A CASE PRESENTATION ON

BRONCHIAL ASTHMA IN ACUTE

EXACERBATION

Roxanne Mae M. Badongen

Marie Antoinette Carreon
Ronnel Landicho
RLE 102 STUDENTS
 Significance of the study
 Lower airway problems directly affect gas exchange and have
serious consequences. Many of these problems are chronic
and progressive, requiring major changes in person’s lifestyles.
Such airway problem includes Bronchial Asthma which is a
serious problem and could probably lead to death if proper
precautions are not observed. This study is made so that every
reader or listener of the case study and research will gain
enough knowledge and understand Bronchial asthma, its
cause, manifestations, treatment, and preventions. This study
points and focuses on the significance of reaching out to the
awareness of every individual who may have this kind of
disease and to the member of the health care team and share
to them the proper ways on how to effectively care to patients
suffering from this problem.
 Objectives of the Study
 At the end of the case-presentation the student
will be able to:
 To identify what Bronchial Asthma is all about.
 Apply the knowledge that they have learned in the
floor.
 Determine the causes, predisposing and
precipitating factors that constitute the onset of
the disease process.
 Render series of nursing interventions for the
client’s care
 Improve skills and knowledge as health care
providers in the clinical area.
 
OVERVIEW OF THE DISEASE
 A condition of the lungs characterized by
widespread narrowing of the airways due to spasm
of
the smooth muscle, edema of the mucosa, and the
presence of mucus in the lumen of the bronchi and
bronchioles. Bronchial asthma is a chronic
relapsing inflammatory disorder with increased
responsiveness
of tracheobroncheal tree to various stimuli,
resulting in paroxysmal contraction of bronchial
airways
which changes in severity over short periods of
time, either spontaneously or under treatment.
 Causes
• Allergy is the strongest predisposing factor for asthma. Chronic
exposure to airway irritants or
allergens can be seasonal such as grass, tree and weed pollens or
perennial under this are the molds, dust and roaches. Common
triggers of asthma symptoms and exacerbations include air way
irritants like air pollutant, cold, heat, weather changes, strong odors
and perfumes. Other contributing factor would include exercise,
stress or emotional upset, sinusitis with post nasal drip , medications
and viral respiratory tract infections.
• Most people who have asthma are sensitive to a variety of triggers. A
person’s asthma changes
• depending on the environment activities, management practices and
other factor.

•  
 Clinical Manifestation
• The three most common symptoms of asthma are
cough, dyspnea, and wheezing. In some
instances cough may be the only symptoms. An
asthma attack often occurs at night or early in the
morning, possibly because circadian variations
that influence airway receptors thresholds.
• An asthma exacerbation may begin abruptly but
most frequently is preceded by increasing
symptoms over the previous few days. There is
cough, with or without mucus production. At times
the mucus is so tightly wedged in the narrow
airway that the patient cannot cough it up.
Prevention
• Patient with recurrent asthma should
undergo test to identify the substance that
participate the
symptoms. Patients are instructed to avoid
the causative agents whenever possible.
Knowledge is the key
to quality asthma care.
Medical Management

• There are two general process of asthma

medication: quick relief medication for
immediate
treatment of asthma symptoms and
exacerbations and long acting medication
to achieve and maintain
control and persistent asthma. Because of
underlying pathology of asthma is
inflammation, control of
persistent asthma is accomplish primarily
with the regular use of anti inflammatory
medications.
• Corticosteroid are the most potent and effective anti
inflammatory currently available. They are broadly
effective in alleviating symptoms, improving air way
functions, and decreasing peak flow variability.
Cromolyn sodium and nedocromil are mild to be
moderate anti-inflammatory agents that are use more
commonly in children. They also are effective on a
prophylactic basis to prevent exercise-induced asthma
or unavoidable exposure to known triggers. These
medications are contraindicated in acute asthma
exacerbation.
• `Long acting beta-adrenergic agonist is use with anti-
inflammatory medications to control asthma
symptoms, particularly those that occur during the
night these agents are also effective in the prevention
of exercise-induced asthma.
Quick relief medication

• Short acting beta adrenergic agonists are

the medications of choice for relief of acute
symptoms and
prevention of exercise-induced asthma.
They have the rapid onset of acton. Anti-
cholinergic may have an
added benefit in severe exacerbations of
asthma but they are use more frequently in
COPD.
 Nursing Management
• The main focus of nursing management is to actively
assess the air way and the patient response to
treatment. The immediate nursing care of patient with
asthma depends on the severity of the symptoms. A
calm approach is an important aspect of care
especially for anxious client and one’s family.
• This requires a partnership between the patient and
the health care providers to determine the
desire outcome and to formulate a plan which include:
-The purpose and action of each medication
-Trigger to avoid and how to do so
- When to seek assistance
- The nature of asthma as chronic inflammatory disease
 
 PATIENT’S PROFILE

•  Client’s Name: Patient Daisy Duck

• Age: 63 years old
• Birthday: June 5, 1947
• Birth Place: Tarlac 
• Address: Villa Pascua, Diffun, Quirino 
• Civil Status: Married 
• Department: Medicine 
• Ward: Female Extension 
• Sex: Female 
• Nationality: Filipino 
• Religion: Roman Catholic 
• Date of admission: January 31, 2011
• Time of admission: 10:00 AM
• Chief complaint: Difficulty of breathing
• Admitting diagnosis: BAIAE
• Attending physician: Dra. De Guzman 
 HEALTH HISTORY
 Family Health History
• ( - )DM
• ( +) HPN
• ( +)Asthma
• ( - ) Heart Disease
• ( - ) Cancer
History of Present Illness
• Patient was discharged from QPH this morning.
She began to experience DOB 3hrs PTA.
Recently admitted at QPH due to asthma.
• (- ) fever
• (+) difficulty of breathing 
 PHYSICAL
ASSESSMENT
• General Appearance:
Seen lying on bed with 565 cc D5 NM +
Aminophylline 250 mg regulated @ 10-
15gtts/min, intact and infusing well. The patient
was observed to be weak. Upon interview the
patient was conscious and coherent.
• Initial Vital Signs:
Temp: 36.3° C
PR: 76 bpm
RR: 24 cpm
BP: 110/70
Body parts Technique findings interpretation
used
a. Scalp Inspection No lesions Normal
palpation No masses and
tenderness

a. Hair inspection Black with white, thick Due to old age

and straight

a. Face inspection Symmetrical Normal

Facial movement

EYES Inspection Parallel; non- normal

protruding

a. Eyebrows Inspection Symmetrical Normal

Black in color

a. Eyelashes inspection black in color Normal

a. eyelids inspection Intact skin Normal

EAR

a. pinna inspection Symmetrical Normal

recoil after folded; bean
shaped
a. ear canal inspection No discharge Normal

MOUTH

a. lips inspection Pink in color Normal

a. gums inspection Pink in color Normal

NECK Inspection Head centered Normal

palpation No palpable lymph node Normal

UPPER EXTREMITIES inspection Can move freely Normal

symmetrical

palpation No masses and Normal

tenderness

Chest inspection Ribs are prominent Due to thin body

auscultation Bronchial sounds normal

palpation No lumps, no masses normal

symmetrical
ABDOMEN Inspection Flat; normal
Symmetrical
movements caused by
respiration

Auscultation Presence of Gurgling Normal

Palpation sound normal
Soft

LOWER EXTREMITIES Inspection Can move freely Normal

Symmetrical

Back palpation bony Due to thin body

Nails Inspection Capillary refill: normal

2-3seconds

Skin inspection Fine hair evenly Normal

distributed; Due to old age
Tan;
Presence of wrinkles
 GORDON’S FUNCTIONAL
PATTERN
HEALTH PATTERN BEFORE DURING
HOSPITALIZATION HOSPITALIZATION

Health Perception Pattern The patient said that she is The patient is now more concern
healthy. with her health.

Nutritional –Metabolic Pattern According to the pt. she eats 3x She still eats 3x a day but with
a day. She eats a lot of rice and small amount because she has
drinks at least 8 glasses of water a loss of appetite.
daily.

Elimination Pattern The pt voids 6 times a day and The pt voids 4 times and doesn’t
defecates once a day. defecate yet.

Sleep Rest Pattern According to the pt she sleeps The pt have more time to sleep
@ 9pm and wakes up at 4 am because she goes to sleep at
because she have lots of things 8pm and wakes up at 6am, she
to do. also takes naps in between.
Activity – Exercise Pattern
Cognitive –Perception Pattern
Self Perception Pattern
Role- Relationship Pattern
Coping Stress Pattern
Sexuality- reproductive pattern
Values-belief pattern
According to the patient she She cannot do anything but
cleans the house and washes lay down on bed because she
clothes as her exercise and is weak.
daily activities.
According to the pt she wasn’t Still, She can speak Ilocano and
able to finish her studies that is a little Tagalog
why she cannot write well and
read well. She can speak Ilocano
and a little Tagalog.
The patient is a well determined The pt said that she thinks she is
person and she thinks she is a strong person and she can
healthy. survive her illness.
According to the pt she is a Still her relationship with her
mother of 3, and her relationship family is ok. Her 2 daughters
with her family is ok. were the once who are taking
care of her in the hospital.
When the pt is experiencing She talks to her children and
stressful moments she just talks pray.
to her husband and kids and she
also asks for God’s guidance.
she had her menarche at the
age of 14 and she menopause at
the age of 45
The pt is an Roman Catholic and
rarely goes to mass.
The Respiratory system
 Anatomy and Physiology

• The upper respiratory tract consists of the nose, sinuses,

pharynx, larynx, trachea, and epiglottis.
The lower respiratory tract consist of the bronchi,
bronchioles and the lungs.The major function of the
respiratory system is to deliver oxygen to arterial blood
and remove
• carbon dioxide from venous blood, a process known as
gas exchange.
• The normal gas exchange depends on three process:
• Ventilation – is movement of gases from the atmosphere
into and out of the lungs. This is accomplished through
the mechanical acts of inspiration and expiration.

 
• Diffusion – is a movement of inhaled gases in
the alveoli and across the alveolar capillary
membrane
• Perfusion – is movement of oxygenated blood
from the lungs to the tissues.
• Control of gas exchange – involves neural and
chemical process
• The neural system, composed of three parts
located in the pons, medulla and spinal cord,
• coordinates respiratory rhythm and regulates
the depth of respirations  
• The chemical processes perform several vital
functions such as:
• regulating alveolar ventilation by maintaining
normal blood gas tension
• guarding against hypercapnia (excessive CO2 in
the blood) as well as hypoxia (reduced tissue
oxygenation caused by decreased arterial oxygen
[PaO2]. An increase in arterial CO2 (PaCO2)
stimulates ventilation; conversely, a decrease in
PaCO2 inhibits ventilation.
• helping to maintain respirations (through
peripheral chemoreceptors) when hypoxia occurs.
• The normal functions of respiration O2 and CO2
tension and chemoreceptors are similar in
children and adults. however, children respond
differently than adults to respiratory disturbances;
major areas of difference include:
• Poor tolerance of nasal congestion, especially in
infants who are obligatory nose
• breathers up to 4 months of age
• Increased susceptibility to ear infection due to
shorter, broader, and more horizontally
• positioned eustachian tubes.
• Increased severity or respiratory symptoms due to
smaller airway diameters .
 
DOCTOR’S ORDER RATIONALE

1-31-2011

 For further management and

Please admit to FMW
treatment of condition
 For legal purposes
Secure consent
 To provide access for
D5NM 1 L+ Aminophylline 250mg
intravenous medications and for
to run for 24 hrs
the treatment of the disease
 To help for fast recovery and for
Hydrocortisone 200mg IV
the treatment of the disease
Salbutamol 1neb q6
Omeprazole 40mg 1 cap OD
 For monitoring and to have
v/s q 2
baseline data
 To prevent difficulty of breathing
high back rest or inhalation @ 2-
and To help for fast recovery
3LPM
refer
DOCTOR’S ORDER RATIONALE

02-1-11
Continue medications To help for fast recovery
TF with D5 NM 1 L @ SR To provide access for
  intravenous medications.
9:35pm  
MGH @3pm tomorrow feb. Preparation for going home
2,2011  
Home meds: .
-cardiomax 1 cap TID x 10 days  
-dexone 500mg BID x 15days  
OPD after 2 wks For follow up check up
   
 
Name of drug Action Indication Contraindic Adverse Nursing
Classification ation Effects Considerations

Cardiomax antihypertensi inhibits ACE, > > Px > CNS – > monitor Px’s BP &
ve preventing hypertension hypersensitiv dizziness, PR frequently
cardiovascular conversion of > left e to the drug fainting, > assess Px for signs
system drug angiotensin I to ventricular headache, of angioedema
angiotensin II, a dysfunction malaise, > monitor WBC &
potent fatigue, fever differential counts in
vasoconstrictor; > CV –
Px with impaired renal
less angiotensin tachycardia,
fxn or collagen
II decrease hypotension,
vascular dse before
peripheral angina pectoris
starting Tx, q 2 weeks
arterial > GI –
for the first 3 mos of
resistance, abdominal pain,
therapy, &
decrease anorexia,
periodically thereafter
aldosterone constipation,
secretion, which diarrhea, dry
reduces Na & mouth,
H2O dysgeusia,
nausea,
vomiting
Name of drug Classification Indication Side effects Nsg consideration

Generic name:  Anti-  relaxes  irritability  Observe 11

aminophillin asthma brochial  restlessness rights in
 bronchodila smooth  dizziness giving
tor muscles  severe depression medication
Stock dose: causing  stammering speech  Observe
250 mg/10ml brocho side effects
dilation and that occur
increasing  Provide
vital TLC
capacity  Watch out
for any
allergic
reaction
 PRECAUTION/ NURSING
GENERIC CONTRAINDIC
INDICATION ACTION ADVERSE CONSIDERATI
NAME ATION
REACTION ON

Salbutamol Reversible Facilitates/ Hypersensitivity PRECAUTION: > drug may be

airway potentiates the Hyperthyroidism decrese
obstruction inhibitory activity ,DM, sensitivity of
including of GABA at the cardiovascular spirometry used
bronchial limbic system disease for diagnosis of
asthma, chronic and reticular ADVERSE RXN asthma
bronchitis formation to Fine tremor of >syrup may be
reduce anxiety, skeletal muscle, taken as young
promote feeling of as age 2
calmness and tension, a >monitor for
sleep compensory evidence of
small increase allergic rxn
in heart rate,
headache,
muscle cramps
 CUES NURSING RATIONALE PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVETION

OBJECTIVES Ineffective Normally the Short term: > monitor VS > to obtain The client shall
: Airway lungs are free After 1 hour of > suction baseline data have
>Wheezes on Clearance from secretions. nursing secretions PRN > to decrease maintained
both lung Pneumonia intervention, > Elevate HOB secretion airway
fields related to bacteria are the client will > Encourage retained in the patency, clear
>uses retained invading the lung be able to deep breathing bronchi breath sounds
intercostal secretions parenchyma thus, maintain airway > give >to maintain (goal partially
muscles upon producing patency, clear bronchodilator patent airway met)
respiration inflammatory breath sounds. as ordered >to take The client shall
process. And Long Term: > refer for any advantage of have
these responses After 1 day of abnormal the gravity expectorated
leading to filling nursing changes in the decrease retained
of the alveolar intervention, body pressure on secretions and
sacs with the client will the diaphragm. maintained
exudates leading be able to > to mobilize normal
to consolidation. expectorate secretion breathing
The airway is retained > to moisten pattern
narrowed thus secretions and secretions for (goal met)
wheezes is being maintain easy
heard. DOB in normal expectoration
some cases breathing > to medically
orthopnea is pattern. manage any
observed. complications.
 DISCHARGE PLANNING
Medication
• Patient will be compliant to take cardiomax 1
cap three times a day for 10 days and
Dexone 500mg two times a day for 15 days
Exercise
• Patient will verbalize need importance of
exercise and demonstrate proper initiation of
appropriate exercise and needs to rest in
between periods of activities
Treatment
• Patient will know appropriate treatment like
using nebulization
• Hygiene
The patient must take a bath daily and know the
proper oral hygiene
Outpatient
• Patient must come back after 2 weeks at the
OPD
Diet
• Low salt low fat diet
Spiritual
• The patient should go to mass and know how
to pray to God