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A Case Presentation On
Aldwin Batugal Roswell Tristan Blancaflor Donald Paloma Jerimar Miranda Earl Omar Tumanguil Marie Natie Adrian Gelacio Krishan Soriano Xiao Xiao Zheng (Sunny)
Asthma is a chronic illness involving the respiratory system in which the airway occasionally constricts, becomes inflamed, and is lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an environmental stimulant (or allergen) such as cold air, warm air, moist air, exercise or exertion, or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold. This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing. The airway constriction responds to bronchodilators. Between episodes, most patients feel well but can have mild symptoms and they may remain short of breath after exercise for longer periods of time than the unaffected individual. The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of drugs and environmental changes. Signs and symptoms
Dyspnea Wheezing Coughing Inability for physical exertion Shortness of breath Tachypnea Tachycardia Overinflation of the chest (barrel chest) Cyanosis (severe attacks) Chest pain Loss of consciousness
Diagnosis Asthma is defined simply as reversible airway obstruction. Reversibility occurs either spontaneously or with treatment. The basic measurement is peak flow rates. In many cases, a physician can diagnose asthma on the basis of typical findings in a patient's clinical history and examination. Asthma is strongly suspected if a patient suffers from eczema or other allergic conditions— suggesting a general atopic constitution—or has a family history of asthma. While measurement of airway function is possible for adults, most new cases are diagnosed in children who are unable to perform such tests. Diagnosis in children is based on a careful compilation and analysis of the patient's medical history and subsequent improvement with an inhaled bronchodilator medication. In adults, diagnosis can be made with a peak flow meter (which tests airway restriction), looking at both the diurnal variation and any reversibility following inhaled bronchodilator medication. Testing peak flow at rest (or baseline) and after exercise can be helpful, especially in young asthmatics who may experience only exercise-induced asthma. If the diagnosis is in doubt, a more formal lung function test may be
conducted. Once a diagnosis of asthma is made, a patient can use peak flow meter testing to monitor the severity of the disease. In the Emergency Department doctors may use a capnography which measures the amount of exhaled carbon dioxide, along with pulse oximetry which shows the amount of oxygen dissolved in the blood, to determine the severity of an asthma attack as well as the response to treatment. There is no cure for asthma. Doctors have only found ways to prevent attacks and relieve the symptoms such as tightness of the chest and trouble breathing. Treatment
Identifying stimulants (pets, aspirin, allergens, smoking) Bronchodilators Antihistamines
For mild persistent disease (more than two attacks a week)
Low dose inhaled glucocorticoids Oral leukotriene modifier (mast cell stabilizer) Theophylline
Fast acting bronchodilators Metered dose inhalers (MDIs) Nebulizers
Emergency treatment When an asthma attack is unresponsive to a patient's usual medication, other treatments are available to the physician or hospital:
• • • •
oxygen to alleviate the hypoxia (but not the asthma per se) that results from extreme asthma attacks; nebulized salbutamol or terbutaline (short-acting beta-2-agonists), often combined with ipratropium (an anticholinergic); systemic steroids, oral or intravenous medications (prednisone, prednisolone, methylprednisolone, dexamethasone, or hydrocortisone). other bronchodilators that are occasionally effective when the usual drugs fail: o intravenous salbutamol o nonspecific beta-agonists, injected or inhaled (epinephrine, isoetharine, isoproterenol, metaproterenol); o anticholinergics, IV or nebulized, with systemic effects (glycopyrrolate, atropine, ipratropium); o methylxanthines (theophylline, aminophylline);
may be used in a hospital setting. Soliman Admitting Diagnosis: Bronchial Asthma in Acute Exacerbation Principal Diagnosis: COPD Final Diagnosis: Bronchial Asthma . for patients in or approaching respiratory arrest. halothane. often used in endotracheal tube induction intubation and mechanical ventilation. 2007 Time of Admission: 11:15am Attending Physician: Dr. a mixture of helium and oxygen. Tuguegarao City Birthday: October 07. R.• • inhalation anesthetics that have a bronchodilatory effect (isoflurane. Isabela Age: 55 years old Gender: Male Civil Status: Married Nationality: Filipino Religion: Roman Catholic Date of Admission: November 14. o the dissociative anaesthetic ketamine. Heliox. enflurane). 1952 Birthplace: Cabagan. It has a more laminar flow than ambient air and moves more easily through constricted airways o PATIENT’S PROFILE Name: OCA Address: Libag Norte.
thrice a year. “Binalewala ko kasi to kaya lumalaya”. Due to poverty he had problems not only financially but also medically rooting up from his childhood. It was on September of the year 1999 when he knew he has asthma he was then prescribed to take asthmasalon tablets when he experiences difficulty of breathing. Oca went for check-up and was diagnosed with pulmonary tuberculosis. the patient said. At the same time. He also had cough with yellowish phlegm and he just rested without taking any medication or any means of managing these. Late in his adult years. herbal medicine). He then went for consultation at People’s Emergency Hospital and the physician diagnosed him of having bronchial asthma.Initial vital Signs: Blood PressureTemperaturePulse RateRespiratory Rate100/80mmHg 36.”. In mild health alterations he usually relies to OTCs like Neozep. He would drink liquor as long as there’s some to drink. In his youthful days he didn’t really mind going to the health centers and free medical missions for check-ups and health assessments because he wasn’t aware he was asthmatic. Oca said. Now he believes and knows that it is not good for him to tire himself or add up more illness to what he already has. He lived the “bad boy” type of life walking around with two packs of cigarette and won’t head home without finishing all. The physician then decided that Oca needs to be admitted. He now goes for check up at Milagros Hospital at Cabagan Isabela. Biogesic.7 ºC 127 bpm 28cpm NURSING HISTORY PAST MEDICAL HISTORY According to patient Oca he lived a typical Filipino life. He didn’t have the needed vaccinations or even knowledge or access to these. FAMILY HISTORY . “Sa katunayan nalaman ko may ganito akong karamdaman siguro pito hanggang walong taon na ang nakakaraan. he also experienced on and off difficulty of breathing. the patient experienced sharp stabbing pain at the chest. HISTORY OF PRESENT ILLNESS Three days prior to admission. Alaxan and any means necessary for treatment (albularyos.
He also .)” 2. he complies to his medication regimen and when he feels that he cant breathe he frequently massages his chest to relieve the short-stabbing pain that he’s feeling. During hospitalization: According to the patient his condition now is the opposite of being healthy. masarap mabuhay eh”. “Pakonti-konti lang ang kinakain ko noon dahil sa klase ng trabaho ko. He then added “Kung pwede lang lahat kami ay mamatay dahil sa pagtanda e di maayos. And taking snacks in the afternoon depends only if someone would serve or give. ”Pag hindi na ako makahinga at walang nurse eh minamasahe ko nalang ng ganito. he believes that health is characterized by a strong body and the absence of sickness. Gordon’s 11 Functional Health Pattern Date of Interview: November 22. A history of hypertension was present on his maternal side and no particular disease or illness on his paternal side. 2007 1. he added.” He also believes in taking medications when getting sick with or without consultation furthermore he said that healing occurs with the effectivity of the medications accompanied by luck of the person.” Patient Oca added that he drinks a cup of coffee in the morning or sometimes 3 sips within one cup is enough. (massages his chest. Health-Perception-Health Management Pattern Before hospitalization: According to the patient. Nutritional-Metabolic Pattern Before hospitalization: According to the patient.”Basta kung anung meron diyan dapat paniwalaan na kung kaya’t sinubukan ko ang pagpunta sa kanila kung may nararamdaman ako at gipit sa pera. He said that one is able to maintain health by following a balanced diet and adequate rest. The patient then boasts that his family has a strong immune system and no certain cause of mortality was due to disease or illness. He also believes in albularyos or hilots. He loves to eat vegetables such as talong and kamatis.Patient Oca said that both his mother and father side has asthma. He drinks 6-8 glasses a day. He said he was particularly fortunate for having no other lung associated disease. “Mahilig kasi ako magsigarilyo at alam ko yun ang rason kung bakit nagkaganito ito” Oca added. he prefers fish more than meat. Naiibsan naman ang nararamdaman ko pagkatapos kung pumunta sa kanila.
3. . He drinks only about 450ml of water each day (approximately 2 cups) but drinks one glass of milk when he wants to drink some. He said “Dapat makontrol mo ang pag-ihi mo kung drayber ka. Since there’s not much to do he only lies and sometimes sits on his bed and reads the newspaper. he added. During hospitalization: When hospitalized. He said that within his 8 day stay in the hospital he only defecated 3 times and his stool is foul. He voids approximately 300ml of slightly turbid urine per day. and semi-formed also depending on what he ate the previous day. During hospitalization: According to the patient his doctor advised him to limit intake of food that go against his hypoallergenic diet. bago ka magmaneho dapat nakaihi ka na”. and semi-hard. Activity-Exercise Pattern Before hospitalization: The patient was a driver of the Ting family’s Deltra Bus here in Tuguegarao for 15 years. He listens to music when he feels like it. During hospitalization: Oca is ambulatory so he voids and defecates with assistance . He said that his actions/movements are limited. Oca also enjoys the company of close friends and family as he said “masaya talaga kung sama-sama” . He said “wala ako masyadong ginagawa na hiwalay sa trabaho”. In his hospital stay he only eats twice a day. He considers walking around as his form of exercise. “Gusto ko kasing maging complete”. Elimination Pattern Before hospitalization: Oca verbalized voiding approximately 800ml summed up on 3 times of regular urination per day (about 250 ml per urination). He does not perform any household chore or any typical leisure work such as gardening and cleaning house premises. His urine is yellow amber in color and has a clear appearance. dark. And he doesn’t have any difficulty in urinating and defecating. one in the morning and one in the evening. He then said “Walang problema sa sakit ng tiyan o pag-ihi basta nahihirapan ako huminga nanghihina na ako gawin ang kung ano” 4. He just sits back and watches television when he is not on travel. dark. the patient can’t do what he usually does. He performs ROM exercises cooperatively to monitor how his lungs respond to certain movements. “Sinabi sa akin na iwasan ko nang kumain ng isda at pagkain na malansa” he added. His stool is foul. He doesn’t have any allergies on food and he does not like those that taste sweet and spicy.takes vitamin supplements like centrum. He defecates once a day usually in the morning.
During hospitalization: He is not able to sleep well because of frequent monitoring of v/s and some medication plus condition check-ups. He seldom takes a nap in the afternoon. He is able to answer open-ended questions concisely and is aware of events happening outside the hospital (family events and country issues). He said “ang umaga niyo e gabi ko e at ang gabi niyo e umaga ko. He can hear well as he added “dapat marunong ka makinig sa problema ng sasakyan kung drayber ka e. basta mahangin o may electric fan”. His sleep pattern was disrupted because of his kind of work. parang hari nga ako e” He is proud of his children and grandchildren and considers them as his achievements. 7. The patient said that he only finished Grade 4 due to poverty but is able to read and write. ganun ang buhay drayber”. palakbay lakbay lang. He said that he doesn’t have that much control on himself anymore. Self-Perception-Self-Control Pattern Before hospitalization: The patient is frank and has a high self-esteem. He doesn’t have any preference on where to sleep. During hospitalization: He can’t identify small letters (about that of font 12) with his naked eye only. During hospitalization: He realizes the seriousness of his condition as evidenced by his willingness to participate in necessary activities (ROM exercises) that are needed for his recovery. “bahala na ang mga doctor. He sleeps utmost 5 hours daily after work. He is still able smell and taste food well and is able to respond to stimuli. nurse at Diyos”. He seldom takes a nap in the afternoon but takes time to compensate for the lack of sleep. kung may ibang tunog kahit mahina lang dapat ayusin na”. Cognitive-Perceptual Pattern Before hospitalization: He has sensory deficit (visual) due to his age but does not wear pair of eyeglasses because they don’t have money to buy. When asked on how he sees himself before he said “ok naman ako dati.5. 8. Sleep-Rest Pattern Before hospitalization: The patient said that he seldom have long hours of sleep because of his work as a driver. 6. he concluded. “Kapag wala nang bisita at wala naman masyadong nurse na nagbibigay ng gamot at nagbbp e nakakatulog ako”. as he added “kahit saan na kahit matigas pa. He is able smell and taste food well and is able to respond to stimuli. Role-Relationship Pattern . He can still hear well.
neighbors. he wants to resolve it immediately with the help of his children and wife. He seldom attends mass but he prays always. During hospitalization: He has an inactive sexual life due to his age and present condition. fellow drivers. Coping-Stress Tolerance Before hospitalization: He used to smoke 2 packs of cigarette a day. Moreover. He said that he tries to convince himself that he understands the things that are happening to him to be able reduce the stress that he is experiencing at present because of his illness. He values the existence of a great social support especially in times of need. He loves to mingle with different kinds of people. . During hospitalization: He is no longer the breadwinner of the family. He said that there are a lot of factors that are needed but the most important thing both should have is love. at pangit naman kung may kaaway ka”. When he encounters problems he consults his children and wife. Sexuality-Reproductive Pattern Before hospitalization: He has an active sexual life. 11. kahit gipit na e nasustentuhan nila ang pamamalagi ko dito gaya ng pagpapalaki ko sa kanila”. Whenever he feels stressed he also drinks 2 bottles of red horse.Before hospitalization: He is the breadwinner of the family and has a good relationship with his family. he has still good relationship with his children even if some are far from him. During hospitalization: He already stopped drinking liquor and smoking because of present condition. He had coitarche when he was 14 years old. love and loyalty 10. He believes that someday they will come together and all are healthy. He started this when he was about 20 years old. Value-Belief Pattern Before hospitalization: The patient is a Roman Catholic. He said “mas pinatibay lang ng nangyaring ito ang samahan naming pamilya. 9. He said that now that he is like that he believes that one can express himself not only through contact but by respect. and boss. when conflict arises. As he said “madali lahat kung tulung-tulong. friends. He has 3 children from his wife and another from another woman. He said “kung kaya pa at pwede di ayos” jokingly. He said that distance is not a hindrance. He used to drink liquor on special occasions such as birthdays and fiestas at an estimated of 1 case of red horse.
He was sitting in bed with ongoing IVF #2 Eurosol M in D5W at 100 cc level patent and infusing well at the right peripheral vein. The Lord is his source of strength.36. He was conscious and coherent and was oriented to time. 2007 Time: 5 pm General Appearance The patient was clean and tidy during the interview.During hospitalization: He strongly believes in miracles and power of God.28 cpm BP. Initial Vital Signs: PR.8°C . date.100/80 mmHg Temperature. place and persons. PHYSICAL ASSESSMENT Date: November 22.127 bpm RR.
equal movement Slightly curved Normal upward tan. cover do not . soft Normal When pinched. resilient Symmetrical Normocephalic Round Absence nodules masses Symmetrical Normocephalic Round of Absence and nodules masses of Normal and Normal Normal Normal Inspection Inspection Inspection Inspection Inspection Inspection Symmetrical Symmetrical Fair. Dark Smooth. do not Symmetrical Symmetrical Tan Symmetrically Normal aligned. Dark Symmetrically aligned.Area Assessed SKIN Color Texture Turgor Techniques Used Inspection Palpation Inspection Normal Findings Fair. resilient Silky. Normal cover tan. Tan. soft Skin snaps back immediately when pinched Evenly distributed Warm to touch Dry. skin folds are normally moist Pink and Clean Smooth Convex curvature Firm 2-3 seconds Black (varies) Actual Findings Analysis Tan Normal Smooth. Tan. equal movement Slightly curved upward Smooth. Smooth. Due to aging it slowly snaps back Evenly distributed Warm to touch Dry skin Normal Normal Due to aging Hair Distribution Temperature Moisture NAILS Color of nailbed Texture Shape Inspection Palpation Palpation Inspection Palpation Inspection Pink Smooth Convex Firm 2-3 seconds Normal Normal Normal Normal Normal Normal. due to aging Normal Normal Normal Normal Normal Normal Nail Base Inspection Capillary Refill Blanch Test time HAIR Color Inspection Distribution Moisture Texture HEAD Scalp Symmetry Skull Size Shape Nodules/ Masses FACE Symmetry Facial Movement Skin color EYES Eyebrows Eyelashes Eyelids Inspection Inspection Inspection Inspection Inspection Inspection and Palpation Palpation Black but slightly going to white Evenly Evenly distributed distributed Neither Neither excessively dry excessively dry nor oily nor oily Silky.
Anatomy of the Respiratory System The Respiratory System Also means ventilation (the movement of air into and out of the lungs). for respiration Gas exchange (O2 and CO2) between air and the blood and between the blood and the tissue Cellular transfusion Regulates blood pH Nose Nasal Cavity Pharynx Larynx Trachea Bronchi Bronchiol e Alveoli Alveolus Lungs .
Oropharynx – joins the oral cavity and contains the palatine and lingual tonsils. 2.Nose Primary structure of the respiratory tract External nares with cilia or hair – traps larger particles that may enter the respiratory tract Nasal cavity – allows the air to enter into the main portion of respiratory tract when inhaling Division of Nasal Cavity 1. The Three Portions of the Pharynx: 1. food and H2O from the mouth. 3. superior nasal conchae 2. sinusitis (mucus tends to lower the sinus) Pharynx The throat. then the particles will adhere along mucous membrane along the nasal cavity which is made up of two cells – goblet cells and ciliated cells. Paranasal Sinus Not part of a nose Lined with mucus membrane If inflamed. middle nasal conchae 3. Larynx Guarded by epiglottis Closes as we swallow the food The epiglottis will cover the passageway so that no food particle will enter the airway. . inferior nasal conchae • If nasal hair falls to trap particles. Laryngopharynx – opens into the larynx and the esophagus. Nasopharynx – where air enters coming from the nose. passageway of both the digestive and respiratory systems Receives air from the nasal cavity and air.
1 pair along the superior portion – false vocal chords but with the help of lower vocal chords that larynx closes (does not vibrate). the larynx opens and the vocal chords will vibrate so as the time we talk. • • Voice depends on air that passes along the vocal chords. Trachea Made up of rings of cartilage (15-20 rings). The larynx opens when exhaling. • Right Lung is divided into 3 lobes (each lobe is supplied with specific secondary bronchi) Tertiary Bronchi • Branches of secondary bronchi Terminal Bronchiole • Connected to alveolar duct which is connected to alveolus . the food will trap the larynx which causes choking. the air leaves the respiratory tract.• Whenever we talk. Its length depends on the individual’s height. From the Trachea Right Bronchus 3 Secondary Bronchi (segmental bronchi) Left Bronchus 2 Secondary Bronchi (segmental bronchi) Primary Bronchi • Responsible for bringing the air to the right and left lung. Structures of Larynx: 1 pair along the inferior portion – true vocal chords (vibrates as we talk).
Secondary. Inspiration (Inhalation) – movement of air into the lungs 2. Tertiary Bronchi Made up of epithelial cells (combination of goblet cells and ciliated cells) Bronchi – there is the presence of cartilage in the vessels Bronchiole – there are no cartilage in the vessels Lungs Principal organ for respiration Mediastinum – divides the lung into left and right lung 1. middle. Physiology of the Respiratory System Ventilation Breathing mechanism Process of moving air into and out of the lungs Two Processes: 1. Expiration (Exhalation) – movement of air out of the lungs • • Air moves from an area of higher pressure to an area of lower pressure. Pressure in the lungs decreases as the volume of the lungs increases and vice versa. Left Lubg – 2 lobes (superior. Pulmonary Volumes and Capacities . inferior) Pleura – external membrane covering the lungs Diaphragm – large dome of skeletal muscles that separate the thoracic cavity from the abdominal cavity. inferior) 2.• Primary. Right Lung – 3 lobes (superior.
During labored breathing. When stimulation of the muscles of inspiration stops. Expiratory Reserve Volume – amount of air that can be expired forcefully after expiration of normal tidal volume. which stimulate the respiratory center. the muscles of inspiration are stimulated to a greater degree and the muscles of expiration are also stimulated to increase expiration. The rate of diffusion depends on the thickness of the respiratory membrane and the partial pressure of the gases in the alveoli and the blood. Tidal Volume – volumes of air inspired or expired during quiet breathing 2. Residual Volume – the volume of air still remaining in the respiratory passages and lungs after a maximum expiration. Control of Respiration The respiratory center in the medulla oblongata and the pons stimulates the muscles of inspiration to contract. . Spirometry is the process of measuring volumes of air that move into and out of the respiratory system. An increase in CO2 or decrease in pH of the blood can directly stimulate chemoreceptors in the medulla oblongata causing a greater rate and depth of respiration. 3. Low blood levels of O2 can stimulate chemoreceptors in the carotid and aortic bodies. Inspiratory Reserve Volume – amount of air that can be inspired forcefully after inspiration of normal tidal volume. Pulmonary Volumes: 1. 4. Spirometer – measures respiratory volume. Input from higher brain cenyers and from proprioceptors stimulates the respiration during exercise. expiration occurs passively. the walls of the alveolus. Gas Exchange The respiratory membranes are thin and have a large surface area that facilitates gas exchange. CO2 is the major chemical regulator of respiration. The components of the respiratory membrane include a film of H2O. and the capillary and an interstitial space.
8 47. HEMATOLOGY REPORT November 14.030 Normal Albumin Trace Negative Normal Sugar Negative Negative Normal MICROSCOPIC EXAMINATION WBC/hpf 1-2hpf 0 – 5hpf Normal RBC/hpf 0-2hpf 0 – 4hpf Normal Epithelial Cells positive Negative Infection Bacteria negative Negative Normal Mucus thread positive positive Normal Rationale: It’s a routine procedure for patients undergoing hospital admission.0 4.5 – 10.3 – 0.2 – 3. 2007 Actual Results Normal Results Analysis Color Yellow Straw – Amber Normal Character Slighly.LABORATORY EXAMINATION URINALYSIS November 15. Turbid Clear Normal pH 5.28 x 10^12/L 3.8 8. It is useful indicator of a healthy or disease state.002 – 1.0 0.8 9.5 Normal Specific Gravity 1. 2007 Actual Results Normal Results 10.030 1.0 – 76.0 – 11.8 x 10^9/L 3.7% 17.2 0.6% 3.7 x 10^9/L 0.0 110.0 – 50.2 x 10^9/L 1.8 – 5.0 145 g/L 110 – 165 4.6 – 6.0 – 48.9 x 10^9/L 1.2 – 6.2 % 35.0 84.5 fL 82.0 WBC Lymph # Mid # Gram # Lymph % Mid % Gran % Hgb RBC Hct MCV Analysis Infection Infection Normal Infection Infection Normal Infection Normal Normal Normal Macrocytic Anemia .0 6.7% 43.0 – 97.
108 . response to treatment. both lung bases. The rest of the chest structures remain unchanged in status.Tobias (Radiologist) CXR II PA 11/ 17/ 07 Follow up examination done 11/ 17/ 07 as compared to the study taken dated 11/ 06/ 07 showed no interval change in the previous findings of upper lobe PTB with bullous changes. give valuable diagnostic information about the hematologic and other body systems.5 Macrocytic Anemia MCHC 307 g/L 315 – 350 Macrocytic Anemia RDW-CV 15.5 – 33. Impression: PTB. and recovery. upper lobes Pulmonary Emphysema Atherosclerotic Aorta Normal heart size Dr.5 – 14.7 15.5 – 11. Dr.M.5 Anemia RDW-SD 58. pulmonary emphysema and calcified aorta. Imelda Turingan (Radiologist) . Aorta is Atherosclerotic.0 Normal PDW 15.8 pg 26.0. prognosis.282 Normal Rationale: This is the basic screening test. Diaphragm is depressed and flattened. The rest of he specialized structures are unremovable.0 – 17.0% 11.0 Normal PCT 0.234% 0.9 fL 6. Heart is enlarged.MCH 33.0 Anemia PLT 237 x 10^9/L 150 – 390 Normal MPV 9.0% 35.0 – 56. X-RAY and ULTRASOUND REPORT CXR (PA) 11/ 06/ 07 Fibrohazard densities are noted the upper lobes.
o.DRUG STUDY ACETAMINOPHEN (PARACETAMOL) Classification: Analgesic/Antipyretic Dosage: 500 mg p. sore throats. muscle aches. Responsibilities: • Administer tablets whole or crushed with fluids • Administer this drug with no combination of another acetaminophen to avoid toxic reactions PREDNISONE Classification: Corticosteroids Dosage: 30 mg OD p. Action: • Resembles salicylates in the manner which it produces analgesia and antipyretics • Reduces fever by direct action in the hypothalamus Indication: • Used to relieve mild to moderate pain fro headaches. Action: . toothaches and to reduce fever • Analgesic (pain reliever) • Antipyretics (fever reducer) Contraindication: • Patients with cardiac or pulmonary disease are more susceptible to toxic effects of acetaminophen Nx.o.
Responsibilities: • Administer after meals or with snack to reduce gastric irritation • Do not stop abruptly with long term therapy.• • Indication: • Treatment of allergic and inflammatory conditions Contraindication: • Systemic fungal infections Nx. Reduce only dosage by scheduled decrements to prevent withdrawal symptom and to permit adrenals to recover from druginduced partial atrophy • Avoid alcohol and caffeine. it may contribute to steroiduker development DUAVENT Classification: Anti-asthmatic Dosage: Neb q 4° Action: • Relaxes smooth muscles of bronchi and bronchioles and reducing formation of cGMP which is a mediator of bronchous tuctus Indication: • Management of Bronchial asthma • COPD Contraindication: • Hypertrophic Obstructive Cardiomyopathy • Tachyarrythmia Nx. Responsibilities: • Do not administer after meals • Do chest physiotherapy after nebulization ANSIMAR Classification: Anti-asthmatic Dosage: 400mg ½ tab BID Action: It works to treat other conditions by reducing swelling and by changing the way the immune system works Has anti-inflammatory properties .
o. Responsibilities: • Measure I&O • Administer with meals • Monitor for symptoms of Hyponatremia LEVOFLOXACIN Classification: Anti-infectives (antibiotics)-fluoroquinolones Dosage: 500mg 1tab OD p. Action: • It works by eliminating bacteria that cause infections • Inhibits bacterial replication Indication: • Used to treat infections such as pneumonia and asthma .• Reduces constriction of bronchioles and edema in bronchial mucosa Indication: • Bronchial Asthma • Chronic Bronchitis Contraindication: • Hypersensitivity to Drug Nx. Responsibilities: • Assess patient as to vital signs and history of asthma ALDAZIDE Classification: Diuretics Dosage: 1 tab OD Action: • Spinorolactone promotes dieresis in patients with edema • It acts by competitive inhibition of aldosterone Indication: • Essential hypertension • Edema • Nephrotic syndrome Contraindication: • Acute renal insufficiency • Anuria • Hyperkalemia Nx.
Treatment of maxillary sinusitis caused by strains of streptococcus pneumoniae Contraindication: • Used cautiously in patients with seizure disorders • Hypersensitive to antibiotics Nx. It is a maintenance bronchodilator and helps to keep narrowed airways open Contraindication: • Hypersensitive to atropine • Hypersensitive to spiriva Nx. Do not stop taking it without talking to your doctor • Avoid NSAIDS while taking levofloxacin if possible • Administer once a day with meals TIOTROPIUM BROMIDE (SPIRIVA) Classification: Bronchodilators Dosage: 18 mg 1 cap for oral inhalation OD Action: • Has an anticholinergic effect for Muscarinic Receptors Indication: • Used for treatment of breathing problems in patients with COPD. Responsibilities: • Use this to maintain treatment for COPD and not to treat sudden episodes of breathing problems (Bronchospasm) • Capsules are not for ingestion • Watch out for sensitivity • Note for allergic reactions (itching and rash) • . Responsibilities: • Take tablets with fluids • Administer it continuously even if patient gets well.
and coughing exercises. The patient maintained a patent airway as manifested by a respiratory rate of 20 cpm. the patient will maintain airway patency. absence of cough and wheezes. intake to at least 2. pressure on diaphragm and enhancing drainage and ventilation. Encouraged pt. EVALUATION Goal met. 500 ml per day Provided supplemental humidification (nebulization) To loosen secretions. Encouraged To mobilize deep breathing secretions. O: *nonproductive cough *wheezes *difficulty vocalizing *changes in respiratory rate and rhythm *wide-eyed and restlessness RR: 28 cpm DIAGNOSIS Ineffective airway clearance r/t retained mucus secretions PLANNING At the end of 30 minutes. .NURSING CARE PLAN ASSESSMENT S: Medyo nahihirapan akong huminga eh” as verbalized by the patient. To liquefy to increase fluid secretions. INTERVENTIONS RATIONALE Elevated head To take of bed and advantage of changed gravity position every decreasing two hours.
absence of nasal flaring and use of accessory muscles to breathe. The patient was able to establish a normal and effective respiratory pattern as manifested by a respiratory rate of 20 cpm. To provide comfort. *nasal flaring DIAGNOSIS Ineffective breathing pattern r/t respiratory muscle fatigue. . Encourage To assist client slower and in taking deeper control of the respirations. the patient will establish a normal and effective respiratory pattern. PLANNING At the end of 30 minutes. Administer oxygen at lowest concentration EVALUATION Goal met. O: RR: 28 cpm *Use of accessory muscles to breathe. INTERVENTIONS RATIONALE Elevated head To promote of bed as physiological appropriate ease of maximal inspiration. avoid fatigue. situation (breathing is considered to be the best bronchodilator) Encourage To limit use of adequate rest energy and periods.ASSESSMENT S: “Nahihirapan akong huminga” as verbalized by the patient.
the patient will report improved sense of energy. improvement in his Provided To avoid sense of energy. Assist with self To minimize care needs tiredness Discuss To provide routines to information on promote restful how to promote sleep. Instruct methods conserve energy in To decrease to fatigue. to the patient.ASSESSMENT S: “Nanghihina ako saka pakiramdam ko lagi akong pagod” as verbalized by the patient. environment exhaustion. adequate rest provide comfort The patient was able to report some periods. conducive to relief of fatigue. relaxation . INTERVENTIONS RATIONALE EVALUATION Encouraged Periods of rest Goal partially met. PLANNING At the end the shift. O: *restlessness DIAGNOSIS Fatigue r/t increased physical exertion and sleep deprivation.
INTERVENTIONS RATIONALE Encouraged to To promote soft increase fluid or moist stool.ASSESSMENT S: “Tatlong araw na ako dito hindi pa ako tumatae. the patient will establish normal pattern of bowel functioning. . the limits of individual ability. EVALUATION Goal met. O:*distended abdomen *hypoactive bowel sounds *bowel sounds 2 DIAGNOSIS Constipation r/t irregular defecation habits. intake at least 2500ml per day. “Tumae ako ng kaninang Instructed To improve konti umaga” as patient to eat consistency of balanced fiber stool and verbalized by the patient.” As verbalized by the patient. Encouraged To stimulate activity or contraction of exercise within the intestines. PLANNING At the end the shift. and bulk in diet. The patient was able to manifest improvement in bowel functioning. facilitate passage through the colon.
INTERVENTIONS RATIONALE EVALUATION Arrange care to To minimize the Goal partially met provide for disturbance the “Nakatulog naman uninterrupted client is ako ng 3 oras at hindi masyadong periods of rest. noise and interruptions for therapeutics and monitoring. Provide quiet environment and To assist client comfort measures establish optimal in preparation for sleep rest pattern. have a restful . meds) Recommended mid For increase morning nap. PLANNING At the end of the shift.) Explain necessity of disturbances To familiarize the done by the nurses patient that it is a (VS monitoring. Explore other sleep To assist client to aids (warm bath. sleep (fixing bed linens etc. adequate rest and to compensate for the loss of sleep. part of care. minsan maingay sa labas. Do experiencing.” as verbalized possible without by the patient. minsan yung pagpasok ng mga nurses” as verbalized by the patient. magulo ang paligid as much care as ko. the patient will be able to identify techniques to promote and improve sleep and rest and to be able to manifest increased sense of well being.ASSESSMENT S: “Hindi ako nakakatulog mabuti dito. waking client. O: *frequent yawning *presence of eye bags *increasing irritability DIAGNOSIS Disturbed sleep pattern r/t excessive stimulation.
gender (female) . Precipitating Factors: .pollution Stimulation of B-lymphocytes Differentiation into plasma cells Production of IgE antibodies Attach to mast cells and basophils in bronchial walls Release of chemical mediators Inflammatory Response Stimulation of Adrenergic Receptors Decrease cyclic adenosine monophosphate (CAMP) Swelling of membranes lining the airways Increase mucus production Bronchospasm .PATHOPHYSIOLOGY of BRONCHIAL ASTHMA Predisposing Factors: .allergies .smoking .irritants .age .history of allergies Etiology: unknown milk bedtime) before sleep.
A Increase workload of breathing (prolonged expiration) Circulatory Obstruction Cough Wheezing Increase Chemical Mediators A Tachycardia Bronchoconstriction Dyspnea Hyperventilition Labored breathing/ use of accessory muscles Increase Respiratory work demand Compensatory Mechanism Failed Fatigue Uneven Lung aeration Hypoventilation Incomplete Emptying of Alveoli Trapping of Air CO2 Retention Respiratory Acidosis Respiratory Failure Hypercapnia Hypoxemia Hyperinflation of Alveoli Increase Chest Diameter B Cyanosis Decrease LOC Chest Tightness .
B Impaired gas exchange Hypoxemia Decrease Tissue Perfusion Cellular Ischemia Tissue Necrosis Hypoxia Vital Organs Failure/ Death DEATH .
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