Question:

Question 1

You will need to identify and use the right professional, ethical or legal framework in order to critically discuss the issue of responsibility and accountability when caring for Joe.

(Q1 Safe, Effective Person Centred Caring)

Person-centred careNMC CODE

Definition of accountability/responsibility

NMC code 2015 4Ps: Definition of legal and ethical principles

Health and Social Care Act 2012: Work Laws

Equality Act consent & confidentiality

Question 2

A) Present a critical discussion about the pathophysiology associated with Asthma. This will include both normal and altered pathophysiology.Q2A(1)Asthma

Definition of Respiratory system; Normal VS. Abnormal

Their Symptoms

Defferential diagnosis

A topic VS. Non Atopic

Occupational Asthma

b. Talk about a psychosocial aspect that may have an effect on Joe.Q2BPsychosocial FactorOccupation < sick zero hours Language barrier Support network for immigrationSmoking- Health impact France has cultural acceptance of smoking Question 3 a. Identify and critically discuss the clinical reasoning, systematic assesement process and person centred care in relation to the scenario. b. Select one of the relevant issues in the scenario. Critically examine how you would offer safe and effective care.

Answer to Question: B721 Nursing

Question 1.

Question 1.

Asthma is a chronic lung condition that causes inflammation and narrowing of the airways of the lungs.

If not treated, this can lead to death.

Hackett (2012) suggests that occupational asthma sufferers may be unable to comply, anger or frustrate due to their condition.

Asthma can also lead to depression and emotional depression.

Acute Asthma could lead to professional losses that can then lead to psychological issues for the patient (Asher, Pearce, 2014).

To manage Asthma, the nursing plan should focus on the management of the hypersensitivity reaction, controlling allergens which may trigger asthma, maintaining the patency and preventing the occurrences of reversible problems (Hackett 2012).

A nurse should offer emotional support to the client in order for Joe to manage his anxiety.

Asthma patients should receive holistic care.

The nursing professional should follow certain ethical and legal guidelines (Groves 2014.)

The nurse must be able provide patient-centered nursing.

Patient-centered care: This is care where patients and their health are the driving forces behind all decisions.

Ritz et.al.2013. Health care providers offer care to patients not only from a clinical perspective, but also from a spiritual and mental perspective.

NMC code: The nurse responsible for Joe must follow the nursing/midwifery code of ethics when caring for JOE.

NMC codes are useful for nurses who want to protect the dignity of patients and provide safe, quality care (Groves (2014)).

Accountability is the concept that a nurse must answer for her actions to herself. This is an essential component to nursing practice.

A nurse can take responsibility for her patient. He should do more than his usual practice to provide patient-centered care (Groves 2014).

Here are four principles of NMC code:

To treat all people as individuals and to maintain their dignity and respect.

Groves 2014 states that nurses should be able respond to the patients’ concerns and listen to them.

A nurse should have the ability to meet the individual’s psychological, social, and physical needs.

To fulfill the patient’s need.

Joe must be educated about Asthma so that it can be managed properly. This aligns well with the NMC codes.

Joe has also been in emotional turmoil and requires psychosocial support (Code number 3).

The Health and Social Care Act (2012) states that it is important to take care of both the physical and mental health.

Therefore, the nurse is responsible for providing comprehensive care to Joe. This could include a physical exam and mental health assessment.

One of the codes for nursing standard is to maintain equality, integrity, confidentiality of patient.

Joe might not wish to share his clinical condition with anyone else.

In such situations, it is important for the nurse not to compromise the dignity or the integrity of the patient.Q. 2A Pathophysiology Of Asthma

Asthma attacks can cause breathing problems by narrowing the airways, which in turn affects normal air flow through the respiratory system.

Doeing and Solway (2013) note that asthma affects the bronchial tubes but not the alveoli.

Asthma attacks are different from normal. The respiratory tract secretes excess mucus as an inflammatory response. This causes respiratory distress (Killeen, Skora, 2013).

Asthma can be characterized by short and fast breathing, chest tightness, prolonged coughing, chest tightness, difficulty in stopping coughing, and a low sounding wheeze while you breathe (Killeen, Skora, 2013).

Asthma typically manifests as wheezing and reversibility.

Wheezing can result from any disease that disrupts the flow of air through the respiratory system. Patients suffering from Asthma should not have had a history of allergy, or suffer from dyspnea following exposure to allergens (Miravitlles 2012).

Other diseases like chronic bronchitis or cardiogenic pulmonary swelling, pulmonary dyspnea, or pulmonary emphysema can cause wheezing. This is not related to allergens.

Atopic Asthma could be defined as a condition that is caused by an allergy to allergens. It’s mainly known as extrinsic or extrinsic.

Pekkanen (2012) states that there is no clinical evidence for IgE-mediated allergies in non-atopic asthma.

Non-atopic asthma has the IgE produced against unknown virus particles and auto-antigens. (Kuhl und Hanania 2012).

In this case study it is obvious that Joe has atopic asthma. Joe is a regular chain smoker. Exercising too much can lead to worsening symptoms (Malinovschi and al. 2012).

Occupational asthma refers to a form of asthma that is mostly found in the workplace due to the high levels of environmental allergens such asbestos particles, smoke, dust and pollen (Tarlo und Lemiere 2014).

Joe works in construction.

Therefore, it is evident that he is frequently exposed to chemicals, dusts, fumes, and other substances that could trigger asthmatic symptoms. (Lemiere, 2013).Q. 2B Psychosocial Factors

Asthma is associated to significant morbidity, mortality, and is often caused by poor socioeconomic circumstances. However, there are many psychosocial factors that may be involved, including anxiety, disease denial, and inability of cope.

These psychosocial issues could lead to poor management of asthma in high-risk patients, such as noncompliance or irregular checkups (Ritz and al. 2013).

Joe’s anxiety was the psychosocial element.

Asthma attacks can be triggered by anxiety and stress.

Anxiety can trigger physiological changes that result in attacks.

Anxiety triggers the release or leukotrienes and histamines. This causes the narrowing of your airway (Li, et al. 2015).

Anxiety attacks can lead to anxiety attacks that cause individuals to forget to take their medications for asthma. This makes the problem even more severe.

A zero hour contract means that employees are hired in a short time and their pay is determined by how many hours they work.

Zero hour contracts do away with sick leaves, and those who are sick are not paid.

Reports have shown that people on zero hour contracts had poor physical and psychological health (Bender & Theodossiou, 2017).

Joe was on a zero hour job, which adversely affected his health.

Language barriers play a crucial role in proper administration of healthcare systems.

Language barriers are a challenge for the healthcare system, as they can prevent the provision of effective and high-quality care to patients (van Panhuis und al. 2014).

Joe is an immigrant to France. As such, he has problems understanding the medication system and healthcare system.

The health of immigrants is also affected if they have a weak support network for immigration.

These immigrants have poor wages and are not covered by their workplace’s health insurance.

Martinez et.al. (2015) found that immigrants with low incomes have limited access to various health care services. 2015).

Joe is a French-born immigrant who works long hours for a small wage.

Smoking can cause respiratory problems.

The settling of irritating substances in the airways from smoking tobacco can trigger asthma attacks.

Tobacco smoke can cause damage to the hair-like projections in the airways called cilia.

Smoking cigarettes can also cause an increase in mucus production by the lungs.

Asthmatic attacks can be caused when there is a combination of damaged cells and excessive mucus.

Because of scarring and inflammation, cigarette smokers have narrower bronchial tube.

These narrow bronchial tubes can result in breathing problems for the person.

Asthma sufferers who smoke can experience wheezing, coughing, or breathing problems (Carsin; et al. 2016).

Joe is also a regular smoker, and he smokes 4 cigarettes daily.

French people are more inclined to smoke.

France is a tobacco haven, and the smoking rate has risen to 60%.

France has 47 billion cigarettes smoked each year according to statistics.

France is the most smokey country in the World.

France has a strong culture of smoking, and the younger generation is very open to it.

Although there have been restrictions, not much effort is made to enforce them (PerettiWatel et.al. 2014).Q. 3.

Clinical Reasoning and Systematic Evaluation

The systematic assessment for asthma includes the collection of a brief medical history in order to identify risk factors, determine socioeconomic status, and determine ethnicity in order provide person-centered care.

The next step involves clinical examinations, which are used to diagnose and assess asthma severity.

Next, treatment or intervention strategies are presented. These include oxygen therapy (NIPPV), intravenous and inhaled bronchodialters, systemic corticosteroids (Restrepo und al. 2015).

ADLs, or ALs, are common terms for the Roper Tierney Model of nursing.

This is because this theory of nursing care focuses on the “activities daily living” or ADL.

This theory can be used to assess the patient’s health and determine how it has changed in response to injury, illness, or admissions to hospital.

The activities of living include maintaining a safe environment, breathing and communication, eating and drinking as well as washing and dressing. They also control temperature, work or play, mobilization, sleep, death, and sexuality (Williams 2017).

Nursing process assessment is the first of five phases. This phase allows the nurse to gather information about the patient, including their physiological, psychological, spiritual and sociological status.

In this instance, communication is the most relevant of all the AL assessments.

Joe, who is French, finds it extremely difficult to understand the English language suggestions made by the nurse practitioners.

Person-centered care can be defined to mean that patients or clients who use the healthcare services are considered equal partners in the planning, design, and monitoring care so that their personal needs can be met (Olsson und al. 2013).

Clinical reasoning is the process where nurses gather and process information to understand patients’ problems, then provide implementations.

It includes evaluation, reflection and learning from experience (Alfaro LeFevre 2015.

In this case, a key issue is the language barrier. It prevents you from providing safe and efficient care.

Joe struggles to understand the inhaler and its use.

His father is an interpreter.

Another problem is his inability or unwillingness to translate medical terminology, medication use and purpose.

His symptoms worsen during work (Purokivi. 2014).

For him, it may be possible to get help from interpreters. They can accompany him during the day and give him proper medication instructions.

Personal protective equipment, such as inhalers, can be helpful to reduce the severity. They are also safe and effective.

Refer to Reference ListAlfaro-LeFevre, R., 2015.

Critical Thinking, Clinical Reasoning, Clinical Judgment and Clinical Judgment Ebook: A Practical Approach. Elsevier Health Sciences.

Hashimoto S. Hashimoto M., Spinhoven P. Pasma H.R. Pasma S. Pasma H.R. Sterk P.J. Sterk P.J. Bel E.H. ten Brinke A.

Anxiety, depression, personality traits, and severe, prednisone -dependent asthma.

Respiratory medicine. 108(3). pp.438-444.

Asher I. and Pearce N. 2014.

Global burden of children with asthma.

International journal on tuberculosis (and lung disease), 18(11), 1269-1278.Bender, K.A.

2017 and Theodossiou I.

The Unintended Effects of Flexicurity. The Health Consequences for Flexible Employment.

Review of Income, Wealth.

Carsin A. Mazenq J. Ilstad A. Dubus J.C. Chanez P. Gras D.

Bronchial epithelium of children: A key actor in asthma.

European Respiratory Review 25, 140, pp.158-169.

Doeing D.C. and Solway J. (2013).

The role of smooth muscle in the airway in asthma pathophysiology and treatment.

Journal of applied physiologicallogy, 114(7). pp.834-843.Groves, W., 2014.

Nursing skills.

Nursing standard, 29(1). pp.51-59.Hackett, T.L., 2012. Epithelial-mesenchymal transition in the pathophysiology of airway remodelling in asthma.

Current opinion on allergy and clinical immunology 12, pp. 53-59.

Killeen K. and Skora E.

Pathophysiology, diagnosis, as well as clinical assessment of adult asthma.

Nursing Clinics, 48(1). pp. 11–23.

Kuhl K. & Hanania N.A. 2012

IgE targets in asthma.

Current opinion on pulmonary medicine 18(1): pp.1-5Lemiere, C., Boulet, L.P., Chaboillez, S., Forget, A., Chiry, S., Villeneuve, H., Prince, P., Maghni, K., Kennedy, W.A.

Blais L. (2013).

Do work-exacerbated asthma or occupational asthma differ?

Journal of Allergy and Clinical Immunology., 131(3).

Li, H.L. He X.L. Liang B.M. Zhang H.P. Wang Y. Wang G., 2015 November

Anxiety, but not depression symptoms, are associated with dyspnea after bronchoconstriction.

In Allergy proceedings and asthma proceedings (Vol. 36, No. 6, pp. 447-457).

OceanSide Publications, Inc.

Malinovschi A., Backer V., Harving H., and Porsbjerg C.

The importance of exhaled Nitric Ox to detect asthma in people who smoke.

Respiratory medicine. 106(6). pp.794-801.

Martinez, O. Wu E. Sandfort T. Dodge B. Carballo-Dieguez A. Pinto R. Rhodes S. Moya E. Chavez-Baray S.

Systematic review on the effect of immigration policies upon health status among undocumented immigrant immigrants.

Journal of Immigrant and Minority Health (17(3)), pp.947-970.

Miravitlles M., Andreu I., Romero Y., Sitjar S., Altes A., and Anton E.

The difficulty in diagnosing COPD/ASTHMA in primary care.

Br J Gen Pract.

Olsson L.E. Jakobsson Ung E. Swedberg K. & Ekman I.

A systematic review of controlled trials that evaluated the efficacy and effectiveness of person?centred treatment.

Journal of clinical nurses, 22(3-4), pages 456-465.Pekkanen, J., Lampi, J., Genuneit, J., Hartikainen, A.L.

Jarvelin M.R.

Analyzing atopic as well as non-atopic asthma.

European journal for epidemiology, 27(4) pp. 281-286.

Peretti-Watel P. Legleye S. Guignard R. Beck F. 2014

Evidence from France.

International Journal of Drug Policy 25, 2:28-290.Purokivi, M., Sauni, R., Hannu, T., Harju, T., Jaakkola, M., Karjalainen, J., Kilpelainen, M., Karvala, K., Malmberg, P., Nieminen, E.M. and Pallasaho, P., 2014.

Work can aggravate asthma. Duodecim; laaketieteellinen aikakauskirja, 130(17), pp.1691-1698.

Restrepo R.D. Tate A. Gardner D.D. Wittnebel L.D. Wittnebel R. Wettstein R. Khusid F. 2015

Current approaches to acute severe asthma treatment.

Indian Journal of Respiratory Care. 4, p.521.Ritz, T., Meuret, A.E., Trueba, A.F., Fritzsche, A. and von Leupoldt, A., 2013.

Psychosocial factors and behavioral medical interventions in asthma.

Journal of consulting clinical psychology, 81(2). p.231.Ritz, T., Meuret, A.E., Trueba, A.F., Fritzsche, A. and von Leupoldt, A., 2013.

Psychosocial factors and behavioral medical interventions in asthma.

Journal of clinical psychology and consulting, 81(2). p.231.Tarlo, S.M.

Tarlo S.M.

Occupational asthma.

New England Journal of Medicine. 370(7). pp.640-649.

van Panhuis W.G. Emerson C. Emerson C., Paul P. Emerson C. Grenstette J. Wilder R. Herbst A.J. Heymann D. Burke D.S.

A systematic review and analysis of data sharing barriers in public health.

BMC Public Health 14, 1 p.1144.Wenzel, S.E., 2012.

Asthma Phenotypes: The Evolution from Clinical to Molecular Approaches. Nature medicine, 18(5), pp.716-725.Williams, B.C., 2017.

Roper, Logan-Tierney’s model of nursing.

Nursing2017, 12(1), pages 17-20.