Clinical Preparation: Preclinical Research

Patient: G. S Age: 87 y/o M F

Diagnosis: Transient ischemic attack Other Health Care problem: Asthma

• Etiology:
Exact etiology of asthma is unknown. It is known that some triggers induce an asthma attack if exposed to
inflamed airways such as allergens, pollutants, exercise, stress, infections, nose and sinus problems, drugs and
foods.
• Pathophysiology:
The airway obstruction in asthma is due to a number of factors which include: 1) bronchospasm; 2) edema of the
airway; 3) increased mucus secretions; 4) cellular, especially eosinophilic, infiltration of the airway walls; and 5)
injury of the airway epithelium and hyperinflation
• Signs & Symptoms:
Symptoms of asthma include shortness of breath, wheezing, tightness in the chest, and/or cough in recurrent
episodes. Symptoms can develop slowly, or suddenly and unexpectedly, creating great distress. Dyspnea or difficult
breathing is the predominant symptom and may be the most common reason patients seek urgent care. Other
symptoms are prolonged expiration, increased anxiety, silent chest (sign of impending respiratory failure).
• Possible complications
Death, ability to exercise and do activities. Lack of sleep r/t SOB @ night, persistent cough, trouble breathing
that needs breathing assistance, status asthmaticus pneumothorax, acute cor pulmonale, respiratory arrest,
pneumomediantinum.

• Medical treatment:

Pharmacologic management includes the use of control agents such as inhaled corticosteroids, inhaled cromolyn or
nedocromil, long-acting bronchodilators, theophylline, leukotriene modifiers, and more recent strategies such as
the use of anti-immunoglobulin E (IgE) antibodies (omalizumab).

Quick relief medications are used to relieve acute asthma exacerbations and to prevent exercise-induced
asthma (EIA) or exercise-induced bronchospasm (EIB) symptoms. These medications include short-acting beta
agonists (SABAs), anticholinergics (used only for severe exacerbations), and systemic corticosteroids, which
speed recovery from acute exacerbations.

Long-term control medications include inhaled corticosteroids (ICSs), cromolyn sodium, nedocromil, long-acting
beta agonists (LABAs), combination inhaled corticosteroids and long-acting beta agonists, methylxanthines, and
leukotriene antagonists. Inhaled corticosteroids are considered the primary drug of choice for control of chronic
asthma.
• Nursing care required by priority:
1. Assess respiratory rate, rhythm, depth of respiration and auscultate lungs.
2. Maintain patent airway and administer O2 inhalation PRN
3. Maintain adequate fluid via IV access or advice on fluid intake.
4. Aspiration precaution
5. Avoidance of asthma trigger
6. Advise on medication compliance to keep asthma control
7. Monitor the person condition by the use of a peak-flow meter
8. Teach proper way of using puffers/ inhalers and inform of the side effects and know when to report
MD.
9. Ensure to rinse mouth after use of corticosteroids.
10. Provide psychosocial support to patient and family.
11. Encourage to do simple physical activities as tolerated.