Case Scenario: Patient with Bronchial asthma

Janice Boracay, a 45-year-old female, married, is admitted with the diagnosis of Bronchial asthma. Upon
admission she complains of shortness of breath associated with chest tightness and cough for 3 days,
use of accessory muscles were noted during inspection and audible inspiratory and expiratory wheezes
were also noted during auscultation.

Janice had asthma when she was 40 years old. She denies having any allergy to house mites and pollens,
but she said her mother is also suffering from asthma. According to her she was diagnosed with Allergic
Rhinitis when she was 25 years old. She was diagnosed with bronchial asthma when she was 40 years
old and had been using prescribed Salmeterol + Fluticasone propionate inhaler and her asthma
appeared to be controlled to which she sometimes reduces the frequency or even discontinues inhaled
steroids. During the last 5 years, she had 2 exacerbations, these exacerbations were usually triggered by
viral upper respiratory tract infections which required her to use oral corticosteroids.

According to her she usually experiences SOB during rainy season and she treats herself with her
prescribed medication of Salmeterol + Fluticasone propionate dry powder inhaler 2 puffs 2x a day and
Doxofylline 200mg 2 x a day as needed. More so, when her asthma is controlled, she only uses her
inhaler at one dose daily and discontinues it when she feels better.

Upon admission to the medical ward her attending physician gave the following doctor’s orders.

 Start Plain NSS 1L @ 20 gtts/ min.

 Hypoallergenic diet
 For CBC and Chest x ray
 O2 inhalation at 2L/ min PRN
 Nebulize with Salbutamol 1 nebule now then q 6 hours
 Salmeterol+ Fluticasone propionate 2puffs BID
 Doxofylline 200 mg BID
 ImmunPro 1 tab OD
 Refer accordingly

Pre- work:

1. Review on the following;

a. Asthma definition
b. Pathogenesis and pathophysiology of asthma
c. Assessment findings in patients with asthma
d. Medical and nursing management with rationale for patients with asthma

Study guide:

1. Explain how family history and personal history determine the natural history of asthma in an
individual.
2. Describe the relationship of asthma to:
a. rhinitis
b. sinusitis
c. Gastroesophageal reflux
d. atopic dermatitis
e. food allergy
3. Determine the components of a physical examination for asthma
4. Interpret the physical findings of a person with asthma
5. Identify Nursing interventions with rationale for patients with asthma.
6. Enumerate the different medications used in the scenario according to;
a. generic and brand names
b. classifications
c. mechanism of action
e. side effects, adverse effects
f. nursing responsibilities
7. Demonstrate how to use and maintain medication delivery devices and formulate health teaching
Plan for patients using these medication delivery devices.
a. Nebulizer
b. Inhalers
c. Spirometry
8. Formulate 2 appropriate nursing diagnosis with Nursing interventions and rationale.

For CBC and chest -