CASE STUDY (CONCEPT: RESPIRATORY DISORDER)

Mr. Dimagiba, a 32 year old asthmatic who is well known to you comes
in to your area. He is known to have a best peak flow of 640 L/min. He tells you
that over the last few weeks he has been waking up once or twice a week
coughing, and he is using his salbutamol inhaler a couple of times a day. He has
recorded his morning and night time peak flows these have averaged 580
mL/min and 540 ml/min respectively. He has recently changed his job and is
now working in the open air rather than in an office. His PMR shows that he
has been maintained on salbutamol 2 puffs as required, beclomethasone 100 2
puffs BID, for the last four year. He is also taking antihistamine 5 mg tablets
OD. His prescription today is seretide 250mcg/50 mcg. 2 puffs twice a day.
Based on the information available, construct a Nursing Care Plan for this
patient.
 NURSING CARE PLAN
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
PEF level, O2 1.) Establish rapport 1.) To gain patient’s trust PEF level, O2 Saturation and
Subjective: Ineffective Saturation and respiratory rate are within
airway clearance respiratory rate 2.) Assess patient’s 2.) To obtain baseline data normal rates.
“These past few related to will fall under condition
weeks I’ve been increased mucus normal rates
waking up, once or secretion as 3.) VS recording and 3.) To track important changes
twice a week, evidenced by Patient will monitoring. in the vital signs. The patient demonstrated
always coughing.” abnormal breath demonstrate pursed-lip breathing and
as verbalized by sounds and pursed-lip 4.) Auscultate breath 4.) To monitor changes in diaphragmatic breathing, goal
the patient. increased breathing and sounds. Note breath sounds will allow the met.
respiratory rate. diaphragmatic adventitious breath nurse to know the condition
breathing. sounds like wheezes and and intervention to be given to
Objective: crackles. the patient
Patient will The patient manifested the
PEF level manifest the signs signs of decreased respiratory
Morning: 580 of decreased 5.) Elevate head of the 5.) Elevating the head of the effort as evidenced by absence
L/min, Evening: respiratory effort bed, have a patient lean bed allows the diaphragm to of dyspnea, goal met.
540 L/min as evidenced by on overbed table or sit contract well. Thus, promoting
absence of on edge of the bed. efficient breathing.
Sa02 = 90% dyspnea.
6.) Encourage deep 6.) To maximize effort for
Abnormal breath Patient will breathing and coughing expectoration Patient already know the
sounds (wheezing) verbalize exercises. causative factors of his asthma
understanding of and demonstrate behaviours
Vital Signs: causative factors 7.) Encourage 7.) To prevent situations that that would improve his
and demonstrate opportunities for rest will aggravate the condition. breathing pattern, goal met.
T: 37.3 C behaviours that and limit physical
P: 82 bpm would improve activities.
R: 28 breaths/min breathing pattern.
BP: 110/80mmHg

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DRUG NAME DOSAGES THERAPEUTIC INDICATIONS
DRUG STUDIES ADVERSE EFFECTS CONTRAINDICATIONS NURSING COSIDERATION
ACTIONS
Beclomethasone Adult: 200 mcg - Respiratory Loss of skin collagen Hypersensitivity. Assessment
Dipropionate daily in 2 divided Beclometason inhalant use: and SC atrophy; local Acute infections •History:
doses. 100 mcg e controls the Control hypopigmentation of uncontrolled by Acute asthmatic attack,
per 1 puff rate of protein of bronchial deeply pigmented antimicrobial status asthmaticus;
Drug classes synthesis, asthma that skin; dryness, chemotherapy systemic fungal infections
- Corticosteriod depresses the requires irritation, epistaxis, ;allergy to any ingredient;
- Glucocorticoid migrationof po corticosteroids rarely ulceration lactation; untreated local
- Hormone lymorphonucl along with or perforation of the infections, nasal septa
ear leukocytes other therapy nasal septum; smell ulcers, recurrent epistaxis
,fibroblasts,rev and taste ,nasal surgery or trauma
ersescapillaryp -Intranasal disturbances ;hoarse •Physical:
ermeabilityan use :Relief ness and candidiasis Weight, T; P, BP,
dlysosomalsta of symptoms of the mouth auscultation; R,
bilisationat the of seasonal or throat adventitious sounds;
cellular level or perennial chest radiograph before
to prevent rhinitis that respiratory inhalant
or control respond poorly therapy; examination
inflammation to of nares before intranasal
other treatment therapy
s; prevention Interventions
of recurrence •BLACK BOX WARNING:
of nasal polyps Taper systemic steroids
following carefully during transfer
surgical removal to inhalational steroids;
deaths resulting from
adrenal insufficiency have
occurred during and after
transfer from systemic to
aerosol steroids.
•Use decongestant nose
drops to facilitate

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 penetration of intranasal
steroids if edema or
excessive secretions are
present

DRUG NAME DOSAGES THERAPEUTIC INDICATIONS ADVERSE EFFECTS CONTRAINDICATIONS NURSING COSIDERATION
ACTIONS
Generic Name: Dosage: Selectively Maintena Contraindicated CNS: Tremor, Assessment and Drug
activates beta nce to patients with headache Effects:
Salmeterol 250/50 2 adrenergic treatment hypersensitivity
senafoate mcg receptors, CV: subjective - Assess patient’s
for COPD to drug or any of
and inhalation which results palpitations and respiratory
including its components.
in cardiac arrhythmias, condition before
Fluticasone powder chronic Caution to patients
bronchodilatio
bronchitis and who are unusually starting therapy.
n and blocks
Brand Name: Route: Inhalation emphysema. responsive to MS: arthralgia,
the release of - Assess peak
Seretide Frequency: BID allergic sympathomimetics
and patients with Others: flow readings
mediators
Classification: coronary artery hypersensitivity before starting
from the mast
Adrenergics insufficiency. reactions, therapy and
cells in the
oropharyngeal
respiratory periodically
irritation,
tract. thereafter.
hoarseness,oral
candidiasis,
- Be alert for
paradoxical
bronchospasm. adverse
reactions and
drug
reactions

- Don’t give drug for

acute bronchospasm.

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 Tell patient to take the
drug at about 12-hour
intervals even if he is
feeling better.
DRUG NAME DOSAGES THERAPEUTIC INDICATIONS ADVERSE EFFECTS CONTRAINDICATIONS NURSING
ACTIONS COSIDERATION
Generic Name: Dosage: Description: Salbutamol has Over use, either by -severe toxaemia

Generic
Salbutamol 100 mcg Salbutamol a pronounced way of more than 2
-intrauterine infection
inhalation activates bronchodilatato puffs or more
Brand Name: powder adenyl ry effect on all frequently than -vaginal bleeding
Proventil, Ventolin forms and every 6 hours can

Name:
cyclase, the resulting from
degrees of produce a rapid or
enzyme that
severity of irregular heartbeat, placenta previa
stimulates the bronchial an elevation of blood
Route: -Eclampsia or severe
production of asthma. It is pressure, shakiness,
Inhalation
cyclicadenosi therefore very nervousness and preeclampsia
ne-3', 5'- well suited for vomiting. If you are

Salmete
Frequency: -Placental abruption
BID monophosph the using an inhaler
ate (cAMP).In acute which is delivering a -Cord compression
creased cAMP treatment of combination or

rol
-use in threatened
leads to bronchospasms, bronchodilators and
activation of even if the steroids, it abortion
attacks are is important that you

senafoa
protein
severe. rinse your mouth
kinase A,
Fenoterol thoroughly after
which andterbutaline each use, to avoid

te and
inhibits have a similar oral thrush
phosphoryla effect, whereas
tion formoteroland
of myosin
and lowers
intracellular
salmeterolhave
longer lasting
effects. Correct
Fluticas
4
 one
ionic Ca use is important
concentratio for a successful
ns, resulting treatment. If
in smooth someone has
problems with a
muscle
metered
relaxation.
doseaerosol, he
Onset:
W/in 5 min
(inhalation)
or she may
achieve better
results with an
Brand
Duration:
Approx 3-6 hr
(inhalation)
inhalation aid
(spacers) or
with a powder
Name:
Pharmacokin inhaler.
etics:
Absorption:
Readily
absorbed Seretid
e
from the GI
tract.
Metabolism:
Undergoes
metabolism in
the liver and in
the gut wall.
Excretion:
Via urine (as
Classifi
metabolites
and unchanged
drug); faeces
cation:
(small

5
amounts)

Adrene
rgics
Generic
Name:

Salmete
rol
senafoa
te and
6
Fluticas
one

Brand
Name:

Seretid
e

Classifi
7
cation:

Adrene
rgics
Generic
Name:

Salmete
rol
senafoa
8
te and
Fluticas
one

Brand
Name:

Seretid
e

9
Classifi
cation:

Adrene
rgics
Generic
Name:

Salmete
rol
10
senafoa
te and
Fluticas
one

Brand
Name:

Seretid
e
11
Classifi
cation:

Adrene
rgics
-Monitor Blood Pressure,
Pulse rate, Electrolyte
and fluid balance,
glucose, lactate and K
levels

.-Store medication
between 15-30 °C-Protect
medication from light
-Administer PO medications

12
 with meals to minimize
gastric irritation

.-Extended-release tablet
should be
swallowed- whole. It
should not be crushed or
chewed.
-Shake bottle before use
-Should not be used in
sudden attacks of
breathing trouble

DRUG NAME DOSAGES THERAPEUTIC INDICATIONS ADVERSE EFFECTS CONTRAINDICATIONS NURSING COSIDERATION
ACTIONS
Generic Name: Dosage: 5 mg Loratadine Relief Fatigue, headache, Contraindicated to -Monitor patient
Loratidine blocks one of symptoms somnolence, clinically.
patients with
Route: Oral type of of asthma, nervousness, dry
Brand Name: histamine atopic mouth, GI disorders hypersensitivity to the - Take medication with
Frequency: OD receptor (the dermatitis ,angi (eg nausea, food
drug
Drug Class: H1 receptor) oedema, gastritis)& allergic
Antihistamine and thus urticaria, symptoms (eg. rash).
prevents seasonal
activation of &perennial
cells with H1 allergic rhinitis,
receptors by food &drug
histamine. It is allergic reaction.

13
used to
manage
symptoms of
asthma
allergic
rhinitis, wheal
formation,
urticaria, and
other allergic
dermatologic
conditions

14
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