Santiago City, Philippines College of Nursing

A Case Study of Bronchial Asthma In Acute Exacerbation (BAIAE)
Submitted by: Orlando Dexter T. Rodriguez SN-NC 3rd Year Block A

Submitted to:

Clinical Instructor

. Such airway problem includes Bronchial Asthma which is a serious problem and could probably lead to death if proper precautions are not observed. requiring major changes in person¶s lifestyles. 2. and preventions. Significance of the study Lower airway problems directly affect gas exchange and have serious consequences. manifestations. This study is made so that every reader or listener of the case study and research will gain enough knowledge and understand Bronchial asthma. Many of these problems are chronic and progressive.A. Objectives of the Study At the end of the case-presentation the student will be able to: 1. its cause. treatment. Apply the knowledge that they have learned in the floor. B. 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. To identify what Bronchial Asthma is all about.

She goes schooling in prep-school and playing or socializing. She didn¶t have difficulty of swallowing. and she could go to comfort room with assistance of mother (with IV). Her bowel elimination pattern is once a day even during her stays at the hospital. mingling with her classmates. Nutritional-Metabolic She doesn¶t have any special diet but she is taking Celeen for her vitamin. 3. and eat all food served. 5. She independently wears her dress but with assistance from her mother.11 Gordon¶s Functional Health Pattern 1. Her way of breathing is better than she is at home. Sleep-Rest Pattern She experience difficulty of sleeping while admitted in the hospital. . talking. 4. Activity-Exercise Pattern Our patient loves to play bahay . Health Perception-Health Management She is a very active and playful child. she sleeps as early as 10 in the evening and wakes at 8 in the morning. she can eat all of the food served. and started solid food as the main composition of the food of the patient. read books. She doesn¶t have any allergies on any foods. She can go to the bathroom. At home. as verbalized by the mother. whenever she wants to urinate and defecate but her mother still washes her anus after defecating. Before her admission. 2. Elimination Pattern She did not experience any decrease in defecating or difficulty of urinating.bahayan and running.

Role relationship She lives with her family and depends on her parents for her needs. She has a good memory for learning activities in school like problem solving and her mother makes decisions for her during medications.During her hospitalization. Self Perception ± Self Concept She¶s feeling better every time she is asked how she feels. and she also learns easily. In their house she can easily express what she wants or needs but during her hospitalization time her parents didn¶t knew what are the needs that she wanted or needed because of her condition. 8. 6. She misses her siblings and likes to talk about them. During night when her asthma attacks. Her illness makes her feel worthless because she cannot do anything. 10. 9. She always . Sexuality-Reproductive Pattern She is a girl 7. she can¶t breathe normally usually having a hard time of breathing so her sleep during night is disturbed during her hospitalization period. Coping ± Stress Tolerance She always wants her mother to be beside her because she provides all that she needs and she cries whenever she can¶t get something that she wants. She is very anxious every time her asthma attacks. She also sleeps one hour in the afternoon. treatments. etc. Cognitive-Perceptual She neither has hearing difficulties nor eye problems. she sleeps at 10 and wakes at 8 in the morning.

so the only thing she can do is to cry. . Value and Beliefs They are Roman Catholic. The parents react patiently to their daughters needs. 11. and they supported all what their child needs.wanted to go home right away but because of the doctors order they can¶t go home right away. She verbalized that she knows God loves her and He will wash her illness away so that she can go home.

and the presence of mucus in the lumen of the bronchi and bronchioles. Chronic exposure to airway irritants or allergens can be seasonal such as grass. cold. In some instances cough may be the only symptoms. Other contributing factor would include exercise. either spontaneously or under treatment. management practices and other factor. tree and weed pollens or perennial under this are the molds. Prevention Patient with recurrent asthma should undergo test to identify the substance that participate the symptoms. edema of the mucosa. An asthma exacerbation may begin abruptly but most frequently is preceded by increasing symptoms over the previous few days. . possibly because circadian variations that influence airway receptors thresholds. At times the mucus is so tightly wedged in the narrow airway that the patient cannot cough it up. resulting in paroxysmal contraction of bronchial airways which changes in severity over short periods of time. dyspnea. Patients are instructed to avoid the causative agents whenever possible. Most people who have asthma are sensitive to a variety of triggers. Common triggers of asthma symptoms and exacerbations include air way irritants like air pollutant. with or without mucus production. and wheezing. sinusitis with post nasal drip . An asthma attack often occurs at night or early in the morning. There is cough. Knowledge is the key to quality asthma care. Bronchial asthma is a chronic relapsing inflammatory disorder with increased responsiveness of tracheobroncheal tree to various stimuli. A person¶s asthma changes depending on the environment activities. strong odors and perfumes. stress or emotional upset.Definition A condition of the lungs characterized by widespread narrowing of the airways due to spasm of the smooth muscle. weather changes. Clinical Manifestation The three most common symptoms of asthma are cough. heat. Causes Allergy is the strongest predisposing factor for asthma. dust and roaches. medications and viral respiratory tract infections.

control of persistent asthma is accomplish primarily with the regular use of anti inflammatory medications. `Long acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma symptoms. Nursing Management The main focus of nursing management is to actively assess the air way and the patient response to treatment. improving air way functions. 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 . and decreasing peak flow variability. These medications are contraindicated in acute asthma exacerbation. Anti-cholinergic may have an added benefit in severe exacerbations of asthma but they are use more frequently in COPD. The immediate nursing care of patient with asthma depends on the severity of the symptoms. They have the rapid onset of acton. y Quick relief medication Short acting beta adrenergic agonists are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. y y y y y This requires a partnership between the patient and the health care providers to determine the desire outcome and to formulate a plan which include. y Long-acting control Medication Corticosteroid are the most potent and effective anti inflammatory currently available.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. They are broadly effective in alleviating symptoms. They also are effective on a prophylactic basis to prevent exerciseinduced asthma or unavoidable exposure to known triggers. Because of underlying pathology of asthma is inflammation. Cromolyn sodium and nedocromil are mild to be moderate anti-inflammatory agents that are use more commonly in children. particularly those that occur during the night these agents are also effective in the prevention of exercise-induced asthma. A calm approach is an important aspect of care especially for anxious client and one¶s family.

To identify precipitating factors. To identify necessity of assistive devices. Note contributing factors to fatigue. 7. 3. To identify severity. 4. Evaluate degree of deficit. To reduce fatigue 8. Provide adequate rest periods. Promotes venous 12. For baseline data. To identify causative factors. To promote independence and increase activity tolerance 11. 6. Assist client in doing self care needs 11. Assess motor function. 10. 5.Assessment Subjective: (none) Objective: y Immobility y Weakness Nursing Diagnosis Risk for Activity Intolerance r/t decrease oxygenation Planning After 8 hours of nursing intervention the patient will participate willingly in necessary/ desired activities such as deep breathing exercises. 4. Assess emotional or psychological factors 7. 3. Increase activity/exercise gradually such as assisting the patient in doing PROM to active or full range of motions. To replenish energy. Plan care with rest periods between activities 8. Monitor VS. 5. Elevate arm and hand 12. Interventions 1. Maintains functional position Evaluation Goal met Patient participated willingly in necessary/ desired activities such as deep breathing exercises. Minimizes muscle atrophy. 2. 6. Ascertain ability to stand and move about. promotes circulation. 2. Place knees and hips in extended position Rationale 1. . helps to prevent contractures 9. 9. Stress and/or depression may increase the effects of illness. 10.

2. to check for the presence of adventitious breath sounds 5. To prevent fatigue. 10. To obtain baseline data 3. Serve to track important changes 4. 8. 2. Reinforce low salt. To minimize difficulty in breathing 6.Assessment Subjective: ³Nahihirapan akong huminga´ as verbalized by the patient Objective: y wheezing upon inspiration and expiration y dyspnea y tachycardia y chest tightness y suprasternal retraction y restlessness Nursing Diagnosis Ineffective breathing pattern r/t presence of secretions AEB productive cough and dyspnea Planning After 4-5 hours of nursing intervention Patient will manifest signs of decreased respiratory effort AEB absence of dyspnea Interventions 1. 6. every 2 hours.¶s condition 3. VS monitor and record 4. Demonstrate diaphragmatic and pursed-lip breathing. Evaluation Goal met Patient demonstrated pursed-lip breathing and diaphragmatic breathing. low fat diet as ordered. 7.¶s trust. Elevate head of the bed and change position of the pt. To decrease air trapping and for efficient breathing. Encourage opportunities for rest and limit physical activities. Auscultate breath sounds and assess airway pattern 5. 8. Rationale 1. assess pt. Establish rapport. To maximize effort for expectoration. Encourage increase in fluid intake 9. . To gain pt. To mobilize secretions. Encourage deep breathing and coughing exercises. 9. 7. To prevent situations that will aggravate the condition 10.

y Increases sputum production y Change in color of sputum y Increased thickness of sputum y Increased SOB. Teach early signs of infection that are to be reported to the clinician immediately. Rationale 1. aerosols. 3. or fatigue y Increased coughing y Fever or chills 5. Early recognition is crucial. increased mucus production. 3. dyspnea. Teach and encourage the use of diaphragmatic breathing and coughing exercises. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of an asthmatic person. 2. hindi na ako nahihirapan´ . 4. Bronchial irritants cause bronchoconstriction and increased mucus production. Evaluation Goal met By verbalization of the patient of ³Ok na po ang aking paghinga. tightness of chest. and fumes. Adequately hydrate the pt. If indicated. and respiratory infection AEB wheezing. extremes of temperature. perform postural drainage with percussion and vibration in the morning and at night as prescribed. 4. Instruct pt to avoid bronchial irritants such as cigarette smoke. and cough Planning After 5-6 hours of nursing intervention the Patient will maintain/impro ve airway clearance AEB absence of signs of respiratory distress Interventions 1.Assessment Subjective: ³Nahihirapan akong huminga´ as verbalized by the patient Objective: y wheezing upon inspiration and expiration y dyspnea y tachycardia y chest tightness y suprasternal retraction y productive cough Nursing Diagnosis Ineffective airway clearance RT bronchoconstri ction. 2. Systemic hydration keeps secretion moist and easier to expectorate. which then interfere with airway clearance. These techniques help to improve ventilation and mobilize secretions without causing breathlessness and fatigue.

pharynx. a process known as gas exchange. conversely. The lower respiratory tract consist of the bronchi. bronchioles and the lungs. . larynx. 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. composed of three parts located in the pons. sinuses. The normal gas exchange depends on three process: y y y Ventilation ± is movement of gases from the atmosphere into and out of the lungs. trachea. helping to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs. Control of gas exchange ± involves neural and chemical process The neural system. coordinates respiratory rhythm and regulates the depth of respirations The chemical processes perform several vital functions such as: y y y 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]. The major function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood. and epiglottis. a decrease in PaCO2 inhibits ventilation. This is accomplished through the mechanical acts of inspiration and expiration. medulla and spinal cord.Anatomy and Physiology The upper respiratory tract consists of the nose. An increase in arterial CO2 (PaCO2) stimulates ventilation.

especially in infants who are obligatory nose breathers up to 4 months of age Increased susceptibility to ear infection due to shorter. children respond differently than adults to respiratory disturbances. . Increased severity or respiratory symptoms due to smaller airway diameters A total body response to respiratory infection.The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in children and adults. vomiting and diarrhea. and more horizontally positioned eustachian tubes. broader. however. major areas of difference include: y y y y Poor tolerance of nasal congestion. with such symptoms as fever.

Patient¶s Profile Name: Age: Sex: Location: Admitting diagnosis: Chief complaint: Date of admission: Attending Doctor: .

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