CASE PRESENTATION EXPLANATION!!!

Greetings , WE are the group 1 for the Bronchial Asthma, I’m Franzy Banawan and here’s my

partner for the simulation Ms. Milfaith Realista. TO review the Case 1 - Nursing care of a
child with Bronchial Asthma
Patient Profile:

Emergency Response Team responds to a residence for a seven-year-old male name Pink LuckSawn
with a cough and trouble breathing. This episode began two hours ago and has been accompanied by a
runny nose without any other symptoms. His mother has been treating him with albuterol by a nebulizer,
but he has progressively become more short of breath. Past medical history is notable for asthma since
infancy, with multiple prior hospitalizations.

(Our pt Pink LuckSawn who is 7 yrs old reported chief complaints of cough, trouble breathing with runny

nose without any other symptoms, karon ang iyaang mother gi treat sya with the use of Albuterol by a

nebulizer and mas samot nagkalisod syag ginhawa)

According to his past medical history, his collected data are: o the pt has asthma since infancy.

o -Allergic with Peanut butter

o -With family history of Asthma

o -Patient appears to be in moderate respiratory distress with suprasternal and intercostal retractions. (this is
a sign nga nag block ang iyaang airway)

note: ang respiratory distress kay ang fluid nag build up sa iyaang tiny air sacs aka alveoli sa iyang lungs.

The fluid keeps the pt’s lungs from filling with enough air, which means less oxygen ang maka reach sa

iyaang bloodstream mao mag lisod syag ginhawa)

VS:

T: 37.1 oC Wt: 21kg

RR: 40 Bpm HR: 120Bpm
BP: 100/70 mmhg

Doctor’s Order:

 Please admit
 Secure consent
 TPR Q4
 NPO
 O2 inhalation via facemask at 6 LPM
 Labs:
o CBC, plt
o CXR AP/L
o ABG
 IV: D5LR 1L @ 15ggts/min
  Meds:
o Nebulize with 1 neb salbutamol + ipratropium 3 doses in 15 mins interval, then Q4
o Hydrocortisone 8mg/kg IVTT as loading dose; then maintain at 4mg/kg/d IVTT
o Paracetamol 10mg/kg/d IVTT Q4 PRN for temp ≥ 38°C
 Place patient on moderate high back rest
 Monitor v/s Q4 to include O2 saturation
 Refer for cyanosis, progress of DOB, seizure or any untoward events

PHYSICAL ASSESSMENT!!!
 General Appearance and behavior
Note overall appearance

-While observing the patient he appears well groomed, appears well nourished and has no unusual body odor. Clothing
is in good condition and appropriate for climate..

Behavioral observation

-While observing the patient he appears alert, active, responsive, cooperative and remains attentive.

FOR THE HEENT

 Head, neck, and cervical lymph nodes

Inspect and palpate the head.

- While palpating and inspecting the patient his Head is normocephalic and symmetric
Inspect and palpate the face
- While palpating and inspecting the patient Head his Face is proportionate and symmetric.
Movements are equal bilaterally. Parotid glands are normal size. .

 Mouth, Throat, and Sinuses

Note the condition of the lips, palates, tongue, and buccal mucosa
- During inspecting of the conditions of the patient his Lips, tongue, and buccal mucosa appear pink
and dry. No lesions are present.
Observe the condition of the teeth and gums
- During the observation of the patient there was no lesions and redness
Inspect nose and sinuses
- During the inspecting of the patient his Nose is in midline in face, septum is straight and nares are
patent.

 Eyes

Inspect the external eye

-During the inspecting of the patient his Inner canthus distance approximately 2.5 cm.
Observe eyelid placement
- During the observation of the patient there was No swelling, discharge or lesions of eyelids.
Inspect the sclera and conjunctiva
- During the inspecting of the patient his Sclera and conjunctiva are clear and free of
discharge, lesions, redness, or lacerations.
Observe the iris and pupils
-During the observation of the patient his Pupils are equal, round and reactive to light and
accommodation
 EARS

Inspect external ears

Note placement, discharge, or lesions of the ears.

-During the inspecting of the patient his top of the pinna are cross the eye-occiput line and is
within a 10-degree angle of a perpendicular line drawn from the eye-occiput line to the lobe.
And there are No unusual structure or markings should appear on the pinna.
Inspect internal ear

-During inspecting of the patient there are No excessive cerumen, discharge, lesions,
excoriations, or foreign body are in external canal.
Assess the mobility of the tympanic membrane

- While assessing the patients his Tympanic membrane is mobile; moves inward with positive
pressure (squeeze of bulb) and outward with negative pressure (release of bulb).

FOR THE HEART

Note rate and rhythm of apical impulse, S1, S2, extra heart sounds, and murmurs

-During the auscultation of the patient Innocent murmurs are auscultated, which are common
throughout childhood

-Classified as systolic; short duration; no transmission to other areas; grade III or less; loudest in
pulmonic area (base of heart)

-Low-pitched, musical, or groaning quality that varies in intensity in relation to position, respiration,
activity, fever, and anemia

FOR THE CHEST AND LUNGS

-while assessing the scapulae they are symmetric and nonprotuding. Shoulders and scapulae are at
equal positions. Spinous process appears straight and thorax appears symmetric. Kyphosis is not
observed.

-while palpating the skin and subcutaneous tissue are free of lessions and masses.

-While palpating there were no tenderness, pain and unusual sensation observed.

-While palpating for crepitus there were no crepitus heard or felt

-FOR POSTERIOR THORAX:

-while palpating the posterior chest wall, and expansion is still symmetric

-While auscultating breath sounds there were some adventitious heard.

ABDOMEN
-while inspecting the abdomen the shape is flat

--During inspecting of the patient Umbilicus is light brown, no discharge, odor,

redness or herniation.
ANATOMY AND PHYSIOLOGY:
The lungs are pyramid-shaped, paired organs

that are connected to the trachea by the right and

left bronchi; on the inferior surface,the lungs are

bordered by the diaphragm.The diaphragm is the flat,

dome-shaped muscle located at the base of the lungs

and thoracic cavity. (so ma loc ate sya at the 4th ICS sa right and 5th ICS sa left.

The lungs are enclosed by the pleurae, which are attached to the mediastinum. ( protect and cushion
the lungs)

How Your Lungs Work

Your lungs bring fresh oxygen into your body. They remove the carbon dioxide and other waste gases
that your body's doesn't need.

To breathe in (inhale), you use the muscles of your rib cage – especially the major muscle, the
diaphragm. Your diaphragm tightens and flattens, allowing you to suck air into your lungs. To breathe
out (exhale), your diaphragm and rib cage muscles relax. This naturally lets the air out of your lungs.
Your smallest airways end in the alveoli, small, thin air sacs that are arranged in clusters like bunches of balloons.
When you breathe in by enlarging the chest cage, the "balloons" expand as air rushes in to fill the vacuum. When
you breathe out, the "balloons" relax and air moves out of the lungs. Tiny blood vessels surround each of the 300
million alveoli in the lungs. Oxygen moves across the walls of the air sacs, is picked up by the blood and carried to
the rest of the body. Carbon dioxide or waste gas passes into the air sacs from the blood and is breathed out

CHEST X- RAY:
Reported features with asthma include: pulmonary hyperinflation.(when an increase in lung volume
prevents efficient airflow in the body. Essentially, air gets trapped so naay blockage mahitabo)
bronchial wall thickening: peribronchial cuffing  (non-specific finding but may be present in ~48%
of cases with asthma 1) (mao ni sya ang nayedema surrounding the bronchial wall.
PATHOPHYSIOLOGY

EXPLANATION:
Asthma starts with a cough or a wheeze, in that case, our chest will become tight, our
breathing speeds up and gets shallower so that's why mahutdan ang pt og ginhawa. So One
way to think about the lungs is usa ra syag network with lots of smaller branches, and kaning
asthma this affects particularly, the small airways atoang bronchi and bronchioles so kaning
duha ka airways naa syay inner lining called mucosa. then ang mucosa is surrounded by
smooth muscles. In our 7 yr old patient who has an asthma already since birth, meaning
inflamed na iyaang airways, pag inflamed na ang airways (so this is the starting point) Now, if
airways are inflamed, this what makes him hyper-responsive to certain triggers. sensitive na
sya to irritants and asthma triggers. everytime ma trigger ang pt, ang smooth muscle sa
iyaang airway kay mag conntract and it will become narrow , so the lining will become more
swollen and secretes more mucus that's why naay blockage and the pt starts to have difficulty
in breathing. So since ang smooth muscle kay nay contract, airway resistance is elevated, as
seen with certain pulmonary diseases, air can become trapped in the lungs, limited nalang
dayon ang gas exchange

 So this gas trapping can lead to increased alveolar Co2 tensions this is due to the inability
of the lungs to properly oxygenate the blood. One of the signs ani is increase sa RR and
HR so that’s why our 7 yr old pt is tachypnic. And if mag increase ang Co2 sa lungs, it
could lead to Hypercapnia due to hyperventilation and having too much carbon dioxide in
the blood.
 Decreased alveolaroxygen tensions  or Hypoxia (the normal expected alveolar oxygen tension is 100
mmHg)

Since the lungs is lack of oxygen and naay fluid nga nag build up sa lungs sa pt. So this leads to
hypoxemia or when atoang blood is nag lack of oxygen. So ofcourse if nag lack atoang blood og oxygen
since this  provides energy and supports its function, this will lead to respiratory failure.

(in which the usual exchange between oxygen and carbon dioxide in the lungs does not occur.
As a result, enough oxygen cannot reach the heart, brain, or the rest of the body. )

 Increased in RR - When the heart cannot pump enough oxygen-rich blood to the muscles and
organs, the body reacts by triggering rapid and heavy breathing to boost oxygen intake.

This also leads to :

 Hyperexertion (exessive movement of joints) of the patient increases oxygen consumption,

making hypoxemia worse. 

WHY medication tickets are color coded?

- To avoid medication errors and and to easily identify by the anesthesiologist, physicians or
even us nurses to identify the drug according to its class and frequency. For example kaning
hydrocortisone that’s why it’s white in color kay iyanag frequency is OD lang and must be
given immediately. Salbutamol it’s because its a bronchodilator and q4hrs. And paracetamol
since it is antipyretic.