UNIVERSITY OF PERPETUAL HELP- Dr. Jose G.

Tamayo Medical University

Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

A CASE PRESENTATION

ON

BRONCHIAL ASTHMA

In Partial Fulfillment
Of the Requirements in NCM112L:
Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious,
Inflammatory and Immunologic Response, Cellular Aberrations, Acute and
Chronic RLE

Submitted by:

Group 2- N3A
Arciaga, Rumhina Jarmaine
Bagabaldo, Krishna
Caadlawon, Ariane Kate
Delleva, Shawn
Enaje, Shania Erika
Flores, Nazarine Joy
Hemedez, Trina Joyce
Insorio, Maricon
Martin, John Elreen
Mendoza, Myla Marie
Oliquiño, Sofia Mae
Quijano, Marc Andrei
Salud, Raul Dante II
Viterbo, Mariane

Submitted to:
Erich Fernandez, RN, EMT

September 2021
 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

I. INTRODUCTION
Bronchial Asthma, commonly known as asthma, refers to the chronic inflammatory
disorder of the airways which is usually characterized by wheezing due to an
individual’s exposure to triggers (i.e. allergens, emotional distress, extraneous
physical activities, etc.). This disease affects an estimation of 262 million people
worldwide with which 461,000 of the cases contributes to the global death count (World
Health Organization, 2021). In the Philippines, 11 million or 1 out of 10 Filipinos are
suffering from asthma (Global Asthma Report, 2021). According to the Department of
Health (2021), this is equivalent to 12% of the 90 million population of the Philippines.

Asthma is categorized into four types based on the symptom indicators of disease
severity. Individuals who are experiencing symptoms for 2 days per week or 2 nights
per month is said to have mild intermittent asthma while those who manifest more than
twice per week but not more than once a day are said to have mild persistent asthma.
People who are experiencing daily symptoms are said to have moderate persistent
asthma while those people who manifest symptoms multiple times a day with their
medications being rendered ineffective are experiencing severe persistent asthma.

The classic manifestations of asthma are dyspnea, wheezing, and coughing.

However, some people may experience a wide range of symptoms including acute
episodes of shortness of breath, chest pain, and fatigue. In severe cases, tachycardia
and cyanosis are evident. Diagnostic tests are also done in order to diagnose if an
individual is suffering from the disease. This includes spirometry to measure the
breathing capacity of the patient and how well they breathe, Peak Expiratory Flow
(PEF) to monitor the progress of asthma in patients and to tell whether the patient's
condition is worsening, and chest X-ray to assess the condition of the airways and the
lungs.

The overall goal of asthma management is to prevent disability as well as minimize

physical and psychologic morbidities by providing immediate interventions that are
necessary. To achieve this, health education for the patient and his or her family plays
a crucial role as this will enable them to immediately recognize symptoms and
determine its severity hence leading to prompt management of asthma exacerbations.
They should also learn how to identify and eliminate allergens that may trigger asthma
attacks. Moreover, pharmacologic management in the form of bronchodilators and
corticosteroids also play an important role in treating asthma by reducing airway
constriction and inflammation. Adherence to the prescribed regimen is essential to
successful management.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 2

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

II. PATIENT’S PROFILE

Patient’s Name: Patient C
Age: 22 years old
Sex: Female
Address: Biñan, Laguna

III. HISTORY OF PRESENT ILLNESS

A. Chief Complain: Difficulty of breathing and persistent cough
B. Admitting/ Working Diagnosis: Severe Persistent Asthma
C. History:
The patient was exposed to dogs 3 days prior to the presentation. Since
then, she experienced cough, becomes dyspneic, and uses her rescue inhalers,
which fail to provide relief. On the day of presentation, the patient awoke feeling
‘suffocated’. Her mother stated “I noticed that her lips turned blue”.
In the emergency department of St. Peter Hospital at February 14, 2021
11:00AM, the patient complains of persistent coughing with difficulty of breathing.
The physical examination reveals that her lips are blue. She is leaning forward in
the tripod position and using accessory muscles to breathe while saying “N-
nahihirapan po akong h-huminga”. She appears apprehensive and restless, and
is unable to speak full sentences without feeling short of breath and fatigued.
“Napapagod akong huminga” as she verbalized. Vital Signs are as follows:
• HR- 124 bpm
• RR- 42 cpm, rapid and shallow
• BP- 150/80 mmHg
• Temp- 37C
• O2 Sat- 85%
Her chest is symmetrical but has decreased bilateral expansion at 2cm. Upon
auscultation, inspiratory and expiratory wheezing were heard throughout her lung
fields. No stridor is present.
A portable chest radiograph reveals lung hyperinflation and peribronchial
cuffing consistent with reactive airway disease. Results of polymerase chain
reaction testing for nine common viral respiratory pathogens are negative.

IV. PAST MEDICAL HISTORY

Patient C’s medical history revealed that she has been diagnosed with
atopic asthma since she was 5 years old. She has a complete immunization
record, was followed by a respirologist for her asthma, had good medication
adherence and had not experienced a significant exacerbation for the last six
months. It was also revealed that her father has allergy-induced bronchial asthma
that can be triggered by grass and pollen.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 3

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

Her common triggers are environmental allergens, predominantly dogs and

cats. Her asthma had been fairly controlled with her current home regimen, which
included daily fluticasone/salmeterol (Advair) 230/21 μg 2 puffs twice daily,
montelukast 5 mg once daily, loratadine, and as-needed albuterol.

V. PHYSICAL ASSESSMENT
A. Head to Toe Assessment

TECHNIQUE
ASSESSMENT NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION
USED

MENTAL STATUS A. Inspection A. Patient must be fully A. The patient appears The longer breathing
alert, attentive in apprehensive and problems go
any action/things restless. uncontrolled, the
that surrounds him more likely a patient
will manifest signs
caused by stress
including
apprehensiveness
and restlessness.
(DerSarkissian,
2020).

HEAD A. Inspection A. Symmetrical and A. Symmetrical and

B. Palpation round round
B. No lesion and B. Patient has no Normal
tenderness lesions and
tenderness

HAIR AND SCALP A. Inspection A. Hair is black A. Hair is black

B. Inspection B. Evenly distributed B. Patient hair is
A. Color C. Inspection C. Shiny and thick evenly distributed
B. Distribution Normal
D. Inspection D. No C. Silky and smooth
C. Coarseness infestation/lesions D. No infestation and
D. Scalp lesions

EYES A. Inspection A. Evenly distributed A. Evenly distributed

B. Inspection B. Evenly distributed B. Evenly distributed
A. Eyebrows C. Inspection C. Skin intact, C. Skin is intact and
B. Eyelashes D. Inspection symmetrically symmetrically
C. Eyelids E. Inspection aligned aligned
D. Conjunctiva F. Inspection D. Pink D. Pink
E. Sclera G. Inspection E. White E. White
F. Pupil Normal
H. Inspection F. Pupils equally round F. Pupils is equally
G. Cornea and react to light round and have a
H. Ocular accommodation normal reaction to
movement G. Must look clear and light
no signs of white G. Clear and no white
substance in cornea substance can be
area seen

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 4

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

H. Can scan up and H. The movement of

down, and left to the patient's eye is
right accurate.

EARS A. Inspection A. No lesion and A. No lesion and

B. Inspection inflammation inflammation can be
A. Skin C. Inspection B. Symmetrical seen
B. Symmetry D. Inspection C. Color same as facial B. Symmetrical
C. Color Normal
skin C. The tone is same as
D. Ear canal D. No presence of facial skin
discharge/s D. No presence of
discharge

NOSE A. Inspection A. Symmetrical, in A. Symmetrical, in mid

B. Inspection midline line
A. Symmetry B. None B. None Normal
B. Nasal
discharge

MOUTH A. Interview A. pink/red, moist and A. Patient’s lips are A. Patient’s blue lips
B. Inspection no lesion blue may be caused by
A. Lips C. Inspection B. Pink B. Pink lack of oxygen in
B. Gums D. Inspection C. Pink or darker hue C. Pink the blood (Jones,
C. Buccal E. Inspection (variations in D. Light pink 2019)
mucosa F. Inspection pigment are relative E. Pink and in midline B. Gums are normal
D. Tongue to the cultural F. White without and healthy
E. Uvula background) impacted teeth C. Buccal mucosa is
F. Teeth D. Light pink in the normal state
E. In midline, pink D. Normal
F. Color white, no E. Aligned
impacted teeth F. Normal

NECK A. Inspection A. No deformities, A. No abnormalities

and Palpation symmetrical, no are present
Normal
enlargement, no
masses

THORAX AND A. Inspection A. Symmetrical A. Symmetrical A. The patient chest

LUNGS B. Inspection B. Respiratory rate for B. Respiratory rate of is normal
C. Inspection adults: 12-20 42 cpm, rapid, and B. The patient’s
A. Symmetry D. Auscultation breaths per minute, shallow respiratory rate is
B. Respiratory deep and regular C. The chest is elevated than
rate C. Symmetrical chest symmetrical but has normal which
C. Respiratory expansion at 3-5 cm decreased indicates
movement D. No adventitious expansion at 2 cm tachypnea (Potter
(chest sound D. Has inspiratory and & Perry, 2019)
expansion) expiratory wheezing C. In asthmatic
D. Lung/breath heard throughout patients, chest
sounds patient’s lung fields. expansion is
symmetrical but
overall chest
expansion could
be decreased if

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 5

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

the obstruction is
severe with air-
trapping (Loyola
University
Chicago, 2021)
D. Wheezing sound
indicates that the
airway is partially
blocked
(Cleaveland
Clinic, 2020)

HEART A. Auscultation A. Heart rate for adults: A. Heart rate of 124 A. The patient’s
60 to 100 bpm bpm. heart rate is
A. Heart rate elevated.

SKIN A. Inspection A. Pinkish A. Pinkish

B. Palpation/ B. Smooth, soft, and B. The skin of the
A. Color Inspection good skin turgor patient is smooth,
B. Texture C. Palpation C. Normal body soft and healthy
C. Temperature D. Palpation temperature: 36.5℃ C. Temperature of the Normal
D. Moisture to 37.5℃ (Potter & patient is 37℃
Perry, 2019) D. No dullness and
D. No dullness, no flaking present
flaking

NAILS A. Inspection A. Pink A. Pink

B. Palpation B. Smooth B. Smooth
A. Color of nail C. Inspection C. Convex curvature C. Convex curvature
beds D. Inspection D. Appears white or D. Return to pink after
B. Texture blanched when 2-3 seconds Normal
C. Shape pinched then
D. Capillary refill returns to pink in 2-3
seconds (Strozik et
al., 1997).

ABDOMEN A. Inspection A. Flat and proportion A. The contour is flat

B. Inspection to body mass and proportion to
A. Contour C. Auscultation B. Smooth, soft and no the body mass of
B. Texture presence of lesion the patient
C. Frequency & C. Normal active bowel B. No presence of
character Normal
sound, non-tender lesions
C. Normal active
sounds and no
presence of
tenderness

UPPER A. Inspection / A. No gross A. No deformities,

EXTREMITIES Palpation deformities, no cyanosis, edema,
cyanosis, no and tenderness Normal
A. Characteristic edema, no
tenderness

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 6

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

LOWER A. Inspection / A. Symmetry, no gross A. The upper

EXTREMITIES Palpation deformities, no extremities of the
cyanosis, no patient are
A. Characteristic Normal
edema, no symmetrical and no
tenderness presence of any
problems

MOTOR A. Inspection A. Can sit with support A. Patient sits while

CONDITION B. Inspection B. Able to hold the leaning forward in a A. Sitting on a tripod
C. Inspection head erect and in tripod position. position means that
A. Sitting midline when in B. Patient can hold his the patient is in
B. Head and vertical position head erect and has respiratory distress.
neck control C. Able to swallow neck control (Zuriati, 2020)
C. Swallowing D. Can stand without C. The patient can B. Normal
D. Standing support swallow C. Normal
D. Patient can stand D. Normal
without support

B. Gordon’s Functional Health Pattern

BEFORE DURING INTERPRETATION

HOSPITALIZATION HOSPITALIZATION

HEALTH The patient complies with The patient was brought According to Besmer (2016),
PERCEPTION her home regimen to by her mother to the the second level of Maslow’s
control her asthma hospital due to 3-day Hierarchy of Needs defines
triggered by allergies. history of difficulty of safety as the protection of
breathing, coughing, and one's assets, work, family, and
wheezing. The patient health from anything that could
appears anxious. The be considered a threat in the
physician ordered well-being such as disease
medications, IV, and state. The patient’s health is
oxygen. an important factor that is
needed to be addressed to
improve her condition, as well
as to relieve her anxiety from
what is happening.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 7

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

NUTRITION/ The patient eats more The patient does not have According to Kendra (2021),
METABOLIC fruits and vegetables than much of an appetite. She Maslow’s Hierarchy of Needs,
PATTERN meat. She is not picky but eats but she does not physiological needs located at
she prefers apples and finish her food and only the bottom of the pyramid
bananas among other eats half of it. include food and water intake
fruits. which are vital for survival.
Nutrition intake throughout
hospitalization is linked to
aspects relating to both the
individuals' status and the
nature of the hospital food.

ELIMINATION The patient defecates Patient’s urine is amber Gonzalo (2021) stated that
PATTERN every 1 to 2 days after colored, and she eliminating body wastes is one
breakfast. Stool is brown experiences no pain when of the physiological
and formed. She urinates voiding. components included in
about 8 to 10 times every Henderson’s Need Theory. It
day. Urine is amber is important to efficiently
colored. remove waste materials out in
the colon and bladder to avoid
significant medical problems
which can also lead to
decreased standards of living.
The patient’s elimination
pattern is still within normal
bounds.

ACTIVITY- Patient does house The patient only plays Javadi et al. (2013) stated that
EXERCISE chores in the morning mobile games a few times according to the Theory of
PATTERN then plays games on her but naps most of the time. Planned Behavior (TPB), a
phone all day. She stated person's probability of
that she does not participating in a healthy
exercise much because activity, such as exercise, is
she feels short of breath. associated with the intensity of
his or her desire to partake in
the said behavior. During
hospital stay, the patient
mostly remained in bed in
order to recover and regain
her strength.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 8

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

COGNITIVE- The patient has no The patient is oriented to According to Marjory Gordon,
PERCEPTUAL sensory deficits. She is people, place and time. author of nursing assessment
PATTERN oriented to people, time, She responds to stimuli and diagnostic, Nursing
place and responds to verbally and physically. choices concerning a patient's
stimuli verbally and She talks with tiredness in level of dependence and
physically. her voice. ability to learn are guided by
assessments of
consciousness, orientation,
memory, reality-based
thinking, and judgment.

SLEEP- REST Patient normally sleeps The patient naps most of According to Potter and
PATTERN for about 6 to 7 hours. the time during Perry’s Fundamentals of
She usually starts the day hospitalization. Nursing, sleep and rest is
at 6 AM and sleeps at 11 important for fast recovery.
PM. Illness that causes pain or
distress can result in sleep
Upon the triggering of her problems.
current asthma attack,
she said she could not
sleep well due to fear of a
worse exacerbation at
night.

SELF- Aside from her asthma,
PERCEPTION/ the patient considers
SELF CONCEPT herself healthy because
she was able to control it
by complying with her
home regimen.
The patient feels scared
because this asthma
attack feels foreign to her
as she was not able to
control it at home.
According to Kozier and Erb’s
Fundamentals of Nursing, any
change in health is a stressor
that potentially affects self
concept. Chronic Illnesses
often alter role performance
which change the individual’s
identity and self esteem.

ROLE AND The patient is the The patient receives According to Health Science
RELATIONSHIP youngest among 3 positive reinforcement and Journal, Family has an
PATTERN siblings. She has a close her mother provides her important role in hospital
relationship with her 2 comfort by being on her treatment of patients since it
sisters who are already side. Her siblings visit her may give excellent
married. Her siblings visit in the ER 2 hours after she psychological and emotional
their home once a week was admitted.
support to patients undergoing
and they didn’t
hospital treatment.
experience any conflicts
between them.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 9

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

SEXUALITY- The patient was 12 years The patient was not on her According to Kozier and Erb’s
REPRODUCTIVE old when her menarche menstrual period during Fundamentals of Nursing,
PATTERN occurred. She has no her hospitalization. sexuality is related to all
history of any diseases dimensions of health, is a part
affecting her genitals. She of each individual’s identity,
did not have any and gender role.
boyfriends before and is
not sexually active.

COPING / The patient copes up with The patient fears her Stress is unavoidable in life,
STRESS stress by watching situation right now and according to Marjory Gordon,
TOLERANCE television and going for always wants her mother author of nursing assessment
walks in the park. The to be on her side. and diagnostic, thus people
patient is competent in must develop good coping
dealing with her problem. strategies.
She overcomes her life's
difficulties before they
become overwhelming.
Despite this, she
continues to seek
guidance from her
mother.

VALUE BELIEF The patient is a Roman The patient always offers a Many people and families
Catholic who usually goes prayer even on bed asking utilize prayer as a coping
to church for a mass. She for protection and healing. mechanism during illness and
has a strong faith in God. crises, according to Marjory
Gordon, author of Nursing
Assessment and Diagnostic.
Beliefs and values also
influenced decisions, goals,
and behaviors.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 10

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

VI. ANATOMY AND PHYSIOLOGY

The lungs are the principal organ for respiration. It is divided in to three
lobes on the right and two lobes on the left. Its function is to supply oxygen through
a process of gas exchange called respiration or breathing. This also houses the
bronchial and alveolar structures needed for gas exchange.
The tracheobronchial tree consists of the main or primary bronchi and
many branches which serves as air passageways that connect your windpipe to
your lungs. Each main bronchus divides into lobar bronchi which conducts air to
each lung lobe. The lobar bronchus in turn divides into segmental bronchi which
lead to bronchopulmonary segments. The bronchi continue to branch many times,
finally giving rise to bronchioles. The bronchioles also subdivide numerous times
to give rise to terminal bronchioles, which then subdivide into respiratory
bronchioles. As the air passageways of the lungs becomes smaller, the structure
of their walls changes. The amount of cartilage decreases and the amount of
smooth muscle increases until, at the terminal bronchioles, the walls have a
prominent smooth muscle layer but no cartilage. Relaxation and contraction of the
smooth muscle within the bronchi and bronchioles can change the diameter of the
air passageways.
Each respiratory bronchiole subdivides to form alveolar ducts. These long
branching ducts opens into the alveoli. Alveoli are small air sacs considered to be
the center of the respiratory system’s gas exchange. The respiratory membrane

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 11

UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

formed by the walls of the alveoli and the surrounding capillaries is the exact site
of gas exchange between the air and the blood.
The Respiratory Process
Respiration is the process by which oxygen enters the body and is utilized
by the cells for their metabolic processes. It essentially involves five interdependent
steps:
• Ventilation refers to the entry of air containing oxygen and other gases into
the lungs. During normal breathing, inspiration occurs by the contraction
and flattening of the diaphragm and the contraction of the external
intercostal muscles which increases the size of the thoracic cavity. On the
other hand, expiration is a largely passive process where inspiratory
muscles relax and there is elastic recoil of the lungs giving rise to a state of
pressure equilibrium before the cycle begins again.
• Ventilation is followed by the diffusion of gases from and into the alveoli.
Oxygen moves from the alveoli to the blood through the capillaries (tiny
blood vessels) lining the alveolar walls.
• Once in the bloodstream, oxygen gets picked up by the hemoglobin in red
blood cells. This oxygen-rich blood then flows back to the heart, which
pumps it through the arteries to oxygen-hungry tissues throughout the body
which comprises the process of circulation.
• The fourth component of the respiratory process involves the diffusion of
gases into target tissues. In the tiny capillaries of the body tissues,
oxygen is freed from the hemoglobin and moves into the cells.
• The final stage of the respiratory process is cell metabolism and
respiration. The delivered oxygen is being utilized by the cell for its
functioning. Carbon dioxide, made by the cells as they do their work, moves
out of the cells into the capillaries, where most of it dissolves in the plasma
of the blood. Blood rich in carbon dioxide then returns to the heart via the
veins. From the heart, this blood is pumped to the lungs, where carbon
dioxide passes into the alveoli to be exhaled.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 12

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

VII. PATHOPHYSIOLOGY

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 13

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

VIII. MEDICAL MANAGEMENT

A. Management given by the Physician

Date/Time Doctor’s Order Rationale/ Nursing Consideration

Date: February 14, Start 5L/min oxygen To resolve cyanosis and attain optimal O2Sat
2020 by nasal cannula level
Time: 11:00AM now ✓ Check the doctor’s order.
✓ Observe 10 rights of administration.
BP: 150/80 mmHg ✓ Check the oxygen cylinder for its
HR: 124 bpm accessories and their working condition
RR: 42 rpm ✓ Ensure that the nasal cannula is placed
T: 37℃ safely and accordingly
O2 sat: 85% ✓ Closely monitor concentration of O2
administered
✓ Monitor and record O2Sat level at regular
intervals during oxygen administration

Start IV of D5LR at Provides as a quick source of energy and

30 gtts/min now replenishes low glycogen stores.
✓ Check the doctor’s order.
✓ Observe 10 rights of administration.
✓ Make sure to check IV at specific times to
ensure line patency.
✓ Make sure to keep IV flow at the proper
drop rate. Giving too much D5LR can
cause swelling and edema.

TPR q shift and To assess improvement or detect any

record deterioration in the patient’s condition as soon as
possible.
✓ The nurse should write and record the
data accurately and legibly. This will
reduce the risk of errors throughout the
shift.

I+O q4 To monitor patient for possible dehydration. Also

to ensure that the patient gets enough fluid and
other nutrients.
✓ Record the type and amount of all fluids
the patient has lost and the route.
Describe them as urine, liquid stool,
vomitus. Consider color, color changes,
and odor too.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 14

UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

✓ Evaluate patterns and values outside the

normal range, keeping in mind the typical
24-hour intake and output.

Diagnostics:
CBC To assess blood cells and give information on
infection and inflammation.
✓ Explain test procedure. Explain that
slight discomfort may be felt when the
skin is punctured.
✓ Apply manual pressure and dressings
over the puncture site.
✓ Monitor the puncture site for oozing or
hematoma formation.

To assess lungs and airway. It is also done to

CXR- PA Stat
identify complications or other sources of
wheezing.
✓ Explain test procedure.
✓ Remove any metallic items. Ensure that
the patient has no metallic implants.
✓ Assess the patient’s ability to maintain a
steady breathing pattern

ABG Stat To assess the function of the patient's lungs and

how effectively they can transport oxygen into the
blood and eliminate carbon dioxide by measuring
the acidity (pH) and amounts of oxygen and
carbon dioxide in the blood from an artery.
✓ Explain test procedure. Explain that
slight discomfort may be felt when the
skin is punctured.
✓ Apply manual pressure and dressings
over the puncture site.
✓ Monitor the puncture site for oozing or
hematoma formation.
✓ Report the results to the doctor
immediately.

To assess acid-base balance of the patient.

Na, K
✓ Explain test procedure.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 15

UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

✓ Observe proper collection, preservation,

and labelling of obtained specimen
Medications:

Salbutamol 2.5 mg Relaxes and dilates the air passageways to the

+ Ipratropium 2.5 lungs to relieve wheezing, difficulty in breathing,
mcg neb now and coughing.
✓ Check the doctor’s order.
✓ Observe the 10 rights of drug
administration
✓ Assess vital signs before giving the
medication to provide a baseline for
evaluation of drug effectivity.
✓ Monitor for indications of paradoxical
bronchospasm (wheezing, coughing,
dyspnea, chest and throat tightness),
especially with higher or excessive
dosages.
✓ Review all other significant adverse
reactions and interactions, especially
those related to the drugs, tests, herbs,
and behaviors

Diphenhydramine Relieves allergic reactions by preventing

50mg IV now, then histamine, a chemical in the body that produces
q8h allergy symptoms, from acting.
✓ Check the doctor’s order.
✓ Observe the 10 rights of drug
administration
✓ Assess vital signs before giving the
medication to provide a baseline for
evaluation of drug effectivity.
✓ Review all other significant adverse
reactions and interactions, especially
those related to the drugs, tests, herbs,
and behaviors.

Hydrocortisone To decrease airway inflammation, enhance

200mg IV now then airway responsiveness, and cut the length of an
100 mg IV q8h exacerbation in half.
✓ Check the doctor’s order.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 16

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

✓ Observe the 10 rights of drug

administration
✓ Assess vital signs before giving the
medication to provide a baseline for
evaluation of drug effectivity
✓ Review all other significant adverse
reactions and interactions, especially
those related to the drugs, tests, herbs,
and behaviors.

If no changes in
SpO2 after
nebulization:
Admit to ICU. To ensure round-the-clock care, careful
Secure consent first monitoring via life support equipment, and
medicines to maintain normal physiological
functioning.
✓ Check the doctor’s order.
✓ Secure consent from the significant other
of the patient.
✓ Ensure that the client or family members
completely understood the associated
facts on the informed consent form.

Refer to According to the Global Initiative for Asthma

Pulmonologist (GINA), referral to a pulmonary specialist is
indicated for patients whose symptoms persist
and/or exacerbations occur despite treatment.
✓ Inform the patient and significant others
that they will be referred to a specialist for
prompt treatment
✓ Rely accurate patient information and
current patient status to the referred
specialist
✓ Document referral process

IX. DIAGNOSTIC/ LABORATORY PROCEDURES

A. Chest X-Ray (Chest Radiography): A noninvasive medical diagnostic test that
utilizes a very small dose of ionizing radiation to produce images of the inside of
the chest. It is used to evaluate the lungs, heart and chest wall and may be used
to help diagnose shortness of breath, persistent cough, fever, chest pain or injury.
(Radiology Info, 2021)

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 17

UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

TEST RESULT INTERPRETATION

Chest X-Ray Reveals lung hyperinflation Results may indicate obstructions

and peribronchial cuffing. in the air passages due to an
abnormal increase in bronchial
wall density interfering with the
expulsion of air from the lungs.

B. Arterial Blood Gas (ABG) Test: A commonly used diagnostic tool for determining
blood gas partial pressures and acid-base levels. (Castro, et. al., 2021)

PARAMETER RESULT REFERENCE INTERPRETATION

VALUES

pH 7.28 LOW 7.35 – 7.45 May indicate elevated

acidity in the blood due
to the increase of CO2
levels.

PaCO2 54 HIGH 35 – 45 mmHg May imply respiratory

acidosis due to alveolar
hypoventilation resulting
in hypercarbia.

HCO3 24 NORMAL 22 – 26 mEq/L NORMAL

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 18

UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

PaO2 50 LOW 80 – 100 mmHg May indicate low levels

of oxygen dissolved in
blood plasma due to
alveolar hypoventilation
resulting in hypoxemia.

SaO2 85 LOW 95 – 100% May imply decreased

percentage of
oxyhemoglobin in the
blood.

C. Complete Blood Count (CBC) Test: A group of tests that evaluate the cells that
circulate in blood, including red blood cells (RBCs), white blood cells (WBCs), and
platelets (PLTs). (Lab Test Online, 2021)

TEST RESULT REFERENCE INTERPRETATION

VALUES

RBC Count 6.35 HIGH 4.1 - 5.1 x 1012/L May indicate decreased
oxygenation in the lungs
hence elevation in
production of RBC
serves as compensation.

Hemoglobin 160 HIGH 123 - 153 gm/L May indicate an increase

in RBC to compensate
for insufficient
oxygenation.

Hematocrit 0.60 HIGH 0.40 - 0.54 gm/L May indicate poor

oxygenation and
increase in RBC.

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 19

UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

MCV 84 NORMAL 80 - 96 fL NORMAL

MCH 26.7 NORMAL 27.5 - 33.2 pg NORMAL

MCHC 342 NORMAL 334 - 355 gm/L NORMAL

WBC Count 7.85 NORMAL 4.5 - 11.0 x 109/L NORMAL

Neutrophils 0.68 NORMAL 0.50 - 0.70 NORMAL

Lymphocytes 0.35 NORMAL 0.20 - 0.40 NORMAL

Monocytes 0.05 NORMAL 0 - 0.05 NORMAL

Eosinophils 0.08 HIGH 0 - 0.06 May indicate presence of

pulmonary allergic
inflammation.

Basophils 0.02 NORMAL 0 - 0.03 NORMAL

Platelet Count 315 NORMAL 150 - 450 x 109/L NORMAL

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 20

 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

D. Electrolyte Panel: A blood test that measures levels of the body's main
electrolytes such as sodium, chloride, potassium and bicarbonate as well as
determine the acid-base imbalances in the blood. This test can also be referred to
as a serum electrolyte test. (MedlinePlus, 2021)

ELECTROLYTES RESULT REFERENCE INTERPRETATION

VALUES

Sodium (Na+) 138 NORMAL 135 – 145 NORMAL

mmol/L

Potassium (K+) 3.2 LOW 3.5 – 4.5 May indicate a reflection

mmol/L of acid-base imbalance
and a side effect of beta
2 adrenergic therapy.

E. Polymerase Chain Reaction (PCR) Test: A laboratory exam used to detect the
RNA or DNA of multiple types of respiratory viruses as a single test, often through
a nasal, nasopharyngeal, or oropharyngeal swab. Viral pathogens are the most
common cause of respiratory tract infections. PCR testing produces a very high
sensitivity and specificity results for confirming respiratory viral infections.
(Centene Corporation, 2020)

TEST RESULT INTERPRETATION

Polymerase Chain Shows negative results for Outcome indicates the absence of
Reaction nine common viral any viral respiratory pathogen
respiratory pathogens. hence, illustrating that the matter
is not contributory to the patient’s
respiratory condition.

X. DRUG STUDY AND NURSING CONSIDERATION

By: Group 2 (N3A) | NCM112L: BRONCHIAL ASTHMA CASE PRESENTATION 21

 5L oxygen by nasal cannula now

NAME OF DRUG CLASSIFICATION MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS

Brand Name: Drug Classification: Oxygen therapy increases the • Hypoxemia • Depression of • Dryness of nasal • Check the doctor’s order.
OXYGEN Medical Gas arterial pressure of oxygen • Increased work of Ventilation mucosa • Observe 10 rights of administration.
and is effective in improving breathing • Hyperbaric Oxygen • Epistaxis • Check the oxygen cylinder for its
Generic Name: gas exchange and oxygen • Pulmonary Toxicity • Oxygen Toxicity accessories and their working condition
Oxygen Gas delivery to tissues if there are hypertension • Absorption • Assess the patency of the nostrils
functional alveolar units. • Pre-oxygenation in atelectasis • Apply water soluble jelly to nares PRN to
Dosage/ frequency: Oxygen plays a critical role as
induction and • Pulmonary Toxicity reduce dryness of nasal mucosa
5L/ min an electron acceptor during
difficult intubation. • Patients with • Ensure that the nasal cannula is placed
oxidative phosphorylation in unfavorable safely and accordingly
Route: via nasal the electron transport chain • Pre and post
cannula suctioning
ventilation response • Closely monitor the dosage and
through activation of to oxygen treatment concentration of O2 administered
cytochrome c oxidase • Postoperative • Patients with >92% • Monitor and record O2Sat level at regular
(terminal enzyme of the oxygenation SaO2 intervals during oxygen administration
electron transport chain). This especially in • Untreated • Assess the patient for changes in
process achieves successful abdominal and Pneumothorax respiration rate and depth
aerobic respiration in chest surgeries
organisms to generate ATP • Monitor the patient closely for risk of
• In aerosol drug aspiration
molecules as an energy
source in many tissues.
delivery • Check for skin breakdown over ears and
● Any other disease nostrils from too tight application of nasal
Oxygen supplementation acts
states and cannula
to restore normal cellular
activity at the mitochondrial
conditions that • Observe for signs of oxygen toxicity
reduce the
level and reduce metabolic
efficiency of gas
acidosis. There is also
exchange and
evidence that oxygen may
oxygen
interact with O2-sensitive
consumption such
voltage-gated potassium
as respiratory
channels in glomus cells and
illnesses, trauma,
cause hyperpolarization of
poisonings and
mitochondrial membrane
drug overdoses.
 Salbutamol 2.5 mg + Ipratropium 0.5 mg neb now

NAME OF DRUG CLASSIFICATION MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS

Brand Name: Pharmacologic Prevents acetylcholine (after To treat ● Hypersensitivity to ● CNS: drowsiness, • Identify patient and check the doctor’s
DuoNeb UDV Class: its release from cholinergic bronchospasm in salbutamol, headache, order.
Anticholinergic fibers) from attaching to patients who require ipratropium or nervousness, tremor • Observe 10 rights of administration.
Generic Name: (ipratropium) + muscarinic receptors on more than one fenoterol, atropine or • Assess vital signs before giving the
ipratropium ● CV: chest pain,
Selective beta2- membranes of smooth-muscle bronchodilator its derivatives. medication to provide a baseline for
bromide + increased heart rate,
adrenergic agonist, cells. By blocking evaluation of drug effectivity.
● Hypertrophic palpitations
salbutamol sympathomimetic acetylcholine’s effects in the • Place patient in a comfortable sitting
obstructive
(albuterol) bronchi and bronchioles, ● EENT: acute eye pain, position or fowler's position.
Dosage: 3 mL (0.5 cardiomyopathy,
ipratropium relaxes smooth altered taste, blurred • As prescribed, administer nebulized
mg ipratropium + tachyarrhythmia.
Therapeutic Class: muscles and causes vision, dry mouth, dose using a mouthpiece or properly
2.5 mg albuterol Bronchodilator bronchodilation. Albuterol ● Hypersensitivity to pharyngitis, sinusitis, fitting face mask attached to a jet
base) attaches to beta2 receptors on peanuts, soya sore throat, voice nebulizer connected to an air
Pregnancy bronchial cell membranes, lecithin, soybeans, or alterations, worsened compressor with adequate airflow.
Frequency: Now Category: C which stimulates the related products angle closure • Instruct patient to inhale deeply and
intracellular enzyme adenylate glaucoma slowly through mouth, hold breath,
cyclase to convert ATP to ● GI: Constipation, and exhale several times until all
cAMP. This reaction reduces diarrhea, indigestion, medication is nebulized.
intracellular calcium level and nausea • Avoid spraying into eyes as this may
increases intracellular cAMP. cause dizziness and blurred vision.
Together, these effects relax ● GU: UTI
• Monitor for indications of paradoxical
bronchial smooth-muscle cells ● MS: back pain, leg bronchospasm (wheezing, coughing,
and inhibit histamine release. cramps, muscle dyspnea, chest and throat tightness),
aches, especially with higher or excessive
● RESP: bronchitis, dosages.
cough, exacerbation • After nebulization, encourage the
of COPD, paradoxical patient to cough after several deep
bronchospasm, breaths.
pneumonia, upper • Evaluate for changes. Review all other
respiratory tract significant adverse reactions and
infection, wheezing interactions, especially those related
to the drugs, tests, herbs, and
● SKIN: flushing behaviors
● OTHER: hypokalemia • Disassemble and clean nebulizer.
• Document the procedure done.
 Diphenhydramine 50mg IV now, then q8h

NAME OF DRUG CLASSIFICATION MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS

Brand Name: Pharmacologic Diphenhydramine acts as an • Allergy symptoms • Documented • CNS: confusion,
• Check the doctor’s order.
Benadryl Class: inverse agonist at the H1 caused by hypersensitivity to dizziness, drowsiness
Ethanolamine receptor, thereby reversing histamine release diphenhydramine or • Observe the 10 rights of drug
Generic Name: • CV: arrhythmias,
derivative, the effects of histamine on (including its components administration
diphenhydramine nonselective capillaries, reducing allergic anaphylaxis, palpitations,
hydrochloride histamine1- reaction symptoms. • Alcohol intolerance tachycardia • Assess vital signs before giving the
seasonal and
medication to provide a baseline for
receptor antagonist perennial allergic • MAO inhibitor use • EENT: blurred vision,
Dosage: 1mL (50 Diphenhydramine produces evaluation of drug effectivity.
rhinitis, and allergic within past 14 days
mg) diplopia
Therapeutic Class: anti dyskinetic effects possibly dermatoses) • For IV use, check compatibility before
Antihistamine, by inhibiting acetylcholine in • Stenosing peptic • GI: epigastric distress,
mixing with other drugs
Frequency: Now antitussive, the CNS. It is also producing • To treat sleep ulcer or nausea
then q8h antiemetic, anti to sieve effects by directly disorders pyloroduodenal • Evaluate for changes. Review all
obstruction • HEME: other significant adverse reactions
antivertigo agent, suppressing the cough center • To provide agranulocytosis, and interactions, especially those
Route: IV
antidyskinetic in the medulla oblongata. antitussive effects • Concomitant use
Diphenhydramine's anti hemolytic anemia, related to the drugs, tests, herbs, and
with other
Pregnancy emetic and anti-Vertigo effects • To prevent motion antihistamine- thrombocytopenia behaviors.
sickness or treat
Category: B may be related to its ability to containing medicines • RESP: thickened • Document medication administered
bind to CNS muscarinic vertigo
(including topical bronchial secretions and patient’
receptors and depress • To treat symptoms antihistamines)
vestibular stimulation and of Parkinson’s ● SKIN: photosensitivity
labyrinthine function. Its disease and drug-
sedative effects are related to induced
its CNS depressant action. extrapyramidal
reactions in elderly
patients who can’t
tolerate more
potent
antidiskinetic drug
 Hydrocortisone 200mg IV now then 100 mg IV q8h

MECHANISM OF
NAME OF DRUG CLASSIFICATION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS
ACTION

Brand Name: Solu- Pharmacologic Binds to intracellular • To treat • Hypersensitivity to • CNS: headache, nervousness, • Check the doctor’s order.
CORTEF Class: Short-acting glucocorticoid symptoms of drug, alcohol, depression, euphoria, vertigo,
corticosteroid receptors and • Observe the 10 rights of drug
low bisulfites, or insomnia, restlessness, increased
Generic Name: suppresses the administration
corticosteroid tartrazine (with some intracranial pressure, seizures
hydrocortisone Therapeutic Class: inflammatory and levels (lack of products) • CV: hypotension, hypertension, • Assess vital signs before giving the
sodium succinate Anti-inflammatory immune responses certain thrombophlebitis, heart failure, medication to provide a baseline for
(steroidal) by: • Systemic fungal
substances shock, thromboembolism, evaluation of drug effectivity
Dosage and infections
• Inhibiting that are usually arrhythmias
Frequency : 200mg • Monitor blood pressure, weight, and
Pregnancy neutrophil and produced by • Concurrent use of • EENT: cataracts, glaucoma,
now then 100 mg monocyte the body and electrolyte levels regularly
Category: C other epistaxis, nasal congestion,
every 8 hours accumulation at are needed for immunosuppressant perforated nasal septum, • Reconstitution:
the information normal body corticosteroids dysphonia, hoarseness,  Prepare solution by adding not
Route: Intravenous
site and functioning). nasopharyngeal or oropharyngeal more than 2 mL of Bacteriostatic
(IV)
suppressing their • Concurrent
• To treat severe fungal infections Water for Injection to the vial
administration of live
phagocytic and
allergic virus vaccines • GI: nausea, vomiting, esophageal  Solution may then be added to 50
bactericidal candidiasis or ulcer, abdominal
reactions and mL of 5% dextrose in water,
activity distention, dry mouth, rectal
edematous isotonic saline solution, or 5%
• Stabilizing bleeding, peptic ulceration dextrose in isotonic saline
states
lysosomal • Metabolic: sodium and fluid solution
membranes retention, hypokalemia,  The resulting solutions are stable
• Suppressing the hypocalcemia, hyperglycemia, for at least 4 hours
antigen response hypercholesterolemia,
of macrophages amenorrhea, growth retardation, • Administer IV push over 3–5 min.
and helper T cells • Musculoskeletal: osteoporosis, Give intermittent infusion over 20–30
• Inhibiting the aseptic joint necrosis, muscle min.
synthesis of pain or weakness, steroid • Assess for edema.
cellular mediators myopathy, loss of muscle mass,
of the tendon rupture, spontaneous • Be alert to infection (reduced
inflammatory fractures immune response): sore throat,
response such as • Respiratory: cough, wheezing, fever, vague symptoms.
cytokines, rebound congestion, • Monitor electrolytes, B/P, weight,
interleukins, and bronchospasm serum glucose.
prostaglandins • Skin: rash, pruritus, urticaria,
 contact dermatitis, acne, bruising, • Monitor for hypocalcemia (muscle
hirsutism, petechiae, striae,
acneiform lesions, skin fragility
and thinness, angioedema
• Other: altered taste; anosmia;
appetite changes; weight gain;
facial edema; increased
susceptibility to infection; masking
or aggravation of infection;
adhesive arachnoiditis; injection
site pain, burning, or atrophy;
immunosuppression;
hypersensitivity reactions
including anaphylaxis
twitching, cramps), hypokalemia
(weakness, paresthesia [esp. lower
extremities], nausea/vomiting,
irritability, EKG changes).
• Assess emotional status, ability to
sleep.
• Evaluate for changes. Review all
other significant adverse reactions
and interactions, especially those
related to the drugs, tests, herbs,
and behaviors.
XI. NURSING CARE PLAN
A. Ineffective Airway Clearance
B. Impaired Gas Exchange
C. Fatigue

ACTUAL NCP 1

Name: Ms C. Age: 22 years old Gender: Female

Nursing Diagnosis: Ineffective airway clearance related to bronchospasm, mucosal edema, and increased mucus production as evidenced by dyspnea, coughing, change in rate and rhythm
of respiration, tripod position, use of accessory muscles when breathing, wheezing, decreased chest expansion, and CXR results showing lung hyperinflation and peribronchial cuffing.
Short Term Goal: After 30 minutes of nursing intervention, the patient will be able to achieve a patent airway as evidenced by absence of coughing, dyspnea, and wheezing, improved chest
expansion, as well as deep and regular respirations with a rate of 18-20 cpm.
Long Term Goal: After 8 hours of nursing intervention, the patient will be able to maintain airway patency as evidenced by absence of bronchospastic attack recurrence, verbalization of
ease in breathing, and normal CXR results.
Medical Diagnosis: Bronchial Asthma

Cues Problem Scientific Reason Nursing Intervention Rationale Evaluation

Airways can’t function as well as they Independent
Subjective: Airway should when you have asthma. Asthma Short-term:
Assessing these values provides Goal met.
“N-nahihirapan po akong h- Obstruction causes inflammation, or swelling, in the
Assess respiratory rate, depth, and information about changes that can After 30 minutes of
huminga” as verbalized by the lungs. It can also cause squeezing,
breathing effort along with a full set reveal respiratory compromise early.
called bronchoconstriction, and extra nursing intervention,
patient of vital signs every 4 hours and as Other vital signs, such as blood
sensitive or twitchy airways. the patient was able to
needed. pressure (BP) and/or heart rate (HR), achieve a patent
Objective: When you experience a trigger, the change with respirations. airway as evidenced
● RR: 42 bpm, rapid and insides of your airways swell even
by absence of
shallow more. This narrows the space for air to Some degree of bronchospasm is
Auscultate breath sounds. Note coughing, dyspnea,
● HR: 124 bpm move in and out of the lungs. The present with obstructions in airway
adventitious breath sounds such and wheezing,
● Temp.: 37°C muscles that wrap around your airways and may or may not be manifested in
as wheezes, crackles, or rhonchi. improved chest
● BP: 150/80 mmHg also can tighten, making breathing even adventitious breath sounds.
expansion, and a
● SaO2: 85% harder. When that happens, it's called
respiratory rate of 18
an asthma flare-up, asthma episode or Note presence and degree of
● Blue lips cpm, deep and
asthma "attack." dyspnea, for example, reports of Respiratory dysfunction is variable
● Leaning forward in the tripod regular.
“air hunger,” restlessness, anxiety, depending on the underlying process.
position (American Lung Association, 2020)
respiratory distress, and use of Note: Using a scale to rate dyspnea
● Uses accessory muscles to accessory muscles. Use a 0 to 10 aids in quantifying and tracking
breathe scale or American Thoracic changes in respiratory distress.
Society’s Grade of Breathlessness.
● Decreased chest expansion
at 2cm
● Inspiratory and expiratory
wheezing heard throughout
the lung fields
● CXR PA:
○ Lung hyperinflation
○ Peribronchial cuffing
● ABG results:
○ Low pH: 7.28
○ High PaCO2: 54 mmHg
○ Low PaO2:50 mmHg
○ Low SaO2: 85%
● CBC results:
○ High eosinophils: 0.08
Precipitators of allergic type of
Limit exposure to allergens respiratory reactions that can trigger Long-term:
or exacerbate onset of acute episodes
Goal met.
Assist the patient sitting up in a An upright position allows for a better After 8 hours of
semi-Fowler’s or high-Fowler’s lung expansion, hence more air nursing intervention,
position. reaching the lungs for gas exchange. the patient was able to
maintain airway
Teach patient about:
patency as evidenced
✓ pursed-lip breathing
These measures enable patients to by absence of
✓ abdominal breathing
participate in maintaining their health bronchospastic attack
✓ performing relaxation
and improving their ventilation. During recurrence, and
techniques
exercises, these breathing techniques “Maluwag na po yung
✓ taking prescribed medications
can be used to reduce the amount of paghinga ko” as
(ensuring accuracy of dose and
air trapped in the lungs. verbalized by the
frequency and monitoring
patient.
adverse effects)
Instruct the family, caregiver, and
The use of oxygen at home requires
patient about the proper use of
proper instructions to ensure safety
respiratory equipment, such as an
and correct use.
inhaler or metered-dose inhaler.
In case of an emergency, the family
Teach the family and caregiver needs to have the skills to provide
signs and symptoms of respiratory initial care and call for help to prevent
distress. care delays and ensure the best
possible patient outcome.
Dependent
To allow for immediate rehydration,
which is required in an emergency
Provide intravenous therapy as and for patients who have not
prescribe responded well to conventional
therapeutic techniques.
Administer 5L/min oxygen via Enhances oxygen delivery to the
nasal cannula as ordered by the lungs for circulatory uptake, especially
physician. in presence of reduced/altered
ventilation.
Administer medications as
indicated:
● Salbutamol 2.5mg + A variety of medications are prepared
Ipratropium 2.5mcg neb to manage specific problems. Most
● Diphenhydramine 50mg IV promote reversion of allergic reaction
and bronchodilation which may
● Hydrocortisone 200mg IV reduce airway resistance.
now and then 100 mg IV
q8h

Collaborative

Monitor and assess arterial blood Alteration in ABG’s may result in

gases (ABG) together with the increased pulmonary secretions and
complete blood count (CBC).
Monitor CXR-PA.
respiratory fatigue. While CBC is
needed to evaluate blood cells and
provide information on infection and
inflammation.
To aid in diagnosing a range of acute
and chronic conditions involving all
organs of the thoracic cavity.
Additionally, it serves as the most
sensitive plain radiograph for
visualizing the lower airway.
 ACTUAL NCP 2

Name: Ms. C Age: 22 years old Gender: Female

Nursing Diagnosis: Impaired gas exchange related to altered oxygen delivery as evidenced by low oxygen saturation, cyanosis, tachycardia at 124 bpm, increased blood pressure at
150/80 mmHg, and abnormal ABG and CBC results.
Short Term Goal: After 1 hour of nursing intervention, the patient will be able to demonstrate adequate oxygenation as evidenced by absence of cyanosis, oxygen saturation of 95-98% heart
rate within 60 to 100 bpm, and blood pressure within 110/ 70 to 120/80 mmHg.
Long Term Goal: After 8 hours of nursing intervention, the patient will be able to maintain optimal gas exchange as evidenced by ABG and CBC results within normal range.
Medical Diagnosis: Bronchial asthma

Cues Problem Scientific Reason Nursing Intervention Rationale Evaluation

Hypoxia is a condition in which
Subjective Cues Insufficient oxygen is not available in
Oxygenation
sufficient levels at the tissue
“I noticed that her lips turned
level to maintain adequate
blue” as stated by the patient’s
homeostasis; it can be caused
mother
by insufficient oxygen transport
Objective Cues to the tissues, which can be
caused by a lack of blood flow or
● BP: 150/80mmHg
a lack of oxygen in the blood
(hypoxemia).
● T: 37°C
Asthma can cause airways in
● RR: 42 cpm, rapid and
different areas of the lung to
shallow
become clogged, resulting in an
● HR: 124 bpm impaired exchange of oxygen
● Oxygen saturation: 85% between the air sacs in the lung
and blood flowing through the
● Cyanosis of the lips
lungs. This means that less
● ABG results: oxygen is absorbed into the
○ Low pH: 7.28 bloodstream and circulated
○ High PaCO2: 54 mmHg throughout the body.
○ Low PaO2:50 mmHg
(Bhutta & Rowaden, 2021) mucous membrane color.
○ Low SaO2: 85%
Independent: Short Term:
Assess respiratory rate, depth, Rapid and shallow breathing patterns
Goal Met.
and effort, including the use of and hypoventilation affect gas exchange.
accessory muscles, nasal flaring, Increased respiratory rate, use of After 1 hour of nursing
and abnormal breathing patterns. accessory muscles, nasal flaring, intervention, the patient
abdominal breathing, and a look of panic
will be able to demonstrate
in the patient’s eyes may be seen with adequate oxygenation as
hypoxia. evidenced by absence of
cyanosis, oxygen
Assess the lungs for areas of Any irregularity of breath sounds may
saturation of 95%, heart
decreased ventilation and disclose the cause of impaired gas
rate of 90 bpm, and blood
auscultate presence of exchange. Presence of crackles and
pressure of 120/80 mmHg.
adventitious sounds. wheezes may alert the nurse to an airway
obstruction, which may lead to or Long-term:
exacerbate existing hypoxia. Diminished
breath sounds are linked with poor Goal met.
ventilation. Also, a blockage in the airway After 8 hours of nursing
could prevent the body from getting intervention, the patient
enough oxygen. was able to maintain
Assess/routinely monitor skin and Cyanosis may be peripheral (noted in optimal gas exchange as
evidenced by ABG and
nail beds) or central (noted around lips or
earlobes). Duskiness and central CBC results within normal
cyanosis indicate advanced hypoxemia. range.
● CBC results: Monitor for alteration in BP and BP, HR, and respiratory rate all increase
○ High RBC: 6.35 HR. with initial hypoxia and hypercapnia.
○ High Hgb: 160 However, when both conditions become
○ High Hct:0.60 severe, BP and HR decrease, and
dysrhythmias may occur.

Monitor oxygen saturation using Pulse oximetry is a useful tool to detect

pulse oximeter. changes in oxygenation. An oxygen
saturation of <90% (normal: 95% to
100%) or a partial pressure of oxygen of
<80 (normal: 80 to 100) indicates
significant oxygenation problems.

Monitor level of consciousness Changes in patient’s mental status may

and mentation changes. indicate worsening effects of hypoxemia.

Position patient with head of bed Upright position or semi/high -Fowler’s

elevated, in a semi/ high - position allows increased thoracic
Fowler’s position as tolerated. capacity, full descent of diaphragm, and
increased lung expansion preventing the
abdominal contents from crowding.

Teach about coughing and deep Exercises such as pursed-lip breathing

breathing methods. and using the tripod position aid in
clearing secretions and increasing lung
expansion, helping facilitate gas
exchange.

Minimize blood loss from To limit adverse effects of anemia

procedures (e.g., blood tests).

Dependent

Give intravenous therapy as To allow for rapid rehydration and to

directed. assess the situation to administer
emergency medications via vascular
administration
Give 5L/min oxygen through a To achieve oxygen saturations of at least
nasal cannula as per doctor's 92%. Extended treatment of high levels
order. Ensure proper oxygen of oxygen could cause lung damage or
administration is done and pulmonary oxygen toxicity.
monitor for possible
complications (e.g., oxygen
toxicity).

Administer medications as Pharmacological agents are varied,

indicated: specific to the client, but generally used
to prevent and control symptoms, reduce
● Salbutamol 2.5mg +
frequency and severity of exacerbations,
Ipratriopium 2.5mcg neb and improve exercise tolerance.
● Diphenhydramine 50mg
IV
● Hydrocortisone 200mg IV
now and then 100 mg IV
q8h
Collaborative
Monitor ABGs and Hgb levels. To detect changes in gas exchange

Assist with procedures as To improve respiratory function/oxygen-

individually indicated (e.g., carrying capacity
phlebotomy, intubation).

Admit to ICU after securing For close observation and monitoring in

consent if no changes in oxygen certain situations
saturation after nebulization, as
per doctor’s order.

Refer to pulmonologist if no According to the Global Initiative for

changes in oxygen saturation Asthma (GINA), referral to a pulmonary
after nebulization, as per doctor’s specialist is indicated for patients whose
order. symptoms persist and/or exacerbations
occur despite treatment.
 ACUTE NCP 3

Name: Ms. C Age: 22 years old Gender: Female

Nursing Diagnosis: Fatigue related to physical exertion to maintain adequate ventilation as evidenced by use of accessory muscles, apprehensiveness, and restlessness
Short Term Goal: After 4 hours of nursing intervention, the patient will be able to demonstrate decreased fatigue as evidenced by less irritability and restlessness.
Long Term Goal: For the duration of hospitalization, the patient will be able to achieve an improved sense of energy as evidenced by readiness to perform usual activities and verbalization
of improved energy.
Medical Diagnosis: Bronchial Asthma

Cues Problem Scientific Reason Nursing Intervention Rationale Evaluation

Fatigue can occur with asthma. When the Independent
Subjective: Sustained body has to work harder to breathe, it Short-term:
Monitor vital signs every 4 hours. Identifying and notifying changes
Physical becomes exhausted. As a result of the
“Napapagod akong huminga” Monitor frequency of work of enables for prompt action to Goal Met.
Exhaustion body compensating by bringing more
as verbalized by the patient. breathing. identify a solution to the problem After 4 hours of nursing
oxygenated blood from the lungs to the
rest of the body, the individual may and reduce fatigue. intervention, the patient
experience general fatigue. Additionally, was able to demonstrate
Ask the client to rate fatigue (using
Fatigue may vary in intensity and decreased fatigue as
Objective: following a significant asthma flare-up,
a 0 to 10 or similar numerical is often accompanied by evidenced by less
the individual may experience significant
• RR: 42 cpm, rapid and scale) and its effects on the ability
irritability, lack of concentration, irritability and
fatigue for a period of time as the body
shallow returns to its normal healthy state. to participate in desired activities.
difficulty making decisions, restlessness.
Persistent coughing episodes combined problems with leisure, and
• HR: 124 bpm relationship difficulties that can Long-term:
with increased use of accessory muscles
• Use of accessory muscle add to stress level and aggravate
during asthma exacerbations frequently
• Restlessness result in muscle fatigue and, in some sleep problems. Goal met.
• Apprehensiveness cases, pain. Constant wheezing For the duration of
associated with exacerbations also Evaluate sleep hygiene (napping Dysfunction in sleep (too much,
hospitalization, the
contributes to a sense of weakness, throughout the day, inability to fall too little, or too many
patient was able to
tiredness, and fatigue. asleep or stay asleep). interruptions) can aggravate
achieve an improved
fatigue (Denlinger et al, 2014;
sense of energy as
(Cannizzarro, 2018) Johansson et al, 2010).
evidenced by readiness
Provide an environment Temperature and level of to perform usual activities
conducive to relief of fatigue. humidity are known to affect and verbalization
exhaustion. “Relaxed na po ako”.
Alternate activities with periods of These measures help to avoid
rest. Avoid scheduling two overexertion and increase
energy-draining procedures on stamina.
the same day. Encourage
activities that can be completed in
short periods.

Encourage the client to use a Getting 8 to 10 hours of sleep

routine sleep/wake schedule. nightly helps reduce fatigue.

Encourage nutritionally dense, To promote energy

easy-to-prepare-and-consume
foods, and avoidance of caffeine
and high-sugar foods and
beverages

Encourage the client to express Such interventions could include

feelings, attribution of cause and
behaviors about fatigue, including
potential causes of fatigue, and
possible interventions or coping
behaviors to alleviate fatigue.
setting small, easily achieved
short-term goals and developing
energy management techniques
to promote a sense of control and
improve self-esteem.

Allow the presence of a parent or The presence of significant

significant others during care. others reduces anxiety and fear,
it can reduce oxygen expenditure
and fatigue.

Discuss the effect of fatigue on To help increase patient

daily living and personal goals. compliance with schedule for
Explore with patient relationship activity and rest
between fatigue and disease
process.

Assist client/SO(s) to develop a Education may provide

plan for activity and exercise motivation to increase activity
within individual ability. Stress level even though the patient
necessity of allowing sufficient may feel too weak initially.
time to finish activities.
 Dependent

Administer diphenhydramine Antihistamines, such as

50mg IV, as prescribed by the diphenhydramine, the active
physician. ingredient in Benadryl, are used
to treat allergic reactions, but as
a side effect, they can cause
sedation. Because of the calming
and sleep-inducing side effects
of Benadryl, it can be used to aid
in relaxation and sleep.

Give 5L/min oxygen by nasal All energy in the body is derived

cannula, as per physician’s order. from oxygen. Without an
adequate supply on a consistent
basis, the body is prone to
disease and malfunction.
Supplemental oxygen can assist
in relieving tiredness and fatigue.
Collaborative:

Refer to comprehensive To help with programmed daily

rehabilitation program, physical exercises and activities to
and occupational therapy improve stamina, strength, and
muscle tone and to enhance a
sense of well-being.
 UNIVERSITY OF PERPETUAL HELP- Dr. Jose G. Tamayo Medical University
Sto. Niño, City of Biñan, Laguna

COLLEGE OF NURSING

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