Cebu Institute of Technology

University
N. Bacalso Ave., Cebu City Philippines

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

MEDICAL- SURGIGAL NURSING

(RLE 304)

“CASE PRESENTATION IN STATUS ASTHMATICUS”

SUBMITTED BY:
Group #4

Leader:
LORELY FIONA NOEL

Members:
NUÑAL, ISRAEL
OPORTO, PATRICK
ROLLO, ANAFI
SALANG, RHEA
SALDAÑA, GERALDINE
SOCOBOS, MAXINE
SOLIDEO NIÑA
SUMABAT, QUEZA
SUMALINOG, CHRISTINE

SUBMITTED TO:
DR. FLEOY YSMAEL, RN
CLINICAL INSTRUCTOR

OCTOBER 2022
I. INTRODUCTION
Status asthmaticus is a medical emergency, an extreme form of asthma exacerbation
characterized by hypoxemia, hypercarbia, and secondary respiratory failure. All patients with
bronchial asthma are at risk of developing an acute episode with a progressive severity that is
poorly responsive to standard therapeutic measures, regardless of disease severity or
phenotypic variant. This is also known as status asthmaticus.
If not recognized and managed appropriately, asthmatics portends the risk of acute ventilatory
failure and even death.
Despite advances in pharmacotherapy and access to early diagnosis and treatment of asthma
itself, it remains one of the most common causes of emergency department visits. No single
clinical or diagnostic index has been known to predict clinical outcomes in status asthmaticus.
Hence, a multi-pronged and time-sensitive approach combining symptoms and signs, assessing
airflow and blood gas, and a rapid escalation of treatment based on initial treatment response is
favored to diagnose and manage the condition.
The time course of progression and the severity of airway obstruction follow two distinct
patterns.
 If appropriately documented, one subgroup shows a slow subacute worsening of peak
expiratory flow rate (PEFR) over days, known as "slow onset asthma exacerbation." This
patient subgroup usually has intrinsic patient-induced predisposition factors, including
inadequate inhaler regimen, suboptimal compliance, and psychological stressor.
 The other phenotype, known as "sudden onset asthma exacerbation," presents with
severe deterioration within hours. They often correlate with sudden massive exposure to
external triggers like predisposed allergens, food articles, sulfites, among others.
Eighty percent to 85% of asthma fatalities are in the subgroup of slow-onset asthma
exacerbation, perhaps reflecting an inadequate disease control over time. In contrast to the
sudden onset of exacerbation phenotype, which presents mostly with clear airways, slow-onset
exacerbation patients have extensive airway inflammation and mucus plugging.
According to the Center for Disease Control and Prevention (CDC), about 10% of the world
population suffers from asthma, with a 15% increase in disease burden in the United States
over the last two decades. Five percent of them are classified as severe asthma. An estimated
3% to 16% of hospitalized adult asthmatic patients progress to respiratory failure requiring
ventilatory support, although the statistics might be lower in children. Afessa et al. have reported
a mortality of around 10% in the intensive care unit (ICU) patients admitted with status
asthmaticus.

CASES OF STATUS ASTHMATICUS IN THE PHILIPPINES:

Summer is usually the time to enjoy the outdoors. However, asthmatic people tend to shy away
from going out due to the intense heat triggering an asthma attack. According to the World
Health Organization (WHO), 12% of Philippine population of 90 million have asthma; and
according to the Global Asthma Report, approximately 11 million or 1 out 10 Filipinos are
suffering from asthma, yet 98 percent of Filipino asthma patients continue to lack proper
treatment.

What is asthma? It is recurring inflammatory disorder in the airways of breathing, which

undergoes variable expiratory flow and reversible bronchoconstrictions, usually caused by
trigger factors, that is different for every patient. In an asthma attack, the lining of the airways
swells, and the muscles around the airways tense up. This condition limits the flow of
air through the lungs and leads to abnormal breathing. Asthma is mostly genetic but can be
triggered by a lot of factors—genes, stress, strong emotions, change of temperature,
environment, dust, pollen, molds, chemicals in the air or in food, tobacco smoke, exercise,
animals and viral infections.

The most common symptoms of asthma are cough, difficulty of breathing and wheezing.
Asthma usually builds up before you actually have an attack. It can range from mild to severe.
Unfortunately a lot of patients dismiss their asthma and asthma control, relying only on as
needed medications when attacks occur. The goal of asthma treatment has always been to
relieve attacks and prevent future exacerbations as well. When asthma is uncontrolled, this
leads to more absent days, more ER visits, more hospitalizations, and reduced quality of life.
This is a disease that can be effectively controlled. There should be good partnership between
patient and physician. Aside from avoiding trigger factors, having the right medications are
important to stop or prevent an attack. Presently, there are a lot of maintenance inhalers
available for asthmatic patients. They just have to look for one that suits them best (considering
price, convenience of use and lifestyle). Aside from having the correct medication, lifestyle
modification is important in the management of asthma.

INCIDENT:

One of the most common causes of emergency room visits in the United States is status
asthmaticus, an acute, emergent episode of bronchial asthma that is poorly responsive to
standard therapeutic measures. If not recognized and treated in a time-sensitive manner, status
asthmaticus can rapidly escalate into acute ventilatory failure and potentially be fatal. Patients
with asthma and their families should be educated about this condition and how to recognize
when they should seek care. A time-sensitive approach to recognizing symptoms and signs of
status asthmaticus followed by the prompt assessment of airflow and blood gasses and rapid
escalation of treatment based on initial treatment response is key to improving outcomes for
patients with status asthmaticus. This activity reviews the evaluation and management of status
asthmaticus and highlights the interprofessional team's role in caring for affected patients.

CONSEQUENCES:

Status asthmaticus is considered a medical emergency. It is the extreme form of an asthma

exacerbation that can result in hypoxemia, hypercarbia, and secondary respiratory failure. In
practice, the role of the physician is to prevent this from happening through patient compliance
with controller medications (eg, steroid inhalers) in an outpatient setting
II. NURSING HEALTH HISTORY

A. Biographic Data
Initials of Client/Patient : J.T.K.Y
Residence: 305, R. Duterte St., Banawa Cebu City
Contact Number : 09152569075 Nationality: Filipino
Religion : Roman Catholic Birth of Date: August 7, 1997
Age: 25 years old Sex: Male Civil Status: Single
Educational Attainment: College Graduate
Occupation: Elementary School Teacher

Name of Hospital: Cebu Institute of Health Hospital Ward & Room No.: AD5
Date of Admission: October 10, 2022 Attending Physician : Dr. CJ Sumalinog, MD
Impression / Admitting Diagnosis: Status Asthmaticus

__________________________ Source of Information:

( ) Patient
( ) Others, (Initials of SO):
Relationship to patient :

B. Admitting Complain/s ____Difficulty swallowing, hoarseness, and chest pain

Vital Signs: Temperature: _38.6 C_ PR: 117 bpm_ RR: 27 cpm_

BP: __130/90 mmhHg___ Pain Score: __4___

C. History of Present Illness

 Symptom: shortness of breath _______________________________

Location: Respiratory ____________
Character: ______Hypoxemia and hypercapnia____________________________
Intensity: Severe __
Timing: 3-4hrs _
Aggravating factors: Hypercapnia __________
Alleviating factors: beta2-agonist agents
Treatments tried: Glucocorticosteroids and albuterol inhaler

D. Review of Systems
E. Past and Present Medical History (Utilizing Gordon’s Functional Health Pattern).
Questions are being included so that students will be guided with each health patterns. Please
answer the following inquiries.
Before During Admission

Gordon’s Criteria Admission

I. HEALTH PERCEPTION The patient verbalizes being The patient verbalized his
HEALTH MANAGEMENT born with asthma and that he anxiety especially when he
PATTERN has been having asthma realized that his asthma
1. How was general attacks since he was a kid. episode wouldn’t respond to
description of the However, it does respond to the medication.
client’s health prior to the medication that he uses
hospitalization or which is the Salbutamol He has to file a leave from
consultation? inhaler. Aside from that, he work in order to be monitored
has no other illnesses. in the hospital.
2. Any childhood or past
year illnesses (both His asthma attacks before
were not very threatening to
physiologic and
the point where he has to be
psychiatric
absent from school or work.
alterations)? Any
absences from work if
client or patient is
working?

3. The most important The client takes medications
things the client/patient in order to avoid severe
asthma attack. He does not
do to keep healthy? use cigarettes or drink alcohol
Use of cigarettes, in order to avoid getting an
alcohol, drugs? asthma attack.
4. Accidents or injuries The patient has been bringing
(home, work, driving)? a Salbutamol inhaler with him
Any operations, since his childhood in case of
treatments and any asthma attack especially
medications when he is not at home. He
was aware of the foods that
received? may cause an asthma attack
The client is on oxygen
therapy in order to maintain
his breathing and keep his
vitals at least at normal levels
while he is at the hospital and
is being continuously
monitored.
He is compliant with the
medications and instructions
of the health care providers.
 5. In past, are there any and he has always been
health suggestions careful not to eat those, as
that were easy for the well as avoid areas where it is
patient to comply? dusty, or where there is an
abundant supply of pollen in
what do you think the atmosphere.
causes this complaint?
Actions taken when
symptoms perceived?
Results of action?

II. NUTRITIONAL- The patient consumes three The patient does not have an
METABOLIC PATTERN main meals and snack on the appetite to eat and does not
1. Describe the typical afternoon. He stated that he merely touch his served
daily food intake? doesn't skip meals even he is hospital meal. However, he is
Supplements busy on his work. In the 24 gradually taking in foods and
(vitamins, type of hours prior to the interview fluids later on due to the
snacks)? the patient stated that the nurses’ encouragement and
food he consumed was health teachings.
2. State the weight of the
cereal, herbal tea, water,
patient in relation to
yoghurt, orange juice, fruit,
the height and the
vegetables and muffins. He is
significance of his
trying to be a vegetarian
weight to his height?
based on his religious beliefs;
he has no food allergies but
does modify his diet regularly
based on his body image and
weight fluctuations.

Before During Admission

Gordon’s Criteria Admission

3. Can the patient

consume his food
during meal or snack
time? If not, why?

4. If the patient has

wound, does it heal
well or poorly? Any
skin problems like
lesions,

dryness and dental

problems?

III. ELIMINATION PATTERN The patient said, he has a The patient said, he has a
normal urine and bowel normal urine and bowel
1. Describe the urine and elimination pattern with no elimination pattern with no
bowel elimination
signs of unusual findings in signs of unusual findings in
pattern? Frequency?
the patient's urine or stool. the patient's urine or stool.
Character?
Discomfort? Problem
in control? Use of
laxatives as over the
counter drug or
prescribed? Odor
problems?
2. Any body cavity
drainage, suction, and
so on that aids the
patient in elimination?
IV. ACTIVITY-EXERCISE As stated by the patient “Maka
PATTERN The patient can do exercises exercise raman pud hinoun ko
on his own. He exercises daily everyday maam and maka
1. Is there sufficient like walking around his house lakaw lakaw rako bahalag
energy for desired or
required activities? hinay hinay lang ug dili
pakalitan”. He is able to walk
2. Does the patient around his room and is able
exercise regularly? What to talk on his spare time.
 type of exercise?

3. What are the patient’s

activities in their

spare-time / leisure
time? If the patient is a

child, what play

activities does he indulge

in?

4. Perceived ability (code

for level) for:

Criteria Rate Criteria Rate Criteria Rate

Feeding 0 Gait 0 Cooking 0

Bathing 0 ROM 0 Shopping 0
Toileting 0 Grooming 0 Bed mobility 0
Home maintenance 0 General mobility 0 Posture 0
Dressing 0 Hand Grip 0

Functional Level Codes

*Level 0: full self-care *Level III: requires assistance or

*Level I: requires use of equipment supervision from another

or device person and equipment or

*Level II: requires assistance or device

supervision from another *Level IV: is dependent and does not

person participate

Before During
Admission
Gordon’s Criteria Admission

V. SLEEP-REST PATTERN He often watches The patient

the television to verbalized that
1. Can the patient rest/sleep? What are the
make his sleep and he can still sleep
usual daily activities of the patient to
he is not having any for about 6-5
induce him to sleep?
problem sleeping hours
2. Are there sleep onset problems? Aids? until then. He can
sleep 6-8 hours per
Dreams (nightmares)? Early awakening?
day, and he can rest
every afternoon.

VI. COGNITIVE-PERCEPTUAL PATTERN He does not show He verbalized

any problem with his that his does not
1. Any hearing difficulty? Presence of hearing
hearing, but he has have blurry
aid? Location: Left or right or both?
2. Is there a problem in vision? Wear a problem with his vision, and he
glasses? Last checked? When Last vision being blurred. does not have
changed? any problem with
3. Any change in memory lately? The patient does not his hearing. He
4. Does the patient experience difficulty in have any difficulties does not have
deciding during problems, family issues, in deciding problems any problem with
etc. ? with the family. He deciding when a
5. What are the patient’s strategies to make is now having any problem occurs.
decisions easier? discomfort when he
6. Any discomfort? Pain? When appropriate: walks.
How do you manage it?
 Before During
Admission
Gordon’s Criteria Admission

VII. SELF-PERCEPTION—SELF-CONCEPT The patient states The patient

PATTERN he is reasonably accept his
satisfied with his present health
1. How will the patient describe self? current status in life status, even
2. Changes in way the patient feel about self
and what he has though he knows
or body (since illness started)?
achieved for himself, that there is a big
3. Things frequently make the patient angry?
his perception of difference from
Annoyed? Fearful? Anxious?
4. Ever feel that the patient lose hope? how he looks the time he is
admitted in the
demonstrates issues hospital until
around physical now. The patient
stated that he will
dissatisfaction, try to lose weight
possible low self- to gain his
esteem confidence and
follow all the
instructions of his
doctor.

VIII. ROLES-RELATIONSHIPS PATTERN The patient has a The patient roles-

select group of relationships
1. Is the patient living alone? With family? friends but feels as a pattern doesn’t
result of his work change at all.
commitments during
the week, coupled
with family
commitments, he
has little spare time
to socialize with
friends. He does not
belong to any social
groups and
mentioned that he
thought social
groups were a waste
of his time.

Draw the family structure or genogram with emphasis

on the specific heredofamilial

Before During Admission

Gordon’s Criteria Admission

 2. Any family problems you
have difficulty handling
(nuclear or extended)?
3. Are the family or others
depend on the patient for
things? How is the patient
managing?
4. How do the family or others
feel about illness or
hospitalization?
5. Are problems with children
also the concern of the
patient? Does the patient
have difficulty in handling
the problems?
6. Is the patient belongs to
social groups? Close
friends? Is the patient
lonely?
7. Are things generally go well
at work or school?
8. Does the income sufficient
for their needs?
IX. SEXUALITY-REPRODUCTIVE He doesn’t experienced The patient sexual-
PATTERN difficulty during sexual reproductive doesn't
intercourse. change at all. He is now
1. When appropriate to age consciously adheres to
and situations: Does the
preventative health
patient’s sexual
measures.
relationships
satisfying? Any changes?
or problems? Use of
contraceptives? Problems?
2. If client is female and of
age: When menstruation
started (menarche)?
Duration? Menstrual
cycle?
3. Last menstrual period, if
with relation? Menstrual
problems?

G___ T___ P _ A
L___ M___

Before During Admission

Gordon’s Criteria Admission

X. COPING-STRESS Gets emotional support Despite his current

TOLERANCE PATTERN
1. Is there any big changes in
the patient’s life in the last
year or two? Any crisis?
2. Who is the most helpful in
talking things over? Is this
person available to you at
present?
3. Is the environment tense or
relaxed most of the time?
When tense, what coping
strategy helps?
from the family, and condition, the client remain
slightly feels faithful to God. He believes
uncomfortable with the in health medicine.
pain occuring. Uses However, fears the side
distraction such as effects that it will cause in
working and hobbies like his body
household chores.
No alcohol consumption
and medications used to
relieve stress.
Does not drink water
often.

4. How do the person handle

stress? Use any
medicines, drugs, alcohol?

5. Is the coping strategies

successful?
 XI. VALUES-BELIEFS PATTERN
1. Important health plans for
the future?
2. Is religion important in life?
When appropriate: Does
this help when difficulties
arise? Does religion
interfere with health
practices?
He’s a roman catholic and The patient’s plan for
has strong faith in God. health in the future is to
He has no religious belief maintain a healthy body
that could hinder his and prevent any diseases.
health practice. Religion is important to his
life, that he was able to
respect other beliefs.

3. Any other values or beliefs

that affect the health care
delivery system.

XII. Other concerns: Any other
things we haven’t
talked about that you would
like to mention?
The patient did not have The patient did not have
any complaints with any complaints with
regards to his health regards to his health

Any questions?

IV. PHYSICAL ASSESSMENT: (HEAD TO TOE) AND REVIEW OF SYSTMEMS

GENERAL SURVEY
Patient’s Findings
Patient JTKY is a 25 years old male. He weighs 58 kg and with a height of 180 cm. He was
assessed with cyanosis, his facial features are symmetric, decrease mental alertness, he
doesn’t responds well to questions and is uncooperative, he has difficulty in breathing and is
using his accessory muscle.

SKIN

Patient’s Findings

 Blue color in skin, fingernails and lips

 Skin turgor is normal

HEAD

Patient’s Findings

 Head size is normal and structure

 Facial features are symmetric
 Hair distribution is normal with no presence of parasite, or lice, dandruff, and lesions.

EYES

Patient’s Findings

 Proper function of eyes and had a good field of vision, cardinal eye movements are all
present, proper function of corneal light reflex.
 Normal cover/uncover test results.
 Normal results in external eye structures inspection.
 Eyeball is symmetrical in size and position.
 The eyeballs are in the same position and plane as the eyebrow and maxilla.
 Upper lids cover the upper portion of the cornea when the patient is looking straight.

EARS

Patient’s Findings

 No middle ear infection

  proper ear alignment in both sides
 no presence of inner ear infection
 no discharges noted
 no skin tags,
 canal is skin-colored with no discoloration or any tenderness, has small hairs.

NOSE AND SINUSES

Patient’s Findings
Inspection:

 Nose is in Midline and symmetry

 No discharges, there is flaring, both nares are patent.
 Nasal septum in the midline and not perforated
 Nasal mucosa is pinkish in color
Palpation:

 No tenderness or masses noted on palpation.

MOUTH

Patient’s Findings
Inspection:

 Lips are dry and cracked, blue in color

 gums and buccal mucosa are pink and free of lesions and swellings;
 tongue is free of lesions, pink, moderately sized
 ventral surface is smooth, shiny, and pinkish in color;
 frenulum is in the midline with salivary flow and moistness;
 frenulum is in the midline with salivary flow and moistness;
 frenulum is in the midline with saliva.

NECK
Patient’s Findings
Inspection:

 When asked to swallow, the thyroid cartilage shifted upward symmetrically;

 pain was felt when the neck was moved;
 neck is symmetric, with the head centered with no apparent bulging masses
Palpation:

 The trachea is located in the middle of the chest,

 The thyroid is smooth and solid and non-tender, and
 The glands are non-tender, indicating the absence of cysts.

THROAT
Patient’s Findings
Inspection:

 Uvula is fleshy, hangs freely in the midline

 No presence of tonsils
 Throat is pink without exudate and lesions
 Normal Gag Reflex
LUNGS

Patient’s Findings
Inspection:

 Patient has difficulty in breathing

 Diminished breath sounds
 Shortness of breath
 Uses accessory muscle to assist in breathing
 Barrel chest
 Persistent productive cough
 Hypersecretions of mucous
Palpation:

 Client reports with tenderness, pain and unusual sensations

Percussion

 Hyperresonance on percussion indicates too much air is present within the lung
tissue.
Auscultation:

 Loud, high-pitched bronchial breath sounds over the trachea.

 Presence of wheezing

CARDIOVASCULAR

Patient’s Findings
Inspection:

 Carotid and jugular pulsations is present.

Palpation:

 Vocal fremitus is decrease in pleural effusion and pneumothorax

Auscultation:

 Increased cardiac output, mainly mediated by increased heart rate

ABDOMEN

Patient’s Findings
Inspection:

 There is no presence of lesions and rashes

Palpation:

 The movement of the abdominal wall is peristalsis or pulsations

 Palpable spleen, soft and non-tender
Auscultation:

 Normal/Active high-pitched gurgling noise.

 Vascular sounds noted (renal arteries, iliac arteries, femoral arteries, and aorta)

MASCUSKELETAL

Patient’s Findings
Inspection:

 The patient's gait is normal

 The spine is aligned
  Paravertebral muscles are equal in size.
Palpation:

 Paravertebral are non-tender.

 No joint swelling, or tenderness

TEST PURPOSE Client’s Response SIGNIFICANCE

Nudge Test To test the balance able to balance normal

Phalen’s Test to assess presence normal
of Carpal Tunnel
Can flexed without
syndrome
pain
Tinel’s Test To assess presence No nerve problems Normal
of Carpal Tunnel noted
Syndrome.

Bulge’s Test To determine the No inflammation of normal

presence of fluid in the knee or there is
the knee joint. no presence of fluid
in the knee joint.

Test for ROM To test the severity of normal

issues with joint
movements

Head, spinal cord Can comply without normal

discomfort.

Lower extremities Patient feels no pain normal

upon compliance.
(feet, ankles and
knees)
Upper extremities normal
(arms, hand and Can comply without
shoulder) discomfort.

NEUROLOGICAL

Patient’s Findings
Mental status and Level of Consciousness

 Awake, not alert and oriented to person, place, and time. Sign of stress and anxiety
Posture and Body Movements

 Restlessness noted during the assessment

Facial expressions, eye contact and affect

 Facial expressions asymmetric yet correlate with mood due to stress and pain when
coughing.
 Client is well-groomed, dressed with appropriate clothes.

CRANIAL NERVES
Name of nerve Function Client’s response and significance

1. Olfactory Smell Can differentiate odors

2. Optic Visual acuity Visual acuity of 20/20, no alterations of

vision

3. Oculomotor Opening of the Patient eyes move in response to images,

eyelids light, moving objects and head motion.

4. Trochlear eye movement Eye movements are normal

(downwards/medial)

5. Trigeminal Facial sensation, Patient has difficulty to swallow and chew

chewing foods properly.
movements

6. Abducens Eye movement Eye movements are normal

(lateral)

7. Facial Facial muscle Grimace in the face due to stress and

movements and pain when coughing
eyelid closing
8. Auditory Hearing and Patient has trouble hearing accordingly
balance and understand to the words said.

9. Glossopharyngeal Taste of the Patient can differentiate the taste of foods

posterior third of the but has no appetite
tongue

10. Vagus Uvula and Patient has difficulty in swallowing

swallowing

11. Accessory Shoulder shrug Patient was able to perform

12. Hypoglossal Tongue movement Can move freely

Test for Reflexes (Biceps, Brachioradialis, Triceps, Patellar, Achilles Tendon and Plantar
Tests).

0: absent reflex

1+: trace, or seen only with reinforcement

2+: normal

3+: brisk
 2+ 2+

2+ 2+

2+ 2+

2+ 2+

Other Tests
Test Purpose Client’s response and
significance

Kernig’s Sign Normal

Brudzinski’s sign Normal

GENITOURINARY

Inspection:
Note distribution of pubic hairs and presence nits/lice.
For female: Observe perineum, labia, clitoris, urethral meatus, vaginal opening, Bartholin’s
glands for lesions, swelling and excoriation as well as enlarged nodes.
For male: Inspect skin of penile shaft for rashes, lesions or lumps, foreskin, glans penis and
meatus for color, location and skin integrity. Also observe the size, shape and position of the
scrotum and its skin, any presence of hernia.
Patient’s Findings
Normal findings

Palpate hypogastrium gently for urine retention and presence of abnormal mass or
growth
 Patient’s Findings
Normal findings

Auscultate labia or the scrotal area for presence of bowel sounds

Patient’s Findings
The patient did not consent.

ANAL AREA
Inspect the perianal area for lumps, ulcers, lesions, rashes, redness fissures and thickening
of the epithelium.
Patient’s Findings
The patient did not consent.

Ask the client to perform Valsalva’s maneuver (bearing down) to note any bulges.
Patient’s Findings
Normal findings.

Palpate the prostate gland (if allowed and with the presence of the clinical instructor) by using
the index finger facing toward the umbilicus. Note the size, shape, consistency identify nodules.
Patient’s Findings
The patient did not consent.
III. ANATOMY AND PHYSIOLOGY
NORMAL LUNGS

The lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax).
The trachea (windpipe) conducts inhaled air into the lungs through its tubular branches, called
bronchi. The bronchi then divide into smaller and smaller branches (bronchioles), finally becoming
microscopic.

The bronchioles eventually end in clusters of microscopic air sacs called alveoli. In the alveoli,
oxygen from the air is absorbed into the blood. Carbon dioxide, a waste product of metabolism,
travels from the blood to the alveoli, where it can be exhaled. Between the alveoli is a thin layer of
cells called the interstitium, which contains blood vessels and cells that help support the alveoli. The
lungs are covered by a thin tissue layer called the pleura. The same kind of thin tissue lines the
inside of the chest cavity -- also called pleura. A thin layer of fluid acts as a lubricant allowing the
lungs to slip smoothly as they expand and contract with each breath.

ASTHMATIC LUNGS
The muscles surrounding the bronchial tubes the airways that usher air into and out of our lungs
begin to tighten as they become inflamed and swollen. Inside the bronchial tubes, those
inflamed membranes secrete thick mucus.
 PATHOPHYSIOLOGY
STATUS ASTHMATICUS

Precipitating factors
Predisposing factors
 Cigarette smoke
Family history of asthma  exposure to dust and pollen
 infection

INFLAMMATION

Pulse Oximetry
Hypersecretion of mucus Airway muscle constriction, Swelling bronchial membranes Arterial Blood Gas (ABG)
inflammatory mediators Pulmonary Function Test
Imaging

Narrow breathing passages

 Prolonged bronchospasm Hypoxemia Low oxygen supply for gas

 SOB exchange
 Chest tightness
 Dyspnea
↓ Diffusion across alveolar
membrane
Airway obstruction

Central: ↓ minute ventilation Peripheral: ↓ alveolar

Non-compliance of medication ventilation
Recurrent asthma attacks
LEGEND:
Disease Process Impaired gas diffusion:
Status Asthmaticus ↓ oxygen in the blood
Signs & Symptoms

Diagnosis Complete blood count (CBC)  Headache,

Arterial Blood Gas (ABG)
 Difficulty breathing
Diagnostic test Serum test
 Rapid heart rate
Allergy skin testing
Spirometry  Bluish skin, lips, and
fingernails
 V. MEDICAL MANAGEMENT
V.I. DIAGNOSTIC AND LAB EXAMINATION

LABORATORY RESULT NORMAL VALUES SIGNIFICANT NURSING

RESPONSIBILITIES

Red blood cell

count:
COMPLETE Increased in Blood eosinophil Explain test
BLOOD COUNT eosinophil Male: 4.35-5.65 counts and derived procedure
neutrophil ratio and million cells/uL ratios
Explain that slight
eosinophil Female: 3.92-5.13 eosinophil/lymphocyte
discomfort may
lymphocyte ratio million cells/Ul e ELR and eosinophil
be felt when the
indicates eosinophil neutrophil ratio ENR
skin is punctured.
asthma can accurately predict
Hemoglobin: eosinophilic asthma Encourage to
With an area under
despite treatment. avoid stress if
the curve of 0.907, P Male: 13.5-16.5
possible because
grams/dL (%) Blood counts a useful
altered
Female: 11.5-15 aid in the monitoring
physiologic status
A CBC count and grams/dL (%) of uncontrolled
influences and
differential asthma.
changes normal
demonstrate
hematologic
an elevated white Hematocrit:
values.
blood cell count. It
Male: 38-48%
determines infection Explain that
Female: 35-45%
in the pulmonary. fasting is not
necessary.
However, fatty
White blood cell
meals may alter
count:
some test results
3,500 to 10,000 as a result of
cells/uL lipidemia.

Platelet count Apply manual

pressure and
Male: 150,000 to
dressing over
450,000/uL
puncture site.
Monitor the
Differential white puncture site for
bloold cell count: oozing or
hematoma
Neuts.% formation.
(Neutrophils):
40% to 60%

Lymphs%
(Lymphocytes):
20% to 40%

Monos.%
(Monocytes): 2%
to 8%
 Eos.%.
(Eosinophils): 1%
to 4%

Baso.%
(Basophils): 0.5%
to 1%

Neuts.# (ANC-
Absolute Count):
1.70-7.00 x 109/L

Lymphs# (ALC –
Absolute Count):
1.00-4.80 x 109/L

Monos# (Number
of Monocytes):
0.30-0.90 x 109/L

Eos# (Number of
Eosinophils): 0.05-
0.50 x 109/L
Baso# (Number of
Basophils): 0.00-
0.30 x 109/L

ARTERIAL ABG results for Normal

BLOOD GAS Asthma value
An ABG value can be Apply manual
 O2CT 15 to
 pH is obtained to assess the pressure and
23% per
decreased to severity of the dressing to
100ml of
6.5 patient’s need for puncture site
blood
 PaCO2 rise to more intensive care. about 3 to 5
 pH 7.35 to
55 mmHg minutes.
7.45 It determines whether
 PaO2
 PaCO2 35 or not to intubate the If the puncture
severely
to 45 patient. site is on the arm,
decreased to
mmHg don’t tape the
40 mmHg
 PaO2 80 to entire
 HCO3 is circumference
100 mmHg
decreased
 HCO3 22 because this may
18mEq/L restrict
to 26
  SaO2 is 85%, mEq/L circulation.
indicates  SaO2 is
Monitor vital
shortness of 95% to
signs and observe
breath 100%
for signs of
 Metabolic
circulatory
acidosis
impairment.

SERUM  Patient has  Normal An allergy blood test Instruct patient

IMMUGLOBULIN 150 UI/ml, total measures a substance that he can eat
E LEVELS indicates it is serum IgE called immunoglobulin and drink before
normal range in- E in the patient’s and after the test.
between blood.
Assess in cleaning
150 and
with alcohol the
300ml.
injection site.
Apply manual
pressure and
dressing to
injection site.

SPIROMETRY 55% severely Percentage of To assess how well the Educate patient
abnormal predicted FEVI patient’s lungs, work in how to use it
value, 80% or by measuring how and the
greater is normal much air the patient importance of
inhale and how much using it regularly.
he exhales and how
-Encouraging
quickly he exhales.
patient to use it
It is used to diagnose often.
asthma.
-monitor lung
sounds for
improvement.

ALLERGY SKIN Sensitivity Test is Negative to any To check if there’s an To make sure
TESTING Positive to allergic to other substances allergic reaction to any patient’s skin to
pollen and dust like fungi, dog- substances and to be tested is
mites. epithelia, mold know what kind of cleaned with
spores etc.. allergens that trigger alcohol.
patient’s asthma.
Assess in injecting
the allergen
solution into the
skin.
To check patient’s
skin after about
15 minutes for
red raised itchy
areas called
wheals, if wheal
appears it
indicates he is
allergic to that
substance.
 V.II. DRUG STUDY

DOSAGE/FRE
NAME OF CLASSIFIC INDICATIONS/CONTRAIND SIDE ADVERSE NURSING
QUENCY/ROU MECHANISM OF ACTION
DRUG ATION ICCATIONS EFFECTS EFFECTS RESPONSIBILITIES
TE/SUPPLIED
Oxygen therapy increases Indication: 1. Obtain history of
the arterial pressure of respirator
oxygen and is effective in Oxygen therapy in clinical
Dosage: conditions and
improving gas exchange settings is used across
collect data
½ L/min – and oxygen delivery to diverse specialties, including regarding current
5L/min tissues, provided that there various types of anoxia, symptoms
are functional alveolar hypoxia or dyspnea and any associate with the
units. Oxygen plays a other disease states and patient’s feeling of
critical role as an electron conditions that reduce the Breathing in higher shortness of breath.
Frequency:
Generic Name: acceptor during oxidative efficiency of gas exchange oxygen 2. Wash cannula or
Once a day phosphorylation in the and oxygen consumption concentration can mask with liquid
Oxygen Dry or bloody
electron transport chain such as respiratory illnesses, cause oxygen soap and warm
nose, water daily.
through activation of trauma, poisonings and drug toxicity, can affect
Medical gas tiredness, and 3. Ensure that
Route: cytochrome c oxidase overdoses. Oxygen therapy all the body’s
Brand Name: morning oxygenation is
(terminal enzyme of the tries to achieve hyperoxia to organs but most
Alnox, Ez-OX, inhalation headaches optimized at
electron transport chain). reduce the extent of hypoxia- often causes
Heliox induced tissue damage and damage to lungs, pulmonary and
This process achieves cellular level as part
successful aerobic malfunction. eyes, and brain.
Supplied: of their duty of care
respiration in organisms to to patients.
Nasal prongs generate ATP molecules 4. If frost forms on
(an oxygen as an energy source in Contraindication: liquid oxygen
cannula) or a many tissues. Oxygen In all patients with equipment don’t
face mask supplementation acts to allow the frosted
unfavourable ventilation
restore normal cellular parts to come into
response to oxygen
activity at the mitochondrial contact with the
treatment
level and reduce metabolic skin of the patient.
 acidosis. There is also
evidence that oxygen may
interact with O2-sensitive
voltage-gated potassium
channels in glomus cells
and cause
hyperpolarization of
mitochondrial membrane
Indications: CNS: 1. Assess lung
Dosage: sounds, PR and
1. To control and Restlessness,
Binds to beta2- adrenergic BP before drug
prevent reversible apprehension,
1.25mg/3mL receptors in airways administration and
airway obstruction anxiety, fear,
(contains 1.50 smooth muscle, leading to Nearvousness, during peak of
caused by asthma insomnia, tremor,
mg albuterol activation of adenylcyclase peak medication
2. Quick relief for restlessness, drowsiness,
sulfate/3 mL) and increased levels of tremr, 2. Administer PO
bronchospasm irritability, medications with
cyclic 3, 5- adenosine 3. For the prevention of headache, weakness meals to minimize
Generic Name: monophosphate (cAMP). exercise induced insomnia, chest
gastric irritation
Frequency: Increases in cAMP activate bronchospasm pain,
Albuterol 3. Extended release
Bronchodilat kinases, which inhibit the 4. Long- term control palpitations,
4-6 hours Cardiac tablet should be
or phosphorylation of myosin agent for patients with angina,
Disorders: swallowed whole.
and decreased intracellular chronic or persistent arrhythmias,
It should not be
Brand Name: calcium. Decreased bronchospasm hypertension, Tachycardia,
Route: crushed or chewed
intracellular calcium Contraindications: nausea and
Salbutamol palpitations, chest 4. If administering
inhalation relaxes smooth muscle 1. Cardiac disease vomiting, pain medication
airway with subsequent including coronary hyperglycemia, through inhalation,
bronchodilation. Relatively insufficiency, a history hypokalemia allow at least 1
Supplied: selective for beta2 of stroke, coronary GI: minute between
(pulmonary) receptors artery disease and inhalation of
vials cardiac arrhythmias Nausea, vomiting, aerosol medication
2. Hypertension mouth and throat 5. Advise the patient
3. Hyperthyroidism irritation to rinse mouth with
 4. Diabetes (inhalation) water after each
5. Glaucoma intubation to
6. Geriatric patients – minimize dry
older indv. are at high Nervous system mouth
risk for adverse disorders: 6. Inform the patient
reactions and may that albuterol may
require lower dosage. Tremor, cause an unusual
7. Pregnancy especially headache, or bad taste
near term dizziness,
8. Lactation restlessness
9. Children less than 2
years of age because
safety of its use has
Respiratory:
not been established
10. Excess inhaler use Pharyngitis,
which may lead to rhinitis, pulmonary
tolerance and edema
paradoxical
bronchospasm
disease
Dosage: Decreases inflammation by Indications: Blood and 1. Adminiter once
suppression of migration of Dizziness, fast, Lymphatic a day before 9
40-60 mg daily 1. Short-term system
polymorphonuclear slow, pounding AM to mimic
management of
Generic Name: leukocytes and reversal of or irregular disorders: normal peak
various inflammatory
heartbeat or corticosteriod
Prednisone Frequency: Corticosterio increased capillary and allergic disorders, Moderate blood levels.
permeability; suppresses dermatologic pulse,
d, leukocytosis, 2. Increase dosage
3-10 days headache,
Gluocorticoid the immune system by diseases, status lymphopenia, when patient is
reducing activity and asthmaticus, and irritability,
Brand Name: eosinopenia, subject to stress
volume of the lymphatic autoimmune disorders mood changes,
polycythaemia 3. Taper doses
Prolix Route: system; suppresses Contraindications: noisy, rattling
when
adrenal function at high breathing
1. Contraindicated with discontinuing
oral doses. Antitumor effects infection, especially Cardiac high dose or
 may be related to inhibition tuberculosis, fungal disorders: long term
of glucose transport, infections, therapy
Supplied: amoebiasis, and Arrhythmia 4. Do not give live
phosphorylation, or
Clear, colorless, induction of cell death in antibiotic-resistant virus vaccines
slightly viscous immature lymphocytes. infections; lacatation with
Antiemetic effects are GI: immunosuppres
solution
thought to occur due to sive doses of
Nausea, vomiting, corticosteriods
blockade of cerebral diarrhea,
innervation of the emetic constipation,
center via inhibition of abdominal
prostaglandin synthesis. distention, gastric
irritation, ulcerative
oesophagitis,
pancreatitis, peptic
ulceration with
perforation and
haemorrhage

Musculoskeletal
and connective
tissue:
Muscle atrophy,
vertebral
compression
fractures

Nervous system
disorders:
 Headache,
restlessness

Indications: 1. Assess for

allergy to
Dosage: 1. Maintenance therapy atropine and
of reversible airway belladonna
20-40 mcg
obstructiondue to alkaloids;
COPD, including patients with
chronic bronchitis and these allergies
Frequency: Dry mouth, may also be
emphysema
constipation, sensitive to
3-4 times daily Inhalation: 2. Rhinorrhea
tachycardia, ipratropium
associated with Dizziness,
Generic Name: Inhibits cholinergic palpitations, 2. Assess
allergic and headache, respiratory
receptors in bronchial arrhythmias,
Ipatropium Route: nonallergic perennial nervousness, status before
smooth muscle, resulting in nausea and
bromide rhinitis or the common blurred vision, administration.
Oral inhalation Bronchodilat decreased concentration of vomiting,
sore throat, 3. Caution patient
or cyclic gaunosine cold dyspepsia,
dryness, to avoid
monophosphate (cGMP). 3. Adjunctive headaches,
Brand Name: hypotension, spraying
Supplied: Decreased levels of cGMP management of dizziness, ocular
rash, allergic medication in
Atrovent produce local bronchospasm complications,
Pressurized reactions eyes; may
bronchodilation. caused by asthma paradoxical cause blurring of
canister with bronchospasm vision or
white Contraindications: anaphylaxis irritation
mouthpiece that
2. Contraindicated in 4. Instruct patient
has a clear, in proper use of
colorless sleeve hypersensitivity to
nasal spray
and a green ipratropium, atropine, Advise patient
protective cap belladonna alkaloids, that rinsing
or bromide; avoid use mouth after
during acute using inhalator,
 bronchospasm good oral
3. Patients with bladder hygiene, and
neck obstruction, sugarless gum
prostatic hyperplasia, or candy may
glaucoma, or urinary minimize dry
retention; geriatric mouth
patients may be more
sensitive to effects

DOSAGE/FREQ NURSING
CLASSIFICATI MECHANISM OF INDICATIONS/CONTRAIND ADVERSE
NAME OF DRUG UENCY/ROUTE/ SIDE EFFECTS RESPONSIBILITIE
ON ACTION ICCATIONS EFFECTS
SUPPLIED S

Binds to beta2- Nearvousne 7. Assess lung

Dosage: CNS:
adrenergic receptors Indications: ss, sounds, PR
1.25mg/3mL in airways smooth 5. To control and restlessnes Restlessness, and BP before
(contains 1.50 muscle, leading to prevent reversible s, tremr, apprehension, drug
mg albuterol activation of airway obstruction headache, anxiety, fear, administration
Generic Name: and during
sulfate/3 mL) adenylcyclase and caused by asthma insomnia, insomnia, tremor,
Albuterol increased levels of 6. Quick relief for chest pain, drowsiness, peak of peak
Bronchodilator bronchospasm irritability, medication
cyclic 3, 5- palpitations,
7. For the prevention of 8. Administer PO
Frequency: adenosine angina, weakness
exercise induced medications
Brand Name: monophosphate arrhythmias with meals to
4-6 hours (cAMP). Increases in bronchospasm ,
Salbutamol 8. Long- term control minimize
cAMP activate hypertensio Cardiac gastric irritation
agent for patients with
kinases, which inhibit n, nausea Disorders: 9. Extended
Route: chronic or persistent
the phosphorylation and release tablet
bronchospasm Tachycardia,
of myosin and vomiting, should be
 inhalation decreased Contraindications: hyperglyce palpitations, chest swallowed
intracellular calcium. mia, pain whole. It should
11. Cardiac disease not be crushed
Decreased hypokalemi
including coronary or chewed
Supplied: intracellular calcium a
insufficiency, a history 10. If administering
relaxes smooth of stroke, coronary GI:
vials muscle airway with medication
artery disease and Nausea, vomiting, through
subsequent cardiac arrhythmias mouth and throat inhalation,
bronchodilation. 12. Hypertension
irritation allow at least 1
Relatively selective 13. Hyperthyroidism
(inhalation) minute
for beta2 (pulmonary) 14. Diabetes between
receptors 15. Glaucoma inhalation of
16. Geriatric patients – aerosol
older indv. are at high Nervous system
medication
risk for adverse disorders: 11. Advise the
reactions and may patient to rinse
Tremor,
require lower dosage. mouth with
17. Pregnancy especially headache,
dizziness, water after
near term each intubation
18. Lactation restlessness
to minimize dry
19. Children less than 2 mouth
years of age because 12. Inform the
safety of its use has Respiratory: patient that
not been established albuterol may
20. Excess inhaler use Pharyngitis,
rhinitis, pulmonary cause an
which may lead to unusual or bad
tolerance and edema
taste
paradoxical
bronchospasm
disease
Dosage: Decreases Indications: Dizziness, Blood and 5. Adminiter
Corticosteriod, once a day
Gluocorticoid inflammation by 2. Short-term fast, slow, Lymphatic
Generic Name: 40-60 mg daily before 9 AM
suppression of management of pounding or system
to mimic
 Prednisone migration of various inflammatory irregular disorders: normal peak
polymorphonuclear and allergic disorders, heartbeat or corticosterio
Frequency: dermatologic Moderate d blood
leukocytes and pulse,
diseases, status leukocytosis, levels.
Brand Name: 3-10 days reversal of increased headache,
asthmaticus, and lymphopenia, 6. Increase
capillary irritability,
Prolix autoimmune disorders eosinopenia, dosage
permeability; mood
Contraindications: polycythaemia when patient
Route: suppresses the changes,
is subject to
immune system by 4. Contraindicated with noisy,
oral stress
reducing activity and infection, especially rattling
Cardiac 7. Taper doses
volume of the tuberculosis, fungal breathing when
lymphatic system; infections, disorders:
discontinuing
Supplied: suppresses adrenal amoebiasis, and Arrhythmia high dose or
function at high antibiotic-resistant long term
Clear, colorless,
doses. Antitumor infections; lacatation therapy
slightly viscous
solution effects may be GI: 8. Do not give
related to inhibition of live virus
glucose transport, Nausea, vomiting, vaccines
phosphorylation, or diarrhea, with
induction of cell constipation, immunosupp
death in immature abdominal ressive
lymphocytes. distention, gastric doses of
Antiemetic effects irritation, ulcerative corticosterio
oesophagitis, ds
are thought to occur
due to blockade of pancreatitis, peptic
cerebral innervation ulceration with
of the emetic center perforation and
via inhibition of haemorrhage
prostaglandin
synthesis.
Musculoskeletal
and connective
 tissue:
Muscle atrophy,
vertebral
compression
fractures

Nervous system
disorders:
Headache,
restlessness

Dosage: Indications: 5. Assess for

Dry mouth, allergy to
20-40 mcg Inhalation: 4. Maintenance therapy
constipation, atropine and
Inhibits cholinergic of reversible airway Dizziness, belladonna
tachycardia,
receptors in bronchial obstructiondue to headache, alkaloids;
Generic Name: palpitations,
Frequency: smooth muscle, COPD, including nervousnes patients with
arrhythmias,
Ipatropium resulting in chronic bronchitis and s, blurred these
3-4 times daily nausea and allergies may
bromide decreased vision, sore
emphysema vomiting,
Bronchodilator throat, also be
concentration of 5. Rhinorrhea dyspepsia,
dryness, sensitive to
cyclic gaunosine associated with headaches,
Brand Name: Route: hypotension ipratropium
monophosphate allergic and dizziness, ocular 6. Assess
Oral inhalation (cGMP). Decreased , rash,
Atrovent nonallergic perennial complications, respiratory
levels of cGMP allergic
rhinitis or the common paradoxical status before
produce local reactions
bronchospasm administratio
cold
Supplied: bronchodilation. anaphylaxis n.
6. Adjunctive 7. Caution
Pressurized management of patient to
 canister with bronchospasm avoid
white caused by asthma spraying
mouthpiece that medication in
has a clear, Contraindications: eyes; may
colorless sleeve cause
5. Contraindicated in blurring of
and a green
hypersensitivity to vision or
protective cap
ipratropium, atropine, irritation
belladonna alkaloids, 8. Instruct
or bromide; avoid use patient in
during acute proper use of
nasal spray
bronchospasm Advise
6. Patients with bladder patient that
neck obstruction, rinsing
prostatic hyperplasia, mouth after
glaucoma, or urinary using
retention; geriatric inhalator,
patients may be more good oral
sensitive to effects hygiene, and
sugarless
gum or
candy may
minimize dry
mouth
 VI. NURSING CARE PLANS

Assessment Nursing Diagnosis Scientific Basis Outcome Criteria Nursing Rationale Actual Evaluation
Intervention
Independent:
Subjective: In effective airway Bronchial asthma After 2 days of -Keep -Some degree of After 2 days of
clearance related is a chronic nursing environmental bronchospasm is nursing
to increased inflammatory intervention the pollution to present with intervention, the
“Nahihirapan production of disease of the patient will minimum obstruction in patient was able to
akong huminga” secretion. airways, demonstrate dust,smoke, and airway and may or demonstrate the
verbalized by the associated with behaviors to pollen particles. may not be improvement of
patient. recurrent,reversible improve airway manifested in airway clearances.
-Elevate head of
airway obstruction clearance. adventious breath
with intermittent the patient lean on sounds.
episodes of overbend table or
wheezing and sit on the edge of -Elevation of
dyspnea. the bed facilities
respiratory
Objective: function by use of
Dependent:. gravity.

-Auscultate -Coughing is most

 Use of
breathing sounds effective in an
accessory
for any upright position
muscle.
 Abnormal crackles,wheezing after chest
breath and rhonchi. percussion.
sounds. -Hydration helps
-Assist with
measures to decrease the
Vital Signs: improve viscosity of
effectiveness of secretion,
T: 38.6C cough effort. facilitating
expectoration
PR: 117bpm
using warm liquids
RR: 27cpm may decrease
bronchospasm.
BP: 130/90 mmHg Collaborative:

SpO2: 84% -Administer

bronchodilators as
prescribed.
 ASSESSMENT NURSING SCIENTIFIC BASIS OUTCOME NURSING RATIONALE ACTUAL
DIAGNOSIS CRITERIA INTERVENTION EVALUATION

Subjective: Imbalanced Imbalanced nutrition in SHORT TERM INDEPENDENT INDEPENDENT SHORT TERM
nutrition: less than the case of less than The patient will be
body body requirements is a able to gain and 1. Ascertain and 1. To determine The patient was
state which occurs verbalize assess informational able to
―Dili naman ko requirements when an individual’s understanding of understanding needs of the understand and
kaon ug pamahaw related to nutritional and appropriate of nutritional patient and verbalize
ma’am, ka 2 sa insufficient dietary metabolic demands interventions to needs and significant
intake as are not supplied promote adequate understanding
isa ka adlaw ra dietary habits. others.
evidenced by sufficiently. nutritional intake regarding health
kasagaran tungod 2. Encourage a 2. The patient can nutrition
wala koy gana mo patient’s skinny healthy weight be very thin
Reference LONG TERM
kaon.‖ and barrel- Vera, M. The patient will from the (barrel-
chested physical (2021). Nursing Care steadily gain and patient. chested) and it
appearance and a Plans. Nurselabs. maintain ideal 3. Help the is important to LONG TERM
BMI of 17.9 Retrieved from weight appropriate patient to make sure that
https://nurseslabs.com/ to age and height, The patient was
select the he is getting
chronic-obstructive- identify appropriate able to cut off
Objective: appropriate proper nutrition
pulmonary-disease- nutritional needs, food choices so that his unhealthy food
copd-nursing-care- and consume
necessary to body will be at habits and
plans/4/ adequate nutrition.
maintain a high its optimal consumed
 Weight of caloric diet in performance. adequate
58kg
small, frequent 3. Small, frequent nutrition, with a
 Height of 5’11 portions. portions might BMI of 20.9 that
 BMI = 17.9
Instruct to eat a be more falls under the
 Skinny
good amount of tolerable and normal
 Barrel
protein-rich increase classification.
chested
foods and overall calorie
.
increase fluid intake. These
intake. food choices
4. Encourage the can also help
Vital Signs: patient to have maintain strong
a rest period of respiratory
T: 38.6C 1 hr before and muscles.
after meals. 4. This helps
PR: 117bpm 5. Instruct the reduce fatigue
patient to avoid during
RR: 27cpm
gas-producing mealtime and
BP: 130/90 mmHg foods and provides an
carbonated opportunity to
SpO2: 84% beverages. increase total
6. Avoid very hot caloric intake.
or very cold 5. These foods
foods. may cause
7. Instruct the abdominal
patient for distention,
frequent oral thereby
care hindering the
8. When optimal
weighing, expansion of
advise patient the diaphragm.
to wear the When the
same clothing diaphragm is
as the initial not able to
weigh expand well,
dyspnea may
worsen.
DEPENDENT 6. Extremes in
1. Weigh the temperature
patient daily as can precipitate
indicated by his or aggravate
physician. coughing
2. Administer spasms.
supplemental 7. Noxious taste,
oxygen during smell, and
meals as sights are
indicated prime
deterrents to
appetite and
COLLABORATIVE can produce
nausea and
1. Refer the vomiting with
patient to a increased
dietician respiratory
difficulty.
8. Wearing of
different
clothes upon
weighing, alters
the results
DEPENDENT
1. This is useful in
determining
caloric needs,
setting a weight
goal, and
evaluating the
adequacy of a
nutritional plan.
2. Decreases
dyspnea and
increases
energy for
eating,
enhancing
intake.
COLLABORATIVE
1. The dietician
can provide
nutritional
assessment
and counseling
applicable to
the patient.
 ASSESSMENT NURSING SCIENTIFIC BASIS OUTCOME NURSING INTERVENTION RATIONALE ACTUAL
DIAGNOSIS CRITERIA EVALUATION
INDEPENDENT
Subjective: Ineffective SCIENTIFIC BASIS SHORT 1. Monitor vital signs INDEPENDENT SHORT
Airway TERM 2. Assess level of TERM
Clearance Ineffective Airway Clearance is consciousness 1. To note any
the inability to clear secretions Verbalize 1. Check for changes in Verbalized
―Maglisod jud ko ug related to
or obstructions from the understanding responsiveness – patient’s blood understanding
ginhawa ma’am ay increased
respiratory tract that may be of causes, able to answer pressure and to current
labi na ug mag production heart rate
of caused by respiratory disorders health status, questions situation - can
higda ko unya huot or pollutants such as asthma, and accurately 2. Essential for enumerate
kaayo sa dughan. secretions identifying
as
COPD, infection, and smoking precautionary 3. Position client in high fowler’s preventive
Ma arang-arangan 1. Regularly check potential for
evidenced measures to measures
rajud ug akong e patient’s position airway
by difficulty avoid further
ubo‖ complications 4. Perform nasotracheal problems, Patient
breathing Reference providing
suctioning, as necessary if identified
and patient is does not know how baseline level avoidance of
Wagner, M. (2022). Ineffective
persistent to cough out secretions of care needed, specific
Airway Clearance Nursing
cough with Patient will 5. Perform Physiotherapy and influencing factors that
Diagnosis & Care plan. demonstrate choice of
Objective: sputum 1. Deep breathing inhibit
Retrieved from intervention
behaviors to 2. Huffing or effective
https://www.nursetogether.com/ improve or 3. To open or
coughing airway
ineffective-airway-clearance- maintain clear 3. Percussion maintain open
 Persistent airway and clearance
productive nursing-diagnosis-care-plan/ airway 6. Provide oral care
7. Increase fluid intake to 3 liters facilitate
cough breathing
 Shortness of daily if not contraindicated.
8. Encourage the patient to turn 4. This is LONG TERM
breath LONG TERM needed for
 Hypersecretions in bed every 2 hours or Patient
Patient will ambulate several times a day patients that
in nasal are unable to maintained
passages maintain 9. Maintain planned rest periods
cough out clear, open
 Presence of clear, open 10. Conduct health teaching
thick, airways as
wheezing regarding smoking cessation
excessive evidenced by
 Vital signs are airways and second-hand smoke secretions that normal rate
as follows: 1. Educate on can obstruct and depth of
T: 38.6C internal and airways respirations
Identify external risk 5. To mobilize and increased
PR: 117bpm factors secretions from
potential ability to
11. Encourage to verbalize airways to be cough out
RR: 27cpm complications
feelings eliminated secretions
and how to 6. Freshens
BP: 130/90 mmHg initiate mouth after Patient
SpO2: 84% appropriate respiratory demonstrated
preventive secretions
DEPENDENT effective
actions have been airway
1. Give medications as expelled clearance
prescribed by physician 7. Helps in easy
1. Bronchodilators elimination of
2. Administer oxygen therapy as secretions
needed 8. Movement aids
3. Provide and assist with in mobilizing
nebulization secretions,
helping the
patient
COLLABORATIVE expectorate
them or
1. Refer to chest physiotherapist
eliminate them
via the GI tract
9. Fatigue can
contribute to
ineffective
cough;
coughing
requires effort
on the patient’s
part
10. Chemical
irritants and
allergens can
 increase
mucus
production and
bronchospasm
11. Aid in
recognizing the
reality of the
situation. This
addresses the
anxiety which
contributes
oxygen
demand

DEPENDENT
1. For
management of
specific
problems
2. To increase
oxygen levels
in the blood
3. Medication
through
nebulizers
allows easy
absorption into
the lungs.

COLLABORATIVE
1. They can
include techniques
of postural damage
 ASSESSMENT NURSING SCIENTIFIC OUTCOME NURSING RATIONALE ACTUAL
DIAGNOSIS BASIS CRITERIA INTERVENTION EVALUATION
 Establish  To gain
rapport patient/SO trust
SUBJECTIVE: Ineffective Ineffective Short Term: and Short Term:
Breathing Pattern Breathing Pattern is cooperation.
 Dyspnea related to the state in which The patient shall
 Monitor and  To obtain
The patient have
decreased lung the rate, depth, have demonstrated demonstrated
record vital baseline data.
volume capacity as timing, rhythm, or appropriate coping appropriate coping
signs
evidenced by pattern of breathing behaviors and behaviors and
OBJECTIVE: methods to improve methods to improve
tachypnea, is altered. When the  Assess breath
presence of breathing pattern is breathing pattern. sounds, breathing pattern.
The patient manifests  To note for
the following: crackles on both ineffective, the body respiratory rate,
respiratory
lung fields and will likely not get depth, and
abnormalities
 Tachypnea dyspnea. enough oxygen to Long Term: rhythm.
that may Long Term:
 Presence of the cells. indicate early
crackles on Respiratory failure The patient shall The patient have
respiratory
both lung fields may be correlated have applied applied techniques
compromise
upon with variations in techniques that and hypoxia. that improved
auscultation respiratory rate, improved breathing  Elevate the  To promote breathing pattern
 Use of abdominal and pattern and be free head of the lung expansion. and be free from
accessory from signs and patient. signs and
thoracic patterns.
muscles symptoms of  Provide relaxing  To promote symptoms of
respiratory distress, environment adequate rest respiratory distress,
AEB respiratory rate periods to limit AEB respiratory rate
The patient may
manifest the following:
within normal range,  Administer fatigue. within normal range,
absence of supplemental  To maximize absence of
 Cyanosis cyanosis, effective oxygen as oxygen cyanosis, effective
 Orthopnea breathing and ordered. available for breathing and
 Diaphoresis minimal use of  Assists client in cellular uptake. minimal use of
accessory muscles the use of  To provide of accessory muscles
during breathing. relaxation causative during breathing.
technique. factors.
 Administer
prescribed  For the
 medications as pharmacologica
ordered. l management
of the patient
condition.
 Minimize
respiratory effort
with good  To promote
posture and wellness
effective use of
accessory
muscles.
 To limit fatigue
 Encourage
adequate rest
periods
between
activities.
 ASSESSMENT NURSING SCIENTIFIC OUTCOME NURSING RATIONALE ACTUAL
DIAGNOSIS BASIS CRITERIA INTERVENTION EVALUATION

SHORT TERM INDEPENDENT INDEPENDENT SHORT TERM

SUBJECTIVE DATA Impaired Gas Impaired Gas Patient will correctly 1. Monitor vital 1. This creates Patient correctly
Exchange Exchange enumerate causative signs baseline enumerated
“Huot akoang pamati sa results from
related to factors and is able to information for causative factors and
akoang dughan.” As
loss of conditions verbalize appropriate  Note is able to
patient condition
verbalized by the patient. that cause respiratory
alveolar preventive measures and helps plan for verbalize appropriate
elastic recoil changes or function preventive measures
OBJECTIVE DATA effective care
collapse of Patient will actively parameters
as evidenced
 ABG results as by decreased the alveoli participate in such as 2. The presence of Patient actively
respiratory that impairs breathing exercises depth, crackles and participated in
oxygen
acidosis, uncompens ventilation, and effective rhythm, rate wheezes is breathing exercises
saturation of
ated altering the coughing. indicative of and effective
84%. 2. Assess and
balance of airway coughing
 Use of accessory Respiratory LONG TERM auscultate lungs
acidosis, oxygen and obstruction,
muscles when for areas of LONG TERM
increase carbon Patient’s ABG should leading to or
breathing be within client’s decreased Patient’s ABG is
respiratory dioxide. exacerbating
usual parameters and ventilation within client’s usual
 Nasal flaring rate, and existing hypoxia
shows lesser and/or presence parameters and
dyspnea and diminished
 Exertional dyspnea symptoms of of adventitious
breath sounds are shows lesser
respiratory distress. sounds symptoms of
 Dusky skin linked with poor
appearance 3. Note for any skin ventilation respiratory distress.
color changes
 Vital signs are as 3. Cyanosis of the
and mucus
follows: nail beds, skin, or
membranes’
ear lobes may be
T: 38.6C status
due to hypoxemia
PR: 117bpm 4. Assess level of and needs
consciousness immediate
RR: 27cpm
BP: 130/90 mmHg 5. Elevate the head attention
of the bed and
SpO2: 84% 4. The LOC may
place the client
impair one’s ability
in an upright
to protect the
position.
airway, potentially
6. Encourage and further adversely
assist with affecting
ambulation oxygenation

7. Assist and 5. Upright or semi-

demonstrate fowler’s position
controlled allows increased
coughing thoracic capacity,
total descent of
1. Have the
the diaphragm,
patient
and increased lung
inhale
expansion
deeply, hold
breath for 6. Ambulation
several facilitates lung
seconds, and expansion,
cough two to secretion
three times clearance and
with mouth stimulates deep
open while breathing
tightening
7. This technique can
the upper
help increase
abdominal
sputum clearance
muscles as
and decrease
tolerated
cough spasms
8. Encourage
8. promotes
pursed-lip
 breathing, elimination of CO2
focusing in
9. This promotes
doubling the
mobilization of
time
secretions
9. Maintain
10. Activities will
adequate fluid
increase oxygen
intake
consumption and
10. Schedule rest should be
periods planned, so the
patient does not
11. Discuss
become hypoxic.
implications of
smoking related 11. Health teaching is
illness or essential to reduce
condition. health risks and/or
Encourage prevent further
patient and decline in lung
significant other function
to stop smoking
DEPENDENT
DEPENDENT
1. This will reduce
1. Administer signs and
medications as symptoms of
per doctor’s disease
prescription
2. Supplemental
 Bronchodilators oxygen may be
 Antibiotics required to
 Corticosteroids maintain Pa02 at
 Analgesics an acceptable
level
2. Maintain oxygen
 administration 3. Improve gas
device as diffusion when
ordered client is showing
desaturation of
3. Suction as
oxygen by
necessary
oximetry or ABGs
4. Assist in slow
4. This technique
deep breathing
promotes deep
using an
inspiration, which
incentive
increases
spirometer as
oxygenation and
indicated
prevents
atelectasis
VII. DISCHARGE PLAN
METHODS INSTRUCTIONS

MEDICATIONS  Instruct mother to give salbutamol in

case status asthmaticus flare ups.
 Instruct the mother to take prescribed
medicine by having a written reminder
of the exact drug, time, and proper
frequency in taking it.

EXERCISE  Tell the mother to take the patient for a

morning stroll a form of exercise, but only
if he/she is not in discomfort.

TREATMENT  Instruct mother to avoid the common

asthma triggers.

HEALTH TEACHING  Discuss to the mother the common

sources of asthma.
 Teach the family how to get rid of the
triggers cause the asthma flare ups.
 Encourage the mother to monitor any
changes in respiratory status.
 Promote proper lung expansion and
reducing pressure in the abdomen. It
minimizes risk of aspiration from
secretions.

OUT-PATIENT  Instruct the family members to have a

check-up or contact a physician once in a
while to keep tract of their health.
Patient’s condition, as well as to identify
recurrences and other issues that may
occur.

DIET  Instruct the mother to avoid feeding foods

that might trigger his/her asthma.
 Instruct the mother to feed rich in fruits
and vegetables and low in processed,
fatty, and fried foods.
SPIRITUAL  Instruct the mother to speak with GOD at
all times through praying and asking for
direction, good health, and strength. Also,
remember to express gratitude for all of
His excellent works.