Post on 30-May-2018
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Introdu
ction
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Asthma is a predisposition tochronic inflammation of the lungs in
which the airways (bronchi) arereversibly narrowed. During asthmaattacks (exacerbations of asthma), the
smooth muscle cells in thebronchiconstrict, and the airways becomeinflamed and swollen. Breathingbecomes difficult,hat Makes a Child
More Likely to Develop Asthma.
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There are many risk factors for developingchildhood asthma. These include:
Presence of allergies
Family history of asthma and/or allergies
Frequent respiratory infections
Low birth weight
Exposure to tobacco smoke before and/or after birth
Being male
Being black
Being raised in a low-income environment
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How Can I Tell If My Child Has
Asthma?
Signs and symptoms to look for include:
Frequent coughing spells, which may occur during play, atnight, or while laughing. It is important to know that coughmay be the only symptom present.
Less energy during playRapid breathingComplaint of chest tightness or chest "hurtingWhistling sound (wheezing) when breathing in or out
See-saw motions (retractions) in the chest from laboredbreathing
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Shortness of breath, loss of breath
Tightened neck and chest musclesFeelings of weakness or tiredness
Dark circles under the eyes
Frequent headaches
Loss of appetite
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Keep in mind that not all children havethe same asthma symptoms, and these
symptoms can vary from asthma episode tothe next episode in the same child. Also notethat not all wheezing or coughing is causedby asthma.
In kids under 5 years of age, the most
common cause of asthma-like symptoms isupper respiratory viral infections suchas the common cold.If your child hasproblem breathing, take him or her to the
doctor immediately for an evaluation.
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Asthma Diagnosed In Children?
Why Is Asthma is often difficult to
diagnose in infants. However, in older
children the disease can often be
diagnosed based on your child's medical
history, symptoms, and physical exam.
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Medical history and symptom description.Yourchild's doctor will be interested in any history of
breathing problems you or your child may havehad, as well as a family history of asthma,allergies, a skin condition called eczema, orother lung disease. It is important that youdescribe your child's symptoms -- cough,
wheezing, shortness of breath, chest pain ortightness -- in detail, including when and howoften these symptoms have been occurring.
Physical exam.During the physical examination,the doctor will listen to your child's heart andlungs.
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Tests.Many children will also have a chest X-rayand pulmonary function tests. Also called lung
function tests, these tests measure the amountof air in the lungs and how fast it can beexhaled. The results help the doctor determinehow severe the asthma is. Generally, childrenyounger than 5 are unable to perform pulmonaryfunction tests. Thus doctors rely heavily onhistory, symptoms and examination in makingthe diagnosis.
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Bronchial asthma triggers may include:
Tobacco smoke
Infections such as colds, flu, or pneumoniaAllergens such as food, pollen, mold, dust mites, and
pet dander
Exercise
Air pollution and toxinsWeather, especially extreme changes in temperature
Drugs (such as aspirin, NSAID, and beta-blockers)
Food additives (such as MSG)
Emotional stress and anxietySinging, laughing, or crying
Smoking, perfumes, or sprays
Acid reflux
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CASE
ABSTRACT
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On 24th day of September 2009, baby X, a 1year and 2 month old boy was admitted to thehospital under the service of Dr. M. Colasito witha chief complaint of DOB & wheezing, this wasassociated with fever. He was advice to secureconsent for management and for RR monitoringevery 2 hours.
On the same day, the child was hooked withD5 0.3Nacl 500cc x 12, the baby was subjectedunder nebulization for every hour for the firstfour hours then contrapted with O2 @ 2LPM viaNC. Then after, he received few medication;
Hydrocortisone 40mg IV q6, Benadryl 9mg IVstat dose, Cefuroxime 500mg IV q12 ANST asordered by Dr. Colasito.
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After a few hours, he was subjected under
CBC and chest X-ray AP-L. Then after, he wasencouraged to have DAT with SAP.
Sept. 25, 2009 8:45am IVF was replaced
with D5 IMB 500cc x 12 and nebulization wasadjusted q4 and he was encouraged tocontinue rest. On the following day he was onD5 IMB # 2 500cc x 12. He is currently underobservation with no further doctors order as of
this day.
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PHYSICAL
ASSESSMENT
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I. General Information
Name: Patient XAge: 1 year old
Sex: Male
II. Vital Signs
Temp: 36.0
Pulse: 12
Resp: 23
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III. Anthropometric Measurement:Height: 81 cm
Weight: 9 kg
Head Circumference: 48 cmAbdominal Circumference: 49 cm
Chest Circumference: 48
cm
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IV. General Appearance:
Patient shows no signs of distress,
mobile and calm
V. Skin
Patient skin color is fair, smooth texture, dry
and warm to touch.
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V. Head
Normocepahalic, posterior and anteriorfonatanelles are closed.
No depression upon palpation.
Hair is fine wit even distribution.
Scalp has no scars or lesions without nits.
Symmetrical eyelids and eyebrows. Eyelashes evenly distributed.
Smooth cornea and lens.
Anicteric sclera.
Pupils are responsive and reactive to light andhave an equal size.
Conjunctivas are pink.\
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VII. Ears
Properly aligned, soft, and non tender pinna.
Levels at the outer canthus of the eye. Ear canal has some cerumen.
VIII. Nose
Appears smooth, nasolabial folds issymmetrical.
Septum is found in midline.
No nasal discharge.
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IX. Mouth and Pharynx
Lips are pinkish in color, moist, symmetrical and smooth.
Gums and buccal mucosa are pinkish in color, smooth
and moist. Soft and hard palate are intact.
Uvula is found at the midline.
Tongue moves freely.
Tonsils are not inflamed.X. Neck
moves freely
trachea is in the midline
No palpable nodules. Thyroid is non palpable
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XI. Chest and lungs
Cylindrical
Breathing is irregular with wheezing to ronchisound.
XII. Heart
Precordium is flat
Apical pulse is located at the fifth intercostalsspace left midclavicular line.
XIII. Abdomen
Appears slightly protuberant and normoactive
sounds upon palpation.
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XIV. Back and extremities
Nails and nail beds are pinkish in color.Peripheral pulses are symmetrical.
Peripheral pulses are symmetrical.
Extremities symmetrical in size. Spine is in the midline.
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ANATOMY AND PHYSIOLOGY
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The upper respiratory tract consists of the nose,sinuses, pharynx, larynx, trachea, and epiglottis.
The lower respiratory tract consists of thebronchi, bronchioles and the lungs.
The major function of the respiratory system is todeliver oxygen to arterial blood and removecarbon dioxide from venous blood, a processknown as gas exchange.
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Bronchi and Bronchial Tree
In the mediastinum, at the level of thefifth thoracic vertebra, the trachea divides
into the right and left primary bronchi. The
bronchi branch into smaller and smallerpassageways until they terminate in tiny
air sacs called alveoli.
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The cartilage and mucous membrane of theprimary bronchi are similar to that in the trachea.As the branching continues through the
bronchial tree, the amount of hyaline cartilage inthe walls decreases until it is absent in thesmallest bronchioles. As the cartilagedecreases, the amount of smooth muscle
increases. The mucous membrane alsoundergoes a transition from ciliatedpseudostratified columnar epithelium to simplecuboidal epithelium to simple squamous
epithelium.
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The alveolar ducts and alveoli consistprimarily of simple squamous epithelium,
which permits rapid diffusion of oxygenand carbon dioxide. Exchange of gasesbetween the air in the lungs and the bloodin the capillaries occurs across the walls ofthe alveolar ducts and alveoli.
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LungsThe two lungs, which contain all the components of the
bronchial tree beyond the primary bronchi, occupy most
of the space in the thoracic cavity. The lungs are soft and
spongy because they are mostly air spaces surrounded
by the alveolar cells and elastic connective tissue. They
are separated from each other by the mediastinum, whichcontains the heart. The only point of attachment for each
lung is at the hilum, or root, on the medial side. This is
where the bronchi, blood vessels, lymphatics, and nerves
enter the lungs.
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The right lung is shorter, broader, andhas a greater volume than the left lung. It
is divided into three lobes and each lobe issupplied by one of the secondary bronchi.The left lung is longer and narrower thanthe right lung. It has an indentation, called
the cardiac notch, on its medial surface forthe apex of the heart. The left lung hastwo lobes.
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Each lung is enclosed by a double-layeredserous membrane, called the pleura. The
visceral pleura are firmly attached to the surfaceof the lung. At the hilum, the visceral pleura arecontinuous with the parietal pleura that line thewall of the thorax. The small space between the
visceral and parietal pleurae is the pleural cavity.It contains a thin film of serous fluid that isproduced by the pleura. The fluid acts as alubricant to reduce friction as the two layers slideagainst each other, and it helps to hold the twolayers together as the lungs inflate and deflate.
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The normal gas exchange depends on threeprocesses:
Ventilation is movement of gases from theatmosphere into and out of the lungs. This isaccomplished through the mechanical acts ofinspiration and expiration.
Diffusion is a movement of inhaled gases inthe alveoli and across the alveolar capillarymembrane
Perfusion is movement of oxygenated blood
from the lungs to the tissues
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The normal functions of respiration O2 and CO2 tensionand chemoreceptors are similar in children and adults.However, children respond differently than adults to
respiratory disturbances; major areas of differenceinclude: Poor tolerance of nasal congestion, especially in infants who are
obligatory nose breathers up to 4 months of age
Increased susceptibility to ear infection due to shorter, broader,
and more horizontally positioned eustachian tubes. Increased severity or respiratory symptoms due to smaller
airway diameters
A total body response to respiratory infection, with suchsymptoms as fever, vomiting and diarrhea
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Control of gas exchange involves neural and
chemical process
The neural system, composed of three parts located in the
pons, medulla and spinal cord, coordinates respiratory
rhythm and regulates the depth of respirations. The
chemical processes perform several vital functions such as:
Regulating alveolar ventilation by maintaining normalblood gas tension
Guarding against hypercapnia (excessive CO2 in the
blood) as well as hypoxia (reduced tissue oxygenation
caused by decreased arterial oxygen [PaO2]. An increasein arterial CO2 (PaCO2) stimulates ventilation; conversely,
a decrease in PaCO2 inhibitsventilation.
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PATHOPHY
SIOLOGY
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Asthma is an airway disease that can beclassified physiologically as a variable andpartially reversible obstruction to air flow,and pathologically with overdevelopedmucus glands, airway thickening due toscarring and inflammation, andbronchoconstriction, the narrowing of theairways in the lungs due to the tighteningof surrounding smooth muscle. Bronchialinflammation also causes narrowing dueto edema and swelling caused by animmune response to allergens.
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Inflamed airways and bronchoconstriction inasthma. Airways narrowed as a result of theinflammatory response cause wheezing.
During an asthma episode, inflamed airwaysreact to environmental triggers such as smoke,dust, or pollen. The airways narrow and produceexcess mucus, making it difficult to breathe. In
essence, asthma is the result of an immuneresponse in the bronchial airways.
Bronchoconstriction
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The airways of asthma patients are"hypersensitive" to certain triggers, also known
as stimuli(see below). (It is usually classified astype I hypersensitivity.) In response to exposure to these triggers, the
bronchi (large airways) contract into spasm (an"asthma attack"). Inflammation soon follows,
leading to a further narrowing of the airways andexcessive mucus production, which leads tocoughing and other breathing difficulties.Bronchospasm may resolve spontaneously in 12 hours, or in about 50% of subjects, may
become part of a 'late' response, where thisinitial insult is followed 312 hours later withfurther bronchoconstriction and inflammation.
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The normal caliber of the bronchus is maintainedby a balanced functioning of these systems,which both operate reflexively. Theparasympathetic reflex loop consists of afferentnerve endings which originate under the innerlining of the bronchus. Whenever these afferentnerve endings are stimulated (for example, bydust, cold air or fumes) impulses travel to the
brain-stem vagal center, then down the vagalefferent pathway to again reach the bronchialsmall airways. Acetylcholine is released from theefferent nerve endings. This acetylcholineresults in the excessive formation of inositol
1,4,5-trisphosphate (IP3) in bronchial smoothmuscle cells which leads to muscle shorteningand this initiates bronchoconstriction.
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Bronchial inflammationThe mechanisms behind allergic asthmai.e.,
asthma resulting from an immune response toinhaled allergensare the best understood ofthe causal factors. In both people with asthmaand people who are free of the disease, inhaledallergens that find their way to the inner airways
are ingested by a type of cell known as antigen-presenting cells, or APCs. APCs then "present"pieces of the allergen to other immune systemcells. In most people, these other immune cells(TH0 cells) "check" and usually ignore the
allergen molecules. In asthma patients,however, these cells transform into a differenttype of cell (TH2), for reasons that are not wellunderstood.
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The resultant TH2 cells activate an importantarm of the immune system, known as thehumoral immune system. The humoral immune
system produces antibodies against the inhaledallergen. Later, when a patient inhales the sameallergen, these antibodies "recognize" it andactivate a humoral response. Inflammationresults: chemicals are produced that cause thewall of the airway to thicken, cells which producescarring to proliferate and contribute to further'airway remodeling', causes mucus producingcells to grow larger and produce more andthicker mucus, and the cell-mediated arm of theimmune system is activated. Inflamed airwaysare more hyper-reactive, and will be more proneto bronchospasm.
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The "hygiene hypothesis" postulates thatan imbalance in the regulation of these TH
cell types in early life leads to a long-termdomination of the cells involved in allergicresponses over those involved in fightinginfection. The suggestion is that for a child
being exposed to microbes early in life,taking fewer antibiotics, living in a largefamily, and growing up in the country
stimulate the TH1 response and reducethe odds of developing asthma.
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Stimuli
Allergens from nature, typically inhaled,
which include waste from common
household pests, the house dust mite and
cockroach, as well as grass pollen, moldspores, and pet epithelial cells;
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Indoor air pollution from volatile organiccompounds, including perfumes andperfumed products. Examples includesoap, dishwashing liquid, laundrydetergent, fabric softener, paper tissues,paper towels, toilet paper, shampoo,hairspray, hair gel, cosmetics, facialcream, sun cream, deodorant, cologne,shaving cream, aftershave lotion, airfreshener and candles, and products suchas oil-based paint.
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Medications, including aspirin,-adrenergic antagonists (beta blockers),
and penicillin.Food allergies such as milk, peanuts, and
eggs. However, asthma is rarely the onlysymptom, and not all people with food orother allergies have asthma.
Use of fossil fuel related allergenic airpollution, such as ozone, smog, summer
smog, nitrogen dioxide, and sulfur dioxide,which is thought to be one of the majorreasons for the high prevalence of asthmain urban areas.
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Various industrial compounds and otherchemicals, notably sulfites; chlorinated
swimming pools generate chloraminesmonochloramine (NH2Cl), dichloramine(NHCl2) and trichloramine (NCl3)in theair around them, which are known to induce
asthma.Exercise or intense use of respiratory
system. The effects of which differsomewhat from those of the other triggers,
since they are brief. They are thought to beprimarily in response to the exposure of theairway epithelium to cold, dry air.
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Early childhood infections, especially viral upperrespiratory tract infections. Children who sufferfrom frequent respiratory infections prior to the
age of six are at higher risk of developingasthma,particularly if they have a parent with thecondition. However, persons of any age canhave asthma triggered by colds and otherrespiratory infections even though their normal
stimuli might be from another category (e.g.pollen) and absent at the time of infection. Inmany cases, significant asthma may not evenoccur until the respiratory infection is in itswaning stage, and the person is seemingly
improving. In children, the most common triggersare viral illnesses such as those that cause thecommon cold.
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Hormonal changes in adolescent girls and adultwomen associated with their menstrual cyclecan lead to a worsening of asthma. Some
women also experience a worsening of theirasthma during pregnancy whereas others findno significant changes, and in other women theirasthma improves during their pregnancy.
Psychological stress. There is growing evidencethat psychological stress is a trigger. It canmodulate the immune system, causing anincreased inflammatory response to allergensand pollutants.
Cold weather can make it harder for patients tobreathe. Whether high altitude helps or worsensasthma is debatable and may vary from personto person.
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Pathogenesis
The fundamental problem in asthma appears to beimmunological: young children in the early stages ofasthma show signs of excessive inflammation in theirairways. Epidemiological findings give clues as to thepathogenesis: the incidence of asthma seems to beincreasing worldwide, and asthma is now very muchmore common in affluent countries.
In 1968 Andor Szentivanyi first described The BetaAdrenergic Theory of Asthma; in which blockage of the
Beta-2 receptors of pulmonary smooth muscle cellscauses asthma. Szentivanyi's Beta Adrenergic Theory isa citation classic using the Science Citation Index andhas been cited more times than any other article in thehistory of the Journal of Allergy and Clinical Immunology.
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In 1995 Szentivanyi and colleaguesdemonstrated that IgE blocks beta-2receptors. Since overproduction of IgE is
central to all atopic diseases, this was awatershed moment in the world of allergy.
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Asthma and sleep apnea
It is recognized with increasing frequency
that patients who have both obstructive
sleep apnea and asthma often improve
tremendously when the sleep apnea isdiagnosed and treated. CPAP is not
effective in patients with nocturnal asthma
only.
A th d t h l
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Asthma and gastro-esophageal
reflux disease
If gastro-esophageal reflux disease (GERD) is
present, the patient may have repetitive
episodes of acid aspiration. GERD may be
common in difficult-to-control asthma, butaccording to one study, treating it does not seem
to affect the asthma. When there is a clinical
suspicion for GERD as the cause of the asthma,
an Esophageal pH Monitoring is required toconfirm the diagnosis and establish the
relationship between GERD and asthma.
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LABORA
TORY
RADIOLOGY DEPARTMENT
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RADIOLOGY DEPARTMENT
Case No. :
Age :Examination:
09-3148
1 Yr. old and 2 MonthsChest PA/L (Radial)
ROENTGENOLOGICAL REPORT:
Point hazy opacity and present in the inner part ofboth Lungs. No definite Hilar Adropathy is.
The heart is normal in size and in configuration.
The Diaphragm, CP sulci & the Thoracic cage are
intact. No other Remarks.
IMPRESSION:
Beginning bilateral Bronchopneumonia
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Bronchopneumonia
Bronchopneumonia or bronchial
pneumonia (also known as lobularpneumonia) is a type of pneumoniacharacterized by multiple foci of isolated,acute consolidation, affecting one or more
pulmonary lobes.It is one of two types of bacterial
pneumonia as classified by grossanatomic distribution of consolidation(solidification), the other being lobar
pneumonia.
Component & Quantity Result
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Component & Quantity Result
Hemoglobin:
M: 12-17 g/dl
F: 11-15 g/dl
12.6 g/dl
Hematocrit:
M: 40-54%
F: 37-47%
34.5%
WBC Count:5,000-10,000/ cu mm 17,200 / cu mm
RBC Count:
M: 4.5-6.0/ cu mm
F: 4.0-5.5/ cu mm
4.28 / cu mm
Reticulocyte Count Result
Platelet Count:
150,000-400,000 / L Adequate
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Hematocrit:Decreased hematocrit indicates anemia, such as
that caused by iron deficiency or other
deficiencies. Other conditions that can result in alow hematocrit include vitamin or mineraldeficiencies, recent bleeding, cirrhosis of theliver, and malignancies. The most commoncause of increased hematocrit is dehydration,
and with adequate fluid intake, the hematocritreturns to normal. However, it may reflect acondition calledpolycythemia verathat is,when a person has more than the normalnumber of red blood cells. This can be due to a
problem with the bone marrow or, morecommonly, as compensation for inadequate lungfunction (the bone marrow manufactures morered blood cells in order to carry enough oxygenthroughout your body).
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WBC:An elevated number of white blood cells is
called leukocytosis. This can result frombacterial infections, inflammation, leukemia,trauma, intense exercise, or stress.
A decreased WBC count is called leukopenia.
It can result from many different situations,such as chemotherapy, radiation therapy, ordiseases of the immune system.
Counts that continue to rise or fall to abnormal
levels indicate that the condition is gettingworse. Counts that return to normal indicateimprovement.
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Platelet Count:
If platelet levels fall below 20,000 per microliter,spontaneous bleeding may occur and isconsidered a life-threatening risk. Patients whohave a bone marrow disease, such as leukemiaor another cancer in the bone marrow, oftenexperience excessive bleeding due to asignificantly decreased number of platelets(thrombocytopenia). As the number of cancercells increases in the bone marrow, normal bone
marrow cells are crowded out, resulting in fewerplatelet-producing cells.
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DRUGSTUDY
N f Cl ifi ti D / R t M h i f I di ti N i
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Name ofthe drug
Classification Dosage/Frequency
Route Mechanism of Action
Indication NursingResponsibilities
Generic:
Diphenhydramine
Brand
name:
Benadryl
Antihistamine 9 mgq 8 hours
stat
IV Diphenhydramine
works by blocking
the effect ofhistamineat H1 rece
ptor sites.
By blocking the H1
receptor on
peripheral
nociceptors,
diphenhydraminedecreases their
sensitization and
consequently
reduces itching that
is associated with
an allergic reaction.
Treatment ofsymptoms of
allergies
Determine why themedication was
ordered and assesssymptoms thatapply to theindividual patient
Name of Classification Dosage/ Route Mechanism of Indication Nursing
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Name ofthe drug
Classification Dosage/Frequency
Route Mechanism of Action
Indication NursingResponsibilities
Genericname:Hydrocortis
oneBrandname:Hydrocortone, Cortef
Anti-inflammatories
Immunosuppressants
40mgq 6 hours
IV Supresses normal
immune response
and inflammation
Used in themanagement of awide variety of
allergic /immunologicreactions
Assess affected skinprior to and dailydaily during therapy.
Note degree ofinflammation andpruritus. Notifyphysician or otherhealth care providerif symptoms ofinfection develop.
Name of Classification Dosage/ Route Mechanism of Indication Nursing
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Name ofthe drug
Classification Dosage/Frequency
Route Mechanism of Action
Indication NursingResponsibilities
Genericname:Cefuroxime
Brandname:Ceftin,Kefurox,Zinacef
Anti-infective( second
generation
cephalosporins)
500 mgq 12
IV Cefuroxime is used
to treat many kinds
of bacterialinfections, including
severe or life-
threatening forms.
Treatment ofrespiratory tractinfections
Assess patient forinfection at thebeginning and
throughout courseof therapyBefore initiatingtherapy, obtain ahistory to determineprevious use of andreactions topenicillin s or
cephalosporins.Observe patients forsigns and symptomsof anaphylaxis(rash, pruritus,laryngeal edema,wheezing).Discontinue the
drug and notifyphysician if theseoccur.
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Name of thedrug
Classification
Dosage/Frequency
Route Mechanism of Action
Indication NursingResponsibilities
Generic
name:
Duavent
( ipratropiu
m
salbutamol)
Brand
name:
DuaNeb
Salbutamo
l Sulfate
Nebule
q 1 hour
Oral
nebuliza
tion
The combination of
ipratropium and
albuterol is used to
prevent wheezing,
difficulty breathing,
chest tightness,
and coughing.
Management of
reversible
bronchospasms
associated with
obstructive
airway diseases,
bronchial asthma
Take care to
ensure that the
nebulizer mask
fits the user's
face properly and
that nebulized
solution does notescape into the
eyes.
Evaluate
therapeutic
response.
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Nursing
Care
Plan
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS & EVALUATION
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RATIONALE
Subjective:
Ubo sya ng
ubo at dimakahinga ngmaayos asverbalized bythe mother
Ineffectivebreathingpatternrelated topainful/ineffectivecough
After 8 hours ofnursinginterventions,the patientsbreathingpattern will be
-Monitor vitalsigns to serve as abaseline data.
-Avoidance ofirritants; smokingallergens, andindustrialchemicals to
prevent furtherirritation.
-Increased basedfluid intake to thinmucus and make iteasier to
expectorate.-Deep breathingexercise toimprove aircirculation andbreathing.
-Goalspartially met.
-After 8 Hoursof Nursinginterventions,the pxbreathingpattern was
improved.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS &RATIONALE
EVALUATION
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RATIONALE
-Positioning tofacilitate breathing(Fowlers or
Orthopneic)-Providingadequate nutritionvia small, frequentmeals to meetnutritional
requirements & toavoid suffocation.
-Avoidance ofextremes of heatand cold to avoidfurther cough.
Interdependent:
-Use of Meds:
Bronchodilators,expectorants &liquefying agents.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS &RATIONALE
EVALUATION
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RATIONALE
SubjectiveNahihirapanhuminga ang
anak koObjective-Restlessness-Irritability-Tachycardia-
P 181-Cyanosis-Diaphoresis-Nasal Flaring-TachypneaRR-41
-Barrel chest-Wheezing onexpiration
Impairedgasexchange
related toventilationperfusionimbalance
After 1 hour ofnursingintervention the
client willimproveventilation
Monitor RR,depthand effort includingof accessory
muscles ,nasalflaring andabnormalbreathing patternsAuscultate everybreath sounds
every 1-2 hoursMonitor the clientsbehavior for theonset ofrestlessnessObserve for
cyanosis of theskin especiallynote the color,tongue and oralmucus membrane
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS &RATIONALE
EVALUATION
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RATIONALE
Position the clientin Semi fowlerswith an uprightposition at 45degree if possibleAdministerbronchodilator asordered by thedoctor
Goals metThe client isimprovedventilationfromP-145RR-22
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Thank Youfor
Listening