary bronchi which later branch into smaller ones, namely secondary bronchioles, three directing to the right lung and a lesser number two, for the left lung in correspondence to their lobes. The division of secondary bronchi further gives rise to tertiary bronchi, then bronchioles. Bronchioles end up with a network of which together with the alveoli extends to form the respiratory bronchi which carry out the process of gaseous exchange (John B. 2007)
The right and the left lungs host millions of alveoli interposed in the connective tissue parenchyma which is elastic in nature. They vary slightly in anatomical orientation with the right lung being larger; narrower compared to the left lung that is shorter and broader. Fissures divide each lung into lobes, with the right lung having three, while the left has two.
Aided by changes in both atmospheric and intra-thoracic air pressures as well as contraction and relaxation of the respiratory muscles, the lungs expand and contract to allow entry, exchange and expulsion of air out of them (Jonathan, Paul & Paul 2013)
Asthma, a chronic airway disease, is characterized by varying and partial reversibility of airway obstruction, to conduction air in and out of the lungs alters the normal physiological functioning of the respiratory system via different mechanisms (Asthma and allergy center 2013). First, the mucous secreting goblet glands found within the airway mucosal hypertrophy. This result in excessive mucus production, more than the required for the normal respiratory functions. The excess mucus in the lumen blocks the airway reducing the efficiency of the airways in air conduction. According to Hasan (2008), the excessive mucous secretion results from hypersensitivity of the airway in response to environmental triggers, including pollen grains, dust particles, odors, hair or fur which irritates the nerve endings along the canal.
Recurrent inflammation in asthma, results in the formation of scar tissue on bronchioles. The scarring causes thickening of the already thin walled bronchi and bronchioles, Followed by tightening of the smooth muscles around the lumen; the bronchioles narrow further, a process known as bronchoconstriction (Marshal, 2008). Another product of the respiratory inflammation process is extracellular fluid as a result of the response to allergen that produces swelling of the respiratory mucosa referred to bronchial edema that further narrows the diameter of the airways ( HYPERLINK “https://www.google.com/search?tbm=bks&tbm=bks&q=inauthor:%22Margaret+Clark%22&sa=X&ei=igZHU56vPInBhAeRsIGoBQ&ved=0CDMQ9AgwAQ” Margaret & Margaret 2010).
As a result of the above pathophysiological changes, air flows into the lungs with difficulty. The individual affected by asthma has to strain during breathing with increased use of accessory muscles for breathing, as well as, assumption of abnormal positions including the tripod position for easy breathing. The air reaching the lungs reduces and so is its exchange. The amount of oxygen entering the blood for circulation reduces and the adverse effect presents by evident cyanosis (Monroe & Monica, 2008).
According to Makino & Ohta (2005), various signs and symptoms present in asthmatic patients. Breath sounds that are not normally present during normal breathing appear in asthma, the characteristic one being a wheeze, a musical high-pitched sound during exhalation due to the narrowed airway, as well as, increased speed of air through the reduced lumen. The cough is also common and persistent due to the consistent irritation of the airway with excessive mucus production. The patient reports tightness of chest and these symptoms worsen, especially with body exertion, or during exposure to allergens such as dust, pollen grains, odors or fur (Pa1, 2011)
Specific effects on the patient
WHO (2014) asserts that, Asthma as a respiratory disease impacts on the patient’s life negatively through various ways. Being a patient with other conditions occurring concurrently with asthma, Helen depends on her relatives almost entirely to meet the daily needs. These ranges from self-care activities like bathing and grooming, and nutritional needs since she requires continued guidance to feed well. Elimination needs also have to be daily catered by the family members in order to make life optimal for living (Kavuru 2010). Because of her affected learning ability, Helen relies on the family even for the activities that she could have done on her own in relation to asthma. The Activities include self drug administration by inhaler since, she has to be monitored for it to be done correctly, as well as, with the right adherence (Heather 2007).
The respiratory system plays a key role during exertion by supplying adequate oxygen that is later transported to the tissues for maintenance of their vital functions. Asthma alters Helen’s exertion pattern since exercise ranging from minimal to strenuous can exacerbate an asthmatic attack, leading to difficulties in breathing in both intra and post exercise period. With her concurrent autism, she requires close monitoring of her activity since unknowingly; she can induce an attack. Her play period should always have the accompaniment by a relative catering for any emergencies that may befall her, in case of imminent or actual asthmatic attack (Christopher, 2004).
In most families, chronic conditions are highly stigmatized. In Helens case, it may be worse due to the autism that, in a way, interferes with her formation of social bonds with other people either from the family or friends. The nature of her medical condition is also delicate. Owing to the fact an attack can occur following encounter of allergens, isolation for Helen is inevitable. Not by her choice, she is unable to attend some functions for the fear of allergen encounter or play with her peers, since exercise to her is more harmful compared to the benefits she could have derived from it (Andrew & Hilary, 2010).
In the present and the future years, Helen’s functioning on the aspect of the occupation is grossly affected. As a result of the asthma, working in some fields poses a great challenge, especially in areas that generate known allergens that may aggravate her condition. These include dusty areas, cold areas as well as, areas with strong scents. Owing to her delayed learning abilities from the autism, a career path in an academic field is also affected. An option remains in careers that require utilization of her basic skills. In most of these, exertion is inevitable, and this may deteriorate her condition further (Samuel, 2013).
According to HYPERLINK “https://www.google.com/search?tbm=bks&tbm=bks&q=inauthor:%22Margaret+Clark%22&sa=X&ei=igZHU56vPInBhAeRsIGoBQ&ved=0CDMQ9AgwAQ” Margaret and Margaret (2010), asthma is a chronic condition and its medical management does not involve a one-time treatment. One has to live on medication for a long term, hence creating a medication dependency. Dependency on medication is costly in terms of purchase of drugs, as well as, strict adherence schedule. Family role in this is ensuring that there is availability of medication all the time as well as guiding Helen on the administration to avoid incidences such as under dosage, overdose, as well as, poisoning that may result from the drugs. Drugs have side effects, and this calls for continued monitoring of bodily changes in Helen, including weight changes due to long term use of corticosteroids in the management of inflammation, resulting from asthma (Muralitharan & Ian, 2013).
Helen has autism, mental condition. She closely requires psychological support and psychiatric management. Counseling her and family members promotes easy coping and living with the condition. Due to its nature and challenges, relatives of a patient with autism may suffer long term stress and burn out resulting from the care. Continued mental health reviews and plan of care is necessary which may include cognitive therapy to enhance her cognitive ability, as well as, behavioral therapy to aid in molding her behavior (Alvina, 2005).
In the handling of a patient with chronic illness and a concurrent lifetime condition, like for Helen, stress is inevitable (Kristi 2009). This is due to the nature of the activities involved in her daily care. She is dependent on the family members throughout, and this creates a caregiver role strain. The family needs realistic stress coping mechanisms such as continued counseling and reassurance as a way of stress reduction and a prophylaxis to stress related conditions such as hypertension and gastrointestinal ulcers and mental conditions such as depression.
Helen has a predisposition to some other health conditions related to the asthma itself, the autism, as well as, the increasing weight. For the asthma, it can lead to chronic obstructive airway disease affecting the patient entirely in her lifetime altering the respiratory system’s anatomy and physiology completely (Kristi 2009). Due to the chronic inflammation, Helen remains at a higher risk of other airway infections such as bronchitis and pneumonia due to the altered integrity of the respiratory system’s mucosa. The treatment of asthma by use of corticosteroids causes reduced body immunity, with a reduced defense against body infections.
Due the autism’s related incidences of aggressiveness and hyperactivity, Helen predisposition to injury is more likely to occur. This can be directed to self, or others; hence necessary interventions needed to reduce the risk of self-harm or harm to others. Autism may also aggravate other mental conditions such as depression. If the increasing weight remains unchecked, it can be a risk factor for her health condition, especially lifestyle related diseases including obesity, diabetes type II and hypertension (Margret & Margret 2010). These can alter her lifestyle and may make her living deteriorate further.
In terms of the economic implications, the management of her condition is costly both financially and time wise for Helen’s family. The medications for asthma management, the clinical visits and the other integrated management require a continuous source of money for its success and support. The time consumed is a lot too. This is for the movement to clinics, as well as, for close monitoring, in which the caregiver may never have adequate free time to do other required activities.
The environment of asthmatic patients requires some alteration. The living area and housing should be well aerated and free from allergens. The entire environment should be clean, free from pollution of whatever kind since these may exacerbate the condition (John 2007).
Socialization is a key process in childhood development. In a child with asthma and autism altogether, the process of socialization is compromised. This results from the difficulties encountered in the process of learning new things.
Though adequate nutrition is a vital requirement for Helen, the feeding habits must be closely monitored. Due to the increasing body weight, fluid retention, increased risk for obesity and, unhealthy diets rich in excessive fats and salts should be avoided (Kristi 2009). Since she is already overweight, Helen has an altered body image. Her sleep pattern has changed, as a result of asthma related sleep apneas. As a result, of her being overweight, as well as, the difficulties in breathing, especially with exercise, Helen has a greatly reduced mobility and cannot tolerate an adequate exertion (Peter, Jeffrey & Stephen 2009).
Asthma has affected Helen’s relationships since some people stigmatize her. As a result of the autism, she cannot form and maintain strong social ties. This has led to her being depressed. Due to lack of these ties and her mental condition, her sexual patterns are also affected, and cannot establish and maintain a healthy sexual relation (John 2007)
How I was involved in the care of Helen.
My involvement in the care of Helen was in an integrated health management approach, with all interventions aimed at improving her health holistically; guided by the patient’s history and needs. Health education as a priority given to the immediate family members involved in the care of Helen. This covered avoidance of allergens, an environment that could trigger an attack, as well as, nutrition for her overall health and well being (Michael & Zuzana 2013)
Nutritionally, I ensured that the family followed a strict diet low in fats, low in sodium to avoid continued fluid retention. This was because Helen on treatment with corticosteroids and cause water retention. Sodium too causes more fluid retention, and this could worsen her condition. Nutritional control went hand in hand with moderate exercise sessions to ensure balanced energy intake and expenditure. I stressed to the family exercise limits in order to avoid triggering an attack. During one of the asthmatic attacks, I initiated nebulization as per the requirements to enable dilation of the bronchioles. Oxygen was concurrently administered to ensure continued oxygen supply. Helen nursed using semi fowler’s position to allow ease of breathing, with pressure area care to avoid decubitus ulcers (Samuel 2013).
During the period of the attack, I monitored her vital signs keenly with a continued analysis of the breathing pattern, her pulse rate, partial pressure since they are key determinants of respiratory improvement or deterioration.
I explained to the family about the need to adhere to the prescribed medications, as well as their timely administration, with the aim of ensuring that there were no missed doses in the treatment that could interfere with the outcome and prognosis of the treatment (Barnes et al., 2009). Through family support center, I conducted a fortnight follow up care through which I could provide direct care to Helen in their home environment with the aim of evaluating the already initiated interventions.
With a goal of ensuring a good socialization process for Helen, I induced the family into joining two (2) local support groups, one for persons living with asthma and another for people with autism. This ensured a good blending with her peers and avoiding isolation. For the autism, I also ensured their appointments for psychotherapies were well adhered to for an optimally desired outcome.
Due to the reported episodes of aggressiveness, I taught the family on how to ensure safety through removal of harmful items near her, which could precipitate an injury to self, as well as, others, and restriction to ensure that her mobility was limited. I also educated the family on how to maintain their house well ventilated and ensure adequate aeration. Asthma calls for change of lifestyle. I taught the family to observe Helen to avoid involvement in smoking that harms the lungs and airway further. For her injured hand, I demonstrated to the family members on how to do a proper home care to prevent the development infection.
Asthma is a chronic and inflammatory airway condition with an origin from childhood and progresses all through to adulthood (WHO 2014). Due to its nature and effects on the various aspects of an individual’s lifestyle, its management is complex and holistic. Asthma appears more complicated when occurring concurrently with another disease as in the case of Helen, compared to when it occurs as a single condition.
According to Elizabeth (2009), health education plays a key role in its management by creating adequate awareness on the conditions in areas such as the aggravating factor management, and their prevention that is possible.
Due to the challenges it poses to the individual, involvement of the whole family in the care and treatment of this patient is vital for a good prognosis and outcome of the care, and treatment. Patients with asthma should always know the precipitating factors that can pose great dangers to their health. Since it’s a lifetime physiological condition, adherence to the prescribed treatment should be emphasized, and be followed keenly. Since the caregiver has to take care of the patient for a long time, proper preparation and coping mechanism to the stress are necessary to avoid caregiver role strain (Michael & Zuzana 2013)
When it occurs concurrently with other mental conditions such as autism, the management differs slightly, and its treatment incorporates other specific types of management, such as psychotherapy and rehabilitation, to enhance the normality of the individual’s life. With the necessary support from the other family members, a patient with asthma can always lead a near normal lifestyle (Richard & Michael 2006)
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