case analysis bronchial asthma

8/3/2019 Case Analysis Bronchial Asthma

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Name: Mr. XXER

Age: 18 years old

Gender: Male

Status: Single

Religion: Roman Catholic

Adress: Brgy.Ibabang Dupay Lucena City

Occupation: None

Significant others: Mr.YYER

Admission Date: January 11, 2012

Admission Time: 10:46 AM

Chief Complaint: Difficulty of breathing


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The patient XXER is brought to the emergency area of Quezon Medical Center, with a chief

complaint of DOB. His Respiratory rate is 43 breaths per minute. As an initial action the chart is

accomplish and vital sign is taken. Oxygen cannula is prescribed to the patient SO. The staff and we thestudent nurse waits for the cannula. Then the oxygen is administered and the patient started to calm,

but with noted respiratory depression and use of accessory muscle also. According to the patient SO the

DOB of patient started at 9:00 am while he is taking a stick of cigarette. From that the DOB of patient

continue until he is brought by his brother at the hospital. The patient DOB can be considered severe as

assessing his RR, its pattern is rapid inspiration and expiration.

The patient has not been hospitalized before according to his brother, the patient SO also told

that the patient DOB is his only problem in terms of health. His brother also mentioned that the only

illness that his brother acquired for the past weeks or months is only simple cough, colds and mild fever

which he treated with over the counter drugs only.

Patient Mother

Patient Father

Patient Brother

Patient


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The patient lives in lucena city, their house is compose of concrete and wood as his brother

describe, although the conversation is short because of dilemma of his brother because of his death. We

can still concur that the patient surrounding may further trigger the patient illness because of the dust

coming from construction mill near on their house as his brother describe. His brother able to describe

his lifestyle to the physician upon hearing it we can also analyze that the patient habit of escaping meal

and taking a pack of cigarette instead may further trigger the situation of the illness itself.


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General:

Mildly Conscious Irritated Restless Respiratory distress The patient is fatigued, weak, shortness of breath noted

Vital signs:

Temperature: 36.8 C axillary Pulse: 71 beat per minute Blood pressure: 150/90 mmHg Respiratory rate: 42 breathe per minute Height: Wight: estimated 50 kg

Skin:

Dry Cold and clammy Pale and bluishin color No rashesorlesion noted

Head: Without masses noted With palpable bruiseon occiput area

Eyes: With pale conjunctivae With whitishsclera With goodvision acuity

Ears:

With goodhearing With minimaldry discharge Upper pinna in line witheye cantus With firm cartilage With good pinna recoil

N

With nasal congestion With whitish discharge


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Chest/breast:

Withlabored breathing Dyspnea noted With abnormal rise and fallof chest With wheeze sound heard upon

auscultation With noted use of accessory muscle on

breathing

Abdomen: With normal bowelsound Without rashesseen on abdomen

Genital:

With normalelimination pattern With normaldefecation pattern


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The upper respiratory tract consists of the nose, sinuses, pharynx, larynx, trachea, and epiglottis.

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, a process known as gas exchange.

The normal gas exchange depends on three processes:

y Ventilation is movement of gases from the atmosphere into and out of the lungs. This isaccomplished through the mechanical acts ofinspiration and expiration.

y Diffusion is a movement of inhaled gases in the alveoli and across the alveolar capillarymembrane

y Perfusion is movement of oxygenated blood from the lungs to the tissues .

Control of gas exchange involves neural and chemical process

The neural system, composed of three parts located in the pons, medulla and spinal cord, coordinatesrespiratory rhythm and regulates the depth of respirations


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The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in childrenand adults. However, children respond differently than adults to respiratory disturbances; major areas

of difference include:

y Poor tolerance of nasal congestion, especially in infants who are obligatory nose breathers upto 4 months of age

y Increased susceptibility to ear infection due to shorter, broader, and more horizontallypositioned Eustachian tubes.

y Increased severity or respiratory symptoms due to smaller airway diametersy A total body response to respiratory infection, with such symptoms as fever, vomiting and

diarrhea.


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BBBRRROOONNNCCCHHHIIIAAALLL AAASSSTTTHHHMMMAAA

DDeeffiinniittiioonn

A condition of the lungs characterized by widespread narrowing of the airways due to spasm of

the smooth muscle, edema of the mucosa, and the presence of mucus in the lumen of the bronchi and

bronchioles. Bronchial asthma is a chronic relapsing inflammatory disorder with increased

responsiveness of trachea broncheal tree to various stimuli, resulting in paroxysmal contraction ofbronchial airways which changes in severity over short periods of time, either spontaneously or under

treatment.

CClliinniiccaall MMaanniiffeessttaattiioonn

The three most common symptoms of asthma are cough, dyspnea, and wheezing. In some

instances cough may be the only symptoms. An asthma attack often occurs at night or early in the

morning, possibly because circadian variations that influence airway receptors thresholds.

An asthma exacerbation may begin abruptly but most frequently is preceded by increasing

symptoms over the previous few days. There is cough, with or without mucus production. At times the

mucus is so tightly wedged in the narrow airway that the patient cannot cough it up.

PPrreevveennttiioonn

Patient with recurrent asthma should undergo test to identify the substance that participate thesymptoms. Patients are instructed to avoid the causative agents whenever possible. Knowledge is the

key to quality asthma care.

MMeeddiiccaall MMaannaaggeemmeenntt

There are two general process of asthma medication: quick relief medication for immediate

treatment of asthma symptoms and exacerbations and long acting medication to achieve and

maintain control and persistent asthma. Because of underlying pathology of asthma is inflammation,control of persistent asthma is accomplish primarily with the regular use of anti inflammatory

medications.


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variability. Cromolyn sodium and nedocromil are mild to be moderate anti-inflammatory agents

that are use more commonly in children. They also are effective on a prophylactic basis to prevent

exercise-induced asthma or unavoidable exposure to known triggers. These medications arecontraindicated in acute asthma exacerbation.

`Long acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma

symptoms, particularly those that occur during the night these agents are also effective in the

prevention of exercise-induced asthma.

y Quick reliefmedicationShort acting beta adrenergic agonists are the medications of choice for relief of acute symptoms and

prevention of exercise-induced asthma. They have the rapid onset of action. Anti-cholinergic may have

an added benefit in severe exacerbations of asthma but they are use more frequently in COPD.

NNuurrssiinngg MMaannaaggeemmeenntt

The main focus of nursing management is to actively assess the air way and the patient response to

treatment. The immediate nursing care of patient with asthma depends on the severity of thesymptoms. A calm approach is an important aspect of care especially for anxious client and ones

family.

y This requires a partnership between the patient and the health care providers to determine thedesire outcome and to formulate a plan which include;

y the purpose and action of each medicationy trigger to avoid and how to do soy when to seek assistancey the nature of asthma as chronic inflammatory disease


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Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation

Subjective:

Nahihirapan akong

huminga as

verbalized by the

patient

Objective:

y wheezing uponinspiration and

expiration

y dyspneay tachycardiay chest tightnessy suprasternal

retraction

y restlessnessy irritated

P: Ineffective

breathing pattern

E: r/t presence of

secretions of

productive cough

and dyspnea

secondary to acute

attack of bronchial

asthma in acute

exacerbation

S: as manifested by

dyspneic movement

and RR of 42bpm

After 4-5 hours of

nursing

intervention

Patient will

manifest signs of

decreased

respiratory effort

Assess pt.sgeneral condition Auscultate breath

sounds and

assess airway

pattern

Elevate head ofthe bed and

change position

of the pt. every 2

hours.

Encourage deepbreathing and

coughing

exercises.

Demonstratediaphragmatic

and pursed-lip

breathing to the

patient.

Encourageincrease in fluid

intake Encourage

opportunities for

rest and limit

physical activities.

Reinforce lowsalt, low fat diet

as ordered.

Toobtainbaselinedata to check forthe

presenceof

adventitiousbreathsounds

To minimizedifficulty in

breathing

To maximizeeffort for

expectoration.

Todecrease airtrapping and for

efficientbreathing.

To preventfatigue.

To preventsituationsthat

will aggravatethe condition

To mobilizesecretions.

Goal not metpatient

remained in

respiratory

distress,

respiratory

effort increase

every hour

until the limit

reach and the

patient expired


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Subjective:

Nahihirapan akong

huminga as

verbalized by the

patient

Objective:

y wheezing uponinspiration and

expiration

y dyspneay tachycardiay chest tightnessy suprasternal

retraction

y productivecough

y restlessnessy irritated

P: Ineffective

airway clearance

E: Related To

broncho

constriction,

increased mucus

production on the

bronchiole area and

tracheal area

S: as manifested by

wheezing uponauscultation,

dyspnea, and

cough

After 5-6 hours of

nursing

intervention the

Patient will

maintain/improve

airway clearance

and there will be a

absence of signs of

respiratory distress

Adequatelyhydratethe pt.

Teach andencouragetheuseofdiaphragmatic

breathing andcoughing

exercises. I

nstruct ptto avoidbronchialirritantssuch as cigarette

smoke, aerosols,extremesof

temperature, andfumes.

Teachearly signsofinfectionimmediately.

y Increasessputumproduction

y Changein colorofsputum

y Increasedthicknessof

sputum

y Increased SOB,tightnessof chest,

or fatigue

y Increasedcoughing

y Feveror chills

Systemichydration keeps

secretion moist

and easier to

expectorate.

Thesetechniques help

to improve

ventilation andmobilize

secretions

without causing

breathlessness

and fatigue.

Bronchialirritants causebroncho

constriction and

increased

mucus

production,

which then

interfere with

airway

clearance.

Minorrespiratory

infections that

are of no

consequence to

Goal not metpatient

remained in

respiratory

distress,

respiratory

effort increase

every hour

until the limit

reach and the

patient expired


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Asorderedperform postural

drainage withpercussion and

vibration in themorning and at

night asprescribed.

the person with

normal lungs

can producefatal

disturbances in

the lungs of an

asthmatic

person. Early

recognition is

crucial.


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Subjective:

Hirap na hirap na

talaga ako huminga

as verbalized by the

patient

Objective:

y Weaknessy Agitatedy Restlessy irritated

P: Risk for Activity

Intolerance

E: r/t decrease

oxygen supply on

the tissue and

muscle in the body

S: as manifested by

distress RR of 42

bpm, increasing

gasping for air as

seen on patient

After 8 hours of

nursing

intervention the

patient will

participate willingly

in necessary/

desired activities

such as deep

breathing exercises.

Assess motorfunction.

Notecontributingfactorsto

fatigue. Evaluatedegree

ofdeficit. Ascertain abilitytostand andmove about.

Assessemotionalor

psychologicalfactors

Plan care withrest periodsbetweenactivities

Increaseactivity/exercise

gradually suchas assisting the

patientin doingPROM to active

or full rangeofmotions.

Provideadequate rest

periods.

Toidentifycausativefactors.

Toidentifyprecipitating

factors. Toidentify

severity. Toidentifynecessity ofassistive

devices. Stress and/or

depression mayincreasethe

effectsofillness.

To reducefatigue

Minimizesmuscle atrophy,

promotescirculation,

helpsto preventcontractures

To replenishenergy.

Goal not met patient

activity continue to

lessen due to

weakness, patient

became unconscious,

patient is try to

revive, patient severe

distress lead him to

his expiration


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Assist clientindoing self care

needs Elevate arm and

hand Place knees and

hipsin extendedposition

To promoteindependence

andincreaseactivity

tolerance Promotes

venous Maintains

functionalposition


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Name of drug Classification IndicationMechanism of

actionContraindication

Adverse

Reaction

Nursing

responsibility

Epinephrine Anesthetic localand general

Adult: Per ml prepcontains lidocaine

HCl 20 mg andepinephrine 5

mcg. Dosagedepends on

several factors

such as route,type andextentofsurgical

procedure,duration of

anesthesia andpatient's condition

and age. Maxdose of lidocaine

given withepinephrine: 7mg/kg and not

>500 mg.Child: 3 mth-12

yr: Per ml prep

contains lidocaineHCl 20 mg andepinephrine 5

mcg. Dosagedepends on

several factorssuch as route,

Lidocaine is alocal anesthetic

which decreasespermeability of

sodium ions,blocking

induction and

conduction ofnerve impulses.Combination

withepinephrine

restrictssystemic spread

of lidocaine,vascular

absorption andits duration oflocal anesthetic

effect.

Tachycardia,hypertension,

cerebralarteriosclerosis,

ischemic heartdisease,IV admin,

anaesthetizes

digits orappendages,myasthenia gravis.

Severity ofadverse effects

in CNS andCVS aredirectly

related to bloodlevels of

lidocaine; the

effects are morelikely to occurafter systemic

administrationrather than

infiltration;dizziness;

muscletwitching; local

anesthetic ofmouth/throatimpairs

swallowing andincreases the

riskof aspiration

(patientscautionedagainsteating or

drinking for 3-4hr system of

neonate;erythema;

pigmentation;

Regular-release:May be taken

with or withoutfood. (Avoid

grapefruit juice1 hr beforeor 2

hr after a dose.)

Extended-release: Shouldbe taken with

food. (Avoidgrapefruit juice

1 hr beforeor 2hr after a dose.

Avoid taking w/high fat meals.

Swallow whole,do notcrush/chew.)


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Hydrocortisone Corticosteroidhormone

Parenteraltherapyof acute adrenal

corticalinsufficiency,

acutehypersensitivity

reactionslikestatus

asthmaticusoranaphylactic

drug allergy incombination with

epinephrine, asadjuncttosevere

acutetraumatic shock;

forinitialIVtreatmentof

generalized,recurrentlupus

eyrthematodes.

Producingrelation effect

on smoothmuscle

Hypersensitivityto corticosteroids,

keratitis,herpetica, acute

psychoses andlatent, curedor

manifesttuberculosis,

gastrointestinalulcer,

hypertension,osteoporosis,

myasthenia gravisand renal

insufficiency.

Corticosteroids,like

hydrocortisone,mightimpair

balance betweenwater and

electrolytesleading to fluid

retention andhypertension,

hypokalemiaand congestive

heart failure.Muscular

atrophy andosteoporosis

may occur.Gastrointestinal

ulcers associatedwith

hemorrhagehaveoften been

reported. Thereis a negative

nitrogen balance

dueto proteincatabolism andhealing wounds

isimpaired.Psychic

disturbances andconvulsions

Beforetreatmentinitiation,itis

recommendedtoperform an

ECG,usTSHassay andserum

potassiummeasurement.

Undesirableeffects (see

AdverseReactions) are

usually doserelated;

therefore,careful attention

should be paidtodeterminethe

minimumeffective

maintenancedosein orderto

avoidorminimize

undesirable

effects.Patientsshouldbeinstructedto

avoidexposuretosun ortouse

protectivemeasuresduring

therapy.


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case analysis bronchial asthma

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