Bronchial Asthma Final

8/6/2019 Bronchial Asthma Final

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INTRODUCTION

Asthma is a chronic inflammatory respiratory disorder that causes

recurrentepisodes of wheezing, breathlessness, chest tightness and cough,

especially atnight or in the early morning. These asthma episodes are associated

with airflowlimitation or obstruction that is reversible either spontaneously or with

treatment.Asthma usually begins in childhood or adolescence, but it also may

first appearduring adult years. While the symptoms may be similar, certain

important aspectsof asthma are different in children and adults.

Asthma affects an estimated 300 million individuals worldwide. Evidence shows

that the prevalence of asthma is increasing, especially in children. Annually, the

World Health Organization (WHO) has estimated that 15 million disability-

adjusted life-years are lost and 250,000 asthma deaths are reported

worldwide.Approximately 500,000 annual hospitalizations (34.6% in individuals

aged 18 y or younger) are due to asthma. The cost of illness related to asthma is

around $6.2 billion. Each year, an estimated 1.81 million people (47.8% in

individuals aged 18 y or younger) require treatment in the emergency

department. Among children and adolescents aged 5-17 years, asthma accounts

for a loss of 10 million school days and costs caretakers $726.1 million because

of work absence. The latest data from Centers for Disease Control indicate an

asthma prevalence rate of 8.4% in the United States.( William F Kelly III,


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Department of Medicine, Walter Reed Army Medical Center,

http://emedicine.medscape.com/article/137501-overview)

Asthma is the third leading cause of hospitalization among children under the

age of 10. Approximately 32.7 percent of all asthma hospital discharges in 2006

were in those under 10, however only 20.1% of the Philippine population was

less than 10 years old.In 2005, there were approximately 679,000 emergency

room visits were due to asthma in those under 10.( Region NCR Agenda -

SETTING THE HEALTH RESEARCH PRIORITIES 2006.)

According to the City Health Office Of Tagum there are 1.48 % children less than

five year old diagnose with bronchial asthma in the year 2009,


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OBJECTIVES:

GENERAL:

y This study aims to deepen our knowledge about bronchial asthma. To be

able to identify possible interventions that can be done to decrease the

possibility of further complications. And to identify the factors that lead to

the occurrence of the disease.

SPECIFIC:

y Gather all relevant information about the patient that will serve us our

baseline data for the fulfillment of this case study,

y Perform the head-to-toe physical assessment to the patient.

y Trace the Pathophysiology of the patient who have bronchial asthma

including the underlying symptoms and its predisposing and precipitating

factors,

y Review the anatomy and physiology of the affected organs,

y Formulate nursing care plans based on the problem. And evaluate the

appropriate interventions to be apply,

y Establish rapport to gain clients/mother (pedia patient) cooperation in

attaining relevant information.


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Developmental history

THEORY THEORIST AGE STAGE TASK FINDINGS

Psychosoci

al theory

Erik Erikson

INFANCY

0 TO 1

YEAR OLD

Trust

vs. Mistrust

The first

stage centers

on basic

needs met by

parents. If the

parents

expose the

child to

warmth,

regularity and

dependable

affection they

Normal

findings


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Psychosexu

al theory

Sigmund

Freud

Birth- 1 yr.

old

Oral stage

- This is

related to

both the

physical

focus and

the

demands

being made

and abusive

the child

develops

mistrust to

them.

Normal

Findings


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world as

he/she

develops.

For each

stage, there

can be two

extremes in

psychologic

al reaction -

either doing

too much or

not enough

of what is

ideal.


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Anatomy & Physiology of the Respiratory System

The respiratory system is responsible for gaseous exchange between the

circulatory system and the outside world. Air is taken in via the upper airways(the nasal cavity, pharynx and larynx) through the lower airways (trachea,

primary bronchi and bronchial tree) and into the small bronchioles and alveoli

within the lung tissue.

The organs of respiratory system make sure that oxygen enters our bodies and

carbon dioxide leaves our bodies.


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Upper Respiratory system

Nose- is the passageway of air and which is important for warming, moistening

and filtering of air.

The space inside of the nose is shaped like a triangle and

is divided into 3 parts:

Nostrils - openings of the nose

Nasal Septum - divides the nostrils and is important for smell

Nasal Passage the space inside of the nose

Sinuses- resonating chamber of speech.

Consist of four pairs of bony cavities; lined by nasal mucosa.

Four pairs location


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Pharynx- muscular passageway commonly called throat.

3 sections

y Nasopharynx which contains adenoids and opening to the Eustachian

tubes.

y Oropharynx which contains palatine tonsils and also a passageway of air

and food.

y Laryngopharynx which extends from the epiglottis to the 6 cervical leveland also allows air to enter from the nose and the mouth.

Larynx- a cartilaginous epithelium lined structure that connects the pharynx and

trachea.

This is also known as the voice box. Sound is generated and that is wherepitch and volume are manipulated.

Lower Respiratory Tract

Trachea-windpipe which extends from the larynx to the 2nd costal cartilage

composed of 16-20 c-shaped cartilage rings.

Carina- terminal point when trachea divides into left and right lungs.


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Bronchioles- are the first airway branches that no longer contain cartilage. They

are branches of the bronchi. The bronchioles terminate by entering the circular

sacs called alveoli.

Right and Left Lungs

The main organ of respiration and lie within the thoracic cavity.

The right lung divides into 3 lobes and the left lung divides into 2 lobes.

Alveoli ducts- arise from the right bronchioles to the alveoli.

Alveoli- the cellular unit of the lungs.

Produce surfactant that is responsible for reduce surface tension and

prevents alveolar collapse.

35% alveolar gas exchange to the alveolar ducts and 65% alveolar gas

exchange to the alveolar sacs.


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The upper respiratory tract consists of the nose, sinuses, pharynx, larynx,

trachea, and epiglottis.

The lower respiratory tract consist 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 process:

Ventilation is movement of gases from the atmosphere into and out of the

lungs. This is accomplished through the mechanical acts ofinspiration and

expiration.

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

alveolar capillary membrane

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, coordinates respiratory rhythm and regulates the depth of

respirations

The chemical processes perform several vital functions such as:

regulating alveolar ventilation by maintaining normal blood gas tension

guarding against hypercapnia (excessive CO2 in the blood) as well as

hypoxia (reduced tissue oxygenation caused by decreased arterial oxygen

[PaO2]. An increase in arterial CO2(PaCO2) stimulates ventilation;

conversely, a decrease in PaCO2 inhibits ventilation.


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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 such symptoms as fever,

vomiting and diarrhea.

Pathophysiology

File name: pathophysiology of brochial asthma by jayster


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Chief complaint: Cough

EENT: (+) sunken eyeballs

Neck: thyroid, lymph nodes (+), dry lips

Lungs: (+) crackles

Impressions: URTI; BA in AE

X-ray result

Chest APL: Heart is normal in size. Patchy infiltrates are noted in both lungs fields.

Impression: suggestive of bilateral pneumonia

LAB TEST:

Salmonella typhi

Igb & IgM negative/ probably not typhoid

Hematology

Segmentres (0,55-0,65) = 6 AM

Basophils (0-0,005) = 255

Hematocrit = 0.35

Dengue Igb & IgM Negative

Urinalysis

Color: yellow Specific gravity: 1-005

Appearance: clear Albumin: Negative

Sugar: Negative Epithelial cells: few

Reaction: acidic Pus cells: 2-3

Fecalysis:


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Hematology:

Hemoglobin

Female (120-150):125

Leukocyte: (5-10) 7,7

Segmentres: (0,55-0,65) 0.67

Lymphocytes: (0,25-0,40) 0,27

Monocytes: (0,02-0,06) 0,05

Eosinophils: (0,01-0,05) 0,01

Thrombocyte: (150-300)

Hematocrit: 0,38

Intravenous Fluid

Date Shift # of Fluid Fluid Volume cc/

1/22/11

1/22/11

1/23/11

1/24/11

1/25/111/26/11

73

117

311

73

117

311

73

1

2

3

4

5

67

D5 0.3 NaCL

D5 0.3 NaCl

D5 IMB

D5 IMB

D5 IMB

D5 IMBD5 IMB

500cc

500cc

500cc

500cc

500cc

500cc500cc

45 cc/

45 cc/

45 cc/

45 cc/

45 cc/

45 cc/45 cc/


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NURSES NOTES

1/22/11

117

73

311

117

1/23/11

73

311

117

1/24/11 73

6 am-Received and admitted this 1 yr.old,F, in due to cough and fever,

under the service of Dr. Mae Dalisay, VS checked and recorded. Dr. Delos

Reyes resident on duty orders laboratory and requested, started with IVF

of D5 0.3 NaCl 500cc @ 40 cc/, infusing well @ left metacarpal vein;

Salbutamol nebulisation as ordered, transported per wheelchair cuddled by

mother; endorsed to ward NOD----------------------------------------------------------

--------

Received lying on bed; awake and responsive, on hypoallergenic diet, ongoing IVF # 1D5.3 NaCl 500 cc @ 40cc/ infusing well and regulated. VS

checked and recorded. Lab results attached to chart seen and examined by

Dr. M.Dalisay with orders made and carried out. Due meds given as

ordered. Endorsed to NOD.---

Received patient on bed awake and responsive, with watchers @ bedside

with on going IVF #1 D5.3 NaCl 500cc @45cc/; infusing well and regulated

accordingly. VS checked ad recoreded. On hypoallergenic diet with

aspiration precaution. Due meds given as prescribed. Endorsed.-------------------------------

Received patient on bed asleep on HAD with IVF #2 D5.3 NaCl 500cc @ 45

cc/. VS checked and recoreded. Due meds given as ordered. Still for

repeat hematocrit and platelet, dengue serology requested. Cared for

continuously.---

@ 7:10 am received on bed awake; on HAD; with on going IVF #2 D5 0.3

NaCl 500cc@ the level of 300cc regulated @ 45 cc/. Attach and infusing

well 2 left metacarpal vein. VS checked and recorded within normal range.Endorsed------

Received on bed asleep on HAD. With lon going IVF #3 D5 IMB 500cc @

45cc/. Attached and infusing well and regulated @ desired rate. VS taken

and recorded. Nebulisation follow up chest X-ray. Due meds given as

ordered. Comforted with cool and comfortable envt. Endorsed to NOD.-----

---------------

Received patient on bed, asleep, with mother at the side, on HAD, with

aspiration precaution, with on going IVF of #3 D5 IMB 500cc@ 45cc/.Infusing well and regulated accordingly. VS checked and recorded. Provided

with restful envt. Due meds given as prescribed. Endorsed to NOD.----------

------

Received on bed awake, on HAD with aspiration precaution; IVF #4 D5 IMB

500cc@ 45cc/, infusing well @ left metacarpal vein; VS checked and


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1/25/11

73

311

117

1/26/11

73

Received lying on bed, awake and responsive, on HAD, with on going IVF #5

D5 IMB 500cc @ 45cc/, infusing well and patent. VS checked and

recorded, due meds given as ordered. Endorsed to NOD.-----------------------------------------------

7am received patient on low fowlers position, asleep with watcher @

bedside, with on going IVF #5 D5 IMB 500cc @45cc/ infusing well @ left

metacarpal vein with the level received @ 15occ, assessment done, very

cooperative, skin is intact without any lesion. Placed on HAD, @ 8 AM VS

checked and recorded. Bedside care done @ 9am above IVF consumed and

followed with the same fluid #6 D5 IMB 500cc@ 45cc/ @ 12pm VS

rechecked and recorded with the result, due Ambroxol HCl 15/5 25ml TIDgiven, due Salbutamol nebulisation 22cc q 6 given, due Xylitol 5% teething

gel checks inner palate and tongue, health teachings recorded as follow:

instruct watcher to give meds on time with correct dosage and schedule @

3pm due Budesomide 250 ml in 2 ml nebule given as ordered, I & O

summed up and recorded, left on bed asleep with watcher @ bedside, with

same IVF still on, no untoward unusualities noted, endorsed to NOD.---------

-----------------------------------------------------------

@ 3:10 PM received on bed awake, responsive, with on going IVF #6 D5IMB 500cc@ 45cc/ hooked and infusing well; patent and dry; VS checked

and recorded; afebrile; due meds given as ordered. All needs attended,

bedside care done; watched and cared for.-------------------------------------------

----------------

Received lying on bed, awake and responsive, on HAD, with on going IVF #6

D5 IMB 500 cc@ 45cc/, infusing well and patent. VS checked and

recorded, due meds given as ordered. Endorsed.------------------------------------

-----------------------Received on bed. On HAD, with on going IVF #6 D5 IMB 500cc@ 45cc/,

infusing well and regulated accordingly. @ 8 am, above IVF consumed and

followed up with #7 D5 IMB 500 cc@ 45cc/ regulated accordingly. VS

checked within normal range. Medicated as ordered, watched and cared

for.--------------


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DATE/SHIFT

NAME OFTHE DRUG

DOSAGE/TIME

ROUTE

INDICATION CONTRA-INDICATION

MECHANISM OFACTION

SIDEEFFECT

NURSINGRESPONSIBILITIE

S

GENER-IC NAME

Ambro-xol

BRANDNAME

Ambro-Lex

CLASSIFICATIONl:

Expec-torant

DRAWING:

TSP.

BID.

Acute &chronic

disorders ofthe patientassociated

with

pathologi-callythickenedmucus &impairedmucus

transfer.

Hypersensi-Tivity to ambroxol.

It acts byincreasing the

respiratory tractsecretion of lowerviscosity mucus&exerting a positive

influence on thealveolar surfactantsystem which

leads to improvemucus flow and

transport.

-allergicskin

reaction.

-assess for anysigns of allergy.-report any signsof unusualitiesafter giving the

medication.


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DATE/SHI

FT

NAME OF

THE DRUG

DOSAGE/TIME

ROUTE

INDICATION CONTRA-

INDICATION

MECHANISM OF

ACTION

SIDE EFFECT NURSING

RESPONSIBILITIES


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GENER-IC

NAME

Parace-tamol

BRANDNAME

Tempra

CLASSIFICATIONl:

Analgesics

DRAWING:

TSP.TID.

Fever &minor

aches,pains

associatedwith

commonColds.

-renal hepaticimpairment.

Decreasesfever by

inhibiting theeffects of

pyrogens onthe

hypothalamicactions

leading tosweating and

vasodilatationrelieves painby inhibiting

prostaglandinsynthesis atthe CNS butdoes have

anti-inflammatory

action onperipheral

prostaglandinsynthesis.

-Skinrashes &

otherallergic

reaction.

-assess forany signs of

allergy suchas itching.-assess for

the history ofhepatic

impairment.-Closely

monitor thepatients

condition andimmediatelyreport to theCI or NOD ofany signs ofunusualities.


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infection, mucus and other foreign material from

your body. Productive cough is caused by

increase eosinophil in the area causing

Increase mucous production.

http://asthma.about.com/od/asthmabasics/a/basic_

chroniccough.htm

Chest tightness As your airways become more inflamed, filled withmucus, and the smooth muscles in your airwaysconstrict, chest tightness may be experienced asthe inability or perception of not being able to moveair in and out of your lungs.

http://asthma.about.com/od/asthmabasics/a/basic_chesttightness.htm

Etiology

Predis-

posing

Actual

findings

Implications


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Factors

Hereditary Research on genetic mutations casts further light on the synergistic

nature of multiple mutations in the pathophysiology of asthma,

particularly as it is related to the role of platelet-activating factor

hydrolyses, an intrinsic neutralizing agent of platelet-activating factor

in most humans.

(ALA Utah, 2000), (http://www.articlesbase.com/health-

articles/bronchial-asthma-symptoms-and-causes-of-bronchial-

asthma-396837.html)

Weakened

Immune

System

On initial exposure to an allergen, the immune system stimulates B

cells that then synthesize IgE. The IgE migrates through the body and

inserts into Mast cells. Upon second exposure, the allergen binds to

the IgE, causes the Mast cells to degranulate and dump a collection

of substances called the mediators of inflammation. The ensuant


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reaction can be violent and life-threatening. So the immune system

recognizes self-proteins and begins to attack the body's own tissues,

setting the stage for autoimmune diseases.

(http://www.microbiologytext.com/index.php?)

Age 5y.o

and below

No one really knows the exact reasons why more and more children

are developing asthma. Some experts suggest that children spend

too much time indoors and are exposed to more and more dust, air

pollution, and secondhand smoke. Some suspect that children are not

exposed to enough childhood illnesses to direct the attention of their

immune system to bacteria and viruses.

Gender According to theAsthma and Allergy Foundation of America, asthmais more common in male children than it is in female children.However, in adults, asthma tends to be more common in women thanin men.


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Precipi-

tating

Factors

Actual

findings

Implications

Allergen

(dust)

Allergens or infections elicit an infectious reaction of the bronchial

mucous membrane. In allergic asthma, an IgE-induced reaction of the

immediate type (Type 1 reaction) occurs immediately after inhalation of

the allergen. The mast cells in the mucous membrane degranulate and

thereby release inflammation mediators like histamine, ECF-A,

bradykinin and leukotrienes ("immediate reaction")

(http://www.flexikon.com/Bronchial_asthma#2._Bronchial_hyperreactivit

y)

Respira-

tory

Infection

An unspecific bronchial hyperreactivity can be detected in almost all

asthmatics. In case of the inhalation of irritants, the hyperreactivity


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manifests as a very strong constriction of the bronchial tubes.

(http://www.flexikon.com/Bronchial_asthma#2._Bronchial_hyperreactivit

y)

Air

Pollution/

environm

ental

factors

Air pollution triggers inflammation and irritation of the bronchial tubes

leading to the lungs. The bronchial tubes swell up and create mucus,

making it hard to breathe, causing coughing and the wheezing sound

that is characteristic of an asthma attack.

(http://www.ehow.com/facts_5206854_air-pollution-causing-

asthma.html)

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