Andres Bonifacio College

School of Nursing
College Park, Dipolog City

Case Presentation on Bronchial Asthma

Submitted by:
Mutia, Sherica Mae E. Submitted to:
Realista, Judie Lyn E. Mrs. Jowillene Pearl J. Tabanao
RN,MN
Reyes, Joshua A.
CLINICAL INSTRUCTOR
BSN-II
 Andres Bonifacio College
Institutional Vision:
ANDRES
A center of excellence BONIFACIO
in instruction, COLLEGE
research, technology, extension, athletics, and the arts.

Institutional Mission:
We commit to provide affordable quality education with values in industry, intelligence, integrity, and undertake relevant
research and socially responsive community service using innovative technologies.

School of Nursing

Mission:
INSTITUTIONAL VISION AND MISSION

The School of Nursing shall generate competent, safe, and compassionate professional nurses committed to:
VISION:
A center of excellence in instruction, research, technology, extension, athletics and arts.
a. Practice high standards of nursing care utilizing research and evidence-based practices that are culturally appropriate and
MISSION:
sensitive.
We commit to provide affordable quality education with values in industry, intelligence, integrity and undertake relevant research and
socially-responsive community service using innovative technologies.
b. Be actively involved in local, national, global issues affecting nursing, people’s health and environment.
School of Nursing Mission
School of Nursing Vision
c. Ongoing holistic growth and development of the self and others.
Excellent Nursing Education
 The School of Nursing shall generate, competent, safe and compassionate professional nurses committed to:

a. Practice high standards of nursing care utilizing research and evidence-based practices that are culturally appropriate and sensitive.
b. Active involvement in local, national and global issues affecting nursing, people’s health and the environment.
c. Ongoing holistic growth and development of the selfTABLE
and others.
OF CONTENTS
Learning Objectives 1

Introduction 2

• Signs and Symptoms

3

Patient’s Profile
4

Physical Assessment
5

Anatomy and Physiology

6

Physiology of Asthma
8

Gordon’s Functional Health Patterns

9
Growth and Development
14

Laboratory Results 15

Pathophysiology 20

Nursing Care Plan #1 Ineffective Breathing Pattern 22

Nursing Care Plan #2 Ineffective Airway Clearance 24

Nursing Care Plan #3 Activity Intolerance 26

Drug Study 28

Overall, Health Teaching

34

Related Articles
35
LEARNING OBJECTIVES

General Objectives:

At the end of the entire Case Presentation, the Learners shall gain more understanding, improve their knowledge, enhance their independent and dependent

skills, and embodies a desirable attitude that provides a holistic care to patients with bronchial asthma.

Specific Objectives:

Within 1 hour, the listeners will be able to:

1. Identify what is bronchial asthma.

2. Enumerate the manifestations and risk factors of the disease appropriately.

3. Review the Anatomy and Physiology of the Respiratory System.

4. Discuss the Disease Process and its Pathophysiology.

5. Explain the Nursing Care Plan, Drug Study, and teaching points related to pediatric patients with bronchial asthma.

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INTRODUCTION

Bronchial asthma is a medical condition that causes the lungs' airways to constrict and
swell. The airway produces excess mucus as a result of the swelling, making it difficult to
breathe, resulting in coughing, shortness of breath, and wheezing.

The condition is chronic and makes it extremely difficult to work on a daily basis. It is
treatable, and inhalers can help overcome attacks. Bronchial Asthma can impact people of any
age or gender, and it is largely determined by environmental and inherited factors. Disease
becomes lethal if it is untreated, claiming lives in many cases.

CAUSES

Although the root cause of bronchial asthma is unclear, it occurs largely due to environmental or genetic
factors. The factors that trigger an asthma reaction are:

 Exposure to substances such as pollen, dust, animal fur, sand, and bacteria, which triggers allergic reactions.

 Viral Infection like cold and flu, or pneumonia.

 Air Pollution, smoke, fumes from vehicles, etc.

 Stress and anxiety.

 Physical activity or exercise induced asthma.

 Medications like aspirin, Ibuprofen, beta-blockers, etc.

 Perfumes and fragrances.

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  Weather, especially extreme changes in temperature.

 Food additives (such as MSG).

SIGNS AND SYMPTOMS

Symptoms differ from person to person and are influenced by environmental factors. A person may exhibit regular disease symptoms or periodic symptoms
that appear at a specific time.
The following are the most common asthma symptoms that can aid in diagnosis:
 Breathlessness or short breath while talking, laughing, or running.
 Chest Pain or tightness.
 Sleep apnea or trouble while sleeping caused by breathlessness.
 Coughing or wheezing (whistling sound from chest while sleeping or lying down).
 Cold and flu due to viral infection.

RISKS FACTORS
 Family history (parent or sibling) of bronchial asthma.
 Susceptive to an allergic reaction such as atopic dermatitis or hay fever.
 Habits which make you overweight.
 Smoking, or passive smoking.
 Exposure to chemical fumes or pollution, and irritants from hair sprays or perfumes.

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 PATIENT’S PROFILE
Name: Josef Patangan Antiquina Age: 7 yrs. Old Gender: Male Civil Status: Child
Mother: Josefa Patangan Antiquina
Father: Joseph Gomez Antiquina
Address: Polanco, Zamboanga Del Norte
Date of Birth: February 7, 2015 Nationality: Filipino
Physician: Dr. Natalia S. Gurdiel
Chief Complaint: Cough with Troubled Breathing and accompanied by runny nose.
Final Diagnosis: Bronchial Asthma
Allergies: Peanut Butter
Family History: Asthma
Weight: 21kg
Vital Signs
RR: 8:00 AM: 40 cpm 12:00: 17 cpm PR: 8:00 AM: 120 bpm 12:00 PM: 75 bpm
T: 8:00 AM: 37.1°C 12:00PM: 37.7°C BP: 8:00 AM 100/70 mmHg 12:00 PM 120/80
mmHg
HISTORY OF PRESENT ILLNESS
Mr. Josef Antiquina, A 7-year-old male with past medical history of asthma since infancy and multiple prior hospitalizations presented a cough
and trouble breathing which began 2 hours ago accompanied by a runny nose. His mother has been treating him with albuterol by a nebulizer, but he
has progressively become shorter of breath. Patient appears to be in moderate respiratory distress, with suprasternal and intercostal retractions. Lung
exam is notable for diffuse inspiratory and expiratory bilateral wheezing, poor air movement and prolonged expiratory phase.

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 PHYSICAL ASSESSMENT

System Findings

Skin Pale and moist with perspiration with a poor skin turgor. No sign of rashes, lesions and ulcers.

HEENT Head is cephalic in shape no hair loss, no trauma present, conjunctiva is slightly reddish in color, runny nose is noted,
and ears not occluded with no discharge.

Respiratory Exhibits nasal flaring, cough, trouble breathing, with shortness of breath. Appears to be in moderate respiratory
distress, with suprasternal and intercostal retractions. Inspiratory and expiratory wheezing with poor air movement
and prolonged expiratory phase is manifested.

Cardiovascular Heart rate is irregular and fast, with normal heart sounds upon auscultation.

Gastrointestinal Nausea and vomiting not manifested.

Genitourinary Decreased urine output, polyuria, dysuria, hematuria, and UTI not observed.

Neurologic Stuttering is manifested. Does not complain of dizziness, no headaches, and no history of neurological conditions.

Psychological Anxiety, depression, and other psychological disorders are not observed.

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ANATOMY & PHYSIOLOGY
The respiratory system has many functions. Besides helping you inhale (breathe in) and exhale
(breathe out), it:
 Allows you to talk and to smell.
 Warms air to match your body temperature and moisturizes it to the humidity level your
body needs.
 Delivers oxygen to the cells in your body.
 Removes waste gases, including carbon dioxide, from the body when you exhale.
 Protects your airways from harmful substances and irritants.
The upper respiratory tract is made up of the:
 Nose – the beginning of the respiratory tract. It warms and moistens the nasal cavity and
filters fine particles.
 Sinuses: Hollow areas between the bones in your head that help regulate the temperature
and humidity of the air you inhale.
 Pharynx (throat): Tube that delivers air from your mouth and nose to the trachea
(windpipe).
 Larynx (voice box): Hollow organ that allows you to talk and make sounds when air moves in and out.

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  Trachea – tube-like structure responsible for transporting air for respiration from the larynx to the bronchi
The lower respiratory tract is made up of the:
 Bronchi - Tube at the bottom of your windpipe that connect into each lung.
 Lungs – are a pair of spongy, air-filled organs whose main function is the process of gas exchange called respiration.  
 Bronchioles: Small branches of the bronchial tubes that lead to the alveoli.
 Air sacs (alveoli) - Tiny air sacs in the lungs where the exchange of oxygen and carbon dioxide takes place.
Air comes into your body 
Air first enters your body through your nose or mouth, which moistens and warms the air since
cold, dry air can irritate your lungs. The air then travels past your voice box and down your
windpipe. Rings of tough tissue, called cartilage, acts as a support to keep the bronchial tubes
open. 
Inside your lungs, the bronchial tubes branch into thousands of thinner tubes called bronchioles.
The bronchioles end in clusters of tiny air sacs called alveoli. 
Air fills your lung’s air sacs 
Your lungs have about 150 million alveoli. Normally, your alveoli are elastic, meaning that their
size and shape can change easily. Alveoli are able to easily expand and contract because their
insides are coated with a substance called surfactant. Surfactant reduces the work it takes to
breathe by helping the lungs inflate more easily when you breathe in. It also prevents the lungs
from collapsing when you breathe out. 
Each of these alveoli is made up of a mesh of tiny blood vessels called capillaries. The capillaries
connect to a network of arteries and veins that move blood through your body. 
Blood low in oxygen flows through the lungs 
The pulmonary artery and its branches deliver blood to the capillaries that surround the alveoli. This blood is rich in carbon dioxide and low in oxygen. 

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 Oxygen flows into your blood 
Carbon dioxide moves from the blood into the air inside the alveoli. At the same time, oxygen moves from the air into the blood in the capillaries.

PHYSIOLOGY OF BRONCHIAL ASTHMA

The lungs are two large, soft organs of sponge-like consistency located within the chest. 
The lungs surround the heart except for just behind the breastbone (sternum).  The ribs,
attached to the upper backbone (vertebrae) and to the breastbone by cartilage, form a firm but
flexible “cage” for the chest contents.  The chest cage changes in size and shape during
inhalation (breathing in) and exhalation (breathing out).
The lungs and other contents of the chest are separated from the contents of the abdomen
by a strong dome-shaped muscle, the diaphragm.  The diaphragm moves down when you
breathe in and moves up when you breathe out.  During normal breathing, the lungs also
change shape, expanding as you breathe in and contracting as you breathe out.
The main function of the lungs is to supply adequate oxygen to the blood and to remove
carbon dioxide from the blood.  The proper exchange of these gases between outside air and
the air in the depths of the lungs depends on clear (unobstructed) air passages.  Air enters the
body through the nose and mouth and travels down the windpipe (trachea) into the smaller
airways (bronchi and bronchioles).  The smallest airways are microscopic in size and end in
clusters of tiny air sacs called alveoli.  Each is surrounded by a network of very fine blood
vessels called capillaries.  The walls of these capillaries and those of the air sacs are thin
which permits the passage of gases between the airway system and the blood.  During

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 inhalation (breathing in) the lungs fill with air containing oxygen which can then enrich the blood.  During exhalation (breathing out), carbon dioxide
which has been removed from the blood is expelled by the lungs.  When excessive mucous or secretions or inflammation of the airways causes swelling
and tightening of the smooth muscle around the airways, air flow is restricted and the normal functions of the lung are affected and breathing becomes
more difficult.

GORDON’S FUNCTIONAL HEALTH PATTERN

Patient’s name: Josef Antiquina Gender: Male Age: 7

USUAL PATTERN INITIAL PATTERN
(7: 00 AM – 3:00 PM)
Health Perception and Health Management Pattern

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  The mother says,” Akong anak sigi jud nag ingon nga importante jud kayo ang VITAL SIGNS
04/11/2022 8 AM 12 PM
maayong panglawas aron mabuhi pa siyang dugay—naglisod mn gud siya sa
7:00 AM
iyang sitwasyon ma’am nga nay hubak maong naa gyuy importansya niya ang 3:00 PM
T 37.1° C 37.7°C
health maskin pito (7) pa sya ka-tuig.
 Completely immunized (seven target diseases); Unvaccinated with COVID – 19 HR 120 bpm 75 bpm
vaccine. BP 100/70 mmHg 120/80 mmHg
 Food allergy: Allergic with peanut butter
RR 40 cpm 17 cpm
 Never had a surgery.
 The mother verbalizes, “Ag bata pa sya, gi examine sya agi atong hubak sad
 Patient is currently using salbutamol + ipratropium and hydrocortisone to treat
niya.”
his asthma as prescribed by the physician.
The mother verbalizes, ” Yes. Ang tambal nga gigamit kay Albuterol by a
nebulizer para sa hubak—para makaginhawa s’yag tarong.”
04/11/2022 9:30 AM
 The mother says, “ Okay rajud unta ang general health niya kung wala’y hubak 7:00 AM - 3:00 PM
SaO2 94%
—luoy kaayo ang bata ron ma’am pero asker (active) raman jud unta ning bataa
ma’am… sa hubak ra nabikil.”
 The mother says, “ Gisip-on sya ron ma’am pero wala ra ni absent.”

Nutrition and Metabolism Pattern

 The mother verbalizes, “ Kasagaran na pamahaw namo kay sunny-side-up na itlog
dayon mga dahon-dahon gulay na gi adobo ma’am. Ang paniudto kay tinolang isda,
usahay manok dayon panihapon namo kay usahay pritong isda dayon mga gulay rasad
ma’am nga usahay ginisa or tinola—gabii kay tinola man to among panihapon maam.”
• The mother verbalizes, ― Kusog ra baya jud unta mukaon ning bataa ma’am…
pero sukad atong gihubak na sya, maglisod na syag tulon kay galisod na baya siya’g
ginhawa… pamahaw, paniudto ug panihapon niya ma’am kay gulay rajud nga naay
sinabawang manok para mauli-an sya dali.
• The child tries to eat the food being served to him including vegetables.

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 The child is restricted to eat peanut butter and other food containing peanut as it may
trigger his asthma.
 No food restriction regarding religious point of view.
 The child eats the food being served to him including vegetables.
 The child drinks 8-12 glasses of water every day.
Elimination Pattern
 The child usually have light yellow urine and void 6-7 times a day
Activity and Exercise Pattern
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• The mother verbalizes, ―Ganiwang baya nang bataa ma’am kay agi anang sigi
na syag hubakon ron.
• No food restriction regarding religious point of view.
• The mother says, ―Medyo nangluspad najud ang bata ma’am pati iyang kuko.
• The mother verbalizes, ―Dali raman unta ni s’ya maulian ug naay bati-bation
ma’am, karon rajud ni sya na in ani nga nisamot iyang hubak.
• The child drinks 8-12 glasses of water every day.
 No difficulty in voiding.
 The mother verbalizes, ―Yellowish jud ang color sa iyang ihi ma’am dayon
gamay rasad kay di naman kayo sya mo inom ug tubig gud… gahapon kay
kalima ra sya nangihi.
 Voids 2 times every morning, voids 1 time in the afternoon and 1-2 time/s at
night.
 Patient drinks more water.

 The child experiences tachycardia during exercise.
 The child feels pale during exercise and experiences tachypnea.
 The child experiences tachycardia when he is playing too much at the playground and
when he runs.
 The mother verbalizes, “Taas man jud unta na siya ug energy ma’am ug mag dula pero
trigger lang gyud dayon iyang asthma maong maluyahan.”
 The patient is experiencing non-productive cough tachycardia and tachypnea
without doing any exercises.
 The mother verbalizes, ―Taas man jud unta na siya ug energy ma’am ug
mag dula pero trigger lang gyud dayon iyang asthma maong maluyahan.
 The patient is having a hard time doing activities

Perceived ability for the following (code level according to Functional Levels Code below)
Feeding- III Perceived ability for the following (code level according to Functional Levels Code
Bed mobility- 0 below).
Grooming- III Feeding- IV
Bathing- 0 Bed mobility- IV
Dressing- 0 Grooming- IV
General mobility- 0 Bathing- IV
Toileting- 0 Dressing- IV
General mobility- III

Cognition and Perception Pattern

 The child knows where he is, however, he doesn’t know the time.  The child has difficulty in making a sentence: stutter.
 No loss of memory.

Sleep and Rest Pattern

 The child usually sleep at 8:00 PM during night and wake up at 6:40 AM; at the afternoon  The child cannot sleep regularly due to asthma attack. He tries to sleep
between 1:00 PM to 2:00 PM, the child will sleep and wake up at 3:30 PM. anytime of the day and night, but the patient is distracted by his asthma

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 After sleeping, the child feels energetic and fresh. attack.
 The child sleeps normally without using any medication.  The child sleeps normally without using any medication.

 The child does not have exercise at night time.  The child needs bronchodilator to help relax the muscle of his airway and
 The child feels ready for daily activities after sleep. widen the airways.

 The child sleeps on time at the afternoon and during night time.  The child is encouraged to practice breathing exercises at nighttime.

 The patient feels tired every time.

 The child cannot sleep on time.

Self-Perception and Self-Concept Pattern

 The mother says, “Para niya [child] ma’am kay strong jud s’ya ma’am.”
 The child wants to grow bigger and taller.
 The child is neat and clean and observes proper grooming.
 The child feels good about himself most of the time except when he experiences asthma
attack.
 The child feels problematic with his illness as it limits his activeness.
 The child feels angry when some of his friends will laugh during his asthma attack.
 The child is hopeful that his illness will be healed.
 The patient sees himself as weak.
 The patient cannot maintain neatness and proper grooming.
 The child feels good about himself most of the time except when he
experiences asthma attack.
 The child feels problematic with his illness as it limits his activeness
 The child is hopeful that his illness will be healed.

Roles and Relationships Pattern

 All the family members are cooperative and giving most of their attention to the child.

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 The child lives with his family.  All the family members are cooperative and giving most of their attention to
 No problems in the family affecting child’s condition. the child.
 The child’s parents handle every problem by consulting each other without shouting in
order for the child to remain calm.
 The patient’s parents are problematic and worried.
 The family is worried by the child’s condition.
 The child has a lot of friends.
 The child is worried of losing friends.
 The child is a competent student and an achiever.
 The child is friendly, and all his neighbors are his friends.  The family is worried by the child’s condition.

Sexuality and Reproduction Pattern

 The child is not sexually active; does not have a problem with his reproductive system. The child is not sexually active; does not have a problem with his reproductive
system.

Coping and Stress Tolerance Pattern

 The child’s coping mechanism towards stress is eating ice cream, playing with friends and
hugging his mother.
 The child doesn’t want to cry because he thinks that it shows weakness; he doesn’t want  The patient cries because of his condition.
anger and violence because he perceives it as “bad”.  The child’s coping mechanism hugging his mother.
 The child is tensed most of the time because he needs to be more particular with the food  The child consults his mother when he has a problem to calm him.
he eats and the activities he do; he gets alarmed when he eats an unfamiliar dish and when he
plays too much.
 The child consults his mother when he has a problem to calm him.
 The child’s way of handling his problems is effective.

Values and Belief Pattern

 The child is Roman Catholic.  The child is Roman Catholic.

 The child prays before and after sleep and before he eats his meal.
 The child is an achiever in school, and he wants to be an astronaut someday.  The child prays before and after sleep and before he eats his meal.

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  The child is an achiever in school, and he wants to be an astronaut someday.

GROWTH AND DEVELOPMENT

School -age child development is a range from 6-12 years of age. During this time period, observable differences in weight, height, and build of children may
be prominent. The language skills of children continue to grow, and many behavior changes occur as they try to find their place among peers.

Slow but steady, gains weight of about 2-3kg per year; Height- 5 cm per year; Bone ossification continues, most
primary teeth are lost, and permanent teeth erupts, muscle mass increases making them stronger.
PHYSICAL
Are becoming more coordinated in activities that use the large muscles, such as swimming and climbing. Use safety
scissors easily, use a pencil to write their name, dressing and toileting independently, drawing detailed pictures with
MOTOR/SENSORYADAPTATION
recognizable objects, and cutting neatly around shapes.
Concrete Operational Stage in Piaget’s Stages of Cognitive development. Concepts attached to concrete situations.
Time, space, and quantity are understood and can be applied, but not as independent concepts. Able to see the
COGNITIVE
perspective of others. Can use simple logic, and can comprehend past, present, and future.
Industry vs. Inferiority in Erik Erikson’s stages of psychosocial development. Children begin to develop a sense of
pride in their accomplishments and abilities. Children need to cope with new social and academic demands. Success
PSYCHOSOCIAL
leads to a greater sense of competence, while failure result in feelings of inferiority.

LABORATORY TESTS & RESULTS

A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood
LABORATORY TESTS: cells, white blood cells, and platelets.
A CBC determines if there are any increases or decreases in your blood cell counts. Normal values vary depending on your age and
COMPLETE BLOOD COUNT (CBC) your gender. It can help diagnose a broad range of conditions, from anemia and infection to cancer.
CBC analysis can provide important clues for prognosis in asthma attacks. It should be considered as a possible indicator of frequent
ED admissions. Furthermore, they will be used as basis for any interventions to be given according to the sudden increase and
decrease of red blood cells, white blood cells, platelets, and other important blood components varying from their normal value.
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 WHITE BLOOD CELLS (WBC) - help the body fight infection and other diseases.
 RED BLOOD CELLS (RBC) - bring oxygen to the tissues in your body and release carbon dioxide to your lungs for you to
 Arterial Blood Gas test refers to a blood test that requires a sample from an artery in your body to measure the levels of
ARTERIAL BLOOD GAS (ABG)
oxygen and carbon dioxide in your blood. The test also checks the balance of acids and bases, known as the pH balance,
in your blood.

 POTENTIAL OF HYDROGEN (pH) - The pH of blood refers to how acidic it is. The typical pH for blood in
the arteries is 7.35 to 7.45.
 PARTIAL PRESSURE OF CARBON DIOXIDE IN THE ARTERIAL BLOOD (PaCO2)- This measures the
pressure of carbon dioxide dissolved in the blood and how well carbon dioxide is able to move out of the body, ph,
 PARTIAL PRESSURE OF OXYGEN IN THE ARTERIAL BLOOD (PaO2) - It reflects how well oxygen is
able to move from the lungs to the blood.
 OYGEN SATURATION (SaO2)- to know the percentage of how much oxygen your blood is carrying.
SPIROMETRY TEST

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 Spirometry is a basic lung function test that measures the volume, time, and flow of air throughout inspiration and
expiration.

Spirometry is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect
breathing.

CHEST X-RAY

Chest X-rays produce images of your heart, lungs, blood vessels, airways, and the bones of your chest and spine. Chest
X-rays can also reveal fluid in or around your lungs or air surrounding a lung.

The value of chest radiography is in revealing complications or alternative causes of wheezing in the diagnosis of asthma
and its exacerbations. It usually is more useful in the initial diagnosis of bronchial asthma than in the detection of
exacerbations, although it is valuable in excluding complications such as pneumonia and asthma mimics, even during
exacerbations.

LABORATORY RESULTS

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 RADIOLOGY REPORT:
CXR AP/L LOCALIZATION
FINDINGS RESULT
IMPRESSION

Hyper-expanded lungs evident best with flattened diaphragm

BRONCHIAL ASTHMA and narrowed cardiac shadow and mediastinum. On a lateral,

the chest may appear “barrel” shaped.

Name of Test: Complete Blood Count

Date: April 11, 2022
Result: Elevated Platelet Count

Name of Test: Arterial Blood Gas

Date: April 11, 2022
Result: Low pH; Elevated PaCO2; Low PaO2; Low SaO2

Name of Test: Spirometry Test

Date: April 11, 2022
Result: 74%

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 Laboratory Result Normal Value Remarks
COMPLETE
Test
BLOOD COUNT

Platelets 500, 000 mm³ 150,000-450,000 mm³ ELEVATED

RBC 7x^12/L 4.70-6.10x10^12/L ELEVATED

WBC 10.9510x^9/L 4.80-10.80x10^9/L ELEVATED

Hemoglobin 12.5 g/dL 14.00-18.00g/dL NORMAL

ARTERIAL BLOOD GAS

pH 7.32 7.35 to 7.45 LOW

PaCO2 48 mmHg 35-45 mmHg ELEVATED

PaO2 78 mmHg 80-100 mmHg LOW

SaO2 94% 95-100 % LOW

SPITOMETRY TEST Result Normal Value Remarks

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74% 80%-120% MILDLY ABNORMAL

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  Teach the patient the proper ways
 Place patient with proper body
of coughing and breathing.
alignment.
 Position the patient upright if
 Teach patient to pace activity and
tolerated.
encourage rest periods.
 Maintain humidified oxygen as
 Suction secretions, as necessary.
prescribed.
 Ambulate patient as tolerated with
 Encourage patient to increase fluid
doctor’s order three times daily.
intake.

Patient maintains an effective breathing Patient maintains clear & open airways
pattern, and respiratory rate remains
within established limits.

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 NCP 1 – Ineffective Breathing Pattern
Nursing Diagnosis: Ineffective breathing pattern related to narrowing of the airways as evidenced by shortness of breath with the use of accessory muscles.

Assessment Planning Interventions Rationale Evaluation

Subjective data: After 8 hours of nursing Independent: After 8 hours of duty, the goal was:
interventions, the patient
 Patient verbalizes will maintain effective 1.Place patient with proper body A sitting position permits maximum 1. Partially Met
“maglisud ko ug breathing pattern as alignment for maximum breathing lung excursion and chest expansion.
ginhawa ma’am evidenced by: pattern (semi-fowler’s position).  SaO2 of 96.9%
dayon gihutoy 2. Fully Met
kaayo kog inubo,  Absence of 2.Elaborate and encourage patient A form of controlled ventilation in
gi sip on pud ko.”  Absence of dyspnea
dyspnea to do pursed lip-breathing: which the expiration phase is
 No respiratory consciously prolonged; helps to
3. Fully Met
distress, with eliminate carbon dioxide.
Objective data:
 Moderate suprasternal and  No respiratory distress, with
respiratory intercostal 3. Assist client to a moderate or Upright position allows increased suprasternal and intercostal
distress, with retractions. high-Fowler’s position. diaphragmatic excursion secondary retractions.
suprasternal and  Normal to downward shift of internal organs
from gravity. 2. Fully Met
intercostal respiratory rate
retractions. of between 20-30  Normal respiratory rate of 25 cpm
 [Lung exam] cpm ahd heart and heart rate of 80 bpm.
diffuse inspiratory rate between 75-
and expiratory 100 bpm.
bilateral wheezing,  SaO2 of 97% 4. Instruct client to take a deep Inhaling through the nose allows air
poor air movement breath, inhaling slowly through to be filtered, warmed, and
and prolonged the nose while counting three. humidified.
expiratory phase.
 RR: 40 cpm

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 5. Instruct client to exhale slowly
through the mouth pursing the
lips as though to whistle for a
count of six or more. Contract
the abdominal muscles.
Expiration should last two or
three times longer than
inspiration.
Dependent
 HR: 120 bpm 1.Administer IV: D5LR 1L @ 15
gtts/min Left cephalic vein as
 SaO2: 94% ordered by the physician.
2.. Administer the ordered
medications (Nebulize with 1 neb
salbutamol + ipratropium and
hydrocortisone)
3. Administer O2 inhalation via
facemask at 6 LPM as ordered by
the physician.
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By pushing the air against the small
orifice made by the pursed lips,
pressure builds backward through the
airways. This back pressure prevents
airway collapse by pushing the
airways open throughout the
exhalation. Thus, more air escapes
during the exhalation and helps
prevent air tapping.
It supplies fluids directly into the
intravascular fluid compartment.
They help to allow good ventilation
and reduce severe asthma attacks.
Oxygen therapy treats conditions that
cause low oxygen levels.
 NCP 2 – Ineffective Airway Clearance
Nursing Diagnosis: Ineffective airway clearance related to increased production of secretions as evidenced by adventitious lung sounds
Assessment Planning Intervention Rationale Evaluation
Subjective data: At the end of 8 hours, the Independent: To avoid fatigue. Increased effort in After my 8 hours duty, the goal was:
patient will establish breathing properly.
• Patient verbalizes 1. Pace the client’s activities. 1. Partially Met
“maglisud ko ug ginhawa behaviors of improved
ma’am dayon gihutoy airway clearance as 2. Encourage deep breathing and Helps loosen and expectorate excess  Clear breath sounds
kaayo kog inubo, gi sip evidenced by: coughing exercises. secretions and contribute to effective
on pud ko” clearing mucus out of the lungs. 2. Fully Met
• Clear breath sounds
• Improved oxygen 3. Encourage increased fluid intake.  Improved oxygen exchange
Fluids help minimize mucosal drying and
Objective data: exchange increases ciliary action to remove 3. Fully Met
• Moderate respiratory • Normal rate and depth of secretions.
distress with suprasternal  Normal rate and depth of
respiration between 20-30 4. Limit alcohol and caffeinated When consumed in excess, it may
and intercostal retractions cpm; heart rate between
respiration of 25 cpm and
drinks. contribute to dehydration making
75-100 bpm. heart rate of 80 bpm.
• Diffuse inspiratory and difficulty for secretions to be
expiratory bilateral expectorated. 4. Fully Met
wheezing, poor air • Ability to effectively
movement and prolonged cough out secretions.
Dependent: IV fluid therapy can be beneficial for  Ability to effectively cough
expiratory phase out secretions.
clients with dehydration. Medications
• RR – 40 cpm 1.Administer IV fluids and medication
such as bronchodilators and inhaled
as ordered.
corticosteroids may be prescribed.
• PR – 120 bpm

2.Administer oxygen as ordered. Oxygen therapy corrects hypoxemia,

which can be caused by retained
respiratory secretions.

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 3. Anticipate the need for intubation Acute exacerbations of asthma can lead
and mechanical ventilation. to respiratory failure requiring
mechanical ventilation.

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 NCP 3 – Activity Intolerance
Nursing Diagnosis: Activity Intolerance related to fatigue

Assessment Planning Intervention Rationale Evaluation

Independent
Subjective Data After 8 hours shift, the 1. Encourage activities such as quite Avoid change in respiratory status and At the end of my 8- hour shift, the goal
patient will be able to play, reading, watching movies, and energy depletion due to excessive was:
 Patient verbalizes have improved activity games during rest. activity.
“maglisud ko ug tolerance as evidenced 1. Partially Met
ginhawa ma’am by: 2.Disturb only, when necessary, perform  Patient gradually returns to
dayon gihutoy all care at one time instead of spreading Conserves energy and limits normal activities.
kaayo kog inubo, 1. Patient can resume over a long period of time, and avoid interruption in rest.
gi sip on pud ko” daily activities doing any care or procedures during 2. Partially Met
 Mother verbalizes with minimal attack.  Dyspnea is slightly alleviated.
dyspnea.
“dli sya
2. Optimize control 3. Fully Met:
makakaon, ug of asthma  Patient is able to verbalize
makalihok ug symptoms and 3.Schedule and provide rest periods in a Promotes adequate rest and decreases comfort and relief by stating
tarong tas reduce the risk of calm peaceful environment. stimuli. “kaya na nako buhaton ang mga
maglisud syag asthma attacks. gam unon ron ma’am di na
kaligo, ilis, ug 3. Verbalizes comfort kapoy akong lawas.”
and relief. 4. Explain the reason for the need to Promotes understanding of the effect
alaga sa iyang
4. Normal breathing conserve energy and avoid fatigue to of activity on breathing and the need 4. Fully Met:
kaugalingon rate and pattern of parents and child. for rest to prevent fatigue.
sobraan jud sya between 20-30
 Normal breathing rate and
pattern of 25 cpm and heart rate
ka dependent cpm and heart rate
5. Assist in planning a schedule for Provides care while promoting of 80 bpm.
namo ma’am. Ug between 75-100
bpm. bathing, feeding, rest that will save activities of daily care.
pa storyahon ko energy and prevent an attack or promote
sa iyang nilihokan resolution of an attack.
sa tanan najud
ma’am kay
6. Reinforce activity or exercise Provides preventive measures to offset
nanginahanglan
limitations if these trigger attack; advice possible attack.

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 jud syayg physician approved activities.
tabang.”

Feeding- IV
Bed mobility- IV
Grooming- IV
Bathing- IV
Dressing- IV
General mobility- III

 The patient
verbalizes “sige
nalang jud ug
kapoy akong
lawas ma’am.”

Objective Data
 Moderate
respiratory
distress, with
suprasternal and
intercostal
retractions.
 RR: 40 cpm
 HR: 120 bpm

DRUG STUDY

27 | P a g e
 DRUG NAME MECHANISM OF INDICATIONS & EFFECTS DRUG & FOOD INTERVENTIONS & CLIENT TEACHING
ACTION CONTRAINDICATIONS INTERACTIONS RATIONALE

GENERIC NAME: Maximizes the Nasopharyngeal

response to treatment INDICATIONS: /Respiratory: DRUG INTERATION: 1. Check Doctors order  Use this drug as an
ipratropium bromide in patients with  Management of Bronchitis, and medication tickets inhalation product.
+ bronchial asthma and reversible dyspnea, cough,  Additive before administering the  Protect from light; do
salbutamol chronic obstructive bronchospasm lower respiratory interaction with medication and obtain the not freeze.
pulmonary disease associated with tract disorders, concomitantly patient’s health history.  You may experience
(COPD) by increasing obstructive airway pneumonia, used these side effects:
BRAND NAME: bronchodilation diseases (e.g., bronchospasm, anticholinergic RATIONALE: To prevent Dizziness, headache,
through two distinctly bronchial asthma). upper respiratory medications. errors in medication blurred vision, nausea,
DUAVENT different mechanisms,  For use in patients tract disorders.  Co- administration. vomiting, GI upset
i.e., anticholinergic with chronic Cardiovascular: administration  Avoid driving or
PREGNANCY (parasympatholytic) obstructive Tachycardia, with other 2. Use nebulizer performing hazardous
CATEGORY: C and beta2-agonist pulmonary palpitation, sympathomime mouthpiece instead of tasks.
(sympathomimetic) disease (COPD) on angina, chest tic agents may face mask  Teach patient not to
effects. Simultaneous a regular inhaled pain. increase risk of store medication in
CLASSIFICATION: administration of both bronchodilator Neurological: adverse RATIONALE: To avoid nebulizer for later use.
Anticholinergic Anti- an anticholinergic who continue to Tremor, cardiovascular blurred vision or  Encourage client to
Asthmatic & COPD (Ipratropium bromide) have evidence of nervousness, events. aggravation of narrow- rinse mouth and
Agents and a beta2-agonist bronchospasm dizziness,  Salbutamol and angle glaucoma. gargle with warm
(Salbutamol) produces and who require a headache, a beta-receptor water.
a greater second drowsiness. blocking agent 3. Ensure adequate  Report rash, eye pain,
bronchodilator effect bronchodilator. Gastrointestinal:  inhibit each hydration, control difficulty voiding,
PHARMACOKINETICS than when either drug Dry mouth, other's effect. environmental palpitations, vision
ONSET: 15-30 MINS is used alone. throat, and  Hypokalemia temperature. changes.
DURATION: 5-7 CONTRAINDICATIONS: tongue, mucosal which may
HOURS  Hypertrophic ulcers, thirst, result from the RATIONALE: To prevent
PEAK: APPROX. 1-2 obstructive diarrhea. administration hyperpyrexia.
HOURS AFTER ORAL cardiomyopathy Endocrine/ of non-
INHALATION VIA or Metabolic: increa potassium 4. Monitor for adverse
NEBULIZATION tachyarrhythmia. sed sweating & sparing diuretics effects.
ELIMINATION OF  Hypersensitivity to hypokalemia (e.g., loop or

28 | P a g e
HALF LIFE: ABOUT 2 any ingredient in Ophthalmic: thiazide RATIONALE: To assure
HOURS the product or to Precipitation or diuretics) can be patient safety and prevent
atropine and its worsening of acutely harm.
derivatives. narrow-angle worsened by
DOSAGE: glaucoma, beta-agonists, 5. Evaluate patients’
3 doses 15 mins. temporary especially when response and notify health
interval pupillary dilation, the care provider if adverse
blurred vision, recommended effects occur.
FREQUENCY: acute eye pain. dose of the
Q4 Genitourinany: beta-agonist is RATIONALE: To check if
Urinary tract exceeded. the medication took an
infection/dysuria. effect and to alleviate
FOOD INTERACTION: adverse effects that might
None happen.

29 | P a g e
30 | P a g e
 OVERALL PATIENT TEACHING

 Inform patient to keep pets out of bedrooms as often as possible (pets that can trigger the asthma).

 Encourage patient to cover the mattresses and pillows in dust-proof zippered covers and change the bed sheets every week.

 Inform patient to avoid smoking or secondhand smoking.

 Advise patient to avoid close contact with people who have a cold or the flu, because catching it will make the asthma symptoms worse.

 Encourage patient to cover nose with handkerchief or wear facemask if it is cold outside.

 Tell patient to exercise regularly to strengthen heart and lungs.

 Explain to the patient the importance of increasing fluid intake.

 Elaborate the proper coughing and breathing techniques and encourage patient to do it.

 Avoid eating foods in which the patient is allergic as it may trigger his/her asthma.

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 RELATED ARTICLES

New asthma drug approved on NHS branded a ‘wonder drug’

Dupilumab (also known as Dupixent) will be available to patients through injections. These injections are given every few weeks and were shown in
clinical trials to reduce the frequency of asthma attacks when combined with standard inhalers. The criteria for people receiving the treatment and get access
to it is strict, and is given to those with type 2 inflammation, as well as having at least four severe asthma attacks in the last year.

Bronchial Thermoplasty in Patients with Severe Persistent Asthma

A new and advanced medical procedure that some people with severe asthma can have to help open their airways. It's a heat treatment that reduces the
amount of thickened smooth muscle on the inside walls of the airways. Over time, severe asthma causes the smooth muscle tissue lining the airways to
thicken.
This new technology designed for asthma patients uses radio waves to burn off overgrown muscle in the airways and lungs. Bronchial thermoplasty
uses thin wires that are lowered down into a patient’s lungs, which then emit radio waves that burn off a portion of the muscle in the airways. With the
reduced amount of muscle, airways, even when contracted, are open for air to flow through easily. Possibly the best thing about this treatment is that, in some
cases, it can reduce the need for allergy medication.
The literature review aimed to see the safety and efficacy of bronchial thermoplasty in patients with severe asthma. We searched the online database,
PUBMED, using bronchial thermoplasty and asthma as the key words and including trials from 2007 to 2021. Our review found that bronchial thermoplasty
reduces asthma-related hospitalizations, emergency room visits and asthma exacerbations with sustained benefits for 5–10 years. This came at the expense of
increased asthma-related adverse events, most commonly during the 7 days immediately after the procedure. Adverse events from 6 weeks after procedure to
up to 5 years were similar between the bronchial thermoplasty group and the medication-only group. Bronchial thermoplasty is a safe and efficacious
treatment modality for patients with severe asthma.

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 REFERENCES

BOOK:

Silvestri, L. (2014). Saunders Nursing Drug Handbook. Elsevier.

Weber, J. & Keley, J. (2014). Health Assessment in Nursing (5th ed.). Wolters Kuwer.

Vanpute, C., Regan, J., & Russo A. Seeley’s Essentials of Anatomy and Physiology (10th ed.). McGrawHill.

ONLINE SOURCES:

Brown, W. (2021). New asthma drug approved on NHS branded a ‘wonder drug’. Retrieved from
https://www.pharmatimes.com/news/new_asthma_drug_approved_on_nhs_branded_a_wonder_drug_1381090

Aftab et al (2021). Bronchial Thermoplasty in Patients with Severe Persistent Asthma: A Literature Review. National Library of Medicine. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221120/

Jat (2013). Primary Care Respiratory Medicine National Library of Medicine. Retrived from. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442789/

Martin, P. (2022). 8 Asthma Nursing Care Plans. Retrieved from https://nurseslabs.com/asthma-nursing-care-plans/

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Bellleza, M. (2021). Asthma Pathophysiology. Retrieved from https://nurseslabs.com/asthma/#pathophysiology

The Asthma and Allergy Center. (2022). Physiology of Asthma. Retrieved from https://www.asthmaandallergycenter.com/article/physiology-of-asthma/

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