BAIAE

CASE STUDY: Bronchial Asthma In Acute Exacerbation

I. INTRODUCTION

A. DEFINITION

Asthma (from the Greek άσθμα, ásthma, "panting") is the common chronic

inflammatory disease of the airways characterized by variable and recurring symptoms,

reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing,

chest tightness, and shortness of breath. Asthma is clinically classified according to the

frequency of symptoms, forced expiratory volume in 1 second (FEV1), and peak expiratory

flow rate. Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic).

It is thought to be caused by a combination of genetic and environmental factors.

Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist (such as

salbutamol). Symptoms can be prevented by avoiding triggers, such as allergens and irritants,

and by inhaling corticosteroids. Leukotriene antagonists are less effective than

corticosteroids and thus less preferred.

Its diagnosis is usually made based on the pattern of symptoms and/or response to

therapy over time. The prevalence of asthma has increased significantly since the 1970s. As

of 2010, 300 million people were affected worldwide. In 2009 asthma caused 250,000 deaths

globally. Despite this, with proper control of asthma with step down therapy, prognosis is

generally good.

ETIOLOGY:

Asthma commonly results from hyperresponsiveness of the trachea and bronchi to

irritants. Allergy influences both the persistence and the severity of asthma, and atopy or the

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genetic predisposition for the development of an IgE-mediated response to common airborne

allergens is the most predisposing factor for the development of asthma.

CLASSIFICATION:

1. Extrinsic Asthma – called Atopic/allergic asthma. An “allergen” or an “antigen” is a

foreign particle which enters the body. Our immune system over-reacts to these often

harmless items, forming “antibodies” which are normally used to attack viruses or

bacteria. Mast cells release these antibodies as well as other chemicals to defend the

body.

Common irritants:

Cockroach particles

Cat hair and saliva

Dog hair and saliva

House dust mites

Mold or yeast spores

Metabisulfite, used as a preservative in many beverages and some foods

Pollen

2. Intrinsic asthma – called non-allergic asthma, is not allergy-related, in fact it is

caused by anything except an allergy. It may be caused by inhalation of chemicals such

as cigarette smoke or cleaning agents, taking aspirin, a chest infection, stress, laughter,

exercise, cold air, food preservatives or a myriad of other factors.

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Smoke

Exercise

Gas, wood, coal, and kerosene heating units

Natural gas, propane, or kerosene used as cooking fuel

Fumes

Smog

Viral respiratory infections

Wood smoke

Weather changes

SIGNS AND SYMPTOMS:

1. Non Productive to Productive Cough

2. Dyspnea

3. Wheezing on expiration

4. Cyanosis

5. Mild apprehension and restlessness

6. Tachycardia and palpitation

7. Diaphoresis

CLINICAL MANIFESTATIONS:

1. Increased respiratory rate

2. Wheezing (intensifies as attack progresses)

3. Cough (productive)

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4. Use of accessory muscles

5. Distant breath sounds

6. Fatigue

7. Moist skin

8. Anxiety and apprehension

9. Dyspnea

Bronchial asthma in Acute Exacerbation

Bronchial asthma acute exacerbation is actually another term for a chronic asthma

attack. During bronchial asthma acute exacerbation bronchial tubes tighten instantly and

make it very hard for the air to flow through them. This is a very difficult situation because a

person suffering from the attack cannot breathe, and can enter a stage of shock.

Many things are considered a trigger for a bronchial asthma acute exacerbation.

These things are allergens (pet hair, pollen, smoke, dust etc), air pollution and air toxins, hard

physical activity and stress and anxiety.

B. MORBIDITY AND MORTALITY

As of 2009, 300 million people worldwide were affected by asthma leading to

approximately 250,000 deaths per year.

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It is estimated that asthma has a7-10% prevalence worldwide. As of 1998, there was a

great disparity in the prevalence of asthma across the world, with a trend toward more

developed and westernized countries having higher rates of asthma, with as high as a 20 to

60-fold difference. Westernization however does not explain the entire difference in asthma

prevalence between countries, and the disparities may also be affected by differences in

genetic, social and environmental risk factors. Mortality however is most common in low to

middle income countries, while symptoms were most prevalent (as much as 20%) in the

United Kingdom, Australia, New Zealand, and Republic of Ireland; they were lowest (as low

as 2–3%) in Eastern Europe, Indonesia, Greece, Uzbekistan, India, and Ethiopia.

Asthma affects approximately 7% of the population of the United States and 5% of

people in the United Kingdom. Asthma causes 4,210 deaths per year in the United States. In

2005 in the United States asthma affected more than 22 million people including 6 million

children. It accounted for nearly 1/2 million hospitalizations that same year. More boys have

asthma than girls, but more women have it than men. In England, an estimated 261,400

people were newly diagnosed with asthma in 2005; 5.7 million people had an asthma

diagnosis and were prescribed 32.6 million asthma-related prescriptions.

C. INCIDENCE AND PREVALENCE

There are no available nationwide data published on asthma prevalence. However, the

limited reports gathered showed a prevalence of 12% in children aged 13-14 years and 17-

22% in older age groups.

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LOCAL PREVALENCE

Three thousand two hundred and seven children in Metro Manila aged 13-14 years

participated in the International Study of Asthma and Allergies in Children (ISAAC).

Participants accomplished a 12-month prevalence of self-reported asthma symptoms from

written questionnaires and from video questionnaires. The results showed that approximately

12% and 8% prevalence based on responses to the written questionnaires and to the video

questionnaires respectively. In a subsequent study, 12.3% of the same population reported

wheezing.

A local study estimating the prevalence of asthma and allergies in adults was

completed in Malolos, Bulacan in 1998. One thousand five (1,005) adults (ages 18-44 years)

were interviewed using a pre-tested questionnaire adapted from the European Community

Health Survey (ECHRS) and the ISAAC. The study showed a prevalence of 17.2% for

asthma and 49.9% for allergy among adults. Another study conducted at the Lung Center of

the Philippines reported a prevalence of 22% in adults.

D. REASONS FOR CHOOSING THE DISEASE

We choose Bronchial Asthma in Acute Exacerbation as our case to be studied because

we want each and all of us whether men and women, children and adult to be aware of the

possible causes of the disease and the prevention and management of patient with such

respiratory disease. Moreover, we are all at our teenage year and smoking as major causes of

BAIAE is very common addiction of most teenagers.

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II. OBJECTIVES

A. GENERAL OBJECTIVES

Within 8 hours of exposure at World Citi Medical Center (WCMC) 7th floor ward,

we, BSN III-A Group 2 student nurses from World Citi Colleges (WCC) Antipolo campus

aim to use our knowledge, skills, and attitude to render holistic care to our client as well as

convey information with regards to the promotion and maintenance of health in order for our

client to achieve possible wellness state and carry out activities of daily living.

B. SPECIFIC OBJECTIVES

Knowledge

>To know how this respiratory disease affects patient’s life.

>To identify the problem of the patient

>To formulate exact and effective nursing care plan to the patient

>To review the normal anatomy and physiology of the respiratory system

>To discern the pathophysiology of the disease

Skills

>To improve our ability to handle respiratory disease and to enhance our skills to the

applications of our knowledge.

>To provide health teachings and nursing interventions

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Attitude

>To establish good nurse-patient relationship with our client and to improve the level of our

communications to our patient and staff nurses.

>To build rapport with the patient

III. SIGNIFICANCE OF THE STUDY

To patient with Bronchial Asthma in Acute Exacerbation:

>To acquire necessary knowledge related to their health condition.

>To be able to manage them when pain and abnormalities related to the disease occurs.

>To be able to understand the treatment that the health care providers offer in their recovery

process.

>To promote prevention of the disease

To staff nurses:

>To properly indentify the needs of the patient

>To be able to render nursing care and information to the patient through the application of

the nursing skills.

>To apply their knowledge and skills when caring to patients with pelvic organ prolapsed.

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To nursing students:

>To properly assess patients who are manifesting the disease.

>To be knowledgeable in the treatment they are providing them.

>To be able to provide more health teachings in the prevention of the disease.

IV. SCOPE AND DELIMITATIONS

We had our duty at World Citi Medical Center (WCMC) 7th floor, in Quezon City last

January 30, 2012. We were able to assess the patient’s condition but not that holistic due to

lack of time and chances and the irritable feelings of our patient due to her condition but

through keen observations, little participation of the client, patient’s chart and records. We

are able to gather certain information needed to formulate this case study. The study lasted

about 8 hours of exposure with the patient. Our client, Mrs. E.M. is suffering from Bronchial

Asthma in Acute Exacerbation (BAIAE) which we will be dealing with this study. This

includes its CAUSES and PREVENTION for the wellness of our patient.

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V. NURSING HISTORY

Name : Ms. EM

Age : 36 y/o

Gender : Female

Birthday : Jan 1, 1976

Weight : 59 kg (129.8 lbs)

Height : 157 cm

Religion : Catholic

Nationality : Filipino

Address : Quezon City

Occupation : Plain Housewife

Status : Married

Hospitalization : (-)

Case Numver : 191944

Date of Admission : January 26, 2012

Chief Complain : fever and cough and colds

Attending Physician : Dr. Agustin

Admitting Diagnosis : Bronchial Asthma In Acute Exacerbation, Hypertension

Final Diagnosis : Bronchial Asthma In Acute Exacerbation, Hypertension

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A. History of Present Illness

Patient is known asthmatic and was maintained on seretide and salbutamol

Turbohaler PRN, last attack was 1 year ago.

One week PTC, patient had on and off episode of fever; Temp is 39 C with

nonproductive cough and night time awakening, > 4x/week and shortness of breath. Patient

just took paracetamol and salbutamol but to no avail. This prompted consult.

B. Past Medical History

(+) Hypertension

(-) DM

(+) BA

C. Family History

(+) Hypertension (Father/Mother)

(+) Asthma (Father)

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VI. 13 AREAS OF ASSESSMENT

Social Status

Mrs. E.M. 36 years old born on Jan 1, 1976 is a plain housewife. She resides at

Quezon City together with her husband and with her 3 kids. She’s the one who takes care of

her 2 daughters and her 1 son. She sometimes goes out of their house to talk with her

neighbors. She does not stay too long along the streets because she tends to have an attack

whenever she inhales street dust.

Mental Status

Mrs. E.M. is oriented to time, place, events and person. She is able to recall recent

and past events in her life. She is able to read and write and can speak in English and

Tagalog. She is responsive and answers to the questions being asked.

Emotional State

Mrs. E.M. says that she feels a little stressed because of her confinement. Also, she is

somewhat irritable because of her condition.

Sensory Perception

Vision Mrs. E.M. only uses reading glasses.

Hearing Mrs. E.M.’s hearing ability is okay because she is able to answers our

questions without us repeating it.

Smell N/A

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Taste Mrs. E.M. claims that she can taste every food she is being offered.

Touch Mrs. E.M. responds to our touch.

Motor Ability

Mrs. E.M. is lethargic and a bit weak. She can move freely in her bed but she needs

help from her companion when sitting up and going to the bathroom.

Nutritional Status

Before Mrs. E.M. was admitted she states that she eats at least three times a day. She

is not picky with food. Her meal normally includes fish, pork, and vegetables. She is a

normal beverage drinker.

BMI = lbs. / inch 2 X 703 .

BMI = 130 lbs. / 61.81 inches2 x 703

= 130 lbs. / 3820.5 inches x 703

= 23. 92 (NORMAL)

Underweight Below 18.5

Normal 18.5 – 24.9

Overweight 25 – 29.9

Obese Above 30

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Body Temperature

DATE TIME BODY

TEMPERATURE

(ºC)

Jan. 31, 2012 8:00 AM 37. 1 ºC

12: 00 PM 37.3 ºC

Feb. 1, 2012 8:00 AM 36. 2 ºC

12:00 PM 36.6ºC

Respiratory Status

DATE TIME RESPIRATORY RATE

(cpm)

Jan. 31, 2012 8:00 AM 21 cpm

12:00 PM 18 cpm

Feb. 1, 2012 8:00 AM 19 cpm

12:00 PM 17 cpm

Circulatory Status

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DATE TIME BLOOD PRESSURE

(mmHg)

Jan. 31, 2012 8:00 AM 120/80 mmHg

12:00 PM 120/80 mmHg

Feb. 1, 2012 8:00 AM 120/80 mmHg

12:00 PM 120/80 mmHg

Elimination Pattern

DATE URINE STOOL

Jan. 31, 2012 3 1

Feb. 1, 2012 2 0

Reproductive Status

Mrs. E.M’s first menstrual period was when she was 10 years old. She got married at

the age of 24 years old. She has 3 children (2 girls/1 boy) with 2 years gap each. She is

sexually active.

Sleep Pattern

Mrs. E.M. stated that she normally sleeps 4-6 hours/day, after she was admitted she

has some difficulty in sleeping because of the nurses coming in and out of her room and

sometimes she has difficulty of breathing. She usually watches television at home during rest

hours and also during admission.

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State of Skin and Appendages

Mrs. E.M. has fair skin. Her wavy hair is up to her shoulders. Her lips are not dried

and slightly brownish in color. Nails are trimmed.

VII. THEORETICAL FRAMEWORK

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FLORENCE NIGHTINGALE: Environmental Theory

Florence Nightingale (1820-1910), considered the founder of educated and scientific

and widely known as "The Lady with the Lamp" wrote the first nursing notes that became the

basis of nursing practice and research. The notes, entitled Notes on Nursing: What it is, what

is not (1860), listed some of her theories that have served as foundations of nursing practice

in various settings, including the succeeding and in the field of Nursing. Nightingale is

considered the first nursing theorist. One of her theories was the Environmental Theory,

which incorporated the restoration of the usual health status of the nurse's clients into the

delivery of it is still practiced today.

Nightingale's theory was show to be applicable during the Crimean war along with

other nurses she had trained, took care of injured soldiers by attending to their immediate

needs, when communicable disease and rapid spread of disease were rampant in this early

period in the development of disease-capable medicines. The practice of environment

configuration according to patient's health or disease condition is still applied today, in such

cases as patients infected with suffering from who need minimal noise to calm them and a

quiet environment to prevent seizure-causing stimulus.

In environmental effects she stated in her nursing notes that nursing "is an act of

utilizing the environment of the patient to assist him in his recovery" (Nightingale

1860/1969) that it involves the nurse's initiative to configure environmental settings

appropriate for the gradual restoration of the patient's health, and that external factors

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associated with the patient's surroundings affect life or biologic and physiologic processes,

and his development.

Major Concepts and Definitions

Environment - concepts of ventilation, warmth, light, diet, cleanliness and noise. She focus

o the physical aspect of environment.

She believed that "Healthy surroundings were necessary for proper nursing care."

5 essential components of healthy environment:

1. Pure air

2. Pure water

3. Efficient drainage

4. Cleanliness

5. Light

Concerns of Environmental Theory

1. Proper ventilation focus on the architectural aspect of the hospital.

2. Light has quite as real and tangible effects to the body. Her nursing intervention includes

direct exposure to sunlight.

3. Cleanliness and sanitation. She assumes that dirty environment was the source of infection

and rejected the "germ theory". Her nursing interventions focus on proper handling and

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disposal of bodily secretions and sewage, frequent bathing for patients and nurses, clean

clothing and hand washing.

4. Warmth, quiet and diet environment. She introduces the manipulation of the environment

for patient's adaptation such as fire, opening the windows and repositioning the room

seasonally, etc.

5. Unnecessary noise is not healthy for recuperating patients.

6. Dietary intake.

7. Petty management proposed the avoidance of psychological harm, no upsetting news.

Strictly war issues and concerns should not be discussed inside the hospital. She includes the

use of small pets of psychological therapy.

Nursing Metaparadigm

Nursing

Nursing is very essential for everybody's well-being. Notes on nursing focus on the

implementation and rendering efficient and effective nursing care.

Person

The patient is the focus of the environmental theory. The nurse should perform the task for

the patient and control environment for easy recovery. She practices nurse-patient passive

relationship.

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Health

Health is the being well and using every power that the person has to the fullest extent. A

healthy body can recuperate and undergo reparative process. Environmental control uplifts

maintenance of health.

Environment

People would benefit from the environment.

Importance of Environmental Theory

Practice

1. Disease control

2. Sanitation and water treatment

3. Utilized by modern architecture in the prevention of "sick building syndrome" applying

the principles of ventilation and good lighting.

4. Waste disposal

5. Control of room temperature.

6. Noise management.

Education

1. Principles of nursing training. Better practice result from better education.

2. Skills measurement through licensing by the use of testing methods, the case studies.

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Research

1. Use of graphical representations like the polar diagrams.

2. Notes on nursing.

The Analysis

Simplicity: The theory is simply explained as the nurse, patient and environment interacts

with each other. There are dangers in the environment and benefits from the good

environment. The roles of environmental management to patient recovery are greatly

emphasized. Manipulating the environment to prevent diseases. Nurse-patient relationship

focuses on cooperation and collaboration. Her care focus on eating patterns and food

preferences of the patients, provision of comfort, protection from emotional distress and

conservation of energy.

Generality: The universality of the concepts provides general guidelines and is still

applicable and relevant today.

VIII. ANATOMY AND PHYSIOLOGY

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The Human Respiratory SystemThe Pathway

Air enters the nostrils

passes through the nasopharynx,

the oral pharynx

through the glottis

into the trachea

into the right and left bronchi, which branches and rebranches into

bronchioles, each of which terminates in a cluster of alveoli

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Only in the alveoli does actual gas exchange takes place. There are some 300

million alveoli in two adult lungs. These provide a surface area of some 160

m2 (almost equal to the singles area of a tennis court and 80 times the area of our

skin!).

Breathing

In mammals, the diaphragm divides the body cavity into the

abdominal cavity, which contains the viscera (e.g., stomach and intestines)

and the

Thoracic cavity, which contains the heart and lungs.

The inner surface of the thoracic cavity and the outer surface of the lungs are

lined with pleural membranes which adhere to each other. If air is introduced

between them, the adhesion is broken and the natural elasticity of the lung causes

it to collapse. This can occur from trauma. And it is sometimes induced

deliberately to allow the lung to rest. In either case, reinflation occurs as the air is

gradually absorbed by the tissues.

Because of this adhesion, any action that increases the volume of the thoracic

cavity causes the lungs to expand, drawing air into them.

During inspiration (inhaling),

o The external intercostal muscles contract, lifting the ribs up and out.

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o The diaphragm contracts, drawing it down.

During expiration (exhaling), these processes are reversed and the natural

elasticity of the lungs returns them to their normal volume. At rest, we

breathe 15–18 times a minute exchanging about 500 ml of air.

In more vigorous expiration,

o The internal intercostal muscles draw the ribs down and inward

o The wall of the abdomen contracts pushing the stomach and liver

upward.

Under these conditions, an average adult male can flush his lungs with

about 4 liters of air at each breath. This is called the vital capacity. Even with

maximum expiration, about 1200 ml of residual air remain.

The table shows what happens to the composition of air when it reaches the

alveoli. Some of the oxygen dissolves in the film of moisture covering the

epithelium of the alveoli. From here it diffuses into the blood in a nearby capillary.

It enters a red blood cell and combines with the hemoglobin therein.

At the same time, some of the carbon dioxide in the blood diffuses into the

alveoli from which it can be exhaled.

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Composition of atmospheric air and expired air in a typical subject.

Note that only a fraction of the oxygen inhaled is taken up by the lungs.

Component Atmospheric Air (%) Expired Air (%)

N2 (plus inert gases) 78.62 74.9

O2 20.85 15.3

CO2 0.03 3.6

H2O 0.5 6.2

100.0% 100.0%

The ease with which oxygen and carbon

dioxide can pass between air and blood is clear

from this electron micrograph of two alveoli (Air)

and an adjacent capillary from the lung of a

laboratory mouse. Note the thinness of the

epithelial cells (EP) that line the alveoli and

capillary (except where the nucleus is located). At

the closest point, the surface of the red blood cell is

only 0.7 µm away from the air in the alveolus.

(Reproduced with permission from Keith R. Porter and Mary A. Bonneville, An

Introduction to the Fine Structure of Cells and Tissues, 4th. ed., Lea & Febiger,

1973.)

Central Control of Breathing

The rate of cellular respiration (and hence oxygen consumption and carbon

dioxide production) varies with level of activity. Vigorous exercise can increase by

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20–25 times the demand of the tissues for oxygen. This is met by increasing the

rate and depth of breathing.

It is a rising concentration of carbon dioxide — not a declining

concentration of oxygen — that plays the major role in regulating the ventilation

of the lungs. Certain cells in the medulla oblongata are very sensitive to a drop

in pH. As the CO2 content of the blood rises above normal levels, the pH drops

[CO2 + H2O → HCO3− + H+],

and the medulla oblongata responds by increasing the number and rate of nerve

impulses that control the action of the intercostal muscles and diaphragm. This

produces an increase in the rate of lung ventilation, which quickly brings the

CO2 concentration of the alveolar air, and then of the blood, back to normal levels.

However, the carotid body in the carotid arteries does have receptors that

respond to a drop in oxygen. Their activation is important in situations (e.g., at

high altitude in the unpressurized cabin of an aircraft) where oxygen supply is

inadequate but there has been no increase in the production of CO2.

Local Control of Breathing

The smooth muscle in the walls of the bronchioles is very sensitive to the

concentration of carbon dioxide. A rising level of CO2 causes the bronchioles to

dilate. This lowers the resistance in the airways and thus increases the flow of air

in and out.

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IX. PATHOPHYSIOLOGY

Bronchial Asthma In Acute Exacerbation

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PREDISPOSING FACTORS

-Gender

-Age

-Family History

-Race

PRECIPITATING FACTORS

-Viral Respiratory Infections

-Allergen exposure (animal dander, dust, pollen, etc.)

-change in Weather

-Exercise

-Smoke ( fr. Vehichles, smokers ect.)

Release of eosinophils (to combat allergen)

Prostaglandins Histamine, Bradykinin, and other inflammatory mediators

Exposure to different pathogens

Entry of allergens

Release of Immunoglobulin E (IgE)

Release of different chemical mediators

Mast cell degranuation

Release of the different inflammatory chemical mediators

Leukotrienes

Opening of the mucosal Intracellular junction


F

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Mucus Hypersecretion

Fatigue, Anxiety

Inflammatory Process

Mucus Production Increase Vascular Permeability

Direct stimulation of vagal efferents

Mucosal EdemaBronchoconstriction

Further edma

More release of other inflammatory

mediatorsEpithelial damage

Decrease Ciliary Function

Increase airway responsiveness

Wheezing, continuous coughing, feelings of chest tightness

Dyspnea, moist skin, tachypnea


PATHOPHYSIOLOGY

The bronchi and bronchioles are very responsive to irritants, leading to contraction of

the smooth muscles (bronchoconstriction), inflammation with edema (swelling), and

increased secretion of thick mucous. These changes can block the airways, totally or

partially, interfere with the air flow and oxygen supply. In extrinsic asthma, the allergic

reaction causes release of chemical mediators like histamine that causes the bronchospasms,

edema and increased mucous secretion. This reaction also stimulates tha vagus nerve,

causing a reflex bronchoconstriction. The second stage of the allergic reaction occurs a few

hours later. During this stage, the increased leukocytes (white blood cells) released additional

chemical mediators that cause tissue damage. Left untreated, frequented and prolonged attack

can lead to chronic asthma later in life. The mechanisms behind intrinsic attacks are not fully

understood.

Partial obstruction of the smaller airways results in air trapping with hyperinflation of

the lungs. Air passes into the areas distal to the obstruction (alveoli), but are only partially

exhaled. Since exhalation is a passive process, less force is available to move air out, and

forced expiration often collapses the bronchial wall, creating a further barrier to exhalation.

The residual volume (air left in the lungs after exhalation) increases and as a result. It

becomes harder to inhale fresh air or to cough to effectively remove the mucous. To better

understand the air trapping, try this experiment. Take several breaths and exhale only

partially before inhaling again. After a few breaths you will see how hard it is to inhale, or to

cough. This is what an asthma attack feels like.

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Total obstruction of the airway results when mucous plugs completely block the

airflow in an already narrowed passage. This leads to atelectasis (collapse of the alveoli). The

air left in the alveoli diffuses out and is not replaced. This could lead to collapse of the lung.

Both a partial and total obstruction will lead to hypoxia. Oxygen levels are further depleted

by the increase demand by the muscles of respiration and by the stress of the individual

fighting for air. Hypoxemia causes vasoconstriction if the pulmonary blood vessels, slowing

blood flow and increasing the workload of the right side of the heart.

With repeated acute asthma attacks, irreversible damage occurs in the lungs. The

bronchial walls become thickened, and fibrous tissue resulting from the frequent infections

that follow attacks develops in atelectic areas. Because it is impossible to remove all of the

tiny mucous plugs in the small airways, complications are common following frequent

episodes of asthma.

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X. NURSING MANAGEMENT

A. Laboratory Test

URINALYSIS

(January 27, 2012)

NORMAL RANGE

RESULT INTERPRETATION

Physical exam

Color Pale yellow to amber

yellow Normal

characteristic Clear to slightly hazy slightly turbid Normal

Chemical exam

Specific gravity 1.003 - 1.040 1.010 Normal

Protein Negative negative Normal

Sugar negative negative Normal

Microscopic exam

RBC 4 /HPF 4-6/HPF Normal

Pus cells 2 to 3 HPF 0-2/ HPF normal

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HEMATOLOGY REPORT

(January 28, 2012)

REFERENCE

VALUE

RESULT INTERPRETATION

WBC Count 5 – 10 10^3/uL 8.7 Normal

Lymphocytes 0.25 – 0.50 0.22 Decreased.

RBC Count 3.80 – 5.8 10^6u/L 4.18 Normal

Hemoglobin 115.00-160.00 g/dL 132 Normal

Hematocrit 0.37 – 0.47 % .41% Normal

B. Nursing Care Plan

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C. Drug Study

Name of Drug Action Indication/ContraindicationNursing Considerations and

Responsibilities

Levopront 15ml /

TID

The medication with drug

Levopront yet to materialize

Indicated with:

Symptomatic treatment of cough dry

unproductive cough with pharyngitis,

influenza, pneumonia, bronchial asthma,

emphysema lungs.

Contraindicated with:

hypersensitivity, the excess rate, expressed

violation of the liver

-Should be taken on an empty

stomach (Take between meals.)

-Instruct patient to increase oral

fluid intake

-instruct patient not to perform

tasks that require alertness

Name of Drug Action Indication/Contraindication Nursing Considerations and

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http://www.mims.com/Philippines/diagnoses/info/560


Responsibilities

Nafarin A

1 Tab BID

The phenylpropanolamine HCl is a sympat

homimetic amine with achemical structure

and pharmacological actions similar to the

ephedrine, but with fewer central stimulant

effects. It is a vasoconstrictor with

decongestant action on the nose and upper

respiratory tract mucous membranes. It

directly and indirectly stimulates the a- and

b-adrenergic receptors. It exerts this last

action by allowing the norepinephrine

liberation (noradrenaline) from its storage

sites. Its action on the a-receptors in the

respiratory tract mucosa produces

vasoconstriction, which results in the

decrease of the mucosa edema and

the consequent increase of the nasal air

flow.

Indicated with:

Urinary incontinence, relive

symptoms of some allergic

disorders such as asthma and

have fever.

Contraindicated with:

Patients with high blood

pressure, over activity of the

thyroid gland, coronary heart

disease or diabetes, or who are

taking antidepressant drugs

-Administer the medication

with a full glass of water after a

meal or snack. The tablet can be

broken in half. However, the

whole or half tablet should be

swallowed whole.

-Assess for kidney disease,

heart disease, lung disease,

asthma, emphysema,

high blood pressure, an overa

ctive thyroid, diabetes, glaucom

a, prostatetrouble, depression,

any allergies of the patient.

-Caution patient not to exceed

recommended doses.

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XI. DISCHARGE PLANNING/ PROGNOSIS

Medications:

Administer prescribed medications, such as bronchodilators, anti-inflammatory, and antibiotics

Give paracetamol if have fever

Exercise:

Patient will verbalize need importance of exercise and demonstrate proper initiation of appropriate exercise.

Advise the patient to exercise daily for good and healthy body.

Treatment:

Respiratory therapy

Combivent neb q6 T.I.D

Health Teaching:

Increase fluid intake Eat a balance healthy diet. Proper hygiene

Out – patient follow up:

Advised the patient to have a follow up check up based on the discharge plan of the doctor for him.

Diet:

It is recommended to eat hypoallergenic diet.

Spiritual:

Advise patient to pray so that God will help him in her daily life and bring forth more blessings.

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BAIAE

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