Asthma Case Study Essay

asthma attack Case Study EssayThis essay is written as a shell study referring to a patient of from my get along atomic number 18a. As I ordain be reflecting on my practice in relation to the flake study, office pull up stakes be made of first person opus where appropriate. Hamill (1999) supports the use of first person report in academic essays such(prenominal) as case studies and suggests it develops self-awareness, reflection, analysis and critique.As this essay is focused on a specific patient from my practice plain it is important to consider issues of confidentiality. Therefore, throughout neither my practice area nor the patient name will be identified. However to be able to deal let on issues in relation to the patient I will refer to their age, gender and reachstyle, and use a false name to aid the flow of writing.Introduction asthma attack affects 5.2 million people in the UK 1.1 million children and 4.1 million adults according to asthma UK in their 2004 r eport. However, depending which report bingle reads, this number gage almost icon to 10.1 million (Masoli et al 2003). This wide variation of prevalence whitethornbe explained by the different studies and reports used to gather the data and differing inclusion criteria used. There is further agreement on the fact that the numbers of cases of asthma are increasing. asthma UK (2004) reports a 400,000 development in the number of adults with asthma in the UK betwixt 2001 and 2004. The rising patterns of asthma prevalence however are not explained by new knowledge of causes of asthma, but are paralleled by increases in former(a) allergic moderates such as eczema and rhinitis (Masoli et al 2003).There is currently no agreed definition of the disease. Widely documented in the books however, is the home(a) Heart, Lung and Blood Institute (1992) definition who describe it as, a continuing inflammatory disorder of the airways causing widespread but variable airflow obstructionO bstruction is often reversible, either spontaneously or with treatment. The unfeelingness of the actor varies significantly (Rees and Kanabar 2000) from mild intermittent asthma, to a distressing change condition which results in time off work or school, overturned sleep, restriction of social and leisure activities and anxiety (Hyland 1998). The main rail of asthma sustainment is to control symptoms, minimise asthma exacerbations and optimise quality of life (Scullion 2005).As a student of the Acute Care alley Degree, star of the specific breeding outcomes for my pathway is to be able to manage programmes of feel for for patients with chronic diseases (St Martins College 2006). Hyland (1998) states that the travel Nurse Practitioner has beat a major(ip) provider of asthma care in the UK. Watkins, Edwards and Gastrell (2003) agree, and suggest that currently the heed of long-term conditions, including asthma, are a core component of a Advanced Nurse Practitioners work. Therefore it is crucial that I be in possession of an reason of this condition and be able to brush up patients effectively (Wiggins 1999) using evidence establish guidelines, and to view the confidence to provide advice on the counselling of their condition.I aim to improve my understanding and asthma prudence skills through critically reviewing key issues of patient care as a case study. The key issues I intend to focus on relating to a specific patient areTreatment of Asthma in the unavoidableness DepartmentPatient teaching methodPatient musical harmonyInitially this essay will examine my current practice in relation to asthma management through reflecting on my present level of knowledge and understanding, discussing the level of care I can provide for patients with asthma at the moment. I then intend to let out a brief outline of the patient chosen for this study, explaining the reasons for that filling and the principle behind the key issues highlighted for discus sion. A critical review of the key issues will follow using up to date evidence based literary works and considering relevant policies. The conclusion will summarise the main points, reflect on what I have learned from this module and consider ongoing learning requirements in relation to asthma management.Reflection on current practiceAt the time of writing I have so far-off completed 16 hours in practise, Therefore my first few age in practice were spent adjusting to this new and very different area of nursing. Neverthe little I have had the opportunity to observe my mentor assessing patients with asthma and of late have become more involved in the review of these patients, with oversight.Prior to starting the course I did feel I had any(prenominal) understanding of the disease process of asthma from on the job(p) in the Emergency Department, albeit very fundamental, and some basic knowledge of the management. Some of this understanding comes from individual(prenominal) ex perience but also through my previous experience working in dermatology. Often patients presenting with atopic eczema would also be asthmatic, there is a intumesce known link between these conditions (Hyland 1998). Some of the advice given in eczema management, for mannequin allergen avoidance, will also be relevant in asthma management (Rees and Kanabar 2000).Using Benners (1984) novice to expert model I would classify myself at present as an advanced beginner. This is someone who has a marginally agreeable performance with some background experience but who lighten requires supervision. I feel this accurately describes my current ability in practice in relation to asthma management. With supervision I am able to encounter an assessment using a template for guidance, defend music usage, check symptoms and carry out peak flow assessment. However I still find the array of inhalers confusing and dont feel confident in construe the information gleaned during assessment into en dned care within the time constraints of the clinic. When I have the time to reflect on the information and review the guidelines remote from the patient I feel more confident. I need however to be able to make the transition from an advanced beginner to a competent practitioner, increasing my level of proficiency to no longer requiring supervision but being aware of my own limitations. I feel with more experience in practice and by working through this case study I should be able to achieve this.Rationale for choice of patient and key issuesRolfe, Freshwater and Jasper (2001) suggest that choosing an event or mishap to reflect upon or analyse is concerned with anything that happens to us that we want to hold open roughly for some reason. It is the significance of the experience within our daily lives which helps us choose one experience over another. Having decided to focus on asthma as the topic for my case study, when I looked back at the patients I had seen with asthma, it w as the above episode of care which held the most significance for me. pharmacologic managementThe aims of the pharmacological management of asthma are to control symptoms, hold on exacerbations and achieve the best possible lung function while minimising side-effects and long-term sequelae (Scullion 2005). National clinical guidelines developed in 2003 by the British Thoracic confederacy (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) were produced in collaboration with, amongst others, Asthma UK and the over-embellished College of Physicians of London, and have more recently been updated in 2005. They are widely genuine as the Gold Standard of evidence-based asthma care for health care professionals working in the UK (Levy and Pearce 2004).Patient cultivation and concordanceThe issues of bringing up and concordance will be discussed together as they are inextricably interlinked. It is tight for the health professional to achieve concordance with the patient with out providing education nearly their disease and its management (Levy and Pearce 2004). It is estimated that one quarter of asthma patients in the UK have a compliance rate of 30% or less (Das Gupta and invitee 2003). The term compliance in health care has become less fashionable recently due to it implying that a patient is perhaps unreal and hasnt followed the health professionals instructions (Hyland 1998). Whereas in reality the reasons for non-compliance are complex (Holgate and Douglass 2006) and not necessarily the fault of the patient, for example, not being shown how to use their inhaler wind properly (Carter et al 2005). Nevertheless non-compliance is thought to contribute to between 18% and 48% of asthma deaths (Asthma UK 2003). Concordance is the term used to describe a negotiated agreement between health professional and patient with regard to the management of their condition (BTS/SIGN 2005). However even when concordance seems to have been achieved a patient still may not adhere to the agreed plan of care for many reasons (Weller and Booker 2006).Ensuring patients are well informed about how their medication works has been shown to improve adherence and control (Boulet 1998). They need to be aware of the risks of taking and of not taking their medication (Levy and Pearce 2004). The latter is of peculiar(prenominal) concern in asthma in that persistent inflammation of the airways may lead to irreversible obstruction (Rees and Kanabar 2000). Written personalised asthma action plans have been shown to improve outcomes of care (BTS/SIGN 2005). They reinforce verbal education and set out for patients what to do if their symptoms worsen (Roberts 2002).ConclusionAsthma is a frequently seen chronic condition in the Emergency Department and one that Advanced Nurse Practitioners are expected to be involved in the management of (Hampson 2002). Therefore as am Acute Care Pathway Degree Student, I need to develop my knowledge and skills in this condition to enable me to provide a high standard of evidence-based care for patients. end-to-end this essay I have endeavoured to demonstrate my understanding of asthma especially in relation to the pharmacological management and issues of education and concordance. These issues have been discussed and have shown to be interrelated without achieving concordance, adherence to prescribed medication cannot be achieved and without patient education concordance cannot be gaind.Although I have been unable to discuss all aspects of asthma management due to word limit constraints, my understanding of asthma medications and the use of the gaitwise guidelines has increased significantly to the point where I now feel more confident in practice. More recently when seeing patients with asthma I have been able to visualise which step they are on which has helped me to decide whether they are on the correct medication in relation to the severity of their disease. Reviewing the issues of concordance and education has made me realise how important these aspects of management are however the time needed to underwrite these issues in practice often doesnt correlate to the time allowed for appointments.To enable me to become a competent practitioner in asthma management I need to consolidate the increased knowledge I have gained from writing this essay with more experience in practice. I need to increase my knowledge in areas not discussed in this essay, such as non-pharmacological management through self-directed study and perhaps consider further education through an accredited asthma diploma course, on completion of my spot course.