CALUMPIT FINAL2003

8/7/2019 CALUMPIT FINAL2003

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CASE PRESENTATION: Bronchial Asthma

FATIMA UNIVERSITY MEDICAL CENTER

McArthur Highway, Marulas, Valenzuela City

In Partial Fulfillment in the Requirements in NCM 103A RLE

Submitted to:

Ms. Edna Co, RN, MAN

Submitted by:

Estares, JainaFatima, Francisco

Jacinto, Alexandra NeconeMacabio, Evangeline

Manahan, GraceMaravilla, DanicaMisajon, MaryvieMorales, DonnaMorales, Joanna

Paguio, CatherineQuico, SherryRocha, RIcha


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BSN 3Y1- 4B S.Y. 2nd Sem 2010-2011

TABLE OF CONTENTS

I. INTRODUCTION

II. ACKNOWLEDGEMENT

III. OBJECTIVES

IV. SCOPE AND LIMITATION

V. ASSESSMENT

1. PERSONAL DATA

2. FAMILY BACKGROUND

3. HEALTH HISTORY

A. FAMILY HEALTH HISTORY

B. PAST HEALTH HISTORY

C GENOGRAM

VI. PHYSICAL ASSESSMENT

VII. DEVELOPMENTAL DATA

A. ERIK ERIKSON

VIII. PATTERNS OF FUNCTIONING

VIII. LEVELS OF COMPETENCIES

IX. GORDONS ASSESSMENT

X. ANATOMY AND PHYSIOLOGY

XI. PATHOPHYSIOLOGY

XII. MEDICAL MANAGEMENT

XIII. NURSING CARE PLAN

XIV. DISCHARGE PLAN

XV. BIBLIOGRAPHY


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Case Presentation of Patient Diagnosed with Bronchial Asthma

I. Introduction:

The student nurse of Our Lady of Fatima University picked a case about Bronchial Asthma. As a health care provider, the student nu

responsibility for planning with the patient and the family the continuation of care with eventual outcome of an optimal state of wellness.

Creating a plan of care begins with the collection of data or assessment. It consists of subjective and objective data information.

Asthma is a condition in which the airways narrow usually reversibly in response to stimuli. It is a chronic inflammatory disorder of the airwa

many cells and cellular elements play a role, in a particular, mast cells, eosinophil, T lymphocytes, macrophages, neutrophils, and epithelial cells. In

individuals this inflammation causes recurrent episodes of wheezing, breathlessness, coughing. There are forms of asthma first is cardiac asthma, asthma, it is the reduced of pumping efficiency of the left side of the heart leads to a buildup of fluid in the lungs. This fluids causes airways to narr

cause wheezing. Cardiac asthma is often indistinguishable from bronchial asthma. The main symptoms are shortness of breath, increase in rapid a

breathing, increase in blood pressure and heart rate and a feeling of apprehension. Second forms of asthma is Bronchial Asthma, for most peop

asthma is the pattern periodic attacks of wheezing alternating with periods of quite normal breathing. Strong risk of getting Bronchial asthma inclu

person genetically susceptible to asthma and being exposed early in life to indoor allergens, such as dust mites and cockroaches, and having fam

asthma. Symptoms of bronchial asthma include a feeling of tightness of the chest, difficulty of breathing or shortness of breath, wheezing and coughing

at night.


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ACKNOWLEDGEMENT

First of all, we, the researchers would like to thanks to our beloved Lord Jesus Christ who guided as through the days of our duty which enables

our case study.

Second, to the family who allow us to interview about the health status of their child.

Third, to the Staff Nurses and to the Chief Nurse who let us feel their heart-warming welcome as we started duty. To the Owner of the Hospital w

opportunity to learn other knowledge about in caring the patients. To the Hospital itself, who gave us another different experience that will help to our c

To our Clinical Instructor, Ms. Edna CO, who guided us and pursued us to finish our Case Study.

Fourth, to our Family who gave us a physical and moral support.

And last but not the least, we would like to thanks ourselves because of the knowledge we shared as each of us was able to contribute and finis

Study within the time frame set by our clinical instructor..

Thats all. God Bless.


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OBJECTIVES

To provide the patient a good and quality of care.

To teach the patient in learning how to effective health and nutrition information in helping their young children to be more healthy.

To learn and understand the disease.

To present the case properly.

SCOPE AND LIMITATION

The patient was admitted at the Emergency Room last Feb. 22, 2011 at around 6pm. The patient was diagnosed with Bronchial Asthma. The

transferred at the Suite Room A MS Ward at the same time.

Student Nurse Jaina Estares handled the patient from August 22-23, 2011. Jaina take care the baby. She took vital signs and monitored the con

baby.

Our group assigned to have a Case Presentation and focused on our patient who have been diagnosed with BAI

The information and other gathered data by our group all came from the primary sources, the parents.

Physical Assessment was carefully done and conducted on Feb. 23, 2011.


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ASSESSMENT

I. GENERAL INFORMATION:

NAME: PATIENT X

AGE: 1 months

Birthday: October 25, 2009

Place of Birth: Marulas, Valenzuela City

Sex: Male Civil Status: Single Religion: Catholic

Nationality: Filipino Weight: 12 kg Length: 62 cm

HEALTH HISTORY

FAMILY HEALTH HISTORY

Baby X is the youngest child of Mr. and Mrs. X. He is 1 1/2 yrs. old or 18 mos. old and weighs 12 kg and length of 62 cm. He was diagnosed w

makes him to have difficulty of breathing.


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According to his mother, baby X father and grandfather have asthma. Also his grandfather has hypertension while his grandmother on his moth

a history of Diabetes Mellitus. Mr. and Mrs. X have enough earnings to sustain their financial need and other expenses.

PAST ILLNESSES:

(+) cough and colds for 9days and have low grade fever.

GENOGRAM

FATHERS SIDE MOTHERS SIDE

Boy

(Father)

ASTHMA

Boy(11mos.) BAI

Lolo 1

HPN

ASTHM

A

Lola 2Lola 2 Lolo 2

DM

Girl

(Aunt)

Girl

(Mother)

Boy

(Uncle)

Girl

(Aunt)

Girl (7y.o)


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- Boy - Patient -Girl

Boy

(13)


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PHYSICAL ASSESSMENT:

I. GENERAL INFORMATION:

NAME: PATIENT X

AGE: 18 months

SEX: male

II. VITAL SIGNS:

TEMP: 37. 9 C CR: 106 RR: 33

III. GENERAL APPEARANCE:

GENERAL SURVEY


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SKULL

BODY PART EXAMINED NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

Inspect the skull for size, shape, and

symmetry

Rounded, smooth skull contour The skull is normocephalic and it is smooth

in contour

NORMAL. The skull i


Body built, height and weight in relation

to the clients age, lifestyle and health

Proportionate height and weight, has a

healthy lifestyle.

Upon inspection and observation the

patient is fat enough for her height.

NORMAL. The pts we

to her height.

Overall hygiene and grooming Clean and Neat As we do the inspection, we noticed that

the patients hygiene is normal because

she take a bath everyday

NORMAL. The pts hy

Attitude Non-cooperative The patient is non-cooperative every time

we ask her some questions.

ABNORMAL The pati

cooperative.


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Palpate the skull for nodules, masses,

or depressions

Smooth, uniform consistency The skull has no nodules, masses, or

depressions

NORMAL. It has no n

depressions

Note symmetry of facial movements. Symmetry in facial movement As the patient moves her face it has

symmetrical movement

NORMAL. The pts fa

symmetrical.

SCALP


Color and appearance Lighter that the skin color The pts scalp is lighter that the skin color NORMAL. The pts sca

skin color

Areas of tenderness No signs of tenderness There is no tenderness on the pts scalp NORMAL. The pts sca

HAIR


Hair distribution and thickness Evenly distributed. Thick hair The hair of the patient is evenly

distributed and thick enough.

NORMAL. The patients

distributed and thick.


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Texture and oil iness over the scalp. Silky, smooth Upon inspection the pts hair is si lky and

smooth

NORMAL. The pts hair

making it normal.

CONJUNCTIVA


Palpebral conjunctiva for color, texture,

and presence of lesion

Pink in color, smooth and no presence of

lesion

Pts conjunctiva is color pink, smooth in

texture and no presence of lesions

NORMAL. The pts conju

pink in color, smooth and

lesion.

EARS



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Cerumen Dry cerumen, has presence of hair

follicles, no pus or blood

The pts ear has dry cerumen, and no

presence of pus or blood.

NORMAL. Has dry cerum

blood or pus

MOUTH, LIPS, GUMS


Symmetry of contour, color and texture Uniform pink color, soft, moist, smooth

texture, symmetry of contour, ability to

purse lips

The patient has pink, moist, smooth lips.

The patient has also the ability to purse her

lips.

NORMAL. The patien

Color and condition, pink, moist, firm, no

retraction and bleeding of gums

Pink, moist, no bleeding The pts teeth have no signs of bleeding. NORMAL. Has no ble

CHEST:



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Adventitious breath sounds, chest

expansion

Symmetrical expansion, no presence of

chest in drawing during breathing

The patient has wheezing breath sounds. ABNORMAL. Has a sign

ABDOMEN


Abdomen integrity and condition Unblemished skin, uniform in color The pts skin is light brown in color

because abdomen is not exposing to sun.

NORMAL. Pts skin i

LOWER EXTREMITIES:



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Condition of legs Uniformity in color and size. The pts lower extremities are aligned and

have uniform color.

NORMAL. The pts

uniform.

DEVELOPMENTAL DATA

Erik Erikson believe that people continue to develop throughout life so he described 8 stages of development.

Eriksons theory proposes that life is a sequence of developmental stages of levels of achievement each stage signals a task that must be acc

The resolution of the task can be complete, partial or unsuccessful. Erikson believed that the more success an individual has at each developmenta

healthier the person is. Failure to complete any developmental stage influences the persons ability to progress to the next level. These developmenta

be viewed as a series of crises. Successful resolution of these crises supports healthy ego development. Failures to resolve the crises damage the ego

I. PHYSICAL DEVELOPMENT

Baby X weighs 12 kg with a length of 62 cm. The rate of increase in height and weight is largely influenced by babys size at birth and by nutrition

is in normal function by moving eyes and follows large objects and blinks in response to bright lights. He has an intact hearing because he reacts with

loud noise called Moro reflex. He also understands many words like no, ma. His smell and taste are functional because he was able to recognize

their mothers milk and he respond to the smell by turning his head toward to his mother. His sense of touch is well developed because of his response


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reflexes are involuntary responses of nervous system to external and internal stimuli like rooting and sucking reflex. His motor development is also norm

he can reach and grasp object and transfer from hand to hand.

II. PSYCHOSOCIAL DEVELOPMENT

Baby X is still depends to his parents because he is 1 mos. Old that needs attention and care to fulfill his nutrition.

III. COGNITIVE DEVELOPMENT

Baby X has a concept of both space and time like his experiment to reach a goal such as a toy in a chair.

IV. MORAL DEVELOPMENT

Baby X is an infant. He doesnt know how to feed and care himself thats why he needs his parents support and care.

VI. SPIRITUAL DEVELOPMENT As an infant, he has not fully developed his sense of spirituality


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PATTERNS OF FUNCTIONING

Eating Pattern

Before Illness During Illness During Hospitalization Analysis


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Patient can consume:

Breakfast:

Breast Milk

Lunch:

300mL formula milk through bottlefeeding.

Dinner:

Breast Milk

300mL formula milk through bottle

feeding.

Patient can consume:

Breakfast:

2 cup of cereals

50mL of formula milk

through bottle feeding.

Lunch:

300mL formula milk


Dinner:

Breast Milk

300mL formula milk


Breakfast:

250mL formula milk


Lunch:

200mL formula milk


Dinner:

200mL formula milk


The patients food intake before

illness doesnt change bu

hospitalization, the diet for the pa

MF-SAP diet.


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Drinking Pattern


Total Intake:

600-800mL of milk per day

and 100-150mL of water per

day.

Intake:

700-950mL/day

Total Intake:

2-3 half of bottle of milk

and 1-2 half bottle of water

per day.

1-1 bottle of milk per day. The intake of fluid before and during illness is still

while during hospitalization the fluid intake decrease

Bowel Movement Pattern


Frequency: 3 times a day. Frequency: 2-3 times a day. Frequency: 1-2 times a day. The patients bowel movement is still

in before and during illness while

hospital, the bowel movement decreas


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Bath Pattern


Takes a bath once a day in the morning. Tepid Sponge Bath Tepid Sponge Bath The patients bathing

changed to TSB due

illness.

Sleeping Pattern


Usually sleeps 8 hours and 3-4 hours nap. Usually sleeps 8 hours and

3-4 hours nap.

Sleep 5 hours and 1-2

hours nap.

The patients sleeping

during hospitalization de

because of the Nurs

interrupt the sleep in

meds and taking the vita


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LEVEL OF COMPETENCIES

Physical

Emotional

Social

Moral

Before Illness During Hospitalization Analysis

- Baby weighs 7.8 kg or 17.16 lbs. witha length of 30 cm. The weight is

largely influenced by babys size at

birth and by his nutrition. His head

circumference is 37 cm. and chest

circumference is 35 cm. within the

normal range.

- He needs his parents to fulfill hisneeds because he cant manage his

own life as an infant.

- He expresses himself through cryingto know if hes hungry or any

irritations about his body and this is

the way to interact with his parents.

- As an infant, he doesnt know whatsgoing on in his world, thats why he

needs his parents to support and

- His physical appearance is stillthe same.

- Cannot be determined

- The same in Before Illness, heexpresses himself through

crying.

- Cannot determine because ofhis age.

- Within all normal

- He feels irritataking his vital s

why he will cry.

- Crying is the oused to intera

parents and other

- Cannot determinof his age.


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Spiritual

guide him.

- As an infant, he doesnt know about

his spiritual level.

- Cannot determine because ofhis age.

- Cannot determinof his age.


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Nursing History (Gordons Assessment)

Name: Baby X

Address: Marulas, Valenzuela City

Age: 18 mos.

Occupation: None

Religion: Roman Catholic

Race: Filipino

Medical Diagnosis: Bronchial Asthma

Informant: Mr. and Mrs. X

I. Patient perception and expectation related to illness/ hospitalization

1. Why did you come to the hospital?

Nahihirapan huminga anak ko

2. What do you think caused your baby to get sick?

Dahil sa sobrang ubo at sinisipon na din

3. Has being sick made any difference in your babys usual way of life?

Tingin ko, hindi naman

4. What do you expect is going to happen to your baby in the hospital?


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Ineexpect ko na magiging maginhawa ang kalagayan ng baby ko

5. What is like for being in the hospital?

Dahil ayoko ng lumala pa ang sakit ng baby ko.

6. How long do you expect to be in hospital?

Mga 3-4 days siguro

7. Who is the most important person for your baby?

Ako naman palagi kasama at nag aalaga ng baby ko, madalas niya ako hinahanap

8. What effect has your coming to the hospital had on your family?

Nag-alala syempre

9. Are any of your family visit your baby in the hospital?

Oo. Tulad ng kanyang mga lola at lolo tsaka mga tito at tita

10. How do you expect to get along after you leave the hospital?

Siguro babalik na ulit ung lakas ng baby ko


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ANATOMY AND PHYSIOLOGY OF THE LUNGS


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Anatomy and Physiology

About the Lungs and Respiratory System

Breathing is so vital to life that it happens automatically. Each day, you breathe about 20,000 times, and by the time you're 70 years old, you'll have take

million breaths.

All of this breathing couldn't happen without the respiratory system, which includes the nose, throat, voice box, windpipe, and lungs.

At the top of the respiratory system, the nostrils (also called nares) act as the air intake, bringing air into the nose, where it's warmed and humidified. Tiny h

protect the nasal passageways and other parts of the respiratory tract, filtering out dust and other particles that enter the nose through the breathed air.

Air can also be taken in through the mouth. These two openings of the airway (the nasal cavity and the mouth) meet at the pharynx, or throat, at the back o

mouth. The pharynx is part of the digestive system as well as the respiratory system because it carries both food and air. At the bottom of the pharynx

divides in two, one for food (the esophagus, which leads to the stomach) and the other for air. The epiglottis, a small flap of tissue, covers the air-only pas

swallow, keeping food and liquid from going into the lungs.

The larynx, or voice box, is the uppermost part of the air-only pipe. This short tube contains a pair of vocal cords, which vibrate to make sounds.

The trachea, or windpipe, extends downward from the base of the larynx. It lies partly in the neck and partly in the chest cavity. The walls of the trachea ar

by stiff rings of cartilage to keep it open. The trachea is also lined with cilia, which sweep fluids and foreign particles out of the airway so that they stay out o

Trachea and Bronchi


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At its bottom end, the trachea divides into left and right air tubes called bronchi, which connect to the lungs. Within the lungs, the bronchi branch into smal

even smaller tubes called bronchioles. Bronchioles end in tiny air sacs called alveoli, where the exchange of oxygen and carbon dioxide actually takes pla

houses about 300-400 million alveoli.

The lungs also contain elastic tissues that allow them to inflate and deflate without losing shape and are encased by a thin lining called the pleura. This net

bronchioles, and bronchi is known as the bronchial tree.

The chest cavity, or thorax, is the airtight box that houses the bronchial tree, lungs, heart, and other structures. The top and sides of the thorax are formed

attached muscles, and the bottom is formed by a large muscle called the diaphragm. The chest walls form a protective cage around the lungs and other c

chest cavity.

Separating the chest from the abdomen, the diaphragm plays a lead role in breathing. It moves downward when we breathe in, enlarging the chest cavity an

through the nose or mouth. When we breathe out, the diaphragm moves upward, forcing the chest cavity to get smaller and pushing the gases in the lungs

the nose and mouth.

In humans, the trachea divides into the two main bronchi that enter the roots of the lungs. The bronchi continue to divide within the lung, an

divisions, give rise to bronchioles. The bronchial tree continues branching until it reaches the level of terminal bronchioles, which lead to alveolar sacs. Alv

made up of clusters ofalveoli, like individual grapes within a bunch. The individual alveoli are tightly wrapped in blood vessels and it is here that gas exch

occurs. Deoxygenated blood from theheart is pumped through the pulmonary artery to the lungs, where oxygen diffuses into blood and is exchanged for carb

the hemoglobin of the erythrocytes. The oxygen-rich blood returns to the heart via the pulmonary veins to be pumped back into systemic circulation.

Human lungs are located in two cavities on either side of the heart. Though similar in appearance, the two are not identical. Both are separated

fissures, with three lobes on the right and two on the left. The lobes are further divided into segments and then into lobules, hexagonal divisions of the lung

smallest subdivision visible to the naked eye. The connective tissue that divides lobules is often blackened in smokers. The medial border of the right

vertical, while the left lung contains a cardiac notch. The cardiac notch is a concave impression molded to accommodate the shape of the heart. Lungs a
http://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Diffusionhttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Red_blood_cellhttp://en.wikipedia.org/wiki/Cardiac_notch_of_left_lunghttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Pulmonary_arteryhttp://en.wikipedia.org/wiki/Diffusionhttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Red_blood_cellhttp://en.wikipedia.org/wiki/Cardiac_notch_of_left_lunghttp://en.wikipedia.org/wiki/Pulmonary_alveolus


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extent 'overbuilt' and have a tremendous reserve volume as compared to the oxygen exchange requirements when at rest. Such excess capacity is one o

that individuals can smoke for years without having a noticeable decrease in lung function while still or moving slowly; in situations like these only a smal

lungs are actually perfused with blood for gas exchange. As oxygen requirements increase due toexercise, a greater volume of the lungs is perfused, allow

to match its CO2/O2 exchange requirements. Additionally, due to the excess capacity, it is possible for humans to live with only one lung, with the other com

its loss.

The environment of the lung is very moist, which makes it hospitable forbacteria. Many respiratory illnesses are the result of bacterial orviralinfection

Inflammation of the lungs is known aspneumonia; inflammation of thepleura surrounding the lungs is known as pleurisy.

Vital capacity is the maximum volume of air that a person can exhale after maximum inhalation; it can be measured with aspirometer. In combinatio

physiological measurements, the vital capacity can help make a diagnosis of underlying lung disease.

The lung parenchyma is strictly used to refer solely to alveolartissue with respiratory bronchioles, alveolar ducts and terminal bronchioles.[4]However, it o

any form of lung t issue, also includingbronchioles, bronchi, blood vessels and lung interstitium.

What the Lungs and Respiratory System Do

The air we breathe is made up of several gases. Oxygen is the most important for keeping us alive because body cells need it for energy and growth. Witho

body's cells would die.

Carbon dioxide is the waste gas produced when carbon is combined with oxygen as part of the energy-making processes of the body. The lungs and resp

allow oxygen in the air to be taken into the body, while also enabling the body to get rid of carbon dioxide in the air breathed out.
http://en.wikipedia.org/wiki/Exercisehttp://en.wikipedia.org/wiki/Carbon_Dioxidehttp://en.wikipedia.org/wiki/Carbon_Dioxidehttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Pneumoniahttp://en.wikipedia.org/wiki/Pleurahttp://en.wikipedia.org/wiki/Pleurahttp://en.wikipedia.org/wiki/Pleurisyhttp://en.wikipedia.org/wiki/Pleurisyhttp://en.wikipedia.org/wiki/Vital_capacityhttp://en.wikipedia.org/wiki/Spirometerhttp://en.wikipedia.org/wiki/Parenchymahttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Respiratory_bronchiolehttp://en.wikipedia.org/wiki/Alveolar_ducthttp://en.wikipedia.org/wiki/Terminal_bronchiolehttp://en.wikipedia.org/wiki/Lung#cite_note-medilexicon-3http://en.wikipedia.org/wiki/Lung#cite_note-medilexicon-3http://en.wikipedia.org/wiki/Bronchioleshttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/w/index.php?title=Lung_interstitium&action=edit&redlink=1http://en.wikipedia.org/wiki/Exercisehttp://en.wikipedia.org/wiki/Carbon_Dioxidehttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Pneumoniahttp://en.wikipedia.org/wiki/Pleurahttp://en.wikipedia.org/wiki/Pleurisyhttp://en.wikipedia.org/wiki/Vital_capacityhttp://en.wikipedia.org/wiki/Spirometerhttp://en.wikipedia.org/wiki/Parenchymahttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Respiratory_bronchiolehttp://en.wikipedia.org/wiki/Alveolar_ducthttp://en.wikipedia.org/wiki/Terminal_bronchiolehttp://en.wikipedia.org/wiki/Lung#cite_note-medilexicon-3http://en.wikipedia.org/wiki/Bronchioleshttp://en.wikipedia.org/wiki/Bronchihttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/w/index.php?title=Lung_interstitium&action=edit&redlink=1


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PATHOPHYSIOLOGY of BRONCHIAL ASTHMA

Etiologic Factor

Intense Exposure to irritating stimuli (dust, pollutants)

Environmental factors (Changes in temperature) Exercise, stressful event Family history of asthma

Predisposing Factor

Age (11mo)

Gender (male)

Family history of asthma

IgE production

Airway hyper-responsiveness

(ASTHMA ATTACK)

Bronchospasm

Shortness of breath

Wheezing

Chest tightness

Re-exposure to antigen

Further release of leukocytes

Mass cell degranulation

Inflammation of bronchial

walls

ortness of breath

Release of chemical

Altered air exchange

Inc. airway

resistanceMuscle & fatigue

exhaustion

No. of mucus by goblet cells

in mucosa and hypertrophy of

submandibular glands

Productive cough


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MEDICAL MANAGEMENT

The aims are 1) Symptom free period, 2) Maintain maximum PEFR, 3) Minimum medication a. Number, b. Doses, 4) Continuing preventive medicat

term to reduce BHR, 5) Minimize oral steroids, 6) Cost effectiveness : As compared to developed countries where inhaled B2 + inhaled steroids form th

in therapy, we still depend a lot on oral medication because they are easily acceptable and relatively less costly.

Drug history - regarding intolerance to oral B2 (tremors, cramps, weakness) to xanthines (gastritis, reflux oesophagitis) should be asked for before plan

Selection of inhaler device both relieving (B2 agonist) and preventive (DSCG, BDP, BUD) are best taken by inhaled route. This permits small quantitie

be delivered directly to the site of action resulting in early action and minimising side effects to a great extent. Whilst the metered dose inhaler

commonly available device, many patients cant coordinate activation with inspiration. For these and other problems of manual dexterity a dry powder

spacer or a chamber device is more appropriate. Correct selection of the device and instruction on its use are almost as important as selection of

treatment. However, it is observed that least attention is paid to this subject. What is needed is careful preliminary selection of the best device for tha

patient followed by careful instructions, follow up and rechecking ofTreatment should be considered in a stepwise manner as described below, at th

appropriate for the initial severity of the patients condition and medication being continued in past, on day to day basis.

A short course of oral steroids may be needed at any time to control asthma.

Step 1 - Patients who have infrequent symptoms, without sleep disturbance, need B2 agonist preferably by MDI salbutamol 100-200 mg or terbutal

mcg 3-4 times a day as required. The alternative is dry powder inhalation by rotahaler. In those who find this difficult, oral form of salbutamol 2-4 mg

100-200 mg can be started.

Step 2 - Patients who need to take bronchodilators (B2 + Theophyllin) almost daily, with nocturnal symptoms and persistently low PEFR or abn

functions require regular inhaled anti inflammatory drugs. 1. Sodium cromoglycate (5-20 mg) 4 times a day (disadvantage - mild, costly, poor complian

frequently is very high), 2. Inhaled steroids beclomethasone diproprionate (BDP) or Budesonide (BUD) 100-400 mcg twice daily.

Step 2 - (Alternative) Considering the cost and difficulty in acceptance of inhaled medication, non availability of trained persons to instruct and follow

technique, a trial of theophyllin is worth a while when it has been shown to have anti inflammatory effects. Theophyllin (Anhydrous and preferably lo

the dose of 10 mg/kg/day, if tolerated, increase the dose, in increments of approximately 25% at 3 day interval to 16-18 mg/kg/day. Make sure that pa

gastritis or reflux oesophagitis.


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Step 3 - Persistent symptoms esp. at night with low peak expiratory flow rates. Add theophyllin with anti inflammatory drugs if it has not been started. A

B2 agonist (salmeterol) should be added. Oral long acting salbutamol (4-8 mg) or terbutaline (5-7.5 mg) can be used as an alternative.

Step 4 - Maintenance treatment with oral corticosteroids. This is given if adequate control is not achieved in step 3. Preparation with short h

prednisolone is preferred, esp. in alternate day regimen to minimise suppression of adrenal pituitary hypothalamic axis.

Step 5 - High dose of inhaled bronchodilators with nebuliser with special solution of salbutamol (5 mg) terbutaline (10 mg) 3-4 times/day. The use

without proper evaluation is not advisable. Before considering giving nebuliser bronchodilator, increased bronchodilator, increased bronchodilaunacceptable side effect should be demonstrated.

Step 6 - High dose of inhaled bronchodilators with nebuliser, steroids BDP or BUD should be increased to a maximum daily dose of 2 mg. A large vo

device is recommended to reduce oropharyngeal candidiasis and systemic absorption. Internationally this is advocated at step 3 but because of

therapy it is not practical in India.

Step 5 and 6 should be considered depending upon patients economic background.

Step 7 - Treatment with short course of oral steroids : 1. Symptoms and PEFR gets progressively worse each day, 2. Sleep is disturbed by asthma

symptoms persist until midday, 4. Emergency nebuliser or injectable bronchodilators are needed. Give prednisolone 2 to 40 mg daily until two da

recovery, when the drug may be stopped or the dose tapered.

Step down - The patients requirement for treatment should be reviewed from time to time. If asthma is well controlled, (asymptomatic, optimum PEFR)

reduction in the medication must be planned. In chronic asthma a 6 month period of stability should be shown before stopping anti inflammatory drugs.

OTHER TREATMENT

Anti histaminics including ketotifen have proved disappointing in clinical practice. There is anecdotal evidence that some patients have benefitted from

acupuncture, ayurvedic and homoeopathic treatment but so far there are no controlled clinical trials to justify the same. Hyponsensitization / desensitiz

not accepted because of uncertainty about the result, cost and availability of better treatment.

5. Give sufficient doses to maintain best lung function


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This is possible with regular monitoring of PEFR at home. If normal PEFR cant be achieved, the best PEFR readings can be maintained.

6. Investigate trigger factor

This requires taking a careful history and performing skin test (pollens, fungi, animal dander, mite, dust, etc.) and in some cases provocationa

occupational ingested agents. Where it is practical, these trigger factors should be removed.

7. Treat aggravating conditions

Asthma is worsened by smoking, rhinitis, gastric reflux, and excessive snoring. Smoking should cease. The other conditions should be investigated and

8. Write a crisis plan

A patient has to be briefed about the symptoms of exacerbation and medicines to be taken in emergency. They should be taught diaphragmatic

minimise sense of breathlessness.

9. See the patient regularly

Regular visits are needed to monitor progress, reassure the patient, check inhaler technique, and adjust doses of bronchodilators. This will prevent e

and hospitalization.

10. Minimise therapy


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DRUG STUDY

Name of DrugGeneric(Brand)

Class ification DoseFrequencyRoute

Mechanismof Action SpecificIndication Side Effects Nursing Implications

Acetaminophen(Paracetamol)

antipyretics,nonopioidanalgesics

1.2 mLq 4 hr PRN

od

Inhibits the synthesis ofprostaglandins thatmay serve asmediators of painand fever, primarilyin the CNS

Mild painFever

Hema: hemolytic anemia,neutropenia,leukopenia,pancytopenia.

Hepa: jaundiceMetabolic: hypoGGI: HEPATIC FAILURE,

HEPATOTOXICITY(overdose)

GU: renal failure (highdoses/chronic use).Derm: rash,

urticaria.

BEFORE:~ Advise parents or caregivers to check con

of liquid preparations. Errors have resserious liver damage.

~ Assess fever; note presence of associate(diaphoresis, tachycardia, and malais

DURING:~ Adults should not take acetaminophen lon

10 days and children not longer than unless directed by health care profes

~ Advise mother or caregiver to take medicexactly as directed and not to take m

recommended amount.AFTER:~ Advise patient to consult health care profe

discomfort or fever is not relieved by doses of this drug or if fever is greate39.5C (103F) or lasts longer than 3


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Name of DrugGeneric(Brand)

Class ification DoseFrequency

Route

Mechanismof Action

SpecificIndication

Side Effects Nursing Implications

Salbutamol Brochodilator SalbutamolNebulizer

q8 12nn

Synthetic sympathomimeticamine and moderatelySelective beta2-Adrenergic agonist withcomparatively longaction. Acts moreprominently on beta2receptors (particularlysmooth muscles ofbronchi, uterus, andvascular supply to skeletalmuscles) than on beta1 (heart)receptors. Minimal orno effect on alphaadrenergicreceptors

To relieveBronchospa sm associatedwith acute or chronic asthma,bronchitis, or otherreversible obstructiveairway diseases.Also used to preventExercise inducedbronchospasm

CNS: tremorsNervousnessHeadacheInsomnia

CV: TachycardiaPalpitationsHypertension

GI: NauseaVomitingHeartburnAnorexiaMetabolic:Hypokamlemia

Position patient on high backrest Do back tappig after you nebulize Do not give food immediately. It cvomiting


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NURSING CARE PLAN

ASSESSMENT DIAGNOSIS BACKGROUND

KNOWLEDGE

PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE:

Nahihirapan

huminga ang baby

ko as verbalized by

the mother

OBJECTIVE:

Abnormal

breath sounds

V/S taken &

recorded as follows:

Temp: 37. 9C

CR: 106 bpm

RR: 33 cpm

Ineffective

airway clearance

r/t bronchospasm

Bronchial Asthma

bronchospasm

increased mucus

production

wheezing sounds

blocking of the

bronchioles

Ineffective airway

clearance

Within 30mins

of nursing

intervention the

patient will be able

to demonstrate

behaviors to

improve airway

clearance

INDEPENDENT:

Monitored V/S

Monitor breath sounds

Suction naso/oral prn

Monitor patient for

feeding intolerance,

abdominal distention

and emotional stressor

Assist with the use of

respiratory devices or

treatments

Keep environment

allergen free

DEPENDENT:

To obtain

baseline data

Indicative of

respiratory distress

and/or

accumulation of

secretions

To clear airway

when excessive or

viscous secretion

are blocking airway

That may

compromise

airways

To clear the

airway

To maintain

adequate, patent

airway

After 30mins of

nursing intervention

the patient was able to

demonstrate

behaviors to improve

airway clearance


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Administer

medications as

prescribed

To mobilize

secretions

NURSING CARE PLAN


KNOWLEDGE



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SUBJECTIVE:

Hindi masyado

nagkikilos anganak

ko as verbalized by

the mother

OBJECTIVE:

The patient

manifested low

level of activity.

V/S taken and


Temp: 37. 9C

CR: 106 bpm

RR: 33 cpm

Risk for

Activity

Intolerance r/t

presence of

circulatory

responsive

problems

Upper respiratory tract

infection

bronchospasm

collection of mucus

secretion

Productive cough

Blocking of the bronchioles

DOB

Risk for Activity

Intolerance

After 8 hrs of


the patient will be

able to participate

in program to

enhance clarity to

perform

INDEPENDENT:

Monitored V/S

Implement

physical therapy

Note presence

of medical

diagnosis or

therapeutic

regimens.

Identify and

discuss to mother

the symptoms o the

illness.

Refer to appropriate

resources for

assistance or

equipments as

needed.

To obtain

baseline data

To develop

alternative ways to

remain active.

To determine

the abilityto

perform at a desired

level of activity

To promote

wellness.

To sustain

activity level

After 8 hrs of

nursing

intervention the

patient was able to

participate in

program to enhance

clarity to perform

NURSING CARE PLAN


KNOWLEDGE



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SUBJECTIVE:

Nahihirapan dumede

ang baby ko as

verbalized by the

mother

OBJECTIVE:

weakness

V/S taken and


Temp: 37. 9C

CR: 106 bpm

RR: 33 cpm

:

Imbalanced

Nutrition: les thanbody requirements

r/t inability toingest/digest food

Pneumonia

Bacteria in the lungs

Weakened immune system

nausea may

experience

inability to ingest/digest

food

Imbalanced nutrition

Within 3 hrs of


the patient will be

able to swallow

food

INDEPENDENT:

Determine patients

ability to chew,

swallow food

Note age, body build,

strength, rest level

Evaluate total daily

food intake

Promote pleasant &

relaxing environment

Monitor nutritional

All factors that can

affect ingestion

and/or digestion of

food

Helps determine

nutritional needs

Changes that could be

made in patients

intake

To enhance food

intake

To enhance food

satisfaction

After 3 hrs of

nursing

intervention the

patient was able to

swallow food

NURSING CARE PLAN


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KNOWLEDGE


SUBJECTIVE:

May ubo ang baby

ko as verbalized by

the mother

OBJECTIVE:

Productive cough

to non-productive

cough

V/S taken and


Temp: 37. 9C

CR: 106 bpm

RR: 33 cpm

Ineffective

airway clearance

r/t cough

Upper respiratory tract

infection

Cough

Non productive cough

Productive cough

Accumulated secretion

Blocking of the bronchioles

Ineffective airway

clearance

Within 30 mins

of nursing

intervention the

patient will be able

to maintain airway

patency

INDEPENDENT:

Monitored V/S

Monitor patient

on small feeding

Position the patient

at Moderate high

back rest

Increase fluid intake

Assist with the use

of respiratory

devices or treatments

DEPENDENT:

Administer

medications asprescribed

To obtain baseline

data

To maintain

adequate airway To maintain open

airway in at-rest

To liquefy viscous

secretion & improve

secretion clearance

To

acquire/maintain

adequate airways

To improve lung

function

After 30 mins

of nursing

intervention the

patient was able to

maintain airway

patency

DISCHARGE PLAN


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Documents

CALUMPIT FINAL2003