REPUBLIC OF THE PHILIPPINES

UNIVERSITY OF NORTHERN PHILIPPINES

TAMAG VIGAN CITY

COLLEGE OF NURSING

A CASE STUDY ON

BRONCHIAL ASTHMA

RESPECTFULLY SUBMITTED BY:

JANELLE C. SUPNAD

RESPECTFULLY SUBMITTED TO:

CLAUDINE CECILIA H. ALMACHAR, MAN

JULY 20, 2020

TABLE OF CONTENTS

TITLE

PAGE…………………………………………………………………………………

I.INTRODUCTION AND

OBJECTIVES…………………………………………………………………………

II. PATIENTS

PROFILE………………………………………………………………………………

III.NURSING HISTORY OF PRESENT

ILLNESS……………………………………………………………………………

IV.PEARSON

ASSESSMENT…………………………………………………………………………

V.DIAGNOSTIC PROCEDURES (IDEAL)

………………………………………………………………………………

VI. ANATOMY AND PHYSIOLOGY OF THE ORGAN

INVOLVED……………………….

VII.PATHOPHYSIOLOGY…………………………………………………………

VIII.MANAGEMENT………………………………………………………………

IX.NCP………………………………………………………………………………
X.DRUGSTUDY

XI.BIBLIOGRAPHY………………………………………………………………
I. INTRODUCTION

Bronchial asthma is a medical condition which causes the airway path of the

lungs to swell and narrow. Due to this swelling, the air path produces excess mucus

making it hard to breathe, which results in coughing, short breath, and wheezing. The

disease is chronic and interferes with daily working. The disease is curable and

inhalers help overcome asthma attacks. Bronchial Asthma can affect any age or

gender and depends upon environmental and hereditary factors at large. When

ignored, disease proves fatal claiming lives in many cases.

Symptoms:

The symptoms may vary from individual to individual and depends on

environmental factors. A person may show regular symptoms of the disease or

periodic symptoms that may prompt at a certain time. The most common signs of

asthma that can help diagnose the disease are:

Breathlessness or short breath while talking, laughing, or running.

Chest Pain or tightness.

Sleep apnea or trouble while sleeping caused by breathlessness.

Coughing or wheezing (whistling sound from chest while sleeping or lying down).

Cold and flu due to viral infection.

Causes:

Though the root cause of bronchial asthma is unclear, it occurs largely due to

environmental or genetic factors. The factors that trigger an asthma reaction are:
Exposure to substances such as pollen, dust, animal fur, sand, and bacteria, which

triggers allergic reactions.

Viral Infection like cold and flu, or pneumonia.

Air Pollution, smoke, fumes from vehicles, etc.

Stress and anxiety.

Physical activity or exercise induced asthma.

Medications like aspirin, Ibuprofen, beta-blockers, etc.

Acid reflux or gastroesophageal reflux disease (GERD).

Perfumes and fragrances.

Weather, especially extreme changes in temperature.

Food additives (such as MSG).

Risks:

The main risk factors include:

Family history (parent or sibling) of bronchial asthma.

Susceptive to an allergic reaction such as atopic dermatitis or hay fever.

Habits which make you overweight.

Smoking, or passive smoking.

Exposure to chemical fumes or pollution, and irritants from hair sprays or perfumes.
OBJECTIVES

GENERAL OBJECTIVE

it aims to analyze the problem and the management of the patient’s condition,

bronchial asthma and to provide information with an overview of the disease process

and its nursing implications.

SPECIFIC OBJECTIVES

 To establish rapport to the patient.

 To know the treatment about the patient’s condition.

 To formulate nursing care plan for the patient

 To gain comprehensive knowledge about bronchial asthma

 To know the medical and surgical procedures/management of bronchial

asthma

 To know the pathophysiology of bronchial asthma

 To improve my skills in assessing holistically

 To identify the risk factor in obtaining bronchial asthma

 To gain knowledge on the anatomy and physiology of the organs involved in

bronchial asthma

 To provide psychological support to the patient

 To impart health teachings to the patient and family members.

II. PATIENTS PROFILE

NAME: Prince Michael Blaza

AGE: 11

SEX: male

CIVIL STATUS: single

RELIGION: Roman catholic

NATIONALITY: Filipino

III. NURSING HISTORY OF PRESENT ILLNESS

Reason for seeking health assistance

Patient X is experiencing on and off difficulty of breathing and keeps

coughing

History of present illness

He was previously well until one day prior to admission when he started to

develop fever. The fever was sudden onset and low grade as he was warm to touch,

mother claimed that the fever might be due to playing actively during the evening.

There is no chills or rigor. His mother gave him a medication. He vomits once after

taking the medication. The vomitus contains some clear mucus and also the

medication. The amount is about one table spoon Not blood-stained or bile-stained.

The fever also associated with productive cough Sputum was light yellow in color
with some clear mucus. Amount was about one tea spoon. It occurred mostly during

night. Patient did not take any medication for this problem. At night, mother noticed

that he was snoring during sleeping. Then around 12a.m, he suddenly awakens from

sleep. He starts to cough continuously and develop the shortness of breath together

with rapid breathing.

IV. PEARSON ASSESSMENT

This section shows the observation of the researcher to patient X, on her two

days of handling and being assigned as student nurse of patient x, the researcher

noticed that the patient is easily get tired and his cough is a dominant sign of his

bronchial asthma. As the researcher establishes rapport to patient x and to his

guardian, patient x and his guardian refused to answer some questions prepared by the

researcher for their privacy.

Observations: weak, pale and having a hard time to breath

General Examination:

 No anemia, jaundice, cyanosis, edema, clubbing, koilonychia or leukonychia

 No lymphadenopathy or thyromegaly

 Neck vein: Not engorged

 Purse lip: Absent

 Nasal polyp: Present on both sides

Vital signs: 

 Pulse: 108/min

 Temp: 36.0 degree celcius

 Respiratory rate: 28/min.

Systemic Examination: 

1. Respiratory examination: 

Inspection:

 Shape of the chest—Normal

Palpation:

 Chest expansion: Reduced

 Vocal fremitus: Normal.

Percussion:

 Percussion note: hyper resonance in both sides

 Area of cardiac dullness: Normal.

Auscultation:

 Breath sound: Vesicular with prolonged expiration

 Vocal resonance: Normal

V. DIAGNOSTICS

Spirometry —
This is a simple breathing test that measures how much and how fast you can blow air

out of your lungs. It is often used to determine the amount of airway obstruction you

have. Spirometry can be done before and after you inhale a short-acting medication

called a bronchodilator, such as albuterol. The bronchodilator causes your airways to

expand, allowing for air to pass through freely. This test might also be done at future

doctor visits to monitor your progress and help your doctor determine if and how to

adjust your treatment plan.

Exhaled nitric oxide –

Nitric oxide is a gas that is produced in the lungs and has been found to be an

indicator of inflammation. Because asthma is an inflammatory process, this test has

become helpful in the diagnosis and management of asthma. The test is performed by

having you breathe into a small, handheld machine for about 10 seconds at a steady

pace. It then calculates the amount of nitric oxide in the air you breathe out.

Challenge tests —

These tests might be performed if your symptoms and screening spirometry do not

clearly or convincingly establish a diagnosis of asthma. There are 2 types of challenge

tests: methacholine and mannitol. These agents when inhaled, can cause the airways

to spasm and narrow if asthma is present. During these tests, you will inhale

increasing amounts of either methacholine aerosol mist or mannitol dry powder

inhaler before and after lung function tests. The test is positive when your lung

function drops during the challenge. A bronchodilator is always administered at the

end of the test to reverse the effects of these agents.

VI. ANATOMY AND PHYSIOLOGY OF THE ORGAN INVOLVED

The respiratory system is situated in the thorax, and is responsible for gaseous

exchange between the circulatory system and the outside world. Air is take in via the

upper airways (the nasal cavity, pharynx, and larynx) through the lower airways

(trachea, primary bronchi and bronchial tree) and into the small bronchioles and

alveoli within the lung tissue.

The respiratory system is an intricate arrangement of spaces and passageways that

conduct air from outside the body into the lungs and finally into the blood as well as

expelling waste gasses. This system is responsible for the mechanical process called

breathing, with the average adult breathing about 12 to 20 times per minute.

When engaged in strenuous activities, the rate and depth of breathing increase in order

to handle the increased concentrations of carbon dioxide in the blood. Breathing is

typically an involuntary process, but can be consciously stimulated or inhibited as in

holding your breath.

NOSTRILS/ NASAL CAVITIES

During inhalation, air enters the nostrils and passes into the nasal cavities

where foreign bodies are removed, the air is heated and moisturized before it is

brought further into the body. It is this part of the body that houses our sense of smell

SINUSES

The sinuses are small cavities that are lined with mucous membrane within the

bones of the skull.

PHARYNX

The pharynx or throat carries foods and liquids into the digestive tract and also

carries air into the respiratory tract

LARYNX

The larynx or voice box is located between the pharynx and trachea. It is the

location of the Adam’s apple, which in reality is thyroid gland and houses the vocal

cords

TRACHEA

The chest and conducts air between the larynx and the lungs

LUNGS

The lungs are the organ in which the exchange of gasses takes place. The

lungs are made up of extremely thin and delicate tissues. At the lungs, the bronchi

subdivide, becoming progressively smaller as they branch through the lung tissue,
until they reach the tiny air sacks of the lungs called the alveoli. It is at the alveoli that

gasses enter and leave the blood stream. The lungs are divided into lobes: the left lung

is composed of the upper lobe, the lower lobe and the lingual ( a small remnant next

to the apex of the heart), the right lung is composed of the upper, the middle and the

lower lobes.

BRONCHI

The trachea divides into two parts called the bronchi, which enter the lungs

BRONCHIOLES

The bronchi subdivide creating a network of smaller branches, with the

smallest one being the bronchioles. There are more than one million bronchioles in

each lung

ALVEOLI

The alveoli are tiny air sacks that are enveloped in a network of capillaries. It

is here that the air we breathe is diffused into the blood, and waste gasses are returned

for elimination.

VII. PATHOPHYSIOLOGY

The underlying pathology of asthma is reversible and diffuse airway

inflammation. The inflammation leads to obstruction from the following: swelling of

the membranes that line the airways (mucosal edema), reducing the airway diameter:

contraction of the bronchial smooth muscle that encircles the airways

(bronchospasm), causing further narrowing and increased mucus production, which

diminishes airway size and may entirely plug the bronchi.

The bronchial muscles and mucus glands enlarge: thick tenacious sputum is

produced and the alveoli hyper inflate. Some patients may have airway subbasement

membrane fibrosis. This is called airway “remodeling” and occurs in response to

chronic inflammation. The fibrotic changes in airway lead to airway narrowing and

potentially airflow limitation.

Cells that play a key role in the inflammation of asthma are mast cells,

neutrophils, eosinophils and lymphocytes. Mast cells when activated, release several

chemicals called mediators. These chemicals which include histamine, bradykinin,

prostaglandins and leukotrienes, perpetuate the inflammatory response, causing

increased blood flow, vasoconstriction, fluid leak from vasculature, attraction of white

blood cells to the area and bronchoconstriction. Regulation of these chemicals is the

aim of much of the current research regarding pharmacologic therapy for asthma.

Further, alpha and beta2- adrenergic receptors of the sympathetic nervous

system are located in the bronchi. When the alpha adrenergic receptors are stimulated,

bronchoconstriction occurs when the beta-adrenergic receptors are stimulated,

bronchodilation results. The balance between alpha and beta2 receptors is controlled

primarily by cyclic adenosine monophosphate. Alpha-adrenergic receptor stimulation

results in a decrease cyclic adenosine monophosphate, which leads to an increase of

chemical mediators released by the mast cells and bronchoconstriction. Beta2-

receptor stimulation results in increased levels of cyclic adenosine monophosphate,

which inhibits the release of chemical.

VIII. MANAGEMENT

Although asthma cannot be cured, appropriate management can control the disease

and enable people to enjoy good quality of life.

Short-term medications are used to relieve symptoms. People with persistent

symptoms must take long-term medication daily to control the underlying

inflammation and prevent symptoms and exacerbations.

Medication is not the only way to control asthma. It is also important to avoid

asthma triggers - stimuli that irritate and inflame the airways. With medical

support, each asthma patient must learn what triggers he or she should avoid.

Although asthma does not kill on the scale of chronic obstructive pulmonary

disease (COPD) or other chronic diseases, failure to use appropriate medications or

to adhere to treatment can lead to death.

Asthmatic bronchitis treatments are essentially the same as those used to treat asthma and

bronchitis, and may include:

 Short-acting bronchodilators, such as albuterol, to help open the airway to

provide short-term relief

 Inhaled corticosteroids.

 Long-acting bronchodilators used together with inhaled corticosteroids

 Leukotriene modifiers

 Cromolyn or theophylline
  Combination inhalers containing both a steroid and a bronchodilator

 Long-acting anticholinergics

 A humidifier or steam

Bacterial respiratory infection may be treated with antibiotics.

Treatment also involves avoiding asthma triggers by following these tips:

 Wash your bed linens and blankets in hot water.

 Dust and vacuum regularly.

 Use a HEPA air filter in your home.

 Keep pets out of your bedroom.

 Don't smoke, and try to stay away from other people who smoke.

 Wash your hands frequently to prevent the spread of infection.

XI. BIBLIOGRAPHY

https://www.webmd.com/asthma/guide/bronchial-asthma

https://www.who.int/respiratory/asthma/burden/en/

https://my.clevelandclinic.org/health/diagnostics/8958-asthma-testing--diagnosis/test-

details#:~:text=The%20two%20most%20common%20lung,of%20airway

%20obstruction%20you%20have.