Republic of the Philippines

ISABELA STATE UNIVERSITY

Echague, Isabela

A Case Study of Asthma

Presented to the
Faculty of the College of Nursing
ISABELA STATE UNIVERSITY
Echague, Isabela

In Partial fulfillment
of the Requirements for the
Subject Care of the Older Adult

APAGA, HAZEL JOY

CARIÑO, ANDREI JOIE
CASALAMITAO, JOVIE
MARCELO, CHRISTEL
MATEO, FEITH AUDREY
Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Data: INEFFECTIVE After 2 hours  Establish rapport to  To gain trust After 2 hours of
“nanakitangdibdibko, BREATHING of nursing the patient and and nursing
nahihirapan din PATTERN related intervention significant others. cooperation. intervention the
akonghuminga” as to the patient patient was able to
verbalized by the patient Hyperventilation will able to maintain an
maintain an  Monitor vital signs  To establish effective breathing
Objective Data: effective base line data. pattern, as
-(+)Dyspnea breathing evidenced by
- Tachypnea pattern, as  Determine the  To determine relaxed breathing
- cough evidenced by presence of related factors at normal rate and
-Unable to expectorate relaxed factors/physical that would depth and absence
phlegm breathing at conditions as noted cause of dyspnea.
-(+) Crackles normal rate in Related Factors. breathing
-(+) wheezes and depth and impairments
-Use of accessory absence of
muscles to breathe dyspnea.
.
-V/S  Identify age and  Respiratory
BP-120/80 mmHg ethnic group of ailments in
RR-27 cpm client who may be general or
PR-87 bpm at increased risk increased in
T-36.5 C infants and
children with
neuromuscula
r disorder the
frail elderly,
and person
living in
highly
 polluted
environments.
Smoking is
prevalent
among such
group with
high level
levels of air
toxin that may
restrict limit
respiratory
effect

 Auscultate and  To help in

percuss chest loosening the
secretions

 Note rate and depth  to evaluate

of respirations, type presence/
of breathing pattern characteristics
of breath
sounds and
secretions

 Evaluate cough  Indicating

(e.g., tight or moist) possible
and presence of obstruction.
secretions,

 Assess for  may restrict

 concomitant Respiratory
pain/discomfort effort.

 Suction airway, as
needed  to clear
secretions

 Elevate head of
bed and/or have  to promote
client sit up in physiological
chair, as and
appropriate psychological
ease of
maximal
inspiration

 Encourage  to assist client

slower/deeper in “taking
respirations, use of control” of the
pursed-lip Situation.
technique,
and so on

 Monitor pulse  to verify

oximetry, as maintenance/
indicated Improvement
in O2
saturation.

 Assist client in  To help

breathing promote good
retraining (e.g., breathing
 diaphragmatic, pattern.
abdominal
breathing,
inspiratory
resistive, and
pursed-lip), as
indicated

 Encourage  to limit
adequate rest Fatigue.
periods
between
activities

Dependent
 Administer  To
medication as determine if
prescribed by the
the Physician medication
or treatment
is working
Assessment Nursing Planning Nursing Intervention Rationale Evaluation
Diagnosis
Subjective Data: Ineffective After 5 hours of Independent After 5 hours of
“nahihirapanpoakonghuminga Airway nursing intervention  Monitor patient vital  To obtain baseline nursing interventi
” as verbalized by the patient
clearance related the Patient will signs data and to the Patient
by identify/demonstrate identify/demonstr
Objective Data: bronchospasmsa behaviors to achieve
determine possible behaviors to achie
 Abnormal breath s evidence by airway clearance. complications airway clearance.
sounds (crackles) adventitious
breathe sound  This is to detect
 restlessness
(Crackles)  Assess and monitor decreased or
 Irritability
presence of abnormal adventitious breath
 Tachypnea
breath sounds sounds.
 Ineffective cough

 Assess the rate,  Altered breathing

Vital Signs
BP-120/80 mmHg rhythm, and depth of pattern may occur
RR-27 cpm respiration, chest together with use
PR-87 bpm movement, and use of accessory
T-36.5 C of accessory muscles muscles to
increase chest
excursion to
facilitate effective
breathing

 Assess cough  To determine the

effectiveness and ability to protect
productivity own airway

 Auscultate lung  To ascertain

fields, noting areas current status and
of decreased or note effects of
absent airflow and treatment in
adventitious breath clearing airways
 sounds: crackles,
wheezes.

 Hydration can help

 Encourage patient to
prevent the
increased oral fluid
accumulation of
intake
viscous secretions
and improve
secretion clearance

 To promote
relaxation of the
 Provide comfortable
patient
and relaxing
environment to the
client

 Provide and Assist  To expel the

the client in health mucous and
teachings regarding facilitates
proper deep maximum
breathing exercises expansion of the
lungs and smaller
airways, and
improves the
productivity of
cough.

 To provide
 Position the client
comfort to patient
into comfortable
position
 Dependent  To relax smooth
 Administer respiratory
medication as musculature,
prescribed by the reduce airway
Physician edema, and
mobilize
secretions.

Assessment Nursing Planning Nursing Intervention Rationale Evaluation

Diagnosis
Subjective Data: Impaired After 1 hour of Independent After 1 hour of nur
“minsan gas nursing intervention  Assess the client’s vital  To obtain baseline intervention the pa
nahihirapan ako exchange the patient will signs. data and to note participated and
humiga at related to participate and progression and performed treatme
magexhale” as altered perform treatment comparative result. regimen such as
verbalized by the delivery of regimen such as breathing exercise
patient inspired breathing exercise  Explain to the patient the  To be able the client use of oxygen with
oxygen or and use of oxygen need of treatment regimen understands the the client’s level o
Objective Data: air within the client’s such as breathing exercise ability.
rationale and
 Abnormal trapping as level of ability. and use of oxygen. importance of it.
breath evidenced
sounds by
 Encourage frequent
(wheezes dyspnea  To promote optimal
position changes, deep
amd and chest expansion and
reduced breathing exercise and
crackles) pursed-lip breathing. drainage of secretions.
tolerance
 restlessness
for activity
 Irritability
 Tachypnea  Reinforce need for  To decrease dyspnea
adequate rest, while and improve quality of
 Limited
encouraging activity and life.
range of
exercises.
motion

Vital Signs  Review the client to risk  To promote prevention

BP-120/80 mmHg factors particularly or management risk.
RR-27 cpm environmental.
PR-87 bpm
T-36.5 C
 Give client information that
provides evidence of  To sustain client’s
daily/weekly progress. motivation.
 Dependent
 Use incentive spirometer,
chest physiotherapy and so  To promote optimal
forth as indicated. chest expansion and
improve respiration
functions.

Assessment Nursing Planning Nursing Intervention Rationale Evaluation

Diagnosis
Subjective Data: Activity After 8 hours of Independent After 8 hours of
“nahihirapan po Intoleranc nursing intervention  Assess vital signs in  To obtain baseline nursing interventio
ako gumalaw at e related to the Patient will report response physical activity data and to note the Patient reported
mabilis mapagod” imbalance measurable increase before and after the progression and measurable increas
as verbalized by between in activity activity. comparative result. activity intolerance
the patient O2 supply intolerance.
and  Ascertain the ability of  To determine current
Objective Data: demand as status and needs
patient to stand and move
 Abnormal evidenced
associated with
about and degree of
breath by
assistance necessary or use participation in needed
sounds dyspnea
and of equipment. or desired activities.
(crackles)
 restlessness shortness
of breath.  Plan care to carefully  To reduce fatigue.
 Irritability
 Tachypnea balance rest periods with
 Limited activities.
range of
motion  Plan for maximal activity  To promote the
within the client’s ability. progressive abilities in
Vital Signs this activity.
BP-120/80 mmHg
RR-27 cpm  Give client information that
PR-87 bpm provides evidence of  To sustain client’s
T-36.5 C daily/weekly progress. motivation.

 Provide information about  To help client to

the effect of lifestyle and
overall health factors on
activity intolerance such as
nutrition, exercise and
adequate fluid intake.
understand the factors
that may affect his
health.
 Dependent
 Note the client’s need of
oxygen during the activity
as prescribed by the
physician.
 To assist the client’s
oxygen demand during
the activity.

Drug Study

Drug Name Dosages Therapeutic Indications Adverse Contraindicat Nursing Interventions

Actions Effects ions
Albuterol sulfate, Adults In low doses, acts  Relief and  CNS;  Ontraindic  Use minimal doses
AccuNeb, Novo- Oral relatively prevention of Restlessness. ated with for minimal periods;
Salmol (CAN),  initially, 2 selectively at bronchospasm Apprehension, hypersensit drug tolerance can
Ventodisk (CAN), or 4 mg (1-2 tsp beta2-adrenergic in patients with anxiety, fear, ivity to occur with
Ventolin HFA syrup) tid-qid PO; receptors to cause reversible CNS albuterol; prolonged use.
may cautiously bronchodilation, obstructive stimulation, tachyarrhyt  Maintain a beta-
Pregnancy increase dosage if and vasodilation airway disease hyperkalemia hmias, adrenergi blocker
Category C necessary to 4 or 8 at higher doses,  Inhalation , insomnia, tachycardia (cardioselective
mg qid, not to beta2 selectivity treatment of tremor,drows caused by beta-blocker, such
Drug classes exceed 32 mg/day is lost and the acute attacks of iness, digitalis as atenolol, should
drug acts at beta2 bronchospasm irritability, intoxicatio be used with
 Sympathomim inhalation receptors to cause  Prevention of weakness, n; general respiratory distress)
etic  each typical exercise- vertigo, anesthesia on standby in case
 Beta2-selective actuation of sympathomimetic induced headache with cardiac arrythnmias
adrenergic aerosol dispenser cardiac effects. bronchospasm  CV: cardiac halogenate occur.
agonist delivers 90 mcg  Unlabeled use: arrhthmias, d  Prepare solution for
 Bronchodilator albuterol: 2 adjunt in tachycardia, hydrocarbo inhalation by
 antasthmatic inhlations q 4-6 treating serious palpitationsP ms o diluting 0.5 %
hours; more hyperkalemia in VCs (rare), yclopropan solkution with 2.5
frequent dialysis anginal pain e (these ml normal saline;
administration or patients; seems  Dermatologic sensitize deliver over 5-15
larger number of to lower sweating, the min by nebulization.
inhalations not potassium pallor, myocardiu  Do not exceed
recommender concentrations flushing m to recommended
 prevention when inhaled by  GI: nausea, catecholam dosage; administer
of exercise patients on vomiting, ines); pressurized
induced hemodialysis heartburn, unstable inhalation drug
bronchospasm: 2 unusual or vasomotor forms during second
inhalations 15 min bad taste in system half of inspiartion,
prior to exercise mouth disorders; because the airways
solution for  GU: hypertensi are open wider and
inhalation increased on; the aerosol
 2.5 mg tid incidence of coronary distribution is more
to qid by leiomyomas insufficien extensive.
nebulization of uterus y, CAD; Teaching points
 One 200 when given history of  Do not exceed
mcg capsules 4-6 in higher CVA; recommended
hr up to two 200 than human COPD dosage; adverse
mcg capsules 4-6 doses in patients effects or loss of
hours preclinical with effectiveness may
 Prevention studies degenerati result. Read the
of exercise-  Respiratory ve heart instructions that
induced asthma: difficulties, disease. come with
one 200 mcg pulmonary  Use respiratory inhalant.
capsule inhaled 15 edema, cautiously  You may experience
min before coughing, with these side effects:
exercise bronchospas diabetes dizziness,
m, mellitus drowsiness, fatigue,
paradoxical (large IV headache (use
airway doses can caution if driving or
resistance aggravate performing tasks
with diabetes that require
repeated, and alertness); nausea,
excessive use ketoacidosi vomiting, change in
of inhalation s); history taste (eat frequent
preparations of seizure small meals); rapid
disorders; heart rate, anxiety,
psyhoneur sweating, flushing,
otic insomnia
individuals  Report chest pain,
; labor and dizziness insomnia,
delivery weakness, tremors,
(oral use or irregular
has heartbeat, difficulty
delayed breathing productive
second cough, failure to
stage of respires to usual
labor; dosage.
parenteral
use of
beta2-
adrenergic
agonists
can
accelerate
fetal heart
beat an
cause
hypoglyce
mia,
hypokalem
ia,
pulmonary
edema in
the mother
 and
hypoglyce
mia in the
neonate):
lactation;
the elderly
9more
sensitive to
CNS
effects)

Drug Name Dosages Therapeutic Indications Adverse Contraindication Nursing Considerations

Actions Reactions s
Generi name: Dosage: Combivent For the CNS: Patients with Assessment and drug effects:
Albuterol and 100/20 mcg inhalation management lightheadedness cardiac 1. Monitor respiratory status:
ipratropium per actuation solution is a of , drowsiness, tachyarrhythmias, auscultate lungs before and after
inhaler of the inhaler combination of bronchospasm insomnia, hypertropic inhalation.
the in patients dizziness, obstructive 2. Report treatment failure
Brand name: Route: anticholinergic suffering vertigo, CNS cardiomyopathy (exacerbation of respiratory
Combivent Inhalation bronchodilator. from chronic stimulation and patients with a symptoms) to physician.
Ipratropium obstructive history of
Classification Frequency: bromide and the pulmonary CV: hypersensitivity to Patient and family education:
: Q6 hours beta2-adrenergic disease hypertension, any of its 1. Do not allow the solution/mist to
brochodilator bronchodilator, (COPD) who arrhythmia, components or to enter the eyes
s salbutamol requires hypotension, atropine or its 2. Consult a doctor immediately in
sulfate, regular tachycardia, derivatives. the event of acute, rapidly
ipratropium treatment angina worsening dyspnea. In addition,
bromide is a with both the patient should be warned to
quaternary ipratropium EENT: seek medical advice should a
ammonium and Sinusitis, reduced response beome
derivative of salbutamol blurred vision, apparent.
atropine and is taste perversion, 3. The concomitant use of
an dry mouth combivent with other
anticholinergic paradoxical sympathomimetic agent is not
drug which has bronchospasm, recommended since such
bronchodilator bronchitis combined use may lead to
properties. deleterious cardiovascular
Salbutamol GIT: effects.
produces Abdominal 4. Eye pain or discomfort, blurred
bronchodilation pain, dyspepsia, vision, visual halos or colored
through gastrointestinal images in association with red
stimulation of distress, ayes from conjunctival and
beta20adrenergi vomiting, corneal congestion may be signs
c receptors in diarrhea, of acute narrow-angle glaucoma.
bronchial constipation Should any combination of these
smooth muscle, symptoms develop, treatment
thereby causing GUT: with mioticdrops should be
relaxation of Dysuria, urinary initiated and specialist advice
muscle fibers. retention, sought immediately.
This action is urinary 5. Allow 30-60 sec between puffs
manifested by an difficulty for opimum results.
increase in 6. Wait 5 min between this and
pulmonary MS: other inhaled medication.
function as Fatigue, 7. Rinse mouth after mediation
demonstrated by weakness puffs to reduce bitter taste.
spirometric
measurements. Others:
Alopecia,
itching, rash,
flushing, edema
 DRUG CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECT ADVERSE EFFECT NURSING
NAME / ACTION INTERVENTIO
N
BRAND Bronchodilator,  Acute  Hypersensitivity to  headache CNS: irritability, ● Monitor for
NAME: spasmolytic. bronchos drug or other  irritability dizziness, nervousness, signs and
Elixophyllin pasm in xanthine (such as  nervousness restlessness, headache, symptoms of
patients coffee,  fast, pounding, insomnia, reflex hypersensitivity
not theobromine) or irregular hyperexcitability,seizure reaction, including
ACTION: receiving  Active peptic ulcer heart beat s rash and fever.
GENERIC Relaxes bronchial theophyll  Seizure disorder  restlessness CV: palpitations, ● Assess
NAME: smooth muscles, ine  insomnia marked hypotension, respiratory status.
Theophyllin suppressing airway sinus tachycardia, Monitor
 tremors
e response to stimuli. extrasystole, circulatory pulmonary
 light-
Also inhibits failure, ventricular function tests to
headedness
phosphodiesterase arrhythmias GI: nausea, gauge drug
STOCK and release of slow-  seizures vomiting, diarrhea, efficacy and
DOSE: reacting substance of  nausea hematemesis, identify adverse
80 mg/ 15 anaphylaxis and  stomach ache gastroesophageal reflux effects.
ml histamine.  diarrhea GU: increased diuresis, ● Monitor
 loss of appetite proteinuria cardiovascular and
ROUTE: Metabolic: neurologic status
Oral hyperglycemia, carefully.
syndrome of ● Assess glucose
inappropriate level in diabetic
antidiuretic hormone patient.
secretion ● Advise patient to
Musculoskeletal: take oral form with
muscle twitching 8 oz of water 1
Respiratory: tachypnea, hour before or 2
respiratory arrest Skin: hours after meals.
urticaria, rash, alopecia, ● Tell patient not
flushing to crush or chew
Other: fever, timed-release
hypersensitivity reaction form.
● Caution patient
not to use different
drug brands
interchangeably.
● Advise patient
that a diet high in
protein and
charcoal-broiled
beef and low in
carbohydrates
makes drug less
effective.
● Tell patient that
a high-
carbohydrate, low-
protein diet
increases risk of
adverse reactions,
as do products
containing
caffeine.
● Advise patient
not to take over-
the counter drugs
without
prescriber’s
approval. Tell him
to inform all
prescribers he’s
taking drug,
because it interacts
with many other
drugs
 DRUG CLASSIFICATION INDICATION CONTRAINDICATION SIDE ADVERSE NURSING
NAME / ACTION EFFECT EFFECT INTERVENTION
BRAND >Maintenance >Hypersensitivity to drug Headache Chest pain ● Assess pulmonary
NAME: Beta2-adrenergic treatment of or its components nervousness Slow irregular status and vital signs
Serevent receptor agonist asthma; Dizziness heartbeat ● Remind patient that
(long-acting), prevention of >Acute asthma attack Cough Severe drug isn’t a rescue
Bronchodilator bronchospasm Stuffed nose dizziness bronchodilator and won’t
GENERIC in patients with Runny nose Fainting give immediate relief in
NAME: ACTION: reversible Shaking of a seizures emergency.
Salmeterol Stimulates obstructive part of body ● Teach patient proper
Xinafoate intracellular airway disease; that can’t technique for using
adenylate cyclase, an maintenance control inhaler or Diskus.
enzyme that catalyzes treatment of Ear pain Instruct him not to exhale
STOCK conversion of bronchospasm Muscle pain into device or use a
DOSE: adenosine in patients with Joint pain spacer with Diskus.
50 mcg triphosphate to chronic Sore ● Advise patient to keep
cyclic-3’, 5’- obstructive Irritated throat Diskus dry. Tell him not
adenosine pulmonary Nausea to rinse, wash, or take it
monophosphates disease Tooth pain apart.
(cAMP). Increased (COPD) dry mouth ● Instruct patient to take
cAMP levels relax white patches regular doses 12 hours
ROUTE: bronchial smooth > Prevention of in the mouth apart. Tell him to take
Inhalation muscle and inhibit exercise- difficulty doses for exercise-
release of mediators induced falling asleep induced bronchospasm
of immediate bronchospasm burning or 30 to 60 minutes before
hypersensitivity tingling of the exercising.
(especially from mast hands or feet. ● Advise patient to take
 cells). drug exactly as
prescribed and not to
exceed one inhalation
twice daily.
● Tell patient to consult
prescriber if he needs
more inhalations than
usual.
● Caution patient not to
stop taking drug without
consulting prescriber.

DRUG NAME CLASSFICATION/AC INDICATION CONTRAINDICATION SIDE ADVERSE NURSING

EFFECT EFFECT INTERVENTION
TION
BRAND NAME Leukotriene receptor Prophylaxis Contraindicated with Headache, Nausea,  Know 12 rights
antagonist and chronic hypersensitivity to Abdominal diarrhea, of drug
Singulair
treatment by montelukast or any of pain, liver administration.
GENERIC relief of its components, acute cough, impairement  Monitor vital
NAME Selectively and symptoms of asthma attacks, status dyspepsia, , influenza,
sign closely
competitively blocks the dizziness, cold
Montelukast receptor that inhibits asthma. asthmaticus. fatigue, generalized  Instruct the
Sodium leukotriene formation, dental pain, rash, client to avoid
thus blocking many of pain. fever. the use of
the signs and symptoms aspirin with
STOCK DOSE of asthma-neutrophil known
and eosinophil
10mg hypersensitivity
migration, neutrophil
while taking this
and monocyte
aggregation, and drug.
ROUTE smooth muscle  Instruct client to
Oral contraction. take this drug
regularly as
prescribed, do
not stop taking
this drug during
symptoms-free
periods and
without
consulting
healthcare
provider.
 Instruct the
patient to not
take this drug
for an acute
asthma attack.
 Instruct patient
to report gever,
acute asthma
attacks, flu-like
 symptoms and
lethargy.

DRUG NAME CLASSFICATION/AC INDICATION CONTRAINDICATION SIDE ADVERSE NURSING

EFFECT EFFECT INTERVENTION
TION
BRAND Corticosteroid Maintenance Contraindicated with Heartburn, Dizziness,  Know 12 rights
NAME treatment and hypersensitivity to drug nervousness, lethargy, of drug
Inhibits accumulation
prophylaxis or for relief of acute abdominal fatigue, administration.
Breecort of inflammatory cells at
therapy of asthma or distention, paresthesis,  Monitor vital
inflammation sites,
GENERIC asthma. bronchospasm. diaphoresis, rash, edema,
phagocytosis, lysosomal sign closely
NAME acne, mood alopecia,
Budesonide enzyme swings, Cushing’s  Instruct client
release/synthesis, increased syndrome, do not use more
STOCK DOSE
release of mediators of appetite, dyspepsia, often than
250mcg/ ml inflammation. facial epistaxis,
prescribed, do
flushing, chest pain,
not stop without
increased bruising and
susceptibilit moon face. consulting
ROUTE
y to healthcare
Inhalation infection, provider.
diarrhea,  Inform client
constipation. that it may take
several days to
achieve good
effects, do not
stop if effects
are not
immediate.
 Instruct client to
use
decongestant
nose drops first
if nasal passages
are blocked.
 Instruct client to
prime unit
before use and
rinse mouth
after each use.
 Instruct client to
report sore
mouth, sore
throat,
worsening of
symptoms,
severe sneezing.