NUR 635 Topic 9 DQ 1

Sample Answer for NUR 635 Topic 9 DQ 1 Included After Question

Beth is a 13-year-old female who is experiencing shortness of breath. She is currently prescribed an albuterol inhaler. Upon examination, she experiences persistent symptoms daily, and sometimes they cause nighttime awakenings.

She finds herself using the inhaler once daily. During PE class she finds her asthma has sometimes limited her ability to participate. Use the guidelines and relevant literature in your topic Resources to discuss the following: 

  • Briefly explain the pathophysiology associated with asthma.
  • How does an albuterol inhaler help treat asthma? What are the key adverse effects associated with the medication?
  • How would you classify Beth’s asthma using the National Heart, Lung, and Blood Institute (NHLBI) Prevention Program? Explain your rationale.
  • Using the stepwise approach, you as a prescriber have decided to add an inhaled corticoid steroid (ICS) to the patient’s regimen. Explain how an ICS will help with the treatment of asthma. Which medication, dose, and frequency will you prescribe? What are the key adverse effects associated with the medication?
  • Three months later, Beth’s symptoms persist as Beth uses her albuterol inhaler daily while on the ICS. Based on the National Heart, Lung, and Blood Institute (NHLBI) Prevention Program, which medication, dose, and frequency will you prescribe? What are the key adverse effects associated with the medication?
  • Also, when reviewing Beth’s most recent BMP, you find that her potassium was 3.0mmol/L. In the past, her potassium has trended within normal limits. Explain a possible cause regarding the potassium shift as pertains to her medication regimen.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 9 DQ 1

Title: NUR 635 Topic 9 DQ 1

Briefly explain the pathophysiology associated with asthma.

Asthma is a chronic inflammatory disorder of the airways. Immune response to known allergens affect 50% of children and some adults with asthma. In the remaining children and most adults, the cause of inflammation is unknown, although, unidentified allergens are suspected (Rosenthal & Burchum, 2020).  

How does an albuterol inhaler help treat asthma? What are the key adverse effects associated with the medication?

Albuterol belongs to the family of medicines known as adrenergic bronchodilators. Adrenergic bronchodilators are medicines that are breathed in through the mouth to open up the bronchial tubes (air passages) in the lungs. They relieve cough, wheezing, and trouble breathing by increasing the flow of air through the bronchial tubes (Mayo Clinic, 2023). 
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, the provider may want to change the dose, or other precautions may be necessary. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco ( Mayo Clinic, 2023). 

How would you classify Beth’s asthma using the National Heart, Lung, and Blood Institute (NHLBI) Prevention Program? Explain your rationale.

According to the NHLBI prevention program, Beth’s asthma would be classified as moderate due to the fact she experiences shortness of breath daily, has some nighttime awakenings, has limits during physical activity and requires use of her inhaler once a day (NHLBI, 2007). 

Using the stepwise approach, you as a prescriber have decided to add an inhaled corticoid steroid (ICS) to the patient’s regimen. Explain how an ICS will help with the treatment of asthma. Which medication, dose, and frequency will you prescribe? What are the key adverse effects associated with the medication?

Inhaled corticosteroids (ICS) are the most effective controllers of asthma. They suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2). Through suppression of airway inflammation ICS reduce airway hyperresponsiveness and control asthma symptoms. ICS are now first-line therapy for all patients with persistent asthma, controlling asthma symptoms and preventing exacerbations. Inhaled long-acting β2-agonists added to ICS further improve asthma control and are commonly given as combination inhalers, which improve compliance and control asthma at lower doses of corticosteroids (Barnes, 2010). 
For Beth, I would prescribe Ciclesonide 50mcg, 2 puffs daily. I would monitor for common side effects which include, stuffy nose, sore throat, and headaches. Serious reactions include, hives, swelling of your face, lips, or tongue, difficulty breathing (GoodRx, 2023). 

Three months later, Beth’s symptoms persist as Beth uses her albuterol inhaler daily while on the ICS. Based on the National Heart, Lung, and Blood Institute (NHLBI) Prevention Program, which medication, dose, and frequency will you prescribe? What are the key adverse effects associated with the medication?

For Beth’s symptoms, I would add a LABA. The medication I would prescribe would be, Salmeterol, DPI (50 µg/inhalation), 1 inhalation every 12 hours. This medication, more frequent use may be needed due to benefits persisting for shorter periods as duration of treatment increases (Rosenthal & Burchum, 2020).  

Also, when reviewing Beth’s most recent BMP, you find that her potassium was 3.0mmol/L. In the past, her potassium has trended within normal limits. Explain a possible cause regarding the potassium shift as pertains to her medication regimen.

Short-acting beta agonists and long-acting beta agonists help people with asthma and chronic obstructive pulmonary disease (COPD) breathe better. But these medications like albuterol (Proair HFA, Ventolin) and salmeterol (Serevent diskus) also lower blood potassium levels by moving potassium into your cells (GoodRx, 2023).

References:

Alvesco (ciclesonide): Uses, side effects, dosage & reviews. GoodRx. (2023). https://www.goodrx.com/alvesco/what-is 

Barnes, P. J. (2010). Inhaled corticosteroids. Pharmaceuticals, 3(3), 514–540. https://doi.org/10.3390/ph3030514 

Mayo Foundation for Medical Education and Research. (2023, October 1). Albuterol (inhalation route) proper use. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/albuterol-inhalation-route/proper-use/drg-20073536?p=1 

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.

A Sample Answer 2 For the Assignment: NUR 635 Topic 9 DQ 1

Title: NUR 635 Topic 9 DQ 1

  • According to the research conducted by Hashmi, et.al. (2023), asthma is characterized by acute and reversible inflammation of the airways, which typically occurs after exposure to environmental stimuli. The pathogenic progression starts with the intake of a stimulus, such as cold air or pollen, which subsequently triggers airway inflammation and heightened mucus secretion owing to bronchial hypersensitivity. This phenomenon results in a notable increase in airway resistance, particularly during the exhalation phase. Airway blockage arises as a result of the confluence of many factors, namely, the infiltration of inflammatory cells, the excessive production of mucus leading to the creation of mucus plugs, and the contraction of smooth muscle. Over time, these alterations may become permanent as a result of basement membrane thickening, collagen deposition, and epithelium desquamation. In chronic diseases, airway remodeling takes place, characterized by smooth muscle hypertrophy and hyperplasia.
  • According to Johnson et al. (2022), Albuterol, also referred to as salbutamol, is indicated for the management and prophylaxis of bronchospasm in patients with reversible obstructive airway disease, including exercise-induced bronchospasm. The absence of albuterol’s bronchodilatory properties may lead to severe asphyxiation, making this medication particularly advantageous for those experiencing recurrent obstructive airway symptoms, such as asthma, to have readily available. Albuterol exerts its pharmacological effects by selectively targeting the beta-2 adrenergic receptors, resulting in the relaxation of the smooth muscle of the bronchial airways. Furthermore, it hinders the secretion of mediators associated with acute hypersensitivity, particularly mast cells. While albuterol does have an impact on beta-1 adrenergic receptors, its influence is modest and has little implications on heart rate. In relation to adverse reactions, the most negative consequences associated with albuterol medication include tremors and anxiousness. These effects are predominantly seen in children within the age range of 2 to 6 years, but they may manifest across all age groups. Tremors arise from the stimulation of beta-2 receptors located on the motor nerve terminals, leading to an elevation in intracellular cyclic adenosine monophosphate (cAMP) levels. The incidence of these adverse effects is seen in roughly 20% of individuals. Additional adverse reactions, such as sleeplessness and nausea, manifest in around 10% of patients. Less frequently observed adverse effects may encompass fever, bronchospasm, emesis, cephalalgia, vertigo, cough, hypersensitivity reactions, otitis media, epistaxis, heightened appetite, urinary tract infections, xerostomia, flatulence, excessive perspiration, pain, dyspepsia, hyperactivity, chills, lymphadenopathy, ocular pruritus, diaphoresis, conjunctivitis, and dysphonia. There is evidence to suggest that Albuterol might elevate blood pressure and perhaps induce hypokalemia. Berlinski (2017) reported infrequent occurrences of elevated blood glucose levels, as well as extended QTc interval and ST-segment depression.
  1. In the study conducted by Liang, TZ, and Chao, JH (2023), it was found that inhaled corticosteroids (ICS) have been recommended by the FDA as the preferred therapy for reducing asthma exacerbations in those with chronic asthma. Inhaled corticosteroids possess robust glucocorticoid properties and exert their effects at the cellular level by counteracting capillary permeability and stabilizing lysosomes, hence mitigating inflammation. The initiation of the therapeutic effect is a slow process, requiring a variable duration ranging from a few days to several weeks, in order to achieve optimal outcomes via regular and continuous use. The process of metabolism occurs via the hepatic pathway, with a half-life of elimination that may extend up to 24 hours. The consistent use of these drugs has been shown to decrease the occurrence of asthma symptoms, bronchial hyperresponsiveness, the likelihood of severe exacerbations, and enhance overall quality of life. The administration of these drugs follows a systematic approach that takes into account the frequency and severity of the symptoms associated with asthma. Inhaled corticosteroids are offered in three different dosage levels, namely low, medium, and high, to effectively manage asthma of varying degrees of severity, ranging from mild to moderate and severe. The local negative consequences associated with the use of inhaled corticosteroids include dysphonia, oral candidiasis, reflex cough, and bronchospasm.
  2. The incidence of these side effects is lower in those using low-dose inhaled corticosteroids compared to those using high-dose inhaled corticosteroids. The use of spacers during the administration of medicine using metered-dose inhalers has been shown to alleviate the aforementioned negative consequences.  One often reported issue among those who take inhaled corticosteroids is the occurrence of oral candidiasis, sometimes known as thrush. The likelihood of this danger is elevated in geriatric patients and individuals who concurrently use oral corticosteroids, high-dose inhaled corticosteroids, or antibiotics. The occurrence of laryngeal and esophageal candidiasis has also been documented in the academic literature. It is recommended that patients engage in mouth rinsing after the administration of inhaled corticosteroids (ICS) in order to mitigate the risk of developing oral candidiasis. The therapeutic interventions for candidiasis including the administration of clotrimazole, miconazole, and nystatin. In addition, The use of inhaled corticosteroids has been shown to be associated with a decrease in growth velocity in pediatric patients diagnosed with asthma. Nevertheless, the impact of modest dosages of inhaled corticosteroids is minimal, does not worsen with time, and has the ability to be reversed. The recommended dosages for inhaled corticosteroids (ICS) The recommended dosage for Beclomethasone Dipropionate (Qvar 80) is 1-2 puffs used twice daily. For Budesonide, the recommended dosage is 189 mcg twice day using either the Pulmocort Flexhaler 90 mcg or Pulmocort Flexhaler 180 mcg. The maximum dosage for Budesonide is 360 mcg twice daily. 
  • Based on the lack of improvement in Beth’s condition during three months of daily inhaler usage and the combination of inhaled corticosteroids (ICS), as a healthcare professional, it may be appropriate to consider increasing the dosage of Albuterol inhalation. The standard dose for managing acute bouts of bronchospasm or preventing symptoms related to bronchospasm in individuals aged 4 years and above typically involves administering two inhalations, which may be repeated every 4 to 6 hours. In addition, a little quantity of oral corticosteroids is administered continuously to maintain optimal management of their asthma. The National Heart Lung and Blood Institute (NHLBI) recommends the following therapeutic approach for managing acute bouts of asthma in outpatient settings, sometimes referred to as “burst” therapy. The recommended dosage for prednisone is 40 to 60 mg administered orally once daily or divided into two doses. The duration of therapy typically ranges from 5 to 10 days. Additionally, the inclusion of Montelukast, a leukotriene-receptor antagonist (LTRA), provides both anti-inflammatory and bronchodilator effects. This is due to the fact that the cysteinyl leukotrienes, which are blocked by Montelukast, play a role in both inflammation and bronchoconstriction (Doherty, 2007). The recommended dosage of montelukast for children aged 6 to 14 is one 5 mg chewable tablet given once a day at night (Knorr, et al., 1999).
  • Beth’s potassium level has decreased to 3.0 since she began taking Albuterol. The off-label use of albuterol includes its use as an adjuvant therapy for hyperkalemia.  Albuterol, classified as a β2‐agonist, induces an intracellular redistribution of potassium from the interstitium. The activation of β2 receptors by Albuterol results in the stimulation of the Na+/K+ pump, which in turn facilitates the intracellular transportation of potassium ions, ultimately causing a transient state of extracellular hypokalemia. Burger et al. (2021) observed a notable occurrence of hypokalemia after the injection of albuterol in individuals experiencing acute exacerbation of asthma. 

References:

Berlinski, A. (2017). Pediatric Aerosol Therapy. Respir Care. 62(6):662-677. 

Burger, C., Vendiola, D. F., & Arnold, D. H. (2021). Nebulized albuterol delivery is associated with decreased skeletal muscle strength in comparison with metered-dose inhaler delivery among children with acute asthma exacerbations. Journal of the American College of Emergency Physicians open2(2), e12422. https://doi.org/10.1002/emp2.12422

Doherty G. M. (2007). Is montelukast effective and well tolerated in the management of asthma in young children?: Part A: Evidence-based answer and summary. Paediatrics & child health12(4), 307–308. https://doi.org/10.1093/pch/12.4.307

Hashmi,  MF., Tariq,  M., & Cataletto, ME.  (2023). Asthma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.  https://www.ncbi.nlm.nih.gov/books/NBK430901/


Johnson, DB., Merrell, BJ., & Bounds CG. (2022). Albuterol.  In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482272/#

Knorr, B., Larson, P., Nguyen, H. H., Holland, S., Reiss, T. F., Chervinsky, P., Blake, K., van Nispen, C. H., Noonan, G., Freeman, A., Haesen, R., Michiels, N., Rogers, J. D., Amin, R. D.,

Liang, TZ, & Chao, JH. (2023). Inhaled Corticosteroids.  In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK470556/

Zhao, J., Xu, X., Seidenberg, B. C., Gertz, B. J., & Spielberg, S. (1999). Montelukast dose selection in 6- to 14-year-olds: comparison of single-dose pharmacokinetics in children and adults. Journal of clinical pharmacology39(8), 786–793. https://doi.org/10.1177/00912709922008434