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specific therapy. Airway inflammation is the result of interactions between various cells, cellular elements and cytokines. Asthma is one of the most common disease
globally affecting about 300million people. This condition is likewise prevalent among Filipinos. International Statistics by country for asthma showed that 5.5 million (15.6%) Filipinos are afflicted with asthma. Asthma differs from other obstructive lung diseases in that it is largely reversible, either spontaneously or with treatment. Patients with asthma may
experience symptoms ±free periods alternating with acute exacerbations that last from minutes to hours or days. Asthma is the most common disease of childhood and can occur at any age. Despite increased knowledge regarding the pathology of asthma and the development of better medications and management plans, the death rate from the disease continues to increase. For most patients, asthma is a disruptive disease, affecting school and work attendance, occupational choices, physical activity and general quality of life. Allergy is the strongest predisposing factors for asthma. Chronic exposure to airway irritants or allergens also increases the risk of asthma. Common allergens can be seasonal (grass, tree, and weed pollens) or perennial (eg, mold, dust, roaches, animal dander.) Common trigger s for asthma symptoms and exacerbations include airway irritants (eg, air pollutants, cold, heat weather changes, strong odors or perfumes, smoke), exercise, stress or emotional upset, sinusitis with postnasal drip, medications, viral respiratory tract infections, and gastroesophageal reflux. Most people who have asthma are sensitive to a variety of triggers. A person¶s asthma changes depending on the environment, activities, management practices, and other factors. The three most common symptoms of asthma are cough, dyspnea, and wheezing. In some instances, cough may be the only symptom. An asthma attack often occurs at night or early in the morning, possibly because of circadian variations that influence airway receptor thresholds.
Possible causes are dust. At times the mucus is so tightly wedged in the narrowed airway that the patient cannot cough it up. Generalized chest tightness and dyspnea occur. Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. pets. response to treatment may be monitored by derail measurements of lung function. If the attacks are seasonal. The hypoxemia is secondary to a ventilation-perfusion mismatch and readily responds to a supplemental oxygenation. certain foods. and pollens. molds. dust mites. Symptoms of exercise-induced asthma include maximal symptoms during exercise. Expiration requires effort and becomes prolonged. Patients are instructed to avoid the causative agents whenever possible. first on expiration and then possibly during inspiration as well. and certain types of cloth. soaps. Although life threatening and severe hypoxemia can occur in asthma. with or without mucus production. In addition. Asthma exacerbations are best managed by early treatment and education. oxygen supplementation may be required to relieve hypoxemia associated with moderate to severe exacerbations. including the use of written action plans as part of any overall effort to educate patients about self management technique especially those with moderate or severe persistent asthma and those with a history of severe exacerbations. not all health care providers follow them. roaches. tachycardia. . There may be generalized wheezing. absence of nocturnal symptoms. and a widened pulse pressure may occur along with hypoxemia and central cyanosis (a late sign of poor oxygenation). There is cough. pollens can be strongly suspected. detergents. Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medications. and sometimes only a description of a ³choking´ sensation during exercise. Unfortunately. In some patients. National guidelines are available for the care of patients with asthma. horses.An asthma exacerbation may begin abruptly but most frequently is preceded by increasing symptoms over the previous few days. Quick acting beta2-adrenergic agonist medications are first used for prompt relief of airflow obstruction. it is relatively uncommon. As the exacerbation progresses. Knowledge is the key to quality asthma care. diaphoresis.
2. 3. OBJECTIVES GENERAL OBJECTIVE 1. is not beneficial for asthma exacerbations. and purulent sputum. To inform how the disease can be treated. evidence of pneumonia. To trace the anatomy and physiology of the system involved. 6. To identify the different ways of treating the disease. 4. To enumerate the signs and symptoms of the disease.Evidence from clinical trials suggests that antibiotic therapy whether administered routinely or when suspicion of bacterial infection is low. SPECIFIC OBJECTIVES 1. complications. To trace the pathophysiology of the disease. its etiological process. 5. fever. Antibiotics may be appropriate in the treatment of acute asthma exacerbations in patients with co-morbid conditions (e. To fully learn about the underlying processes involved in Bronchial Asthma in Acute Exacerbation. suspected bacterial sinusitis. and treatments for its prevention and termination. . To identify the causes of Bronchial Asthma in Acute Exacerbation.g.
OBJECTIVE: > conscious > coherent > difficulty in secretions as manifested by difficulty of breathing. feather. pillows. >keep allergen environment free (eg. clearance. verbalized by the client.NURSING CARE PLAN ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION SUBJECTIVE: ³nahihirapan akong huminga´ as Ineffective airway clearance related retained bronchial to After 8 hours of nursing >Elevate head of the bed position hours or change every 2 >to take advantage After 8 hours of gravity decreasing pressu nursing on the Diaphragm and enhancing drainage of /ventilation to different lung segments interventions the client have a patent airway interventions the client will have a patent airway clearance. breathing > ( +) productive cough > cyanosis dust. smoke) >encourage breathing deep and >to maximize effort coughing exercises >assessed condition patient¶s .
cold exposure to allergen. inhaled irritants.Eosinophil. Basophil. No. pulmonary infection. in mucosa and hypertrophy of submandibular glands Basement membrane underlying the mucosal Epithelium is thickened and there is hypertrophy Chest Wheezes Intense inflammation of Bronchial walls Productive cough Peak Flow Variability Shortness of breath . SRS-A. Bradykinines Leukotines Airway Hyper responsiveness Vascular Permeability Bronchospasm Edema Further release of leukocytes (Neutrophils .PATHOPHYSIOLOGY Exercise. Of mucus by Goblet cell. stress IgE Production Re-exposure to antigen Release pre-formed mediators that open tight junctions between Antigen enter the Mucosa Activation of mucosal mast cells and Mediators: Histamine. ingestion of aspirin. prostaglandin.
rhonchi. causing episodic smooth muscle spasm that severely constrict the airways. the narrower the bronchial lumen. On inhalation. Leukotrienes also caused prostaglandin to travel through the blood stream to the lungs. Histamine attaches to receptor sites in larger bronchi. Mast cells in the lungs interstitium are stimulated to release histamine and Leukotrienes. A wheeze maybe audible during coughing ± the higher the pitch. Sudden dyspnea. the narrow bronchi lumen can still expand slightly. On subsequent exposure to antigen. Mucus membrane become inflamed. prolonged expiration and an increased respiratory rate.PATHOPHYSIOLOGY Environmental factors interact with inherited factors to caused asthmatic reactions with associated bronchospasms in asthma bronchial lining over react to various stimuli. The following signs and symptoms are possible to occur. The patient may experience dyspnea. Leukotrienes attached to the receptor site in the smaller bronchi and can cause local swelling of the smooth muscle. On exhalation. wheezing and tightness in the chest . mast cells degranulate and release mediators. Mucosal edema and thicken secretions further block the airways. Histamines stimulates the mucos membranes to secrete excessive mucusto further narrow the bronchial lumen. increase pitch wheezing and increases respiratory distress. where they enhance the histamine¶s effect. Goblet cells secrete viscous mucus that is difficult to cough out resulting in coughing. allowing air to reach the alveoli. where causes swelling of smooth muscles. increase intrathoraxic pressure closes the bronchial lumen. irritated and swollen.
Lipa City September 6. Two days prior to admission. the patient experienced non productive cough. 1967 Pola O. watery nasal discharge. and (-) fever and decreases in appetite. One week prior to admission. Maraouy. HISTORY OF PRESENT ILLNESS The patient was diagnosed with bronchial asthma since she was young. Marjorie Reyes Felix. . MD CHIEF COMPLIANT The patient is complaining of difficulty of breathing.R Mindoro 44 years old Female Married Roman Catholic Librarian (De La Salle Lipa) Filipino Dr. the patient experienced difficulty of breathing and she experienced it fewer at night that caused of feeling fatigue during the day.PATIENT¶S PROFILE Case no: Name of the patient: Address: Birthday: Birthplace: Age: Sex: Civil Status: Religion: Occupation: Citizenship: Attending Physician: 21837 Patient X Villa de Lipa.
In her eating habits. ³My father and my husband are smoker´ said by the client LIFESTYLE AND HEALTH PRACTICE The client never tried to smoke cigarettes or other tobacco products. . she is always eating carbohydrates. Their house also is near from the highway. but the people around her environment are smokers like her father and her husband. she has a complete immunization status. No use of alcohol reported. she has no allergies when it comes to food or medications. they have a history of being Asthmatic. cough and colds. According to her she is exposed to some environmental conditions that can affect her breathing. She also doesn¶t experience of having an accident that might endanger her life or death. she suffered from minor illness such as fever. And she undergo a TAHBSO surgery. She is exposed to the air pollution coming from the vehicle. because she is a librarian maybe she can inhale dust that came from the book. Her rest and sleep pattern was not good because of her frequent coughing at night. FAMILY HISTORY In the father side of the client. high cholesterol and some fruits.HISTORY OF PAST ILLNESS During her childhood.
LABORATORY EXAMINATONS LABORATORY EXAM Hemoglobin NORMAL VALUE Female:12.45 0.000450.000 cu/mm 11.0g/dl RESULT 13. Leukocyte number 5-10x10 9/l 3x10 9/l This indicates low level of concentration hyponatremia Lymphocytes Volume 0.000/mm3 Normal .000±10.0-16.26 Lymphocytes is slightly lower than normal range which may reduce resistance in fighting against infection White Blood Cells 5.000/mm3 206.9 INTERPRETATION This shows that the hemoglobin is in normal range.000 cu/mm Above normal count signifies presence of infection Thrombocytes 150.24-0.
Salbutamol was ordered in two inhalations every 4 to 6 hours. Levofloxacin 500 mg IV once a day. Negative allergy against medicines was proven.COURSE IN THE WARD June 24. 2011. June 26. IVF rate maintained. Seen and examined by the attending physician. IVF rate was maintained during five cycles.it was ordered to admit the patient to the room of choice under the service of Dr. . 2011. Urinalysis. 3:10pm. chest X-ray. Seretide 500 mg discussed 1 puff twice a day was ordered and carried out by the staff nurse. . Other medications are continued as ordered.the patient was given Metformin twice a day and acetyl salicylic acid due to positive diabetes mellitus. . Fluimucil 600 mg tablet in ½ glass of water once a day. Laboratory examination was ordered such as: complete blood count. MD. June 25. The consent was secured. Marjorie Reyes Felix. Hypoallergenic diet was advised and IVF 1L x 12 hours was also ordered. 2011. and HBa1C. 12:40pm.
coordinates respiratory rhythm and regulates the depth of respirations. a decrease in PaCO2 inhibits ventilation. An increase in arterial CO2 (PaCO2) stimulates ventilation. The neural system. guarding against hypercapnia (excessive CO2in the blood) as well as hypoxia (reduced tissue oxygenation caused by decreased arterial oxygen [PaO2]. The chemical processes perform several vital functions such as: regulating alveolar ventilation by maintaining normal blood gas tension.ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM The upper respiratory tract consists of the nose. Control of gas exchange involves neural and chemical process. . larynx. conversely. a process known as gas exchange. and epiglottis. trachea. The lower respiratory tract consists of the bronchi. bronchioles and the lungs. The major function of the respiratory system is to deliver oxygen to arterial blood and remove carbon dioxide from venous blood. This is accomplished through the mechanical acts of inspiration and expiration. pharynx. helping to maintain respirations (through peripheral chemoreceptors) when hypoxia occurs. The normal gas exchange depends on three processes such as ventilation which is movement of gases from the atmosphere into and out of the lungs. composed of three parts located in the pons. medulla and spinal cord. sinuses. diffusion which is a movement of inhaled gases in the alveoli and across the alveolar capillary membrane. and perfusion which is movement of oxygenated blood from the lungs to the tissues.
and more horizontally positioned eustachian tubes. a total body response to respiratory infection. increased severity or respiratory symptoms due to smaller airway diameters. children respond differently than adults to respiratory disturbances.The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in children and adults. major areas of difference include: poor tolerance of nasal congestion. vomiting and diarrhoea. increased susceptibility to ear infection due to shorter. with such symptoms as fever. however. broader. . especially in infants who are obligatory nose breathers up to 4 months of age.
If indicated. and cough Planning After 5-6 hours of nursing intervention The Patient will maintain/impro ve airway clearance AEB absence of signs of respiratory Distress Intervention 1. dyspnea. Evaluation Goal met By verbalization of the patient of Ok na po ang aking paghinga. Provide warm or tepid liquids. 3. perform postural drainage with percussion and vibration in the morning and at night as prescribed. Bronchial irritants cause bronchoconstriction and increased mucus production.Assessment Subjective: Nahihirapan akong huminga as verbalized by the patient Objective: wheezing upon inspiration and expiration dyspnea tachycardia chest tightness suprasternal retraction productive cough Nursing Diagnosis Ineffective airway clearance RT bronchoconstri ction. These techniques help to improve ventilation and mobilize secretions without causing breathlessness and fatigue. Increases sputum production Change in color of sputum Increased thickness of sputum Increased SOB. 3. increased mucus production. and fumes. and respiratory infection AEB wheezing. Systemic hydration keeps secretion moist and easier to expectorate. . 4. Teach and encourage the use of diaphragmatic breathing and coughing exercises. tightness of chest. Collaborative: 1. which then interfere with airway clearance. Adequately hydrate the pt.Increased fluid intake to 3000 ml/ day. Rationale 1. . Teach early signs of infection that are to be reported to the clinician immediately. aerosols. extremes of temperature. Early recognition is crucial. or fatigue Increased coughing Fever or chills 4. Instruct pt to avoid bronchial irritants such as cigarette smoke. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of an asthmatic person. hindi na ako nahihirapan 2. 2.
4-8 mg sustained release two times a day Inhaled 1-2 inhalations every 4-6 hours - Exercise Deep breathing and coughing exercise Treatment Continue medications prescribed by the physician Provide adequate rest periods Health teaching Teach the client to do purse-lip breathing and relaxation techniques Maintain a dust-free environment Reduce exposure to pollen Out patient follow up Notify the health care provider when respiratory infection occurs Make appropriate referrals to home health agencies for assistance in obtaining medical and assistive equipment .DISCHARGE PLANNING Medication Continue medications prescribed by the physician Salbutamol: adult: PO 2-4 mg 3-4 times per day.
is warm & Cool Clean.Diet Hypoallergenic diet Increased fluid intake to thin bronchial secretion PHYSICAL ASSESSMENT Parts Skin Technique Inspection Palpation Normal Findings Skin is brown and generally equal No edema Good skin turgor No lesion Temp. smooth Pink to light No lesion No dandruff Symmetrical in movement & Position Face is Symmetrical Normocephalic Symmetrical in Position Sclera is white & Glossy PERRLA Equal in size Symmetrical No swelling or Discharges Symmetrical No inflammation Air can be felt in both nare Tongue is at Midline Abnormal With rushes Pale Actual Findings Normal Significance Indicates hydration Nails Inspection brown nail beds Normal For sufficient blood supply Hair Inspection Even in distribution Not symmetric Normal Head Inspection Normal Head inspection may indicate brain damages Eyes Inspection Brisk reaction to Light Pale conjunctiva Normal To determine the cability for light sensitivity Ears Inspection Unequal Normal Nose Inspection Palpation Asymmetrical Normal Nasal obstruction may increase difficulty of breathing Mouth & Throat Inspection Cracked lips Tongue is pale Dental caries Present Asmmetrical Missing tooth Sores may indicate presence of microorganisms related to BAIAE Neck Inspection Palpation Symmetrical with normal ROM No jugular vein Distention Trachea is visible at the midline No nodule None .
Lymph nodes are not palpable Breast & Axilla Inspection Palpation One breast is slightly larger No nipple discharge No masses No lymph nodes palpated Nipple discharge Presence of masses and lymph nodes None Chest Inspection Palpation Auscultation Normal contour Tactile fremitus Bronchial breath sounds Limited chest excursion Color is consistent with the body Poor contour Wheezes Wheezes May indicate BAIAE Abdom en Inspection No lesion or any abnormal findings Bowel sounds is normo.active (13/min) No tenderness Limited ROM Slightly limited ROM May indicate body malaise Extremities Inspection Norma hair distribution No edema No swelling Capillary refill around 1-3 seconds .
glucophagexe Ntidiabetic Adjunct to die and exercise to lower blood glucose in patients with type 2 diabetes Contarindicated with allergy to metformin. drug tolerance prolongd use -maintaining beta a drenergic bladder on h andby in case cardiac arrhythmia occur.. lactation. Monitor urine or serum glucose levels frequently to ermine affecting of drug and discharge Albuterol hydrochloride salbutamol Antaasthmatic Relief for bronchospasm in patients with with reversible obstructive airway disease Contarindicated with allergy toalbuterol. parainfunce adjunct to diet and exercise to lower blood in patiets with type 2 diabetes Reconstituted solution should be clear.DRUG STUDY GENERIC NAME BRAND NAME CLASSIFICATION INDICATIONS CONTRA INDICATION allergy to floutoquinolones. bid.slightly yellow and free of particulate matter -Levoploxacin shouldonly b be administered by slow infusion because a rapid be bolus administration t that result in hypotension. Use minimal doses for normal and nominal periods. CHF. . caused by digitalis intoxication. diabetes complicate by fever. -don¶t mix with other drugs METFORMIN HYDROCHLOR IDDE 1tab. m. catarrhalis. s. Use cautosly with renal dysfunction. tachycardia. seizures and emergenxy NURSING INTERVENTION levaquin LEVOFLOXACI N 500mg IV Antibacterial Acute s bacterial caused by sta exacerbation of chronic bronchitis caused by staphylococcus aureus. oral Glucophage.pneumomiae.h.
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