Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 109 RLE CLINICALS

GENERAL TASK 1
WEEK 11
BSN 2D - Group 2

Group Members:
Mr. Allosada, Willy II M.
Ms. Asignar, Julia Ryan G.
Ms. Bispo, Roseanne Karla D.
Mr. Boc, Michael Eliezer L.
Mr. Chua, Hance G.
Mr. Co, Ronald Jr. B.
Ms. Dinoy, Alyssa Marie T.
Ms. Domapias, Regene Katherine L.
Ms. Gabasa, Ana Monica O.
Ms. Huynh, Kristy Tu Anh G.
Ms. Leyson, Precious Anne G.
Ms. Longakit, Zia Princess Angela Haven V.
Ms. Maglasang, Janine F.
Ms. Paco, Ericka China M.
Mr. Paden, Evanno Dave G.
Ms. Remedio, Johanna Marie C.
Ms. Rodrigo, Kisha Bethel G.
Mr. Roma, GV B.
Ms. Rosal, Aaliyah Mai. M.
Ms. Sampilo, Shyne Tiffany Y.
Ms. Tabuco, Nicole Uriel P.
Ms. Tambidan, Sittie Cera Kenji O.
Ms. Villafuerte, Alliah Marie B.

Facilitator: Mrs. Marichelle Valerie Pil-Merioles, MAN, RN

Date Submitted: April 8, 2021
Task 1 (Ms. Longakit): Present a Profile of the newborn / child as to the following data:
● Age of gestation (Ballard Scoring)
● Anthropometric measurements
● Vital signs
● Screening tests
● Medications / vaccines
● Maternal History / Records (labor records, mode of delivery)
● Medical History: Medical, Surgical, Familial Illness

Initials: E.D.I Medical History:

Age: 2 years and 6 months Asthma
Birthdate: October 24, 2018 1st hospitalization: low-risk pneumonia
2nd hospitalization: severe pneumonia

Surgical History:
None

Familial Illness:
Paternal: History of cysts, Pneumonia,
Asthma
Maternal: Hypertension

Anthropometric Measurements

Birth weight and recent weight 2.240 kg and 14kg

Head Circumference 20 inches

Chest Circumference 21 inches

Abdominal girth 18 inches

Length 35 inches

Vital Signs

Blood Pressure: N/A

Heart Rate: 79bpm

Pulse Rate: 19bpm

Temperature: 36.1°C
 Screening Tests

Newborn screening test October 25, 2018

Medication / Vaccines

Type of Vaccine Date Administered

BCG (at birth) October 26, 2018

DPT (6 weeks, 10 weeks, 14 weeks old) January 22, 2019 / March 5, 2019 / April
23, 2019

OPV (6 weeks, 10 weeks, 14 weeks old) January 22, 2019 / March 5, 2019 / April
23, 2019

Hepatitis B (within 24 hrs, 6 weeks) October 25, 22018 / December 14, 2018

MMR October 3, 2019 / July 18, 2020

PCV13 January 22, 2019 / March 5, 2019 / April

23, 2019

Ascorbic Acid (Celin)

 OBSTETRICAL HISTORY

YEAR PREGNANCY DURATION MODE OF LIVE SEX &

OF LABOR DELIVERY BIRTH/STILL WEIGHT
BIRTH

2018 1st 8hrs Normal Live Birth M, 2.2kg

Spontaneous
Vaginal Delivery

2020 2nd 12hrs Normal Still Birth M, 1.40kg

Spontaneous
Vaginal Delivery
 Task 2 (Ms. Maglasang): Organize all assessment findings (IPPA), laboratory /
diagnostic results (ex. transvaginal sonogram). Use the CDU-CN Nursing Assessment
template to show the focused-assessment and significance of the laboratory findings.

Nursing PHYSIOLOGIC
History

Patient’s Body Part Inspect Palpate Percuss Auscultate

Initials:
E.D.I Head -symmetric, -hard and
round, erect and smooth, without
Age: 2 years in midline and lesions
old appropriately
related to body
Sex: M size

Status: Single
Hair -hair color is -smooth and
Occupation: black and thin. firm, somewhat
N/A elastic

Past Medical
History which Scalp -clean and no
has relevance dandruff
to present
condition:
Two times of Face -symmetrical and
pneumonia. proportional
After there is
acute
pneumonia Skin -no edema, -his skin is
there is a lesions, bruising, rough, dry, and
severe burns, and warm
pneumonia soares temperature

Reasons for -presence of

Current rashes
admission:
The child has
an asthma Nails -Clean -Nails are hard
and immobile
Duration: -pink tones
It lasts five returns
days and, immediately
sometimes when pressure
every six hours is release
for five days, or
every eight Neck -presence of -no swelling
hours for five lumps in the and tenderness
days neck

Anthropometri
c measure- Eyes -Clear, without
ments: redness or
Birth weight: purulent
2.240kg discharge
Birth length:
35 inches
Blink reflex -pupils are
equal, round and
Head
reactive to light
circumference:
and
20 inches
accommodation
Chest
circumference:
Ears -is equal in size -no tenderness
21 inches
bilaterally
Abdominal
girth: -no lesions and
18 inches presence of
lumps back in
GTPAL: the ear
G-2
T-0
P-1 Nose -no sinuses or
A-1 clear patency
L-1

AOG: Mouth -presence of

7 months / 28 tongue or mouth
weeks. sores

-no edema,
bleeding or pain
of the gums and
mouth
 -complete teeth
and no decays
areas on the
mouth

-His gums are

pink and tongue
are moist

Throat -his throat pink,

and without
exudate or
lesions
-no difficulty in
swallowing

Thorax and -RR: 19bpm - no tenderness -Wheezing

Lungs -no enlargement sound is
present in
lungs

Heart -presence of
shortness of -HR: 79bpm
breath if asthma -No heart
attack occurs murmurs

-presence of
nocturnal
dyspnea

Peripheral -Arms are -Warm to touch

Vascular bilaterally -Capillary beds
System symmetric. refill returns in
Legs are free 2 seconds.
from lesions

Abdomen -yellowish skin -enlarged upon

tone touching
 -belly button is
in the midline
and there is no
redness or
discharge

Musculoskel -Shoulders and -Extremities are

etal System elbows warm and
deformities mobile.

-Feets and legs

are symmetrical

- no lesions and
edema

Neurologic -active and

System responsive

-no seizure and

head injury

Health Before, the child is thin and takes different medications. After the
Perception child is not that thin as before and there is only an asthma attack.
/mgt.

Cognitive/ The child has no deficit in sensory perception. If the child speaks,
Perceptual it is still not fully developed but can identify colors, alphabets, and
numbers.

Self- The mother is concerned about recurring pneumonia, asthma, and

concept the skin of his child. They only have a nebulizer at home.

Sleep/ The child has trouble sleeping because of his skin rashes and
Rest sometimes wakes up early in the morning just because of an
asthma attack.

Activity/ He plays outside but for a short period because the child has been
Exercise asthmatic. He easily gets tired and has trouble breathing.
 Attending Physician: Dr. N.P
Psychosocial Spiritual Diagnostic Normal Patient’s Significance
Culture Tests Value Result

Role The mother Blood test: 12.0 - 16.0g/ Within the High hemoglobin can
Relationship: and the child Hemoglobin dL normal range be caused by
The child has a good are Roman dehydration, living in
relationship with theCatholic.The high altitude areas,
family on the mother or other conditions,
maternal side. On participates such as lung or heart
the paternal side, hein worship disease. Low
doesn’t have a good groups and hemoglobin levels
relationship because also tries to lead to anemia,
the family lives go to which causes
abroad churches in symptoms like fatigue
other and breathing
Values religions problems.
The mother is always (born again
there for his child, church). Hematocrit 36.0 -46.0% Within the Dehydration is the
and she is the one normal range most common cause
making the decision. of increased
hematocrit and the
Moral Beliefs decrease of
-the child tries to get hematocrit is a
a toy that is stuck or characteristic of
under in the bed, anemia which may be
and he finds a way caused by blood loss
to get it and also or nutrient deficiency.
analyzes the
situation. RBC 4.00-5.20x10 Within the High RBC count or
^6/uL normal range Polycythemia Vera
Coping/ may be caused by
Stress overproduction of
Tolerance RBCs or underlying
Before, the child hit medical problems.
his head when he is Low RBC count may
angry or stressed, be caused by anemia,
but now he only bone marrow
cries. failure,and
erythropoietin
deficiency.

WBC 4.10 - 10.9 Within the An increase or

normal range decrease in WBC
signifies an infection
Urinalysis: Yellow Not so yellow Light yellow urine
Color (light/pale to signifies good
dark/deep hydration and a less
amber) concentrated urine.

Trans- Clear or Clear Clear urine indicates

parency cloudy that the child is well
(turbidity) hydrated. It could
also suggest that
they are too
hydrated.Urine
appears clear due to
the absence of
sediments that
causes a cloudy
appearance.

Reaction pH - 4.6 to Within the Neutral pH is at 7.0.

8.0 normal range The higher the
number, the more
basic (alkaline) the
urine. The lower the
number, the more
acidic the urine is. An
acidic urine could
indicate an
environment
conducive to kidney
stone.

Specific 1.0053- Within the Urine specific gravity

Gravity: 1.030 normal range indicates the kidney’s
ability to concentrate
urine. A result outside
the normal range
may signify renal
impairment. An
increased value may
be due to diabetes
insipidus and fluid
overload. A
decreased value may
be due to dehydration
or glycosuria.
Task 3 (Ms. Paco): Interview the mother of the high risk infant/child guided by the
Gordon’s Health Pattern (Health Pattern 1-5)

Health Pattern #1: Health Perception-Health Management Pattern

The mother describes her son’s health before as frail since he was extremely
small and thin. Her son’s blood sugar was also relatively low and he was taking different
varieties of antibiotics. On top of that, she noted that her son was sickly. On the
brighter side, the client’s health got much better. He was no longer fragile and the only
complications he’s had so far is asthma and cough. Several practices have been
prescribed to the mother and the child; the latter shall avoid dogs whereas the former
shall be prepared and keep her body as healthy as possible if and when she plans to
have another pregnancy due to the fact that she was already diagnosed with cervical
infection. Additionally, the mother mentioned that she always makes sure to keep her
child away from dust and smoke and that they clean their house as often as they can to
ensure a safe and clean environment for her child. The client also has regular checkups
twice a month. As with his asthma attack history, the first one was in 2018 and the
second attack was in 2019. The mother further verbalized that whenever her son gets
an asthma attack, she would always bring her child immediately to the doctor.

Health Pattern #2: Nutritional Metabolic Pattern

The client’s daily nutritional intake is almost usually porridge. The mother also
mentioned that her child likes to eat egg (boiled, scrambled, sunny side up). The
client’s appetite is relatively low some days. As for vegetables, the client doesn’t like to
indulge himself in green leafy dishes. Water intake is pretty poor; an average of 2
glasses per day however this increases when the weather is so unbearable and hot.
Currently, the client has no food restrictions. Most of the time, he prefers to drink
Chuckie and Yakult to which he can consume 6 in two days. Aside from taking vitamins
such as Celine, he’s also taking Piperacillin for his Pneumonia and lung medication.

Health Pattern #3: Elimination Pattern

BLADDER
The client does not have any problems with his pattern of urinating. He is not
also using any form of assistive devices used for urinating.

BOWEL
The mother confirmed that her son’s bowel elimination is daily, once almost
every 10 in the morning. Moreover, poop is color black due to frequent ingestion of
Chuckie. The client doesn’t use any assistive devices and usually doesn’t experience any
difficulty unless he’s eliminating hard stool; he always cries when this happens.
Health Pattern #4: Active-Exercise Pattern
The client usually wakes up at around 9 AM, eats then does his usual routine like
bowel elimination and taking a bath. Afterwards, he plays a little bit and then doze off
to sleep at around 2 in the afternoon until 6 in the evening. Then, he watches TV and
plays cars, lego and fix things until he gets sleepy. Although asthmatic, he still likes to
play outside but only for a short period of time since he always gets tired easily.

Health Pattern #5: Sleep-Rest Pattern

The client’s daily activities are eating, bowel elimination at around 10 AM, taking
a bath then playing lego, cars and fixing things. He usually sleeps at midnight then
wakes up at 9AM. According to the mother, her child is well rested. There are times
that he has trouble sleeping due to his rashes but when this happens, usually she uses
a comb to scratch the back of her child as this relaxes him and induces sleep. On
average, the client gets 7-8 hours of sleep a day excluding his siesta.
Task 4 (Ms. Gabasa): Interview the mother of the high risk infant/child guided by the
Gordon’s Health Pattern (Health Pattern 6-11)

Health Pattern #6: Cognitive Perceptual Pattern

The child has no deficits in sensory perception (e.g. hearing, sight, touch) and
does not wear any assistive devices (e.g. glasses, hearing aid). The mother mentioned
that there are times when her child would be insensitive to the cold but most of the
time there are no problems with the child’s perception of heat and cold. Since the child
is still 2 years old, he doesn't know how to read or write yet and when he speaks it is
not that comprehensible or as structured yet. However, the child can already identify
the letters of the alphabet as well as colors and numbers. She also verbalized that her
child is starting to have improved thinking and problem-solving skills.

Health Pattern #7: Self-Perception Pattern

The mother verbalized that she is most concerned about the condition with his
lungs (e.g. asthma, recurring pneumonia) and his skin (prickly heat). They have a
nebulizer at home but no metered dose inhaler to maintain the health of the child when
there are instances where the child is having difficulty in breathing. When asked as to
how she would describe her child she said that he is a happy and active kid; very loving
and very intelligent.

Health Pattern #8: Communication and Role Relationship Pattern

● Communication
○ The family speaks mainly Bisaya but they are also knowledgeable in
speaking in English and Tagalog and they plan to teach the child the
same. Since the child is still 2 years old he still cannot formulate concrete
sentences but the mother said that he uses gestures and a few words to
communicate to them.
● Family
○ In the household, aside from the mother and her son, the mother’s
live-in-partner (not the biological father of the child), the grandfather and
grandmother of the child, the sisters of the mother (the aunts of the child)
and their children (the cousins of the child). The biological father is not
that involved so the child is not that close with his grandparents on his
biological father's side. The mother and the child is Roman Catholic and
actively participates in church activities. The mother mentioned that she
wished the child’s father was more involved and more responsible with
regards to caring for their child and providing for his needs. She
mentioned that she is worried that her son will not feel love from her
biological father. However, the child stepdad (the mother’s current
live-in-partner) has a great relationship with the child and makes her son
feel love and warmth.
Health Pattern #9: Sexuality-Sexual Functioning
The mother verbalized that she is concerned that because of his asthma, he will
not enjoy his childhood as much. She explained that it is no doubt that as he becomes
older (because he is a boy) he will become more inclined or he would want to join
sports such as basketball and other physical activities so she is worried he wouldn’t be
able to do so because of his asthma.

Health Pattern #10: Coping Stress-Management Pattern

With regards to decision making, the mother is the one who is making the
decision for her son as he is still a toddler and has not developed a sense of rationality
yet. In addition, the mother makes decisions along with the child’s grandmother. Last
year, the mother got pregnant but lost the fetus during the 6th month of the
pregnancy. At that time, the mother needed to be quarantined because of safety
protocols so she was alone after she lost the baby. She had mixed emotions during that
time because she was missing her other baby and at the same time mourning the other
baby that she lost. When asked what she wants to change in her and her child’s life,
she said that she wants the condition of her son to be gone and she wishes that the
biological father would become more responsible and more involved in their life. The
mother verbalized that whenever the child feels stressed/angry before, he would bang
his head against the wall but now he just cries.

Health Pattern #11: Value-Belief System

The client’s family is Roman Catholic but they go to a Born again church because
she said that it did not matter as long as the belief in God is there. The mother
participates in worship groups and usually gets her strength from worshiping God. Their
family participates in religious activities in the community for example, their family
 Task 5 (Ms. Remedio and Ms. Rodrigo): Identify 1 actual physiologic nursing problem.
Develop a care plan based on the identified problem. List down 10 Nursing
Interventions (5 Independent, 3 Dependent, 2 Interdependent). Use the CDU-CN NCP
template.

NEEDS/ NURSING SCIENTIFIC OBJECTIVES OF NURSING RATIONALE EVALUATION

PROBLEMS/ DIAGNOSIS BASIS CARE INTERVENTIONS
CUES

I. Physiologic Ineffective During asthma General Measures to

Deficit breathing attacks, airway Objectives: improve maintain
a. Ineffective pattern: closure and After a week of airway patency:
breathing respiratory expiratory holistic
pattern muscle fatigue airflow nurse-patient Independent
related to limitation result interaction, the
asthma. in a dynamic client will 1. Elevate the 1. To promote
Objective Cues: increase in establish a patient’s head of the physiological and
● Severe wheezing end-expiratory normal bed and /or have psychological ease
● Chest tightness lung volume. In respiratory the client sit up in a of maximal
● Cough turn, pattern, maintain chair as appropriate. inspiration.
● Dyspnea hyperinflation airway patency,
● Vitals signs: compromises perform ADL’s 2. Encourage 2. To prevent onset
- RR: 19pbm the function of within the child's ambulation/ or reduce severity
- HR: 79bpm inspiratory ability and exercises, as of respiration of
muscles, participate in individually indicated complications and
especially that desired activities to improve
Subjective Cues: of the and the client’s respiratory muscle
Client’s mother diaphragm, by mother will strength.
verbalizes: reducing their develop
● “Dali ra siya force-generatin knowledge and 3. Encourage slower 3. To assist client in
kapuyon basta g capacity understanding of and deeper taking control of the
magduwa siya (muscle the nutritional respirations. situation, especially
kuyog sa iyang shortening) and intake that is when conditions are
igagaw” impairing their appropriate for associated with
mechanical her child. anxiety and air
● “Maka mata siya advantage on hunger.
eneg kadlawn, the chest wall.
then mag asthma Thus, 4. Instruct and 4. Education may
attack” exacerbations reinforce breathing include many
of asthma retraining. measures, such as
● “Maka experience cause an acute conscious control of
siya og shortness increase in Specific breathing rate,
of breath kung mechanical load Objectives: breathing exercises
naa iya asthma” together with After eight hours (diaphragmatic,
decreased of SN-patient abdominal
ventilatory interaction, the breathing,
capacity, client will be able inspiratory resistive,
thereby to: maintain pursed-lip), and
predisposing to airway patency as assistive devices.
inspiratory evidenced by
muscle fatigue 1. clear breath 5. Plan for periods 5. Fatigue is
and sounds of rest between common with the
precipitating activities. increased work of
hypercapnic 2. improved breathing from the
respiratory oxygen ineffective
failure in severe exchange breathing pattern.
cases. Dependent:
3. normal rate,
and depth of 6. Assist with or 6. To assess the
Sources: respiration. review results of severity of lung
Hill A. R. necessary testing ( diseases.
(1991). e.g. x-rays and
Respiratory ABG)
muscle function
in asthma. 7. Administer 7. They relax the
Journal of the medication as muscles lining the
Association for ordered: airways that carry
Academic Short-acting air to the lungs;
Minority beta-2-adrenergic treatment of choice
Physicians : the agonist. for acute
official ● Albuterol exacerbation of
publication of (Proventil, asthma.
the Association Ventolin).
for Academic ● Levalbuterol
Minority (Xopenex)
Physicians, ● Terbutaline
2(3), 100–108. (Brethine).

8. Medicate with 8. To promote

analgesics as deeper respiration
appropriate and cough.

Interdependent:

9. Refer for general 9. To maximize the

exercise program as client’s level of
indicated functioning.

10. Provide referrals 10. May include a

as appropriate. wide variety of
services and
providers, including
support groups, a
comprehensive
rehabilitation
program,
occupational nurse,
oxygen and durable
medical equipment
companies for
supplies.

Sources:
Doenges, M. E.,
Moorhouse, M. F., &
Murr, A. C. (2019).
Ineffective
Breathing Pattern.
In Nurse's pocket
guide: Diagnoses,
prioritized
interventions, and
rationales (15th ed.,
pp. 107-112).
Philadelphia,
Pennsylvania: F.A.
Davis Company.

Martin, P. (2020,
January 09).
Ineffective
Breathing Pattern.
Retrieved April 07,
2021, from
https://nurseslabs.c
om/asthma-nursing-
care-plans/
 Task 6 (Mr. Roma and Ms. Rosal): Identify 1 actual physiologic nursing problem.
Develop a care plan based on the identified problem. List down 10 Nursing
Interventions (5 Independent, 3 Dependent, 2 Interdependent). Use the CDU-CN NCP
template.

NEEDS/ NURSING SCIENTIFIC OBJECTIVES OF NURSING RATIONALE EVALUATION

PROBLEMS/ DIAGNOSIS BASIS CARE INTERVENTIONS
CUES

I. Physiologic Deficit Ineffective It is known that Specific Measures to

a. Ineffective airway the reversible Objectives: maintain normal
airway clearance: and diffuse After eight hours breathing:
clearance shortness of inflammatory of SN-patient
breath, and process of interaction, the Independent
adventitious airways caused client will be able
lung sounds by asthma is to maintain ● Assess the ● To assist in
characterized
(wheezing) airway patency patient’s vital creating an
by:
related to and improved signs and accurate
edema,
Objective Cues: asthma airway clearance characteristics diagnosis and
bronchospasm
● Severe wheezing and increased as evidenced by of respirations monitor
● Dyspnea mucus respiratory rates at least every effectiveness of
● Nasal Flaring production. The between 20 to 30 four (4) hours. medical
● Weakness/tiredness symptomatolog bpm. treatment.
● Vitals signs: y associated
- Respiratory Rate: with this ● Assist clients ● Elevation of the
19pbm process to maintain a head facilitates
- Heart Rate: includes cough, comfortable respiratory
79bpm dyspnea, position to function using
wheeze, facilitate gravity;
variable airflow breathing by however, clients
Subjective Cues: limitation and elevating the in severe
● “Dali ra siya increased head of bed, distress will seek
kapuyon basta mucus leaning on or the position that
secretion. When
magduwa siya over the bed most eases
these
kuyog sa iyang table, or breathing.
complications
igagaw” as occur, the child
sitting on edge Supporting arms
verbalized by the has difficulties of bed. and legs with a
mother. to breathe, to table, pillow,
● The mother added, clear secretions and so on helps
“Maka experience and keep the to reduce
sya og shortness of airways muscle fatigue
breath kung naa iya unobstructed. and can aid
asthma” These chest expansion.
indicators point
to the ● Encourage and ● Provides a client
occurrence assist with with some
of respiratory abdominal or means to cope
diagnoses in pursed-lip with and control
nursing, among breathing dyspnea and
which, the exercises reduce
ineffective
air-trapping.
airway
clearance
● Observe for ● Cough can be
persistent, persistent but
hacking or ineffective,
moist cough. especially if a
 Assist with client is ederly,
Sources: measures to acutely ill, or
Carvalho OMC, improve debilitated.
Silva VM, effectiveness Coughing is
Távora RCO, of cough most effective in
Araújo MV, effort. an upright or in
Pinheiro FR, a head-down
Sousa TM, position after
Lopes MVO. chest
Ineffective percussion.
airway
clearance: ● Keep ● Precipitators of
accuracy of environmental allergic type of
clinical pollution from respiratory
indicators in sources such reactions that
asthmatic as dust, can trigger or
children. Rev smoke, and exacerbate
Bras Enferm. feather pillows onset of acute
2015;68(5):58 to a minimum episodes.
0-6. DOI: according to
http://dx.doi.o individual
rg/10.1590/00 situation.
34-7167.20156
80514i

Dependent:

● Administer ● To increase the

supplemental oxygen level
oxygen as
prescribed.

● Administer ● To dilate or relax

bronchodilator the muscles on
s as ordered the airways.
by the
physician.

● Administer ● To reduce the

steroids as inflammation in
prescribed. the lungs.

Interdependent:

● Assist with ● Breathing

respiratory exercises help
treatments, enhance
such as diffusion;
spirometry and aerosol or
chest nebulizer
physiotherapy. medications can
reduce
bronchospasm
and stimulate
expectoration.
Postural
 drainage and
percussion
enhance
removal of
excessive and
sticky secretions
and improve
ventilation of
bottom lung
segments. Note:
chest
physiotherapy
may aggravate
bronchospasm in
asthmatics.

● Monitor and ● Establishes

graph serial baseline for
ABGs, pulse monitoring
oximetry, and progression or
chest x-ray regression of
disease process
and
complications.

Sources:

Doenges, M. E.,
Moorhouse, M. F., &
Murr, A. C. (2014).
Nursing care plans:
guidelines for
individualizing client
care across the life
span. Edition 9.
Philadelphia, PA:
F.A. Davis
Company.
 Task 7 (Ms. Sampilo and Ms. Tabuco): Identify 1 psychologic nursing problem.
Develop a care plan based on the identified problem. List down 10 Nursing
Interventions (5 Independent, 3 Dependent, 2 Interdependent). Use the CDU-CN NCP
template.

NEEDS/PROBLEM NURSING SCIENTIFIC OBJECTIVES NURSING RATIONALE EVALUATION

S/CUES DIAGNOSIS BASIS OF CARE INTERVENTIONS

I.Psychologic Deficient Child care is Specific Measures to

Deficit: Knowledge as mostly the Objectives: promote client’s
A. Deficient evidenced by responsibility of After 8 hours of adherence on child’s
Knowledge ineffective care mothers. Lack of SN-client nutritional needs:
towards child preparedness at a interaction, the
related to lack time of increased client will Independent
of information responsibility and verbalize ● Determine ● Learning is
Objective Cues: regarding vulnerability, they awareness of level of easier when
● Lack of source specific care were and plan for knowledge and it begins
of information necessities in overwhelmed. feeding changes readiness to where the
● Neglect on child with Propelled into to maintain the learn. learner is.
child’s poor asthma. information child's adequate
appetite seeking by their nutritional ● Provide written ● Helpful as a
● Inability to lack of knowledge, needs. information for reminder of
answer some they were further clients and reinforceme
questions hampered by SOs. nt of
conflicting and learning.
Subjective Cues: fragmented
● The mother advice. The ● Discuss ● Complicatio
verbalized that independent role consequences ns can
her child’s that a mother's of behavior occur
appetite nutrition-related and potential because of
depends and knowledge can for recovery electrolyte
“usahay di mo play on child and relapse. imbalances.
kaon or wala nutrition
gana” outcomes. ● Review dietary ● Clients and
● The mother Mother’s needs, family may
verbalized that knowledge of food answering need
her son can choices, feeding, questions as assistance
finish at least 6 and health care indicated. with
packs of seeking are vital planning a
chocolate milk for producing new way of
(Chuckie) good nutrition eating.
within 2 days. outcomes for
● The mother young children. ● Provide an ● Conveying
verbalized that Eating a healthier atmosphere of respect is
her child does diet may improve respect, especially
not eat asthma openness, important
vegetables like symptoms. trust and when
her. Evidence suggests collaboration. providing
that diets education
emphasizing the to patients
consumption of with
plant-based foods different
might protect values and
against asthma beliefs
development and about
improve asthma
symptoms health and
through their illness.
effects on
systemic ● Advise mother ● Children
inflammation, to serve small have
oxidation, and portions smaller
microbial frequently. stomachs
composition. Fruit than adults.
and vegetable They do not
intake has been eat as much
associated with at meals.
reduced asthma
risk and better ● Explain the ● To promote
asthma control, importance of a positive
while dairy avoiding atmosphere
consumption is distraction at and
associated with meal times. encourage
increased risk and children to
might exacerbate eat well.
asthmatic
symptoms.
Dependent:
Source: Mother’s
nutrition-related ● Administer ● This is to
knowledge and vitamin and help the
child nutrition supplements, client have
outcomes. as appropriate a healthy
Retrieved, April 8, and indicated. growth and
2021 from: developmen
https://www.ncbi. t.
nlm.nih.gov/pmc/
articles/PMC63949 ● Administer ● To ensure
22/ parenteral adequate
fluids, as fluid and
The role of ordered. electrolyte
nutrition in levels.
asthma prevention
and treatment. ● Review serum ● It
Retrieved, April 8, albumin, determines
2021 from: transferrin, deficits and
https://academic. amino acid monitors
oup.com/nutritionr profile, iron, effectivenes
eviews/article/78/ nitrogen s of
11/928/5804968# balance, nutritional
208259851 glucose, liver therapy.
function, and
electrolyte
laboratory
values as
ordered.

Interdependent:
● Consult with a ● May need
dietitian to assistance
provide a diet to ensure
high in adequate
calories,
 protein, intake of
carbohydrates, nutrients.
and vitamins.

● Involve client ● This is to

and SO in provide
care, assisting care,
them to learn supervision,
ways of ADL
managing assistance,
them with adaptive
their food and devices or
liquid intake changes to
the living
environmen
t.

Sources:
Doenges, M. E.,
Moorhouse, M. F.,
& Murr, A. C.
(2014). Nursing
care plans:
guidelines for
individualizing
client care across
the life span (9th
ed.). Philadelphia,
PA: F.A. Davis
Company
 Task 8 (Ms. Tambidan and Ms. Villafuerte): Identify 1 risk nursing problem. Develop a
care plan based on the identified problem. List down 10 Nursing Interventions (5
Independent, 3 Dependent, 2 Interdependent). Use the CDU-CN NCP template.

NEEDS/ NURSING SCIENTIFIC OBJECTIVES OF NURSING RATIONALE EVALUATION

PROBLEMS/ DIAGNOSIS BASIS CARE INTERVENTIONS
CUES

I.Physiologic Deficit Risk for Asthma is a Specific Measures to

A. Risk for Activity chronic Objectives: increase patient’s
Activity Intolerance inflammatory After 8 hours of tolerance to physical
related to lung condition
Intolerance SN-patient activity:
decreased that causes
oxygenation interaction, the
hyperresponsiv client will: Independent
eness, mucus
production and
Objective Cues: 1. increase ● Assess ● To have a
mucosal edema
● Vital signs: activity physical health baseline data
resulting in
- Pulse rate: 79 reversible
tolerance as level and
bpm airflow evidenced potential
- Respiratory obstruction. by injuries and/or
Rate: 19 bpm This attendance illnesses.
● Shortness of breath inflammatory of self-care Identify if the
● Sleeping problems process leads to needs. health
due to coughing recurrent condition is
● Weakness/ episodes of severe or
Tiredness asthmatic minor and
conditions such short term or
Subjective Cues: as wheezing, long term.
● As verbalized by the shortness of
mother “kanang breath, chest ● Use portable ● May
lalaki man gud sya tightness, and pulse oximetry determine the
coughing.Asthm to assess for use of
niya ang mga lalaki
a can interfere
kay gusto jud baya oxygen supplementar
with a patient’s
ug mga activities desaturation y oxygen to
activities of
nga lihok ba gusto daily living and
during activity. help
ko pagdako niya also put compensate
kay mawala na unta him/her at risk for the
iya asthma kay para for asthma increased
makaduwa siya ug attacks oxygen
maayo”. especially that demands
● The mother added, inadequate during
“dali sya hangakon oxygen in the physical
ug kapuiyon kung circulation can activity.
makipag dula sya sa develop
iyang mga weakness in our ● Encourage ● Avoid change
ik-agaw”. muscles. activities such in respiratory
Muscles need as quiet play, status and
oxygen to move reading, energy
and to do its watching depletion due
function. If the
movies, games to excessive
patient cannot
during rest. activity.
tolerate any
activities
because of the ● Teach deep ● To allow the
low breathing patient to
oxygenation exercises and relax while at
caused by relaxation rest and to
ventilation-perf techniques. allow enough
usion imbalance Provide oxygenation in
caused by adequate the room.
pathological ventilation in
minimized lung the room.
expansion.
Quality of life
for children ● Assist client in ● To promote
with asthma is
doing self-care independence
often measured
needs. and to
by missed
school days,
gradually
inability to carry increase the
out normal patient’s
activities, or tolerance to
perceived poor physical
health status. activity.

Dependent:

● Administer ● Bronchodilator
Sources: prescribed s: to dilate or
asthma relax the
Belleza, M., medications ( muscles on
R.N. (2021, bronchodilator the airways.
February 20). s such as Steriods: to
Asthma. Albuterol, reduce the
Retrieved from steriods or inflammation
https://nursesl combination in the lungs.
abs.com/asth inhalers/
ma/ nebulizers)

Washington ● Administer ● To increase

State (2013) supplemental the oxygen
How Asthma oxygen as level and
Affects the prescribed. achieve an
Quality of Life Discontinue if SpO2 value
in Youth. SpO2 level is within the
Retrieved on above the target range.
April 7,2021 target range
from or as ordered
https://www.d by the
oh.wa.gov/Port physician.
als/1/Documen
ts/Pubs/345-33 ● Administer ● Non-invasive
2-QualityOfLife noninvasive positive
.pdf positive-pressu pressure
re ventilation ventilation is
(NPPV)as increasingly
indicated used in
children both
in acute and
chronic
settings. It
enhances
alveolar
ventilation,
improves gas
exchange, and
 reduces the
need for
endotracheal
intubation and
mechanical
ventilation.

Interdependent:

● Refer the ● To provide a

patient to a more
physical/ specialized
occupational care for the
therapy team patient in
as required. terms of
helping him
build
confidence in
increasing
daily physical
activity.

● Refer the ● Respiratory

patient to a therapists can
respiratory demonstrate
therapist as the correct
required use of medical
devices such
as peak-flow
meters, help
patients
identify and
reduce their
exposure to
asthma
triggers, and
give asthma
education and
guidance.

Sources:
Lian JX.(n.d)
Managing a Severe
Acute Asthma
Exacerbation.
Retrieved on April
7,2020 from
https://www.nursin
gcenter.com/journal
article?Article_ID=8
59826&Journal_ID=
606913&Issue_ID=
859810
Martin, P., BSN, RN
(2020, January 9).
8 Asthma Nursing
Care Plans.
Retrieved from
https://nurseslabs.c
om/asthma-nursing-
care-plans/5/

Vera, M., BSN, R.N.

(2017, September
24). Activity
Intolerance Nursing
Care Plan. Retrieved
from
https://nurseslabs.c
om/activity-intolera
nce/
Task 9 (Mr. Allosada and Ms. Asignar): In tabular form, present a Care Guide of all the
identified problems focusing on nutrition, prevention of complications such as
immunization, respiratory, cardiac, bowel and bladder functions. Provide a clear
rationale for each. Use the Nursing Interventions Classification (NIC) and the Nursing
Outcomes Classification (NOC).

INTERVENTION RATIONALE

Nutrition

● Encourage everyday intake of Fruits, ● The vitamins found in fruits and

and Vegetables vegetables, especially A, C, and E, as
well as many plant compounds called
phytochemicals, act as antioxidants,
helping to reduce airway stress and
tissue damage. As a result,
antioxidant-rich produce may help
prevent or manage asthma.

● Encourage the intake of Whole grains ● Helps protect children from asthmatic
wheezing

● Encourage intake of Omega-3 fatty
acids (Fish), and avoid Omega -6 fatty
acids
● Omega-3 fatty acids found in fish like
salmon, tuna, and sardines, and some
plant sources like flaxseed oil, have a
number of health benefits. A recent
study showed that kids who ate an
adequate amount of Omega-3s from
fish had better airflow and resulted in
low dependency of asthma medication
as opposed to children who did not
consume fish. Omega-6 fatty acids,
found in some margarines and
processed food on the other hand,
need to be avoided because it may
worsen asthma and other serious
health conditions such as heart
disease.

● Encourage the intake of milk ● Milk can be very helpful to asthma

sufferers. It contains high amounts of
calcium and magnesium, which
studies have shown can help reduce
inflammation and increase airflow to
help make breathing easier.
 ● Encourage increased fluid intake
● Eliminate Trans fat
● Provide parents with appropriate
information about nutritional needs of
client and how to meet them
● Determine client’s ability to meet
nutritional needs
Immunization
● Encourage parents to have their child
get flu vaccination and pneumonia
shot
● Dehydration can lead to water
retention and inflammation, both of
which can aggravate asthma
symptoms. Getting enough water
helps the body run smoother and the
lungs work better. Choosing water
instead of juice or soda can also help
kids avoid too much sugar. Kids need
between 5 and 10 glasses per day,
depending on age. Be sure to give the
asthmatic child water to drink
whenever he gets thirsty.
● Trans fats can be dangerous to
asthma sufferers. In the process of
digesting these fats, the body
produces chemicals that can cause
inflammation in the lungs. Trans fats
are found in butter, most baked goods
and sweets, chips or other fried
snacks, and nearly all fast foods.
Avoid serving the child any processed
food, and keep fast food meals to a
bare minimum. Less processed food
can mean less asthma symptoms
● To allow the parents to meet the
nutritional needs of the client and to
know what to avoid
● To know the limitations of the client’s
family
● Asthmatic people are at high risk of
complications from the flu. Flu
infection in lungs can cause/trigger
asthma attacks, can worsen asthma
symptoms, and may lead to
development of pneumonia. CDC
recommends that people 6 months of
age and older, get a flu vaccine every
year to protect against getting flu
complications. A study of influenza
related pediatric deaths between 2000
to 2016 found that 12% had asthma
(Shang, M. et. al. 2018)

Respiratory
● Limit the child’s exposure to asthma
triggers
● Don’t allow smoking around the client
● Educate families on asthma triggers
and avoidance
Cardiac
● Encourage parents to help child
maintain a healthy weight
Bowel
Encourage client’s family members to:
● Help the child for regular elimination
of wastes
● Help the child in increasing fluid
- One risk factor of Pneumonia is
Asthma. Pneumonia shot for the child
will help prevent lung infection and
can help the child get rid of the risk of
having the infection.
● Help the child avoid the allergens and
irritants that trigger asthma
symptoms. Irritants bother the airway
and can induce bronchospasm when a
child with asthma is exposed.
● Exposure to tobacco smoke during
infancy is a strong risk factor for
childhood asthma, as well as a
common trigger of asthma attacks.
● Efforts should be made to mitigate
exposure to allergens that trigger
asthma. Environmental triggers are a
major contributor to health disparities
in pediatric asthma.
● Being overweight can worsen asthma
symptoms, and it puts your child at
risk for respiratory and cardiac
problems. Conversely, being
underweight is also a risk factor of
asthma.
● Encourage the child to use the
bathroom at regular times during the
day, especially after meals and
whenever they feel the urge to go. Let
your toddler sit for at least 10 minutes
at a time. This helps improve bowel
habits of client
● Additional fluid leads to an increase in
 intake, with fiber to the diet, and bowel transit time by bulking up
avoid other beverages that will lead to faecal matter. Fiber increases the
constipation weight and size of your stool and
softens it.
● Help child enjoy a full and active life
with proper guidance ● Make sure the client gets out to play
for at least 30 to 60 minutes a day.
Moving the body keeps the bowels
moving, too.

Bladder

● Advice the parents of the child to limit ● This helps reduce the number of trips
the amount of fluid taken before bed to the bathroom needed to make
time during the night and avoid sleep
disturbances.
 Task 10 (Ms. Bispo and Mr. Boc): Search for at least six (6) recent evidence-based
studies/practices across culture that contribute/address the health needs of the client.
Give relevant information such as the author’s name, date the study was published,
findings, conclusion and recommendations.

Evidence-Based Studies (Title) Findings Conclusions Recommendations

1. Chinese herbal medicine formula To observe the efficacy The PCYQ as the Administer 6.0 g of
for acute asthma: A multi-center, and safety of Chinese Chinese herbal medicine PCYQ daily via oral
randomized, double-blind, herbal medicine formula formula significantly administration for 7
proof-of-concept trial entitled PingchuanYiqi improves lung function days.
a. Authors: (PCYQ) granule, on and symptoms of acute
i. Hong Ping Zhang acute asthma and to asthma, and reduces
ii. Lei Wang explore its possible SABA dosage possibly via
iii. Zhen Wang mechanism. Participants decrease of
iv. Xian Rong Xu with acute inflammatory
v. Xian Mei Zhou mild-to-moderate biomarkers.
vi. Gang Liu asthma recruited from
vii. Lv Yuan He seven centers in China
viii. Jun Wang were randomly assigned
ix. Alan Hsu to receive PCYQ or
x. Wei Min Li placebo.
xi. Gang Wang
Chinese herbal medicine
b. Date Published: July 2018 formula significantly
improved the asthma
symptoms (shortness of
breath, wheeze, chest
tightness, and cough)
compared with placebo
after 4-day (−3.93 ± 6.8
vs. −2.58 ± 2.82,
P = 0.002) and 7-day
treatment (−5.55 ± 3. 95
vs. −3.83 ± 3.24,
P = 0.001). But there
were no differences in
numbers of eosinophils
in blood (0.206 ± 0.153
vs.
0.195 ± 0.156 × 109/L,
P = 0.2753) or
percentage of
eosinophils (3.09 ± 2.31
vs. 3.02 ± 2.35%,
P = 0.4005) between the
two groups at the end of
the treatment. During
the study period, no
patients required
systemic glucocorticoids
 or hospitalizations due
to asthma deterioration,
although the patients
were asked to contact
physicians if asthma
symptoms worsened.

2. Japanese guidelines for childhood Recently, the number of Long-term management Non-pharmacological
asthma 2020 hospitalizations and with anti-inflammatory management:
a. Authors: deaths of children from controller drugs, ● Use anti-mite
i. Hirokazu Arakawa asthma has dramatically elimination of airborne sheets and covers;
ii. Yuichi Adachi decreased in Japan. The antigens from the wash bedding
iii. Motohiro Ebisawa reasons for this include patient’s living frequently and
iv. Takao Fujisawa the wide use of inhaled environment, and hang it outdoors to
v. Committee for corticosteroids (ICS) and enlightenment and dry in the sun
Japanese Pediatric leukotriene receptor education about asthma ● Do not use
Guideline for antagonists (LTRA), including mattresses;
Childhood Asthma which are pathophysiology are wooden floors are
vi. Japanese Society of anti-inflammatory drugs three fundamental preferable
Pediatric Allergy and for children with asthma, factors for the treatment ● Use sofas made of
Clinical Immunology as well as the and management of leather or artificial
vii. Japanese Society of development and childhood asthma. leather; no fabric
Allergology dissemination of devices made sofas
for the effective use of ● Do not use stuffed
b. Date Published: April 25, ICS. toys; use washable
2020 ones if necessary
The International Study ● Do not keep
of Asthma and Allergies mammals and/or
in Childhood (ISAAC) birds inside rooms
and the American
Thoracic Society-Division
of Lung Diseases
(ATS-DLD) with
modifications are used
to survey the prevalence
of childhood asthma. In
Japan, asthma
prevalence in
schoolchildren has been
increasing during the
last two decades
according to a survey
targeting children in the
same primary schools
within the same given
area (3.2% in 1982,
4.6% in 1992 and 6.5%
in 2002). However, a
very recent survey
indicated that asthma
prevalence was declining
(4.7% in 2012).
3. Variations in asthma treatment in Doctors in the The variation in For treatment of
five European countries — Netherlands prescribed treatment may be exacerbations, doctors
judgement analysis of case more oral steroid attributed to variations in prescribed oral steroid
simulations courses and fewer the underlying tendency courses and antibiotics.
a. Authors: antibiotics than doctors to prescribe, and in part
i. Rolf Wahlström in Norway and Sweden, to different use of clinical For maintenance
ii. Eva Hummers-Pradie whereas doctors in patient characteristics. treatment, doctors
iii. Cecilia Stålsby Germany and the Slovak These findings can be prescribed inhaled
Lundborg Republic prescribed the used in tailoring corticosteroids.
iv. Maria Muskova least oral steroids and educational programs to
v. Per Lagerløv the most antibiotics. improve treatment
vi. Petra Denig practices.
vii. Thimothy Oke The physicians
viii. D Mark Chaput de participating in this
Saintonge study were all enrolled
ix. Drug Education in the Drug Education
Project Group Project (DEP). In
Sweden and The
b. Date Published: Oct. 9, Netherlands,
2002 pre-existing groups of
general practitioners
(GPs) were recruited,
while in Norway and
Germany GPs were
recruited as individuals.
In the Slovak Republic,
GPs do not treat asthma
independently, and
therefore lung
specialists/allergologists
at out-patient
departments were
recruited individually for
the study.

A comparison of sales of
antibiotics in the
countries in the
European Union showed
that The Netherlands
had the lowest total
sales, followed by
Denmark, Sweden and
Germany.27 Expressed
as daily defined doses
per 1000 inhabitants,
the figures for these
countries were 8.9,
11.3, 13.5 and 13.6,
respectively.
4. Attitudes, Beliefs, and Practices
Regarding Asthma Care Among
Providers and Adult Asthmatics in
Imperial County, California
a. Authors Name:
i. Paula Kriner
ii. Yolanda Bernal
Iii. Amy Binggeli
Iv. India Ornelas
b. Date Published: 2003
Latino patients do not Two focus groups with The value of patient
want to be diagnosed area health-care education, the
with asthma, as professionals were held establishment of an
observed in one focus to learn more about the asthma clinic, and
group conducted by the obstacles that keep them frequent prescription
researchers in this from adopting the review and follow-up
specific study. One National Asthma with patients emerged
physician explained, Education and as themes around
"They don't like hearing Prevention Program healthcare provider
the word "asthma." (NAEPP) guidelines. guidelines for improving
“They believe it to be a Asthma is one of the patient-centered
chronic, life-threatening most common and asthma treatment.
disease.” severe health conditions
that doctors face,
Providers agree that according to the majority HCPs emphasized the
cultural factors play a of focus group importance of reviewing
role in patients' drug participants. patients' drug usage on
use. “We speak about Several providers a regular basis, as well
inhalers... they think the mentioned that they do as tracking their use of
child will become not have spirometers or inhalers or peak flow
addicted to it or prefer lack the necessary meters, to ensure that
not to use it equipment to diagnose they are using them
sometimes,” one or advise patients about correctly. Long-term
provider explained. how to manage their patients who had never
Instead, they assume asthma in their offices. learned how to use
that if the patient does Patients' comprehension their medicine properly
not take the drug, their of asthma treatment and were reported by also
asthma will go away management is often providers.
with time and age on its hampered by cultural,
own. language, and literacy Patients using diaries to
barriers, as well as track their asthma have
Providers also identified financial barriers that had limited success,
a lack of time to spend prevent patients from according to providers
with patients during the purchasing equipment who use them.
initial visit as a reason not covered by Both focus groups'
for not following the low-income health providers agreed that
guideline insurance patient diaries and
recommendations. “I policies.Patients' action plans are
used to work in private unwillingness to take beneficial.
practice, and I prescribed drugs, as well
remember how busy it as issues with patients Participants in the focus
was, and I couldn't have who self-medicate, were groups have stressed
spent as much time with mentioned by a few the importance of
patients as I do now,” providers. continuing education
one physician said. and a multi-faceted
Despite these limitations, approach to patient
Patients who do not clinicians understand the education.
have access to peak value of updating
flow meters face medication regimens and Patients should be
another major challenge proper inhaler and peak trained by a nurse who
in controlling their flow meter techniques specializes in asthma
asthma. They are not on a regular basis, as treatment, a health
 covered by Medi-Cal, the
state's low-income education.
health insurance
program, and they are
too expensive (around
$25) for patients to buy
on their own. One
patient who had
been using an inhaler
for 14 years told his
physician that it did not
work well. After the
physician took the time
to demonstrate how to
use the inhaler properly,
the patient told him,
“Gosh, I never knew it
could work this well.”
well as overall patient instructor, or a team
approach, such as the
type offered by an
asthma-care facility,
according to providers.
Patients must be
trained in a variety of
ways, according to
providers. To
“demystify and
de-stigmatize childhood
asthma,” one provider
proposed making public
service announcements
that could be broadcast
on radio or television.

Patients also do not read

written materials,
according to some
providers, not because
they are illiterate, but
because the pamphlets
and other written
information are too
technical.

5. Barriers to medication adherence
in asthma: The importance of
culture and context
(African-American & Latino
American focus groups)
a. Author’s Name:
i. Elizabeth L. McQuaid, PhD,
ABPP
b. Date published: 2018
For racial and ethnic There is strong evidence
minority asthma that racial and ethnic
patients, there are minorities are
several obstacles to underusing asthma
strict adherence to controller drugs. This
controller medication. happens on many
Cultural variations in occasions, including: (1)
attitudes regarding the initial prescription of
traditional medications, drugs in certain
as well as mental health circumstances, such as
conditions such as at hospital discharge for
depressive symptoms, publicly insured patients;
are linked to lower levels (2) filling the prescription
of controller drug usage once it has been
at the person level. initiated; and (3) taking
medication once it has
been received.
Disparities in the use of
controller medications
are widespread.
Identifying the causes of
There is growing
evidence that
patient-centered
communication and
cultural competence
training can have a
significant impact on
patient adherence. An
analysis of the results
of physician
communication training
found that it improved
patient adherence in a
variety of medical
conditions.
Lieu and colleagues
discovered that practice
sites with policies to
encourage cultural
competence among
workers were less likely
these inequalities is a
crucial first step in
developing intervention
strategies.
Over the next few
decades, the
sociodemographic
composition of the
United States is expected
to increase. Our research
and clinical practices
must develop in order to
find the most
appropriate ways to
assist patients with
asthma from a variety of
backgrounds in
successfully managing
their condition, including
consistent medication
usage when indicated. It
will also become
increasingly relevant to
encourage strategies to
improve disease
management contact
between clinicians and
patients from various
cultures. To overcome
disparities in asthma
treatment and
subsequent health
outcomes, interventions
must take into account
not only patients' cultural
values, but also
clinicians' unconscious
prejudices and methods
of dealing with minority
patients, as well as
system barriers to care
for those at risk.
to have patients
underusing asthma
controller medications
in an early review of
pediatric asthma
procedures in Medicaid
health maintenance
organizations.These
findings indicate that
providing training to
facilitate effective
communication with
culturally diverse
patient populations can
enhance patient
adherence to provider
recommendations.
Increasing health care
providers'
understanding of their
patients' use of
complementary and
alternative medicine
(CAM), beliefs about
controller medications,
and general health
concerns may lead to
more effective asthma
medication
communication in the
clinical encounter,
which is arguably the
most effective medium
for increasing
adherence to controller
medications.
6. Perceived Barriers to Asthma
Therapy in Ethno-Cultural
Communities: The Role of Culture,
Beliefs and Social Support among
the Mandarin and Punjabi speaking
Community in Canada
a. Author’s Name:
i. Michele Shu
ii. Iraj Poureslami
iii. Jing Liu
iv. J. Mark FitzGerald
b. Date published: July 2017
Asthma affects Better understanding of Some findings reveal
approximately 2.2 patient needs, provision that educational
million adults and 0.8 of culturally and handouts and videos be
million children (12 linguistically appropriate developed and
percent of the Canadian education, and inclusion distributed by an
population) and is very of home caregivers into asthma educator or
common in the general the management doctor in their group.
population; however, it practices are necessary They believe that the
is less well regulated to improve asthma emphasis of such
among people of lower outcomes in Chinese and discussions should be
socioeconomic status Punjabi communities. on drug discrepancies,
and those from possible medication side
low-income families. effects, and proper
Asthma is also common inhaler use. They also
in recent immigrant stressed the importance
communities in Canada, of bringing educational
and they bear a materials home with
disproportionate burden them.
of disease compared to
Canadian-born people. These findings back up
When compared to the the findings of research
white population, ethnic that looked at the
groups are affected impact of educational
differently by asthma in interventions on asthma
terms of disease-related outcomes in minority
consequences such as populations, with a
morbidity and mortality. specific emphasis on
Mandarin, Cantonese, improving
and Punjabi-speaking patient-provider
immigrants, who make communication and
up one of Canada's reducing illness and
largest and medication-related
fastest-growing cultural misunderstandings, and
groups, are among use of appropriate
them. educational material.
Findings of the study
indicated that In One of the problems
general, the majority of found in this study is
participants in both the target communities'
ethnic groups struggled "access" to relevant
to understand why they information. Developing
should use reliever vs. educational
controller drugs, and interventions and
several of them blamed directly engaging
their doctors for their patients and caregivers
misinterpretation, is one suggestion for
claiming they never enhancing information
obtained guidance or an and service
action plan in their accessibility.
language about how to
properly use inhalers
and the reasons for
using different
medications.
In their views of the
causes and
consequences of having
asthma as well as
self-management
behaviors, the Chinese
and Punjabi groups
shared some similarities
and differences. For
example, many Chinese
and Punjabi patients
believe that asthma is a
contagious disease
similar to the common
cold: “A lot of people in
my community believe
that asthma is a
contagious disease.
Many Punjabi
participants also
expressed
embarrassment about
using an inhaler in
public, fearing that
people would think they
had a transmissible
infectious lung disease
like tuberculosis. There
were disparities in
perceptions of smoking
among the groups
surveyed.There were
disparities in perceptions
of smoking among the
groups surveyed.
Although smoking was
freely and widely
practiced among
Chinese patients, as
they suggested, smoking
is heavily encouraged by
Chinese culture and aids
in the formation of social
bonds with peers/friends
and coworkers. In
comparison, Punjabi
patients stated that
smoking is not a
common practice in their
community, especially
among women, and that
many of them prefer not
to smoke in front of
their elders, citing
religious and cultural
norms as reasons.
Patients' decisions to
engage in self-care of
their chronic condition
may be influenced by
these values and lack of
understanding.

Significant obstacles to
adherence were
identified by study
participants as a lack of
communication between
the patient and the
healthcare provider,
concerns regarding drug
costs, and
misconceptions about
medication side effects.
The target populations'
risk of poor outcomes
may be increased as a
result of such difficulties
and ability barriers.
 Task 11 (Mr. Chua and Mr. Co): Make a drug study of all the medications the
infant/child is taking. Use the CDU-CN Drug Therapeutic Record (DTR) template.
Further search for at least 3 recent studies / update about the medication in treating or
managing the client condition.

Indications/
Drug/ Dose/ Classification/ Contraindications/ Principles of Care Treatment Evaluation
Frequency/ Mechanism of Action Side effects/ Adverse
Route reactions

Classification: Indications: Storage: ● Store bottle ● Patient did

Ascorbic Acid
away from not manifest
(Ceelin)
Pharmacologic ● Pneumonia ● Place the bottle sunlight any side
2.5 mL Class: ● Whooping cough Inside the effects; the
Vitamin C ● Tuberculosis refrigerator ● Tell patient patient did
OD PO ● Faulty Bone ● Room it has a not vomit.
(0800H) ● Scurvy temperature metallic The patient
● Gingivitis not exceeding taste tolerated the
Mechanism of ● Bleeding gums 25°C vitamin well
Action: ● Loosened teeth ● Use syrup
instead of
Vitamin C (ascorbic
tablets
acid) dissociates at
Recommendation:
physiological pH to Contraindications:
form ascorbate, the ● The daily
redox state of the ● Patients with amount for
vitamin which is found blood disorders vitamin C is
most abundantly in like 65 to 90
cells. It is well known thalassemia,G6PD milligrams
that ascorbate acts deficiency, sickle (mg) a day,
physiologically as a cell disease, and and the upper
reductant and enzyme hemochromatosis limit is 2,000
cofactor. mg a day.
● Best absorbed
when you
Side effects: take them
empty
● GI: Diarrhea,
stomach.
nausea and
● An ideal way
vomiting,
would be to
abdominal
take your
cramps/pain
supplement
● CV: Heartburn
first thing in
the morning,
30-45 minutes
Adverse Reactions: before your
meal.
● Urinary: Calcium
oxalate
crystalluria
Drug-Drug
● Digestive: Interactions:
Esophagitis ● Aluminum.
Taking
vitamin C can
increase your
absorption of
aluminum
from
medications
containing
aluminum,
such as
phosphate
binders. This
can be
harmful for
people with
kidney
problems.
● Chemothera
py. There is
concern that
use of
antioxidants,
such as
 vitamin C,
during
chemotherapy
might reduce
the effect of
chemotherapy
drugs.
● Estrogen.
Taking
vitamin C with
oral
contraceptives
or hormone
replacement
therapy might
increase your
estrogen
levels.
● Protease
inhibitors.
Oral use of
vitamin C
might reduce
the effect of
these antiviral
drugs.

1st study: Vitamin C: Fact sheet for Health Professionals (Weinstein, 2021)

Most infants in developed countries are fed breast milk and/or infant formula,
both of which supply adequate amounts of vitamin C. For many reasons, feeding infants
evaporated or boiled cow’s milk is not recommended. This practice can cause vitamin C
deficiency because cow’s milk naturally has very little vitamin C and heat can destroy
vitamin C.

2nd study: Vitamin C: An update on current uses and functions (Yussif, 2019)

A few studies in humans have examined whether bioavailability differs among

the various forms of vitamin C. In one study, Ester-C and ascorbic acid produced the
same vitamin C plasma concentrations, but Ester-C produced significantly higher
 vitamin C concentrations in leukocytes 24 hours after ingestion . Another study found
no differences in plasma vitamin C levels or urinary excretion of vitamin C among three
different vitamin C sources: ascorbic acid, Ester-C, and ascorbic acid with bioflavonoids.
These findings, coupled with the relatively low cost of ascorbic acid, led the authors to
conclude that simple ascorbic acid is the preferred source of supplemental vitamin C.

3rd study: Vitamin C and asthma in children (Hemila, 2019)

“We found strong evidence that the effect of vitamin C on asthmatic children is
heterogeneous. Further research is needed to confirm our findings and identify the
groups of children who would receive the greatest benefit from vitamin C
supplementation” -Harri Hemila.
Indications/
Drug/ Dose/ Classification/ Contraindications/ Principles of Care Treatment Evaluation
Frequency/ Mechanism of Action Side effects/ Adverse
Route reactions

Piperacillin and Classification: Indications: Storage: ● Assess ● Patient did

tazobactam hypersensit not manifest
(Zosyn) Pharmacologic ● Moderate to ● stored at ivity to signs and
Class: severe bacterial controlled drug symptoms of
Antibiotics infections, room infection.
q6h IV
including temperature ● Monitor
(0000H- 0600H- pneumonia, E coli 20°C to 25°C daily
1200H- 1800H) infection and (68°F to 77°F) pattern of
Mechanism of appendicitis prior to bowel
Action: reconstitution. activity,
stool
Piperacillin: Inhibits cell
consistency
wall synthesis by Contraindications:
binding to bacterial cell Recommendation:
● Be alert for
membranes. ● Hypersensitivity
● Use Zosyn superinfecti
to
Tazobactam: exactly as on: fever,
piperacillin/tazoba
Inactivates bacterial directed on vomiting,
ctam, any
betalactamase. the label diarrhea,
penicillin
● Do not use in anal/genital
larger or pruritus,
smaller oral
Side effects: amounts or mucosal
for longer changes
● CNS: Dizziness, than
headache recommended
● GI: Diarrhea,
 nausea, vomiting, ● Infuse over 30
constipation minutes
● Integumentary:
rashes
● RT: Shortness of
breath Drug-Drug
Interactions:

● Vancomycin:
Adverse Reactions: Studies have
detected an
● CNS: Seizures, increased
neurologic incidence of
reactions acute kidney
injury
● GI: ● Methotrexat
Antibiotic-associat e:
ed colitis may reduce
the clearance
● Immune:
of
hypersensitivity
methotrexate
reaction,
due to
Anaphylaxis
competition
● Lymphatic for renal
System: secretion
Thrombophlebitis ● Vecuronium:
prolongation
● Respi: Dyspnea of the
neuromuscula
r blockade of
vecuronium.
● Probenecid:
Inhibits
tubular renal
secretion of
both
piperacillin
and
tazobactam.

1st study: Developmental Pharmacokinetics of Piperacillin and Tazobactam

Using Plasma and Dried Blood Spots from Infants (Cohen-Wolkowiez, et al.
2018)

This study showed that sparse plasma or plasma plus DBS samples can be used
to characterize the PK of piperacillin-tazobactam in infants. On average,
piperacillin-tazobactam concentrations in DBS samples were lower (50 to 60%) than
those in plasma. Tazobactam/piperacillin (TAZ/PIPC) is widely used for the treatment of
this entity, because it is stable to beta-lactamases and effective against both
gram-positive and gram-negative bacteria. Broad-spectrum carbapenem antibiotics are
often used for the treatment of pneumonia in children and have been shown to be
effective against aspiration pneumonia.

2nd study: Clinical Benefits of Piperacillin/Tazobactam versus a Combination

of Ceftriaxone and Clindamycin in the Treatment of Early, Non-Ventilator,
Hospital-Acquired Pneumonia in a Community-Based Hospital (Park. et al
2020)

Treatment with piperacillin/tazobactam was more effective than that with

ceftriaxone plus clindamycin in patients with early NV-HAP. This study supports the
recent treatment recommendations that patients with early NV-HAP should be treated
empirically with broad-spectrum antibiotics.

3rd study: Results of the effectiveness of piperacillin molecules in the real

world (Mendoza, 2019)

Piperacillin–tazobactam is one of the broadest spectrum antimicrobials available,

covering Gram-positive, Gram-negative, and anaerobic bacteria. It has been shown to
be effective in the treatment of moderate and severe infections, such as complicated
urinary tract infections, intra-abdominal infections, soft tissue infections, gynecological
infections, and pneumonia . The innovator antibiotic, which is highly effective and safe
in critically ill patients, has been marketed since 1993 , but due to its increasingly
frequent use in the ICU, concern has been raised about the high costs of health care for
these patients.
Task 12 (Mr. Dinoy and Mr. Domapias): Show in tabular form the materials, supplies,
and equipment a nurse and the health care team shall use in the care of a high risk
infant/child. Use the template provided.
Material, Supply, Description / Purpose
Equipment with Picture
Stethoscope Stethoscope is an
apparatus used for
auscultation, and listening
for the internal sounds of
the human body. Purpose
is to listen for the sounds
made by the heart, lungs,
intestines as well as blood
flow in blood vessels.
Metered-Dose Inhaler An MDI is a complex drug
(MDI) delivery device designed to
provide a fine spray of
medicament, commonly
Guidelines in the
Use and Care
Sit down and open the
blood pressure testing kit.
Raise arm to heart level.
Wrap the cuff around the
upper arm. Make sure the
cuff is snug, but not too
tight. Place the wide head
of the stethoscope on the
arm. Clip the pressure
gauge to a stable surface.
Take the rubber bulb and
tighten the valve. Inflate
the cuff. Release the valve.
Note the systolic blood
pressure. Note the
diastolic blood pressure.
Check the blood pressure
again to have an accurate
result.
Remove the cap from the
MDI and chamber; Shake
well before use; Place the
mouthpiece between the
 with a particle size of less
than 5 μm. An MDI is
generally used for
treatment of respiratory
diseases such as asthma
and COPD; it can be given
in the form of suspension
or solution.
Nebulizer A nebulizer is an
electrically powered
machine that turns liquid
medication into a mist so
that it can be breathed
directly into the lungs
through a face mask or
mouthpiece. People with
asthma can use a nebulizer
to take their medications.
client's teeth and seal lips
tightly around it; Breathe
out completely; Press the
canister once; Breathe in
completely through your
mouth; Hold breath for 10
seconds; Repeat the above
steps for each puff ordered
by your doctor; Wait about
1 minute in between puffs;
Clean the mouthpiece
when finished; Put back
the cap.
First wash your hands well.
Connect the hose to an air
compressor and fill the
medicine cup with your
prescription. To avoid
spills, close the medicine
cup tightly and always hold
the mouthpiece straight up
and down. Attach the hose
and mouthpiece to the
medicine cup. Place the
mouthpiece in your mouth.
Keep lips firm around the
mouthpiece so that all of
the medicine goes into
your lungs. Let the client
breathe through their
mouth until all the
medicine is used. This
takes 10 to 15 minutes. If
needed, use a nose clip so
that he/she breathes only
through his/her mouth.
Turn off the machine when
done and wash the
medicine cup and
mouthpiece with water and
air dry until your next
treatment.
 Thermometer Thermometer is a medical Put the end of the
device used to measure thermometer in the center
and display body of the armpit. Bring arms
temperature. This down, close to the side.
measurement can help Hold the thermometer
diagnose when a patient tightly in place until it
has a fever, a symptom of beeps (may take up to 5
many diseases or minutes). Remove the
infections. thermometer and read it.

Weighing or Bathroom A weighing scale (in Make sure the scale is

Scale common usage) is a device calibrated before starting
for measuring and the weighing process. The
monitoring weight of a person being weighed
person. should remain motionless
until the weight and height
are recorded. The person
being weighed should not
be wearing shoes or heavy
clothing. Make sure the
scale is set at zero before
weighing. Record all
relevant results.

Height Chart A tool for tracking a child's
physical growth and
development. They help a
pediatrician make sure a
kid is gaining inches,
putting on pounds, and
increasing in head size (an
indicator of healthy brain
development) at a rate
that's typical for their age.
Let the child stand straight
in front of the chart.
Ensure that the child is
looking straight ahead,
without shoes. Measure
the length. When the
length stops, take a
reading on the height
chart.

Recording Sheet / It is a sheet that comprises Identification sheet should

Chart accurate and relevant be first identified (name,
information where nurses age, address, sex); Use
and other health care the correct color coded
 providers reflect their pens. Never use pencils;
assessment findings. This Do not use correction
is to promote continuity of tape/inks when there are
care. errors. Cross it out with a
single line; Secure client’s
information.

Powerpoint It is a presentation or Limit the number of words

Presentation slideshow program that and lines in one slide;
showcases unique and always simplify the
creative features to content; use pleasing text
enhance and secure the color and fonts.
best learning experience.

Visual Aids Visual aids are items of a Font size should be clear
visual manner, such as enough to read by the
graphs, photographs, video readers and the
clips, etc. used in addition presentation should be
to spoken information. easily understood or
comprehend.

Infographics Infographics are graphic It should be simple but

visual representations of informative. Make the
information, data, or texts and designs clear,
knowledge, intended to attractive, and
present complex understandable.
information quickly and
clearly. It helps in
organizing data, and
makes it visually digestible
so that viewers can easily
 process the information.

Task 13 (Ms. Huynh, Mr. Paden, and Ms. Leyson): Choose a most relevant concept
that addresses the 3 learning domains (cognitive, psychomotor and affective) based on
the assessment findings / health needs. Develop a health teaching plan appropriate for
the family using the CDU-CN HTP template. Design a creative medium that will be used
during the health education forum.

Objectives Content Methodology Evaluation

General Objectives:
After a week of holistic
nurse-patient interaction, the
client will maintain airway
patency as evidenced by
clear breath sounds,
improved oxygen exchange,
normal rate and depth of
respiration, and ability to
effectively cough out
secretions.
Specific Objectives:
After 30-45 minutes of
nurse-client interaction, the
client will:

Cognitive Domain: Asthma is a chronic inflammatory -Interactive

1. Define asthma & its disorder of the airways characterized by discussion
manifestations. recurring symptoms, airway obstruction, with
and bronchial hyperresponsiveness powerpoint
(National Asthma Education and presentation
Prevention Program, 2007).

In susceptible children, inflammation -Pamphlet

causes recurrent episodes of wheezing,
breath- lessness, chest tightness, and
cough, especially at night or in the early
morning. These asthma episodes are
associated with airflow limitation or
obstruction that is reversible either spon-
taneously or with treatment. The
inflammation also causes an increase in
bronchial hyperresponsiveness to a
variety of stimuli (National Asthma
Education and Prevention Program,
2007).

The classic manifestations of asthma are


2. Determine triggers on the
onset of asthma.
3. Enumerate cares for
dyspnea, wheezing, and coughing.
The child with asthma who sweats
profusely, remains sitting upright, and
refuses to lie down is in severe
respiratory distress. Also, the child who
suddenly becomes agitated, or the
agitated child who suddenly becomes
quiet, may be seriously hypoxic and
requires immediate intervention.
Allergens: -Interactive
Outdoor—Trees, shrubs, weeds, grasses, discussion
molds, pollens, air pollution, spore with
powerpoint
Indoor—Dust or dust mites, mold,
presentation
cockroach antigen
Irritants—Tobacco smoke, wood smoke,
odors, sprays -Pamphlet
Exposure to occupational chemical
Exercise
Cold air
Changes in weather or temperature
Environmental change—Moving to new
home, starting new school, and so on
Colds and infections
Animals—Cats, dogs, rodents, horses
Medications—Aspirin, nonsteroidal
anti-inflammatory drugs, antibiotics, beta
blockers
Strong emotions—Fear, anger, laughing,
crying
Conditions—Gastroesophageal reflux,
tracheoesophageal fistula Food
additives—Sulfite preservatives
Foods—Nuts, milk and dairy products
Endocrine factors—Menses, pregnancy,
thyroid disease.
-Interactive
Prevention of asthma episodes: discussion
asthmatic patient. Avoid allergens: with
● Cover pillows and mattresses with powerpoint
dust proof covers. presentation
● Wash bedding in hot water once a
week.Dry completely.
-Pamphlet
● Avoid using feather- or
down-filled pillows and
mattresses.
● Keep the child indoors while the
lawn is being mowed, bushes and
trees are being trimmed, or pollen
count is high.
● Keep windows and doors closed
during pollen season; use an air
conditioner if possible, or go to
places that are air condi- tioned,
such as libraries and shopping
malls, when the weather is hot.
● The child should not be present
during cleaning activities:
● Wet-mop bare floors weekly;
wet-dust and clean child’s room
weekly.
● Vacuum carpet and fabric-covered
furniture every week to reduce
dust buildup, using a
high-efficiency particulate air filter
(Environmental Protection
Agency, 2012).
● Limit or prevent child’s exposure
to tobacco and wood smoke; do
not allow cigarette smoking in the
house or car; select day care
centers, play areas, and shopping
malls that are smoke free.
● Use air conditioners with
high-efficiency particulate air
filters.
● Use indoor air purifiers with
high-efficiency particulate air
filters.
● Choose stuffed toys that can be
washed in hot water. Dry
 completely before the child plays
with the toy.

Drug therapy:
● Corticosteroids are
anti-inflammatory drugs used to
treat reversible airflow obstruction
and control symptoms and reduce
bronchial hyperresponsiveness in
chronic asthma. Inhaled cor-
ticosteroids should be used as
first-line therapy in children over 5
years of age.
● β-Adrenergic agonists (short
acting) (primarily albuterol,
levalbuterol [Xopenex], and
terbutaline) are used for
treatment of acute exacerbations
and for the prevention of EIB.
● Cromolyn sodium is medication
used as maintenance therapy for
asthma in children over 2 years of
age.
● Leukotrienes are mediators of
inflammation that cause increases
in airway hyperresponsiveness.
4. Define MDI.

5. Indicate techniques used
in metered-dose inhaler.
Inhaled respiratory medications are often
taken by using a device called a metered
dose inhaler, or MDI. The MDI is a
pressurized canister of medicine in a
plastic holder with a mouthpiece.
Video
The MDI should always be attached to a presentation
spacer when an inhaled corticosteroid is
administered to prevent yeast infections
in the mouth. Spacers are also important
for children who have difficulty
coordinating or learning proper
inhalation techniques.
Steps in using MDI:
1. Remove the cap and hold the
inhaler upright.
2. Shake the inhaler for about 8-10
secs.
3. Prime the inhaler by giving out 4
sprays. Depending on
manufacturer
4. Attach spacer, as appropriate. Tilt
the head back slightly and
breathe out slowly.
5. With the inhaler in an upright

Psychomotor domain:
1. Demonstrate the steps in
using a metered-dose
inhaler (MDI).
position, insert the mouthpiece:
a. About 3 to 4 cm (1 to 112
inches) from the mouth, or
b.Into the mouth, forming an
airtight seal between the lips and
the mouthpiece.
6. At the end of a normal expiration,
depress the top of the inhaler
canister firmly to release the
medication (into the mouth), and
breathe in slowly (about 3 to 5
seconds). Relax the pressure on
the top of the canister.
7. Hold the breath for at least 5 to
10 seconds to allow the aerosol
medication to reach deeply into
the lungs.
8. Remove the inhaler and breathe
out slowly through the nose.
9. Wait 1 minute between puffs (if
an additional puff is needed)
when using a bronchodilator. Video
presentation
Step in using MDI:
1. Remove the cap and hold the
inhaler upright.
2. Shake the inhaler for about 8-10
secs.
3. Prime the inhaler by giving out 4
sprays. Depending on the
manufacturer.
4. Attach spacer, as appropriate. Tilt
the head back slightly and
 breathe out slowly.

5. With the inhaler in an upright

position, insert the mouthpiece:
a. About 3 to 4 cm (1 to 112
inches) from the mouth, or

b.Into the mouth, forming an

airtight seal between the lips and
the mouthpiece

6. At the end of a normal expiration,

depress the top of the inhaler
canister firmly to release the
medication (into the mouth), and
breathe in slowly (about 3 to 5
seconds). Relax the pressure on
the top of the canister.

7. Hold the breath for at least 5 to

10 seconds to allow the aerosol
medication to reach deeply into
the lungs.

8. Remove the inhaler and breathe

out slowly through the nose.

9. Wait 1 minute between puffs (if

an additional puff is needed)
when using a bronchodilator.

NOTE: Inhaled dry powder such as

budesonide (Pulmicort) requires a
different inhalation technique. To use a
dry powder inhaler, the base of the
device is turned until a click is heard. It
is important to close the mouth tightly
around the mouthpiece of the inhaler
and inhale rapidly. Also, rinse mouth and
spit with water when taking a
corticosteroid.
Video
2. Demonstrate breathing presentation
exercises for asthma

Diaphragmatic breathing:
○ Sit in a comfortable position or lie
flat on the floor, your bed, or
another comfortable, flat surface.
○ Relax your shoulders.
○ Put a hand on your chest and a
hand on your stomach.
○ Breathe in through your nose for
about two seconds. You should
experience the air moving through
your nostrils into your abdomen,
making your stomach expand.
During this type of breathing,
make sure your stomach is moving
outward while your chest remains
relatively still.
○ Purse your lips (as if you’re about
to drink through a straw), press
gently on your stomach, and
exhale slowly for about two
seconds.
○ Repeat these steps several times
for best results.
nasal breathing
○ Deep slow breathing through nose
pursed lip breathing
○ Sit with your back straight or lie
down. Relax your shoulders as
much as possible.
 ○ Inhale through your nose for two
seconds, feeling the air move into
your abdomen. Try to fill your
abdomen with air instead of just
your lungs.
○ Purse your lips like you’re blowing
on hot food and then breathe out
slowly, taking twice as long to
exhale as you took to breathe in.
○ Then repeat. Over time, you can
increase the inhale and exhale
counts from 2 seconds to 4
seconds, and so on.
Affective:
1. ask questions with
Open forum
regards to the
discussions Letting the client or significant others
communicate openly and be able to
answer their questions and clarifications
2. express regarding asthma, MDI etc.
understanding on the sharing of
use of MDI and its input &
proper usage.

3. Recognize and
Feedback
verbalize awareness
of one’s responsibility
One-to-One
in health compliance Discussion
References:

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