A CASE STUDY ON BRONCHIAL ASTHMA IN ACUTE EXACERBATION
Presented to Level II Clinical Instructor of Saint Anthony College of Roxas City Nursing Department
In Partial Fulfillment of the Requirements in Related Learning Experience
Submitted to: Mrs. Mabel Alona Macahilig, R.N. Clinical Instructor
Submitted by: Charmie Lou D. Celestial Niño de Prada Ward BSN-2B Group 4
Clinical Assessment A. Objectives III. Family Health History B. Nursing History 1. Introduction II. Case Discussion VI. Drug Study IX. Nursing Care Plans X.TABLE OF CONTENTS
I. Past Health History 3. Anatomy VII. Vital Information IV. History of Present Illness 2. Discharge Planning
. Pathophysiology VIII. Clinical Inspection V.
Although the two types of asthma have similar symptoms. tobacco smoke or other pollutants. they have quite different causes. and intravenous medications. oxygen. with spasms of the bronchial musculature. the allergy is not necessarily the cause of the asthma symptoms. Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath. the individual usually breathes relatively normally. Despite its most strenuous efforts. and can become dangerous if the airflow becomes severely restricted. but the incidence is 1 in 10 in children. Persons with significant asthma (symptoms occur at least every week) should be treated with anti-inflammatory medications. In the initial stage. edematous swelling of the bronchial wall and increased mucus secretion. Asthma attacks can last minutes to days. reducing airflow and producing the wheezing sound. cold or exercise. Bronchial asthma is the more correct name for the common form of asthma. Acute severe asthma may require hospitalization. but is occasionally caused by a specific allergy (such as allergy to mold. Risk factors include self or family history of eczema. The result is a characteristic asthma attack. allergies or family history of asthma. Although most individuals with asthma will have some positive allergy tests. Bronchial asthma causes cough. dander. the patient can be totally symptom-free for long periods of time in the intervals between the attacks. INTRODUCTION Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways. but some children seem to outgrow the illness. cold air. Asthma affects 1 in 20 of the overall population. The muscles of the bronchial tree become tight and the lining of the air passages become swollen. including wheezing (a whistling sound in the chest) and shortness of breath. Treatment is aimed at avoiding known allergens and controlling symptoms through medication. Mucus production is increased. People with mild asthma (infrequent attacks) may use inhalers on an as-needed basis. exercise. or by food allergies or drug allergies. and will have periodic attacks of wheezing.
. Bronchial asthma is an allergic condition. Symptoms can occur spontaneously or can be triggered by respiratory infections. which in part builds up in the airways and can then lead to secondary bacterial infections. As the disease progresses. in which the airways (bronchi) are hyper-reactive and constrict abnormally when exposed to allergens. stress or anxiety. and then with bronchodilators such as inhaled Alupent or Vanceril. Asthma can develop at any age. Typically. shortness of breath. the respiratory musculature is unable to provide sufficient gas exchange. and wheezing. dust). increased mucus is secreted between attacks as well.I. The cause is a sharply elevated resistance to airflow in the airways. Bronchial asthma is usually intrinsic (no cause can be demonstrated). which is a separate condition that is caused by heart failure. preferably inhaled corticosteroids. The term 'bronchial' is used to differentiate it from 'cardiac' asthma. A variety of medications for treatment of asthma are available.
To be able to determine the purposes of all the medications being administered to the patient and its actions and mechanism of action. assessment. 5.
Asthma affects 7% of the population. organize and validate data. and to be able to carry out and practice all these things with Vincentian values. Specific Objectives KNOWLEDGE 1 2 3 To be able to comprehend the pathophysiology of Bronchial Asthma in Acute Exacerbation. OBJECTIVES General Objective After our clinical exposure.
patient. nursing statements. conduct physical To be able to formulate nursing diagnoses and collaborative To be able to select nursing strategies and interventions. and evaluate our nursing procedures towards phases. and 300 million worldwide.
II. SKILLS 1. implement. To be able to set priorities and goals in collaborative with the To be able to obtain a nursing health history. 4 5 To be able to correlate learned knowledge from the classroom to the clinical area. and affective domains. To be able to determine the implications of laboratory and diagnostic results. 2. psychomotor. Allergy desensitization is rarely successful in reducing symptoms. review records. Also to be able to materialized specific objectives on cognitive. To be able to perform planned nursing interventions. 4. removing animals from bedrooms or entire houses. we should be able to assess and diagnose patient’s current status and to plan.
. and avoiding foods that cause symptoms. 3. To be able to gather factual information through interview and medical chart.Decrease or control exposure to known allergens by staying away from cigarette smoke.
To be able to know the patient better and encourage verbalization of fear and anxiety. Roxas City Religion: Roman Catholic Date and Time Admitted: January 20. ATTITUDE 1 2 3 4 To be able to establish rapport with the patient and folks.
To be able to perform physical assessment in a head-to-toe
approach. 2011 at 1:40 p. 2010 Address: Li-ong.M.
III. VITAL INFORMATION:
Name: R. To be able to empathize with the patient and folks. Samillano
IV.m Ward: Niño de Praga Ward (Broncho Ward) Chief Complaint: Difficulty of breathing Admitting Diagnosis: Community Acquired Pneumonia. Bronchial Asthma in Acute Exacerbation Attending Physician(s): Dra. To be able to understand the feelings of the mother towards her daughter’s condition.M Age: 3 years 10/12 months Sex: Female Nationality: Filipino Civil Status: Single Date of birth: March 27.6. Bronchial Asthma in
Final Diagnosis: Pneumonia. CLINICAL ASSESSMENT
2. Past HealthHistory: 2007 patient was admitted at Saint Anthony College Hospital with the chief complaint of burns. symptoms persisted. patient’s mother decided to seek for consulation at Dra.
3. History of Present Illness: 3 days prior to admission. Samillano’s clinic. On the day of admission. patient had experienced difficulty of breathing so her grandmother decided to put “lampunaya” to her head. 2 days prior to admission. Patient’s mother decided to bring her to Saint Anthony College Hospital and prompted admission at Niño de Praga ward for further care under the service of Dra. Family Health History:
. Nursing History
Throat: No mass palpated. dry and warm to touch. Ears.
Head. Vital Signs:
During my Shift
Temperature: Respiration: Apical Rate:
36.3 °C 38 bpm 107 bpm
2. pupils constrict 2mm and reactive to light and accomodation. Nose: Nasal mucosa pink. its capillary refill is normal. smooth and moist. Hair and Nails: • Skin: Brown complexion. Septum is found in midline. Eyes: Equally round. Nose. Mouth. No presence of lesion found. Lymphatics: Normal in size and palpable. • Hair: Equally distributed. Tongue moves freely. Throat and Lymphatics: • • • • • • • Head: Symmetrical and freely movable. Tonsils are not inflamed. posterior and anterior fonatanelles are closed. Eyes. mobile and calm conscious and oriented
Skin. no polyps nor discharges. normal turgor. scalp is smooth and hairs are thick in quantity. • Nails: Clean and well trimmed.1. Mouth: Gums and buccal mucosa are pink.3 kgs BMI: 13. Levels at the outer cantus of the eye. no lice. Normocephalic. No significant finding.8 °C 62 bpm 162 bpm
36. no flakes. Ears: Symmetrical.
. similar in color to face with good hearing capacity. Height: 90.17 cm
Weight: 11.9 (Underweight)
3. Physical Assessment
General Appearance: • • • Patient shows no signs of distress. No presence of lesions and discharges.
Carotid pulses are strongly palpable. Urine output is adequate every hour.Neck • Symmetrical. trachea at the midline. No complaints of pain noted. proportional to head and shoulders.
Genito-urinary System: • No catheter attached.
Gastrointestinal System: • • Able to urinate adequate amount of urine.
Cardiovascular System: • Palpable pulsation. able to stand with two feet.
Respiratory System: • Respiration rate ranging from 34-40 breaths per minute. Can walk without any support.
Musculoskeletal System: • On complete bed rest with bathroom privileges. can move freely on bed. Abdomen: The bowel sounds are heard. No abdominal tenderness noted. heart rate ranges 104-110 beats per minute with a regular rhythm.
CASE DISCUSSION Definition A condition of the lungs characterized by widespread narrowing of the airways due to spasm of the smooth muscle. Chronic exposure to airway irritants or
. Bronchial asthma is a chronic relapsing inflammatory disorder with increased responsiveness of tracheobroncheal tree to various stimuli. and the presence of mucus in the lumen of the bronchi and bronchioles. either spontaneously or under treatment. resulting in paroxysmal contraction of bronchial airways which changes in severity over short periods of time.V. edema of the mucosa. Causes Allergy is the strongest predisposing factor for asthma.
An asthma exacerbation may begin abruptly but most frequently is preceded by increasing symptoms over the previous few days. cold. dust and roaches. Long acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma symptoms. Clinical Manifestation The three most common symptoms of asthma are cough. management practices and other factor. These medications are contraindicated in acute asthma exacerbation. They are broadly effective in alleviating symptoms. Common triggers of asthma symptoms and exacerbations include air way irritants like air pollutant. At times the mucus is so tightly wedged in the narrow airway that the patient cannot cough it up. Other contributing factor would include exercise. and decreasing peak flow variability. with or without mucus production. particularly those that occur during the night these agents are also effective in the prevention of exercise-induced asthma. Most people who have asthma are sensitive to a variety of triggers. An asthma attack often occurs at night or early in the morning. tree and weed pollens or perennial under this are the molds. control of persistent asthma is accomplish primarily with the regular use of anti inflammatory medications. Medical Management There are two general process of asthma medication: quick relief medication for immediate treatment of asthma symptoms and exacerbations and long acting medication to achieve and maintain control and persistent asthma. possibly because circadian variations that influence airway receptors thresholds. Because of underlying pathology of asthma is inflammation. • Long-acting control Medication Corticosteroid are the most potent and effective anti inflammatory currently available. weather changes. A person’s asthma changes depending on the environment activities. strong odors and perfumes. stress or emotional upset. In some instances cough may be the only symptoms.allergens can be seasonal such as grass. They also are effective on a prophylactic basis to prevent exerciseinduced asthma or unavoidable exposure to known triggers. sinusitis with post nasal drip . Patients are instructed to avoid the causative agents whenever possible. improving air way functions. heat.
. Prevention Patient with recurrent asthma should undergo test to identify the substance that participate the symptoms. dyspnea. Cromolyn sodium and nedocromil are mild to be moderate anti-inflammatory agents that are use more commonly in children. There is cough. medications and viral respiratory tract infections. Knowledge is the key to quality asthma care. and wheezing.
The immediate nursing care of patient with asthma depends on the severity of the symptoms. Nursing Management The main focus of nursing management is to actively assess the air way and the patient response to treatment. They have the rapid onset of action.ANATOMY AND PHYSIOLOGY
. A calm approach is an important aspect of care especially for anxious client and one’s family. Anti-cholinergic may have an added benefit in severe exacerbations of asthma but they are use more frequently in COPD. This requires a partnership between the patient and the health care providers to determine the desire outcome and to formulate a plan which include. • The purpose and action of each medication • Trigger to avoid and how to do so • When to seek assistance • The nature of asthma as chronic inflammatory disease
VI.• Quick relief medication Short acting beta adrenergic agonists are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma.
The lower respiratory tract consist of the bronchi. medulla and spinal cord. This is accomplished through the mechanical acts of inspiration and expiration. larynx. a process known as gas exchange. composed of three parts located in the pons. children respond differently than adults to respiratory disturbances. sinuses.The upper respiratory tract consists of the nose. and epiglottis.
Control of gas exchange – involves neural and chemical process The neural system. trachea. The normal gas exchange depends on three process: Ventilation – is movement of gases from the atmosphere into and out of the lungs. The major function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood. helping to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs. a decrease in PaCO2 inhibits ventilation. conversely. Diffusion – is a movement of inhaled gases in the alveoli and across the alveolar capillary membrane Perfusion – is movement of oxygenated blood from the lungs to the tissues. An increase in arterial CO2 (PaCO2) stimulates ventilation.
The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in children and adults. pharynx. bronchioles and the lungs. major areas of difference include: Poor tolerance of nasal congestion. coordinates respiratory rhythm and regulates the depth of respirations The chemical processes perform several vital functions such as: regulating alveolar ventilation by maintaining normal blood gas tension guarding against hypercapnia (excessive CO2 in the blood) as well as hypoxia (reduced tissue oxygenation caused by decreased arterial oxygen [PaO2]. however. especially in infants who are obligatory nose breathers up to 4 months of age
vomiting and diarrhea. with such symptoms as fever.
. Increased severity or respiratory symptoms due to smaller airway diameters A total body response to respiratory infection. and more horizontally positioned eustachian tubes.
Increased susceptibility to ear infection due to shorter. broader.