Case Study Analysis

A 16-year-old African American female with a five-year history of intermittent asthma, which had been controlled by medication, presents worsening symptoms following a COVID-19 diagnosis and has been administering an albuterol inhaler to relieve dyspnea and wheezing, but this is not organizational, and therefore, she has to visit the emergency room. In light of her recent COVID-19, this analysis examines the pulmonary pathophysiological processes and the effect of racial-ethnic variables on her physiological functioning.

Pulmonary Pathophysiological Processes

The chance of the worsening of asthma in this patient can be attributed primarily to her recent COVID-19 infection. COVID-19 has been seen to cause an inflammatory response that would, in turn, cause an increase in airway hyperreactivity and mucus production, hence worsening asthma. This response is even much worse in a patient diagnosed with asthma; the airways of this patient are highly sensitive and are likely to constrict whenever triggered. Given that the number of inflammatory cytokines and immune cells increases in response to the virus, the deterioration of the patient’s dyspnoea and her reliance on her albuterol inhaler strongly suggests a profound derivation in airway function (McCance & Huether, 2019). Furthermore, chest X-rays show hyperinflation, a characteristic feature in asthma exacerbation, as it leads to a decrease in the effective lung volumes, worsening the breathing problem.

Racial/Ethnic Variables Influencing Physiological Functioning

Racial and ethnic disparities in asthma prevalence and outcome are well-documented, with African Americans often experiencing higher rates of asthma and more severe symptoms compared to other racial groups. These differences could be due to genetics, the environment, social class, and divergent paths in medical treatment and care (Perez & Coutinho, 2021). Regarding this patient, she may be at a higher risk of developing an inflammatory response or, at least, having different efficacy of medications used in asthma treatment after COVID-19 infection.

Interaction of Processes

The interaction between the patient’s pre-existing asthma and her COVID-19 infection creates a complex clinical scenario. COVID-19’s effect on exacerbating asthma involves a multifaceted immune response, likely intensified by her racial background, which may predispose her to a more severe reaction. This interaction complicates her recovery path and necessitates a nuanced approach to her treatment, considering her immediate clinical presentation and long-term management needs (Ramakrishnan et al., 2021).

Clinical Implications and Management

The complexity of managing asthma exacerbated by COVID-19 requires a tailored approach that considers both the immediate exacerbation and underlying chronic issues. Additional changes in her asthma management may involve advancing inhaled anti-inflammatory medications, spirometry testing, and the introduction of targeted biological medicine that targets certain inflammatory processes in severe asthma. The healthcare team should still strengthen patient education on monitoring signs of deterioration and proper techniques for using inhalers.

Social and Behavioral Considerations

It is important to address the social and behavioral health factors of chronic asthma management in adolescence, especially during acute infections such as COVID-19. Some of the modifiable lifestyle factors that influence asthma severity include stress, anxiety, and the degree of compliance with the set medical regimen. It may be necessary to involve counselors, social workers, pulmonologists, and primary care providers to attend to these broader health determinants.

Conclusion

The presented case describes the challenges associated with asthma care when COVID-19 complicates it in racially and ethnically diverse communities. Knowledge of the etiology, demographic factors, and behavioral health components is paramount in the determination of suitable management approaches. It is therefore recommended that an interdisciplinary multiple-factor approach that takes into cognizance the patient’s respiratory status/asthma management plan as well as socio-economic, healthcare access, and behavioral factors be addressed adequately to support this patient.

References

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Mosby/Elsevier

Perez, M. F., & Coutinho, M. T. (2021). An overview of health disparities in asthma. The Yale Journal of Biology and Medicine, 94(3), 497–507. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461584/

Ramakrishnan, R. K., Al Heialy, S., & Hamid, Q. (2021). Implications of pre-existing asthma on COVID-19 pathogenesis. American Journal of Physiology-Lung Cellular and Molecular Physiology, 320(5). https://doi.org/10.1152/ajplung.00547.2020

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Week 4 Assignment 

An understanding of the respiratory system is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that oftentimes, the respiratory system works closely with the cardiovascular system.  A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.

Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

An understanding of the symptoms of alterations in the respiratory system is a critical step in diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

• By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
  • Scenario:
    • A 16-year-old African American female presents with her mother to the emergency room with complaints of dyspnea and wheezing without relief after using her albuterol inhaler. The patient was diagnosed with COVID – 19 six (6) days ago and started noticing that her breathing effort was getting harder in the last 2 days. She reports a fever of 101F originally but has not had a fever in the last 24 hours. She denies any chest pain but is having some increased dyspnea when she is walking around. The patient has a 5-year history of intermittent asthma which has been controlled with her current medication. The patient is currently using loratadine 10mg po daily, singular 10mg at bedtime, and albuterol 2 puffs via inhalation every 6 hrs. as needed. She reports that she had to use multiple doses in the last 24 hours because her symptoms were worsening. VS: BP 132/88, pulse 120, respirations 28, O2 sat 94%, and temp 99.4F. Upon exam the patient has diffuse wheezing bilaterally on expiration and minimal upon inspiration. Breath sounds are diminished bilaterally. Chest x-ray reveals hyperinflation with no infiltrates.

The Assignment
In your Case Study Analysis related to the scenario provided, explain the following

• The pulmonary pathophysiologic processes that result in the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.

Resource:

• McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.