CEYAN PEACHES S.

GARANCHON BSN2E

Objectives:
This presentation aims to:
1.Present the patient’s profile, including the patient’s history, to
determine the nature of underlying problems.
2.Discuss the normal findings of physical assessment.
3.Understand the disease pathophysiology and etiology of the
case being presented.
4.Understand the role of drug therapy in managing the client in
relation to the diagnosis.
5.Present data in relation to the case.
6.Effectively provide appropriate nursing diagnosis with regards to
client’s condition and develop a nursing care plan for the identified
problem.
7.Apply effective nursing interventions which are necessary for
the client’s condition.

ACTUAL NURSING DIAGNOSIS:

-Asthma as related to a complaint of coughing for 2 weeks. Coughing is present every
night. Patient also has mild fever, morning sneezing and nasal congestion.
- Bronchial asthma as related to the findings of increased AP diameter and it is
tympanitic (hyper resonant) to percussion. Rhonchi and occasional wheezes are heard
on auscultation which is the result of turbulent airflow through secretions in large
airways.

Patient’s Profile:
Patient's name: Age: 12 years old Sex: Male Birthday: Not indicated

Address: Lopez Jaena St. Jaro, Iloilo City

Room No: None Diet:

Religion:Not Indicated Physician: Not indicated

Nursing History: Present Medical
History
A12-year- old with a complaint of coughing for 2 weeks. Coughing is present every
night. Patient has also has a mild fever morning sneezing and nasal congestion

Nursing History: Past Medical History

-Patient have had Similar episodes in the past.ceyatfh
- Eczema and dry skin since infancy. He is otherwise healthy and he is fully immunized.
No known allergies to foods or medications. His family history is notable for a brother
who has asthma.

Physical Assessment
Client’s admission assessment reveals:

-He is alert and cooperative in minimal distress if any.

-His eyes are clear

-The nasal mucosa is boggy with clear discharge,

-His skin is dry, but not flaky, inflamed, or thickened.

-pharynx has moderate lymphoid hypertrophy. He has multiple small lymph nodes
palpable in his upper neck.

- Chest- has an increased AP diameter and it is tympanitic (hyper resonant) to

percussion. Rhonchi and occasional wheezes are heard on auscultation, but there are
no retractions.

-The heart is in a regular rhythm and no murmurs are heard.

Exam: VS T 38.1, P 100, RR 24, BP 85/65, oxygen
saturation 99% in room air

Parameter

Temperature 38.1,

Heart Rate

BP 85/65,

Respiratory Rate 24/min

Sa02 99% in room air

PATHOPHYSIOLOGY

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Montelukast

Mechanism Of Action Drug Indication Drug Contraindication Adverse Effects

Montelukast Montelukast is an Montelukast is Neuropsychiatric events have

been reported in patients
(empirical formula orally dosed drug contraindicated in receiving montelukast.
C35H35ClNNaO3S) (available as a patients with a history These events have been
is a highly selective film-coated tablet, of hypersensitivity to noted in adults, teenagers,
and younger patients, and
leukotriene receptor chewable tablet, or the drug or its include among others:
antagonist that binds oral granules) that is components. For anxiety, depression,
with high affinity to FDA-approved for patients with aggressiveness, agitation,
attention and memory
the cysteinyl treating chronic phenylketonuria impairment, sleeping
leukotriene receptor asthma and (PKU), caution disorders (insomnia,
for leukotrienes D4 prophylaxis and the should be exercised somnambulism, dream
anomalies), seizures,
and E4. These prevention of with paresthesia, hypoesthesia, as
leukotrienes are exercise-induced phenylalanine-contai well as suicidal thoughts and
excreted by various bronchoconstriction. ning formulations. behavior.Headaches, fever,
fatigue
types of cells, such as It is also approved for
mast cells, and are the relief of
involved in the symptoms of both ● Upper respiratory
signs (rhinorrhea,
inflammatory process seasonal and pharyngitis,
that may cause the perennial allergic laryngitis, sinusitis,
signs and symptoms rhinitis.[1][2][3] epistaxis)
● Auricular signs:
of asthma and allergic otitis
rhinitis. Leukotriene ● Lower respiratory
receptors are found in signs: a cough,
pneumonia,
airway cells, such as wheezing
macrophages and ● Ocular signs:
smooth muscle cells. conjunctivitis
● Gastrointestinal
When bound to signs (nausea,
leukotriene receptors, diarrhea, vomiting,
montelukast inhibits abdominal pain,
dyspepsia,
leukotriene pancreatitis). Some
physiologic effects of these may be
(such as airway secondary to
lactose that is
edema, smooth compounded with
muscle contraction, montelukast.
and impairment of ● Hepato-biliary
signs: liver injury
normal cellular (hepatocellular and
activity) without mixed-pattern),
exhibiting any cholestatic
hepatitis
agonist activity. In ● Infections
asthmatics, low doses (influenza,
of montelukast (5 varicella)
mg) induce a ● Dermatologic
significant inhibition manifestations
(pruritus, eczema
of and atopic
bronchoconstriction dermatitis,
caused by leukotriene angioedema,
urticaria, skin rash,
D4. bruising, erythema
multiforme,
erythema
nodosum, toxic
epidermal
necrolysis,
and
Stevens-Johns
on syndrome)
● Musculoskelet
al signs:
Arthralgia,
myalgia
● Hypersensitivi
ty
manifestations
: anaphylaxis,
eosinophilic
infiltration of
the liver
● Biologic
anomalies:
thrombocytop
enia,
increased
plasmatic
alanine
aminotransfer
ase
Nebulized Albuterol

Mechanism Of Drug Indication Drug Adverse Effects

Action Contraindication

An albuterol Albuterol sulfate Albuterol sulfate ● Abnormal

nebulizer relieves inhalation solution is inhalation solution is growth
muscle tightening indicated for the contraindicated in filled with
in the airways to relief of patients with a history fluid or
help a person bronchospasm in of hypersensitivity to semisolid
breathe more patients 2 years of any of its material
easily. The age and older with components. ● blemishes
nebulizer turns reversible obstructive on the skin
airway disease and
liquid medicine ● blood in the
acute attacks of
into a mist, bronchospasm.
urine
helping it reach ● bloody
the lungs nose
faster.Albuterol is ● burning,dry,
a type of or itching
bronchodilator eyes
drug. It works by ● burning or
dilating the stinging of
the skin
airways, making
● cough
it easier to
producing
breathe for
mucus
people who
● cramps
experience
● diarrhea
bronchospasm,
● difficulty
or tightening of
having a
the airways.
bowel
Albuterol sulfate
movement
(AccuNeb) is a
liquid form of this
medication.

Nebulized Corticosteroids
Mechanism Of Drug Indication Drug Adverse Effects
Action Contraindication
help reverse the Inhaled These include Local adverse
pathologic process of corticosteroids (ICS) hypersensitivity to
bronchial asthma.
effects of inhaled
are the the medication and
Corticosteroids FDA-indicated
corticosteroids
enhance the severe include
treatment of choice hypersensitivity to
beta-adrenergic
in preventing dysphonia, oral
response to relieve the
muscle spasm. They asthma milk candidiasis,
also act by reversing exacerbations in proteins/lactose.
the mucosal edema,
reflex cough, and
patients with Dry powder
decreasing vascular persistent
bronchospasm.
permeability by inhalers often These adverse
asthma.[1] contain lactose as
vasoconstriction, and
Persistent asthma is effects are less
inhibiting the release of a stabilizing agent.
LTC4 and LTD4. classified by common with
symptoms more Though not
Corticosteroids reduce
intentional, there
low-dose inhaled
the mucus secretion by than two days a corticosteroids
inhibiting the release of week, more than have been reports
secretagogue from three nighttime of milk protein than with
macrophages. awakenings per contamination high-dose
Corticosteroids inhibit month, more than within inhaled
the late phase reaction
by inhibiting the
twice a week using lactose-containing corticosteroids.
inflammatory response
short-acting beta-2 medications, These adverse
and interfering with agonists for including dry effects are also
chemotaxis symptom control, or powdered
any limitation of mitigated by
inhalers.[18] spacer use when
normal activity due
to asthma.[1]
Therefore, in taking the
Regular use of these patients with medication via
medications reduces severe milk protein
metered-dose
the frequency of or lactose
allergies, DPI inhalers.
asthma symptoms,
bronchial asthma
hyperresponsivenes medications are
s, risk of serious contraindicated.
exacerbations and Additional
improves the quality contraindications
of life.[2] These include untreated
medications are
fungal, bacterial,
initiated in a
stepwise fashion and tubercular
based on the infections of the
frequency and respiratory tract.
severity of the Inhaled
asthma symptoms. corticosteroids are
Low, medium, and recommended
high-dose inhaled therapy for treating
corticosteroids are asthma during
available to treat pregnancy.
mild, moderate, and Maternal ICS use
severe persistent
during pregnancy
asthma,
respectively.[3] If
has not
inhaled demonstrated an
corticosteroids alone increase in the risk
are not adequate in of congenital
 controlling a malformations or
patient's asthma impaired fetal
symptoms, other growth
controller
medications such as
long-acting
beta-agonists or
leukotriene receptor
antagonists may
also be started.
Asthma controller
medications often
are used in
conjunction with
short-acting
beta-agonists such
as albuterol as part
of an asthma action
plan to address
acute and chronic
symptoms.[

Nebulized Cromolyn
Mechanism Of Drug Indication Drug Adverse Effects
Action Contraindication
Cromolyn sodium is a Hypersensitivity
mast cell stabilizer The frequency of
● Cromolyn to cromolyn adverse effects
that prevents the
sodium is an products or remains unclear.
subsequent release of
FDA-approve components of the Adverse effects vary
inflammatory
mediators, including d medication formulation is the depending on the
histamine and used for absolute route of
leukotrienes, which prophylaxis of administration.
contraindications
cause allergic mild to
symptoms and moderate for the use of The ophthalmic
bronchoconstriction. bronchial cromolyn sodium. solution may
It inhibits mast cell asthma and correlate with
degranulation, adjunctive transient burning of
normally implicated treatment of eyes upon
in anaphylaxis allergic administration, eye
following exposure to rhinitis and dryness, puffiness,
reactive allergens. systemic mast irritation, itchiness,
Cromolyn sodium cell disease rash, and styes.
differs from (mastocytosis) Adverse events
antihistamine in pediatric associated with oral
medications, which patients and solution include
reduce the action of adults. It is nausea, vomiting,
histamines following not diarrhea, abdominal
the release from mast immediate-act pain, constipation,
cells. Unlike ing, has no erythema,
corticosteroids that direct photosensitivity,
inhibit the late bronchodilato urticaria, and
response of r effects, and angioedema. In
antigen-induced thus does not addition, there are
asthmatic reactions, treat acute reports of nasal
cromolyn sodium asthma congestion, sneezing,
inhibits immediate attacks. nasal itching,
and late ● It is also nosebleeds,
reactions.[10][6] The available as rhinoconjunctivitis,
use of cromolyn an ophthalmic and headaches with
sodium has been solution for the use of cromolyn
associated with the sodium nasal spray.
improvement in symptomatic
flushing, headaches, treatment of Additional adverse
diarrhea, vomiting, certain effects reported with
nausea, urticaria, allergic eye the inhalation
abdominal pain, and conditions solution were throat
itching in patients such as vernal irritation and
with mastocytosis. conjunctivitis, hoarseness,
keratitis, and esophagitis, laryngeal
keratoconjunc and pharyngeal
tivitis. edema, drowsiness,
dizziness, bronchial
irritation, pulmonary
infiltrates, and cough.