A CASE STUDY OF BRONCHIAL ASTHMA IN ACUTE

EXACERBATION
CASE PRESENTED BY:
ACELOM, LILIJANE
AGANA, LOVELYN
FABROS, JANELLE FAYE
GACUSAN, LORNALYN
LIM, AMELEEN
MADAMBA, SHERYL MAE
MAGTUBO, ELIZABETH
MENDOZA, JOIE ANTONETTE
PANGILINAN, CHENNY JOY
RAGUDO, KATHLEEN

TABLE OF CONTENTS
CASE STUDY/CASE PRESS
OVERVIEW
DEMOGRAPHICS
HISTORY OF ILLNESSES
PAST MEDICAL + OB HISTORY
PRESENT
FAMILY
PHYSICAL ASSESSMENT
(HEAD TO TOE)
GORDONS
COURSE IN WARD
LABORATORY
ANATOMY AND PHYSIOLOGY
PATHOPHYSIOLOGY, BOOK
PATHOPHYSIOLOGY, PATIENT
DRUG STUDY
NCP
DISCHARGE PLANNING

OVERVIEW

Bronchial Asthma is a serious global health problem. According to data 5% to 10% of

persons of all ages are suffering from this chronic airway disorder.

The main cause of bronchial asthma is the exposure to various irritants and substances
that trigger allergies and can trigger signs and symptoms of asthma. Bronchial asthma is
a chronic inflammatory disease of airways characterized by bronchial hyperreactivity
and a variable degree of airway obstruction.

This disease affects the lungs and it’s chronic condition mainly doesn’t go away and
needs an ongoing medical management. It can be chronic or acute. The type of
bronchitis determines how long it will last. Acute bronchitis typically lasts between 10-
14 days.

This study presents the important considerations of diagnosis and treatment in view of
the ongoing study of the admitted patient.

Method used is the collecting of data on a selective patient being admitted with
bronchial asthma. It is diagnosed on the basis of the clinical history, physical
examination, and pulmonary function tests, including reversibility testing and
measurement of bronchial reactivity or laboratory tests.

The goal of treatment is to control the symptoms of the disease effectively, to become
acquainted with the various conditions that enter into the differential diagnosis of
bronchial asthma, and to be able to apply the types of treatment recommended for
patient.
Demographic data:
Name: Patient S
Age: 61
DOB: April 19, 1961
Sex: Male
Ward: General ward
Address: Ilang-ilang St., Baptista Village, Calao East, Santiago City
Contact Number: 09267691024
Occupation: Construction Worker
Marital status: Married
Date of admission: October 13, 2022
Allergic to: (-) allergy
Date of discharge: October 17, 2022

PAST MEDICAL

-Asthma and hypertension (admitted to SIMC last 2021)

PRESENT
History of present illness:
-One day Hx Cystic fibrosis cough, assisted within 16 hours.
-Shortness of breath prompted patient to be admitted to hospital

The patient is 61 years old that has been diagnosed with Bronchial asthma. Patient began to
experiencing symptoms a year ago. The patient rushes to admission because of shortness of
breath and cough. The date of admission is October 13, 2022 time 2:40 am.

According to the patient, he is working as a construction worker and is aware of having asthma
that trigger by the poor environment and seasonal weather. He is also taking Amlodipine
maintenance for his Hypertension.

FAMILY HISTORY
-His father died due to severe asthma
- (+) hypertension
 History of past illness:
-Asthma and hypertension (admitted to SIMC last 2021)
In year 2021, the patient admitted at SIMC and found out that his diagnosed of having a
Bronchial asthma. He is also taking Amlodipine 10mg tab once a Day in order to balance his
blood pressure.

Before, he is experiencing of difficulty in breathing, wheeze sounds and cough. And the history
behind his Family, His Father is also has asthma which is caused of his death.

PHYSICAL ASSESSMENT
(HEAD TO TOE)

AREA METHOD FINDINGS INTERPRETATIONS

Neck Inspection, Palpation Swollen lymph node in Normal
the neck noted, Thyroid
gland not tender and
not enlarge, Neck
muscles are equal in
size, Trachea is
positioned in the
midline upon palpation.
Chest and Lungs Auscultation Wheezing sound Abnormal
Heart Inspection, Auscultate The apical beat of the Normal
heart is heard over the
apex of the heart which
is located at fifth
intercostal space (point
of maximal impulse).

Breast and Axilla Auscultate, percussion, Breast size are equal, Normal
Palpation slightly rounded and
symmetrical. Nipples
are similar, small,
rounded and with a fair
brown color. Areoles
 are round and
bilaterally the same.
Axilla is smooth without
lesions. No enlarged is
tympanic in sound. No
masses or pain noted
upon palpation.

Nail Inspection Convex in curvature , Normal

rough with normal
capillary refill.

UPPER EXTREMITES Inspection Decorticate Normal

position ,arms are able
to abduct and adduct.

ABDOMEN Inspection, percussion, The abdomen is Normal

Palpation generally symmetrical
in configuration and has
normal growing sound
of 12. Upon percussion,
the abdomen is
tympanic in sound. No
masses or pain noted
upon palpation.

LOWER EXTREMITES Inspection Able to flex abduct and Normal

adduct.

GENETALIA Inspection Skin of the glands penis Normal

is smooth, no ulceration
,urethral meatus
located ventrally on the
end of the penis ,no
discharge and palpable
masses.
11 GORDONS

1.Health perception/management pattern

Before During
According to the patient he is not using The patient is using effective as nebuliser
nebuliser for the delivery of drugs used in bronchial
Asthma.

2.Nutrition and metabolic pattern

Before
According to the patient sometimes late in
eating because his work in construction
During
The patient nutritional management
bronchial Asthma by eating fruits and
vegetables but not regularly and not eating
appropriate but he is drinking more water
so that he is not totally suffered difficulty
breating.

3.Elimination pattern
Before During
Before 2x day urinate Urination 3x a day Light yellow, Turbid
Ph – Amorphous urates

4. Exercise Pattern
Before During
The patient said that the exercise his doing
is not totally everyday like if he attacked
the bronchial Asthma then he will do the
inhale and exhale exercise. According to the
patient working and walking his consider
that is a exercise for him.

5.Cognitive – Perceptual
Before During
The visual and hearing is normal .
Sometimes loss of appetite and Breathing is
not totally okay because sometimes he had
difficulty in breathing
VOCABULARY- Tagalog-Ilocano
Eye contact- Normal
Nervous rate is 3
Assertive 3
 Interaction with the family members
Family decisional conflict – Father

6. Sleep – Rest Pattern

Before During
Difficulty in sleeping .Sometimes he use
pillow to side to easier to breathe .

7.Self Perception – self concept Pattern

Before During
Hard working
Loving Father
Father perceives himself as an important
members his family.

8.Role – Relationship pattern

Before During
Marriage Marriage
Major problem –Financial , work ,Health Major problem- Financial, work , Health
Occupation-Contraction Occupation-Contraction
Neighbor – Nuclear Neighbor- Nuclear

9.Sexuality- Reproductive pattern

Before During
He is satisfy in sexuality and fulfilment of Not totally regular sex because of short of
sexual needs and perceive level of breath and tire
satisfaction

10. Copping – Stress Tolerance Pattern

Before During

11. Value
Before During
Religion- Catholic Religion- Catholic
Values that relate to Values that relate to
happiness ,wealth ,career success or family happiness ,wealth ,career success
or family
COURSE IN THE WARD

Patient S was admitted on October 13, 2022 at 7:15 am with a chief complaint of cough
and difficulty of breathing and was admitted to General Ward of Flores Memorial
Medical Center.

DATE/ TIME DOCTOR’S ORDER RATIONALE

October 13, 2022  admit patient to ROC For further monitoring,
under the service of Dr C management, and evaluation
2:40 am of the client’s condition.
 Secure consent for To have ethical
Temperature: 39 admission and considerations and also to
Respiratory Rate: 26 management protect patients’ freedom to
Blood Pressure: 140/100 make health care decisions.
 TPR q 6 hours and TPR stand for Temperature,
Weight: 58 kg record Pulse, and Respiration. To
Height: 167.6 cm obtain baseline data and
monitor condition of patient
until stable.
 Hypoallergic diet To monitor and properly
managed patient to avoid
nutritional deficiencies.
DIAGNOSTICS
CBC A Complete Blood Count
(CBC) is a blood test used to
evaluate overall health and
detect a wide range of
disorders, including anemia,
infection and leukemia.
Urinalysis A test of urine. It’s used to
detect and manage a wide
range of disorders, such as
urinary tract infections,
kidney disease and diabetes.
Na+ K+ It helps maintain resting
potential, affects transport,
and regulates cellular
volume.
BUN (Blood Urea Nitrogen) A type measurement of
Creatinine kidney function.
Chest X-Ray PA It is used to diagnose or test
 conditions like pneumonia,
emphysema or COPD
(Chronic Obstructive
Pulmonary Disease)
12L ECG A medical test that is
recorded using leads, or
nodes, attached to the body.
RAT Antigen tests are
immunoassays that detect
the presence of a specific
viral antigen, which indicates
current viral infection.
 IVF PNSS 1L X 16 hours To helps patients, manage
and treat dehydration,
metabolic alkalosis in the
presence of fluid loss and
mild sodium depletion.
 Hydrocortisone 100mol To calm down the patient’s
IV now then Q12 body immune response to
reduce pain, itching, and
swelling or inflammation.
 Nebulization of Salbutamol is used to relieve
Salbutamol + Iprat symptoms of asthma and
bromide 1 neb Q30 mins chronic obstructive
x 3 dose then Q6 pulmonary disease such as
coughing, wheezing, and
feeling breathless.
Iprat bromide is used to help
control the symptoms of lung
disease, such as asthma,
chronic bronchitis, and
emphysema.
 V/S Monitoring Measured and monitored to
obtain basic indicators of
patient’s health status.
 Watch out for untoward
ADENDUM
 Catapres 75mcg/tab SL This medication is used to
Now treat hypertension.
 Amlodipine 10mg/tab This medication is used to
OD PM treat high blood pressure.
 Hook patient to O2 This is to ensure that the
support at 2-3 LPM / NC patient receives an adequate

October 14, 2022  Start ceftriaxone 1g TIV
8:00 q 12 with NAST
 Seretide 250 mcg
 Start Aminophylline drip
500mg
 Shift to D5NM 1L x
16hours
October 14, 2022  Continue Aminophylline
8:25 drip then DC shift to
Doxofylline 400mg tab
OD
 Diazepam 10mg at HS
OD
 IVF D5NM 1L x 16hours
October 15,2022 MGH
8:07 HOME MEDS:
1. Seretide 25/250 Diskus
BID
oxygenation.
This medication is used to
treat bacterial infections in
many different parts of the
body.
This medication is used to
help with asthma and chronic
obstructive pulmonary
disease.
This medication is used to
treat the acute symptoms of
asthma, bronchitis,
emphysema, and other lung
diseases.
D5NM is indicated for
parental maintenance of
routine daily fluid and
electrolyte requirements
with minimal carbohydrate
calories from dextrose.
Aminophylline used to treat
the acute symptoms of
asthma, bronchitis,
emphysema, and other lung
diseases in a hospital setting.
Doxophylline medication is
used in the treatment and
prevention of chronic
obstructive pulmonary
disease.
This medication is used to
treat anxiety, alcohol
withdrawal and seizures.
D5NM is indicated for
parental maintenance of
routine daily fluid and
electrolyte requirements
with minimal carbohydrate
calories from dextrose.
This medication is used to
help with asthma and chronic
 obstructive pulmonary
disease.
2. Doxophylline 200mg OD This medication is used in the
x 7 days treatment and prevention of
chronic obstructive
pulmonary disease.
3. Amlodipine Provas PO This medication is used to
OD treat hypertension.
4. Levocetirizine + This combination of two
montelukast 25mg/tab medicine is a more effective
1tab OD strategy in the treatment of
persistent allergic rhinitis.
5. Exflem 600mg BID 2x a This medication is used for its
day mucolytic activity in
respiratory disorders
associated with productive
cough and thick viscous
hypersecretion.

Follow up on Wednesday at SMC 9am as OPD

Advise Home Care

LABORATORY AND DIAGNOSTICS

URINALYSIS
ROUTINE:
COLOR LIGHT YELLOW WBC 3-6/HPF
Transparency TURBIC RBC 8-10/HPF
Specific Gravity 1.030 Epithelial Cells RARE
pH 5.0 Amorphous Urates FEW
Protein +2 Amorphous Phosphates
Glucose NEGATIVE Mucus Threads MANY
Ketone Bacteria FEW
Casts HYALINE: 1-3/LPF Pregnancy Test
Crystals Urine Micral

Remarks: COARSE GRANULAR: 0-1/LPF

HEMATOLOGY
TEST RESULT REFERENCE DATA
 Hemoglobin 13.1 13.00 – 18.00 g/dL
 Hematocrit 38.2 40.00 – 55.00 %
 RBC Count 3.91 4.00 - 6.00
x10^6/uL
 WBC Count 8.7 5.00 – 10.00
x10^3/uL
 Platelet 108 150.00 – 400.00
x10^3/uL
 MCV 97.7 82.50 – 98.00 fL
 MCH 33.5 26.10 – 32.50 pg
 MCHC 34.3 30.70 – 35.90 g/dl
 Segmenters 78 50.00 – 65.00 %
 Lymphocyte 12 25.00 – 35.00 %
 Monocyte 07 3.00 – 7.00 %
 Eosinophils 03 1.00 – 3.00 %

MISCELLANEOUS

TEST RESULT REFERENCE RANGE

COVID ANTIGEN TEST NEGATIVE
(SCREENING)

CLINICAL CHEMISTRY
TEST RESULT REFERENCE RANGE
 BUN 21.93 17.00 – 43.00
mg/dL
 Oreatinine 119.34 80.00 – 115.00
umol/L
  Sodium 143.2 135.00 – 150.00
mmol/L
 Potassium 3.90 3.50 – 5.50
mmol/L

CHEST X-RAY PA OR AP (ADULT)

Result:

Examination: CHEST PA VIEW

Radiological Findings:

There are no active parenchymal infiltrates in both lungs.

The heart is not enlarged.
Pulmonary vascular markings are within normal limits.
Diaphragm and costophrenic sulci are intact.
Visualized osseous structures appear normal Impression:

Lung Anatomy and Physiology:

Bronchial Asthma
The Lungs constitute the largest organ in the respiratory system. They play an important role in
the respiration, or the process of providing the body with oxygen and releasing carbon dioxide.
The lungs expand and contract up to 20 times per minute taking in and disposing of those
gases.
Air that is breathe in is filled with oxygen and goes to the bronchus enters a lung. There are two
lungs, one on each side of the breastbone and protected by the ribs. Each lung is made up of
lobes, or sections. There are three lobes in the right lung and two lobes in the left one. The
lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch
out into minute pathways that go through the lung tissue. The pathways are called bronchioles,
and they end at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and
provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the
heart throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from
the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling
results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane,
or the pleura, that under normal circumstances has a very small amount of fluid between the
layers. The fluid allows the membranes to easily slide over each other during breathing.
Asthma is a chronic inflammatory disease of the airway. During an asthma attack, the
respiratory tract becomes narrowed. This may be a survival mechanism — a reduction in airflow
to limit lung injury from harmful airborne materials — that has gone awry in some individuals.
The transient feeling of not getting enough air into your lungs is not a comfortable feeling, and
that is with the airway maximally dilated and clear. Now consider the feeling and double the
discomfort and effort required to inhale and exhale. That’s roughly how an asthma attack feels.
And instead of rapidly diminishing with a couple minutes of recovery time, an asthma attack
can last from many minutes to several days, with the sufferer not knowing when it actually will
resolve.
The most common way to diagnose an asthma attack is to test how much air can be exhaled
through a measuring device. A flow meter or spirometer is used to assess how fast one can
exhale air over one prolonged breath. An average adult female will have a peak flow rate of 385
to 460 liters per minute. An adult male will have a rate somewhere around 485 to 670 liters per
minute.
Asthma induces airway constriction that, in many instances, is persistent, present even when
there is no perceived difficulty breathing. This means asthmatic flow rates must be based on
individual measurements, not on population norms. A 20-50% reduction in a person’s airflow is
considered an asthma attack, and a reduction greater than 50% is an emergency. 
The first consideration here is that the trachea, the biggest respiratory pipe in the human body
(usually about 2 centimeters or a bit under 1 inch in diameter), has a built-in limitation for how
significantly asthma can affect it. The trachea’s reduction in diameter is limited by its
cartilaginous scaffolding, which means the lumen cannot be occluded. When an attack begins,
the smooth muscle around the trachea contracts, but only the muscular walls between
cartilage rings will bow inward a bit and reduce the internal diameter of the lumen. Before an
attack the trachea looks relatively smooth. During an attack it looks more like the hose of a
vacuum cleaner.
The tubular divisions that branch from the trachea are where the major constrictive issues lie.
The bronchi, bronchioles, and respiratory bronchioles are tremendously more susceptible to
the effects of asthma.
During an asthma attack the diameters of the bronchi, bronchioles, and respiratory bronchioles
get smaller, reflecting roughly the same percentage of reduction noted in flow rate testing. The
effect of reducing diameter on the inside area of the lumen (inside of the tube) is profound:
Figure 1: Involuntary smooth muscle contraction drives bronchoconstriction. The more severe the
triggered effect, the more profound the diminution of the lumen area. From left to right: a normally
functioning bronchi, an affected bronchi at the onset of an asthma attack (20% reduction), and an
affected bronchi during a severe attack (50% reduction).

Figure 2: Uncontrolled mucus production within the smaller bronchiole branches leads to accumulation
and physical obstruction of smaller lumen.
The lungs are intimately intertwined with the heart and blood vessels in an elegant system of supply and
demand. As a key part of the respiratory system, the lungs help process a critical element of life and
exercise: oxygen. The circulatory system then helps distribute oxygen throughout the body.
The pulmonary veins deliver blood from the right ventricle of the heart to the lungs and return blood
from the lungs to the heart’s left atrium. We can’t see or touch them, but we certainly can feel them
when we are training hard.
Our lungs sit in the thoracic cavity, bounded in front, behind, to the sides, and on top by the axial
skeleton. They are bounded below by the diaphragm. As the diaphragm is attached to the contour of the
lowest ribs, the lungs can extend no lower.
 

 
Each lung is visibly divided into segments called lobes. Lobes are defined by indentations or
creases in the exterior surface of the lung. The left lung has two lobes, and the right lung has
three lobes. A lobe provides a structural enhancement that aids in lung expansion during
respiration and has a survival function. Damage or disease in one lobe does not necessarily
prevent function of other lobes.
The lungs are contained within a membranous bag called the pleural sac. The pleural sac is a
two-layered membrane, the outer layer of which is called the parietal pleura and the inner layer
of which is called the visceral pleura. A small amount of pleural fluid sits in the space between
the thoracic cavity wall and the parietal pleura. The primary job of the fluid is to reduce friction
between the wall and the pleura during breathing. Pleural fluid is also important as it provides a
degree of surface tension that keeps the lung surfaces in close proximity to the inner walls of
the chest cavity. Thus, when the chest cavity expands, so do the lungs. As each lung has its own
pleural membrane, they are somewhat independent of each other
The lungs have a space between them called the mediastinum. Within that space are the heart,
thymus, lymph nodes, esophagus, stored fat, and the trachea. The trachea is the only
atmospheric inlet into the lungs.

Diaphragmatic contraction and rib cage expansion increases lung volume, reduces intra-lung pressure,
and draws air into the lungs. Relaxation produces the opposite effects and expels air from the lungs.
From their location within the rib cage, the lungs are affected by many thoracic muscles, a few cervical
muscles, some abdominal muscles, and most importantly, the diaphragm.
When we inhale, the diaphragm contracts, pulling the floor of the thoracic cavity downward. By pushing
the underlying abdominal anatomy down and forward (lie down and watch your belly when you breathe
normally) and by virtue of the fluid seal provided by the pleura, a negative pressure, one lower than that
in the environment around you, is created. Gases will move from an area of high pressure to one of low
pressure, so air enters the lungs via the airway.
 History and physical
exam

Confirm the diagnosis

of asthma

Very severe
Mild to moderate severe

-speaks in incomplete
-can speak in complete sentences -confusion
sentences -pulse>120 beats/min -drowsiness
-pulse 100-120 -silent chest
-SpO2<90%
beats/min -use of accessory
-SpO2>90%

Transfer to the
emergency
department
-IVF PNSS 1L X 16 hours
-Hydrocortisone 100mol
IV now then Q12
-Nebulization of
Salbutamol + Iprat -SpO2,>94%
bromide 1 neb Q30 mins x -adequate support no
3 dose then system

discharge
yes
 PATHOPHYSIOLOGY

Environmental factors Genetic factor

-working area(construction site)

-his father has an asthma
-tobacco smoke

Bronchial Asthma

Initial assessment

Admitted to ward

Mild to moderate

cough Shortness of breath

Apply medication

After an hour,
Observe and re-
evaluate

Good response/stable

no

Admitted to ward

-IVF PNSS 1L X 16 hours

-Hydrocortisone 100mol IV now then Q12
-Nebulization of Salbutamol + Iprat
Improved/good response bromide 1 neb Q30 mins x 3 dose then
Q6

discharged
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Goal met
Subjective: -ineffective -after 4 days -Auscultate breath -To check for the -After 4 days of
“Nahihirapan airway of nursing sounds and assess presence of nursing
ako huminga” clearance intervention airway pattern adventitious intervention the
related to the patient breath sound patient was able
Objective: asthma as a will Monitor V/S to demonstrate
-shortness of manifested demonstrate -Changes in the behaviors to
breath by difficulty behaviors to vital sign will improved airway
-wheezing of improve show the client clearance
sound breathing airway - keep environment progress -Demonstrate
- crackles clearance free of allergen, -To prevent behaviours of
sound such as dust, smoke, irritation of improved airway
- tachypnea powder bronchial walls clearance
- tachycardia -Administer oxygen
as ordered -To increase
oxygen of the
patient

NCP
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: -sleeping - following a 1 -Assess sleep -High -After a 1 days of

”hindi ako disturbance day of nursing pattern percentage of nursing
makatulog intervention the disturbances that sleep intervention the
kagabi kase patient will are associated disturbances patient was able
nahihirapan achieve optimal with can affect the to display
akong amount of sleep environment. recovery of the improvement in
huminga”as as evidenced by: patient. sleeping pattern
4verbalized by -Observe and -To determine as evidenced by:
the patient. Objective obtain feedbacks usual sleeping -The patient
-verbalized of regarding on the pattern and to verbalized:
Objective: feeling rested usual sleeping compare if Medyo nakatulog
Presence of pattern ,bedtime there are any na ako ng maayos
eyebags -decreased the routine and the improvements kumpara dati
presence of eye usual number of on the sleeping -The patient does
Weakness bag hours of sleep pattern of the not look weak
Restleeness and rest. patient. and restlessness
-To avoid compare to the
-Do as much care disturbances past
as possible during sleep, -The presence of
without waking and also to eye bags have
up the client and maximize the been minimized
do as much care sleep and rest of or have gone
as possible while the client
the client is still
awake.
ASSESSMEN DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
T
SUBJECTIVE: Deficient After the -Assess the Knowledge of Goal partially
“Hindi ko po knowledge nursing client’s how to handle met as
alam related to intervention knowledge of care can save evidenced by
gagawin ko lack of the patient care for status time response of the
pag inaatake information will verbalize asthmaticus as patient to
ako ng and understandin appropriate learning plan
asthma” as education g of condition -Assess the and actions
verbalized by about disease client’s -Identifying performed
patient asthma as process and knowledge of the asthma
evidenced by treatment asthma triggers will
frequent triggers and make the
OBJECTIVE: questioning asthma client know
Inaccurate medication how to control
follow- -Instruct the them
through of client how to
instruction or avoid asthma -
performance triggers Environmental
on test or trigger control
procedures can lessen the
frequency of
asthma
attacks.
 DRUG STUDY

DOSAGE/ MECHANIS ADVERSE NURSING

NAME OF DRUG FREQUENC M OF INDICATION CONTRAINDICATION EFFECT RESPONSIBILITIES
Y/TIMING ACTION
DOSAGE;
BRAND NAME: 1 tab Inhibition of Bronchial Contraindicated in Nausea, -Monitor sign of
Ansimar phosphodies Asthma and individuals who have vomiting, hypersensitivity
FREQUENC terase pulmonary shown epigastric reaction or
GENERIC NAME: Y activity thus disease w/ hypersensitivity pain, anaphylaxis,
Doxofylline BID increasing spastic component Acute cephalgia, including pulmonary
the level of bronchial myocardial irritability, symptoms or skin
DRUG TIMING CAMP and component infraction, insomia, reactions.
CLASSIFICATION: 8AM -6PM promoting hypotension ,arrhyth tachycardia - Notify physician or
Antiasthmatic & smooth mia duodenal tachypnea, nursing staff
COPP preperation muscle ulcer,epilepsy hyperglyce immediately if these
relaxations mia, reaction occur
albumumin
uria
 DOSAGE/ MECHANISM ADVERSE NURSING
NAME OF DRUG FREQUENCY OF ACTION INDICATION CONTRAINDICATIO EFFECT RESPONSIBILITIES
/TIMING N
DOSAGE
BRAND NAME: 1 tab Inhibits Alone or w/ Contraindicated in Hightheaded -Monitor patient
Provasc calcium ion other agents patient w/ known ness,swelling BP very carefully if
FREQUENCY influx across in the hypersensitivity to ankles/feet patient is also on
GENERIC NAME: OD cell management amlodipine or its or flushing nitrates.
Amlodipine membrane, of dosage form may occur - Monitor rhythm
TIMING with a greater hypertension componentsss regularly during
DRUG 8AM effect on angina stabilization of
CLASSIFICATION vascular pectoris, and dosage and
: smooth vasospastic periodically during
Calcium channel muscle cell angina long term therapy
blockers

DOSAGE/
NAME OF FREQUENCY/ MECHANIS ADVERSE NURSING
DRUG TIMING M OF INDICATION CONTRAINDICATION EFFECT RESPONSIBILITIES
ACTION
DOSAGE
BRAND NAME: 1 activation Respiratory Indicated for Contraindicated in Effect on -Assess patient’s
Seretide Inhalant the regular patient with a heart, serious repiratory
FREQUENCY combos treatment of history of allergic condition before
GENERIC BID chronic hypersensitivity to reaction, starting therapy
NAME: obstructive drug or any of its effect on
Diskus TIMING pulmonary components nervous -Be alert for the
7AM-7PM disease system, adverse reactions
DRUG including upper and drug reactions
CLASSIFICATION chronic respiratory
Respiratory bronchitis and tract
Inhalant emphysema. infection,
combos SERETIDE is for throat
inhalation only irritation,
nausea
vomiting, and
headache
 DOSAGE/
FREQUENCY MECHANIS ADVERSE NURSING
NAME OF DRUG / M OF INDICATION CONTRAINDICATIO EFFECT RESPONSIBILITIE
TIMING ACTIONS N S
GENERIC NAME: DOSAGE: Mucolytic For the Contraindicated Headache,
Exflem 1 Tab that reduces treatment of with flusing, nausea, Caution patient
dissolved the viscosity respiratory hypersensitivity to vomiting, fever, not to chew or
DRUG of conditions any x anthine or to syncope, crush enteric-
CLASSIFICATION FREQUENCY: pulmonary characterize ethylenediamine, drowsiness,ches coated timed-
: BID secretions by thick and peptic ulcer, active t tightness, release forms
by splitting viscous gastric disturbance of Monitor results
TIMING: disulphide hypersecretio liver function, of serum
8AM-6PM linkages n such as bronchocons theophylline
between acute triction, levels carefully,
mucoprotein bronchitis, irritation to the and arranged for
molecular chronic trachea reduced dosage if
complexes bronchitis and serum levels
its exceed
exacerbation, therapeutic
pulmonary range of 10-20
emphysema, mcg/mL
cystic fibrosis
and
bronchiectas
 DOSAGE/ MECHANISM INDICATION CONTRA ADVERESE NURSING
NAME OF DRUG FREQUENCY/ OF ACTION INDICATION EFFECT RESPONSIBILITIES
TIMING
GENERIC NAME: Dosage: Relaxes Symptomatic Contraindicated Irritability, Caution patient
AMINOPHYLLINE 500mg bronchial relief or with restlessness, not to chew or
smooth prevention of hypersensitivity dizziness, crush enteric-
muscle, bronchial to any x anthine muscle coated timed-
causing asthma and or to twitching release forms
DRUG bronchodilator reversible ethylenediamine, seiruze, severe Monitor results of
CLASSIFICATION: and increasing bronchospas peptic ulcer, depression, serum
BRONCHODILATOR vital capacity, m associated active gastric stammering theophylline
which has been with chronic speech levels carefully,
impaired by bronchitis and and arranged for
bronchospasm emphysema reduced dosage if
and air serum levels
trapping in exceed
higher therapeutic range
concentrations, of 10-20 mcg/mL
it also inhibits
the release of
slow reacting
substances of
anaphylaxis
and histamine.

NAME OF DRUG DOSAGE/ MECHANISM INDICATION CONTRA ADVERESE NURSING

FREQUENCY OF ACTION INDICATION EFFECT RESPONSIBILITIES
/ TIMING
GENERIC NAME: Dosage: Suppresses Adjunct in Hypersensitivity Hypotension/ Monitor BP, PR, RR,
Diazepam 10 mg the spread the reflex prior to periodically
of seizure management tachycardia throughout therapy.
DRUG Frequency: activity of seizures
CLASSIFICATION: HS OD through the
Anticonvulsant, motor cortex
Sedative, Skeletal of the brain
Muscle relaxants

DOSAGE/
FREQUENCY/ MECHANISM CONTRA ADVERSE NURSING
NAME OF DRUG TIMING OF ACTION INDICATION INDICATION EFFECT RESPONSIBILITIES
GENERIC NAME Dosage: Inhibiting the Susceptible Hyperbilirubinemic Chest pain, Monitor sign of
Ceftriaxone 1g mucopeptide bacterial or premature cough, fever, allergic reactions
synthesis in infections of neonates. shortness of including
Frequency: the bacterial the lower Concomitant breath, sore pulmonary
Q12 cell wall respiratory calcium containing throat, painful or symptoms( tightn
DRUG tract, skin IV solution or difficult ess in the throat
CLASSIFICATION Route: structure, products in urination, and chest,
Cephalosporin TIV bone and neonates. diarrhea, rashes, wheezing, cough)
antibiotics joint, acute Ceftriaxone urticaria or skin reactions
otitis media, containing Monitor injection
lidocaine for IV site for pain,
administration swelling and
irritation.

DOSAGE/
FREQUENCY/ MECHANISM CONTRA NURSING
NAME OF DRUG TIMING OF ACTION INDICATION INDICATION ADVERSE EFFECT RESPONSIBILITIES
GENERIC NAME Dosage: Reduced Management Local skin Hypotension, Monitor blood
CATAPRES 75mcg/tab symphathetic of all grades of irritation, allergic bradycardia pressure and
outflow from hypertension contact Rebound pulse rate
Frequency: the central dermatitis hypertension if frequency
nervous hypopigament of stopped abruptly Dosage is usually
system and in the skin adjusted to
DRUG Route: decreases in patient BP and
CLASSIFICATION Sublingual peripheral tolerance
Alpha2 resistance,
Agonists, renal vascular
Central-Acting resistance,
heart rate, and
blood pressure
 DOSAGE/
NAME OF FREQUENCY/ MECHANISM CONTRA ADVERSE NURSING
DRUGS TIMING OF ACTION INDICATION INDICATION EFFECT RESPONSIBILITIES
GENERIC NAME Dosage: Relaxes the Use in the Contraindicated in Muscle pain or Observe 10 right in
Nebulizer 3 dose smooth route patient weakness, giving medication
Salbutamol muscles of all management hypersensitive to muscle cramps, Monitor RR,
Frequency: airways from of chronic drug or its or a heartbeat oxygen saturation,
Q30 minutes the trachea to bronchospas ingredients that does not and lungs sound
DRUG then Q6 the terminal m feel normal before and after
CLASSIFICATION bronchioles unresponsive administrationf
Bronchodilators to condition o
conventional
therapy and
the treatment
of acute
bronchial
asthma

DISCHARGE PATIENT
Patient Name: Patient S
Age : 61
Sex: Male
Admitted: October 13, 2022
Diagnosis: Bronchial Asthma Acute Exacerbation
A. Objectives
1. Understand The disease process/prognosis and therapeutic regimen to promote proper
knowledge of long – term management
2. Promote self-care and family members engagement to client treatment
3. Modify lifestyle patterns to prevent or minimize complications
4. Strengthen coping mechanism based upon client belief and values
B. Home Management
1. Medication
Name of drug Dosage and Route Curative Effects Side effects
frequency

Amlodipine 1 Tab OD Lower blood Excessive tiredness

pressure Nausea
Headache
Feeling dizzy
Exflem 600mg BID Mucolytic activity Vomiting,fever,chills
1tab respiratory Bronchial tracts
disorders with Convultions
productive cough
and thick viscous
hyper secretion
Seretide 25mg/200 BID Help with asthma Soreness in mouth
Tab and chronic Throat or tongue
obstructive Increase in heart
pulmonary rate
disease pneumonia
Doxophylline 200mg BID Prevent and treat Dyspepsia or hearth
1tab wheezing, burn
shortness of Insomnia
breath Fast heart rate
Livocetirizine 25mg tab QD Treatment of Skin rush
+montelukast tab allergic rhinitis Vomiting
Dry mouth
Headache
diarrhoea

METHODS RATIONALE

Medication This will the patient from taking their medication

Correctly at the right time and in the right way as at prescribed specific time
prescribed

Present way such as utilization of alarms to Organizing medication taken help the patient
prevent skipping or extra intake of medications remember .

Leave yourself notes to help remember . Post it

notes on your bathroom mirror or door .

Keep calendar to write down doses

Education
Explain to the patient the bronchial asthma.
Advice drink enough water.
Don’t forget to wear a mask while cleaning
Hygiene
Encourage to maintain good hygiene .
Out patient
Encourage to visit the doctors at the given time
Follow check up
1 week Wednesday 9:00 am
Diet
Hydroallergic
Eat to maintain a healthy weight
Spiritual care Encourage patient to have faith and
pray to god
Encourage patient to have faith and pray to god
Perform a comprehensive assessment of pain.
Determine the location, Characteristics ,onset
duration, frequency, quality.
These will help their knowledge about there
condition and to avoid inhaling dust and stay away
from someone who smokes. To not have difficulty
breathing.
To promote good hygiene give comfort in
breathing and to be presentable
To determine the effectiveness of the medications.
For health status monitoring
Patient suffering from moderate or severe forms
of a topic dermatitis.
It is recommended that this diet be used in the
diagnostic workup of food allergy
TO determine what findings to patient like in
difficulty of breathing