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Sarah Jones is a 12 year old female who was admitted to the emergency department for a severe exacerbation of her asthma. Sarah presents with nasal flaring, labored breathing, and wheezing present bilaterally in her lungs. She also has a tight cough and her respirations are 30 per minute with an oxygen saturation of 85% upon arrival to the emergency department. Laura states, "I haven't been sleeping and I am having trouble breathing." Her past medical history includes coughing and a clear nasal discharge over the last 3 to 5 days. Sarah lives with her parents, along with one younger sibling. Sarah has also mentioned that both of her parents are smokers. She was diagnosed with asthma last year, but has a difficult time managing her symptoms. Sarah has revealed that she has not been using her inhalers. She also informed the nurse that her asthma becomes a problem during her physical education class at school. She enjoys playing soccer, but is currently unable to do so because of her asthma.

Sarah understands that she needs to manage her symptoms better, and she states that she is eager to learn. Before the nurse leaves, she asks Sarah if there is anything she can do to make her feel comfortable. Sarah states, "I just need someone to talk to, and keep me company". Sarah's mother is with her during the interview but has been on the phone most of the time. She is busy making arrangements to have someone pick up her brother from school. Her mother is very distracted and not focusing very closely on Sarah and the nurse as she completes the interview


There is an emerging need to understand some of the inflammatory diseases like tuberculosis and asthma which have recently became a threat to humanity. They have existed for centuries but the current one has developed some strains which have become difficult for the health professionals to handle them. Between these two, asthma has become the centre of interest for its chronic systems and the ability to be influenced by several factors including environment. Asthma is a one of the chronic disease affecting the lungs. it derives its name from the Greek word panos, which means panting. According to researchers, the cause of asthma is not known yet. They have hypothesized the causes to range from children acquiring from their asthmatic parents.  Newly born babies who have low birth are at high risk of getting infected if exposed to tobacco smoke. During this infantry stage, boys are more likely to develop asthma than their counterpart girls. Another alleged cause is the combination of so many factors which the experts in the health field link them to hereditary genes and environmental conditions. They argue that asthma can be as a result of the inherited tendency to be allergic, infantry respiratory infections which can be as a result of contact with airborne allergens and viral exposures. The disease also affects people of all ages although the victims hardly escape it at thee childhood. (Platts, 1999)

It also interferes with the breathing by inflaming and narrowing the airways. They become swollen and tend to become sensitive by strongly reacting to breathing in of particular substances. This reaction makes the muscles around them to tighten and narrow hence limiting the amount of air-flow to and out of the lungs. The situation is worsening further by the cells in the airways which malfunction by secreting excess mucus which blocks the narrowed paths. From the Sarah's case study, the symptoms range from mild to cute. They include nasal flaring, difficulty in breathing, wheezing and associated coughing with clear nasal discharge. The worsen conditions follows oxygen levels drop in the lungs which can propagate to difficulty in breathing accompanied by sleepless nights.

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Other facts from research on asthma shows that it non-psychological condition but emotional imbalances cause flare-ups. One can also show asthma symptoms during childhood stages which can disappear as one grows however they will still appear in few cases. Changing to a new environment can improve the asthma symptoms.

There are several theorists have come up with models describing the nursing process and the conditions involved. According to Watson's theory (1979), there exist four meta-paradigms followed in caring a patient. These are; person, environment, health and nurse.

Philosophy of Nursing

Nursing is an art and science responsible for the wellness and upright conditions of others. It is a profession dedicated to promotion of health from the perspectives of (spiritual, mental, physical and emotional) with an aim of restoring one's optimal functionality.

Nursing Meta-paradigm (Watson, 1979)

According to Watson's theory (1979), nursing meta-paradigms are the four interrelated factors of which he believed that through their incorporation in nursing practice, the philosophical core of nursing which is to care is achieved. These are persons, health, environment, and nurse.

The person perspective represents individuals, families and communities. Watson believed that the patients are inseparably attached to the families and the community surrounding them. In nursing practices, the practitioner does not only care for the patient, but also the whole patient's support system. The person is viewed as being in the world and holds three spheres; mind, body, and spirit influenced by the concept of self and who is unique to make choices.

From the case study, Sarah should not only be cared but also the care should be extended to the family and community as a whole. We are told of the patient who lives with her parents and a sibling. The parents are smokers therefore the young child may be in danger of contracting asthma also. The care should be taken to establish a way the parents can stop smoking at the same time Sarah is treated. This is quite obvious since we are told that she was diagnosed with asthma the following year a likelihood that it started from smoking parents. The caring should also try and advise the mother who does not take close on Sarah to take full responsibility and concern. By doing all this, the caring will have been extended beyond the individual level as stipulated by Watson.

Health is viewed as the absence of disease or illness. In nursing, one is said to health if the overall state of well-being. The parameters are; emotional, physical, spiritual and mental which can merge with pending or long-term /permanent state of illness whereby one is described as healthy though coping with a chronic disease. Person's health is defined as a subjective experience. It corresponds to ones harmony and balance within the mindbodyspirit. The higher degree of health can be assured if harmony exists within the mindbodyspirit. The parameter here is deterioration which can be perceived or experienced.

According to he Watson's theory, health factor don't apply too much. The only concern here is to restore Sarah's good health condition. What it means here to be health, is that she will won't be feeling the symptoms though she is not fully cured. 

The environment is viewed as the key factor in ensuring one's health and wellness.  A person leaving in encouraging environment is most likely to see positive outcomes than a person living in a discouraging environment. Home life, positive work, physical pain, addiction and mental sates are factors known to impact on the recovery or one's desire to recover.

Extending this to the case study, Sarah's sleeping environment should be checked to ensure that it is warm and free of any allergens. We are told she spends sleepless nights associated with difficult in breathing. The environment should be made encouraging by making her bedroom ventilated without compromising the temperature to curb the difficulty in breathing. Parents should be advised to keep away smoking from her. It is somewhat clear that she acquired the ailment by exposure to the smoke; therefore she must be given hopes of healing by not exposing her to what might worsen the situation. Her teachers should also be requested to exempt her from physical education; which she narrates she encounters difficulties in participating. Her emotions should be kept at good moods by providing her with company she requests. The mother's distraction due to congestion of responsibilities should be relieved by assigning extra duties to another party. Try to reduce anxiety on her keeping the environment quite calm. By so doing, you will be promoting her normal respiratory rate. All these will ignite recovery or the desire to recover. (Bush, 2001)

As mentioned before, nursing is the care of one's wellness form all perspectives including; spiritually, emotionally, mentally, psychologically, and physically. It is also a human science concerned with people and human health. It is mediated by professional, esthetic, scientific, personal, ethical and human care transactions. Nursing plays an important role in a patient by availing comfort measures, helping the cared-for to alleviate pain, stress, and suffering. Watson goes ahead to explain the role of nursing being to preserve human dignity through assisting one to understand the meaning of illness and suffering in order to bring harmony to the patient. (Appleby & Blackie, 1998)

From the case study, nursing plays a major role in making Sarah recover from asthma. The concerned professionals should ensure that patient recovers from the ailment. She should be administered medicine to alleviate the nasal flaring, to ease the difficult in breathing.

As a nursing practice, intervention should be made to facilitate the Sarah's recovery and ease the pain. The nurse should administer rapid acting bronchodilators for example albuterol to help open up the patient's airways. To counteract the inflation on the airways the nurse should administer corticosteroids such as prednisone as soon as Sarah arrives at the hospital. Since she experiences difficulty in breathing, the nurse should curb this by to her low flow humidified oxygen to prevent any possibility of hypoxemia. Depending on further reactions inside airways, any further case of blockage due secretion should be treated by administering intravenous fluids which will prevent further dehydration and helps to liquefy the secretions stuck on the airways. If the condition worsens to a failure in breathing the nurse should administer mechanical ventilation if she succumbs to such situation. (Gulledge & Beard. 1998)

For long term care, the nurse should ensure the patient is provided with medications to take at regular basis. The nurse should also ensure the patient continues with inhalants like cromolyn and leukotriene inhibitors prescribed by the physician are taken by the patient even the symptoms are no longer there. We are told that Sarah confessed of skipping her inhales therefore the nurse should take the responsibility to ensure such abuse don't occur any other time.

While at he hospital the nurse should speak to her about the importance of adhering to prescriptions. The need to be optimistic about recovery and should ensure she keeps her emotions low by advising her the need to understand the mother's commitment. She should be kept busy with jokes to avoid any mental crunch through support on spiritual matters. Lastly the nurse should monitor the side effects the drugs might have on the patient and take appropriate action.

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