bronchial asthma: a case presentation

CASE PRESENTATION: BRONCHIAL ASTHMA

INTRODUCTION

A.BACKGROUND OF THE STUDY

Asthma is a chronic disease of the airways that causes airway hyperresponsiveness, mucosal edema and mucus production. This inflammation, ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing and dyspnea. (Medical-Surgical Health Nursing Volume 1 by Smeltzer and Bare page 587). It is a multifactorial disease process associated with genetic, allergic, environmental, infectious, emotional, and nutritional components. Because of their symptomatology the majority of individuals with asthma experience a significant number of missed work or school days. This can create a severe disruption in quality of life, often leading to depressive episodes. It also disrupts the lives of caregivers and family members of the affected individual. Asthma patients who have increased symptomatology at night (a significant portion) also tend to have disturbed sleep patterns and impaired daytime attention, concentration, and memory.B.RATIONALE FOR CHOOSING THE CASE

Most of our patient assignments have bronchial asthma. We choose the case of bronchial asthma because it would help us to have a focus study regarding this case—more nursing care would be given. Added to that, we choose the client because of the fact that she is cooperative in the sense that she always try to answer the questions asked in her full knowledge and try to verbalize anything that she wants to say. Moreover, other patients without asthma were may go home (MGH) and was given discharge teaching by student nurses according to their respective cases

C.LEARNING OBJECTIVES

(1) To explore patient’s past health history prior to bronchial asthma

(2) To review the body system involve in bronchial asthma (anatomy and physiology)

(3) To review the disordered function of the body related to bronchial asthma (pathophysiology)

(4) To review the laboratory results and compare it to normal and the implication of the abnormal

(5) To make a list of nursing problems(6) To prioritize listed nursing problems(7) To make Nursing Care Plan for prioritized problem(8) To make a health teaching to the client and other potential

candidates regarding about bronchial asthma

I. CLINICAL SUMMARY

A.GENERAL DATA

Name: B.V. y BAge: 56 years oldBirth date: May 9, 1950Birth place: Samar, LeyteSex: FemaleReligion: Roman CatholicCivil Status: MarriedAddress: K.V. D.DOccupation: vendorRoom & bed #: Female Medical Ward 364BDate Admitted: November 15, 2006Time Admitted: 11:15 pm

B.CHIEF COMPLAINT

The chief complaint of the patient is difficulty of breathing

HISTORY OF PRESENT ILLNESS

A few days prior to admission, the client has on and off difficulty of breathing (DOB). She added, “Bago ako isugod dito sa ospital, nakalanghap ako noon ng pamatay ng ipis tapos sa bahay nag-insenso sila kaya inatake ako ng asthma ko. Nanikip na ang dibdib ko tapos ayun na, sinugod na nila ako dito”

When asked about her medication whenever she has an asthma attack, she verbalized, “Kapag inaatake ako ng asthma, salbutamol lang ang iniinom ko tapos nawawala naman pagkatapos.”

The client was admitted at President Diosdado Macapagal Memorial Medical Center last November 15, 2006 around 11: 15 in the evening

According to the client’s medical history, asides from bronchial asthma, she also has hypertension

C.PAST MEDICAL HISTORY

1. Childhood Illnesses--The client verbalized that she had experienced having

measles, small pox, diphtheria and asthma during his childhood days

2. Immunizations--According to the client, she had completed her childhood

immunizations.

3. Allergies--The client stated that whenever she smells and inhales

pollutants and fume of insecticides, her asthma is triggered. She added that when she inhales these allergens, she has chest tightness at dyspnea.

4. Accidents--According to the client she doesn’t have any accidents

encountered

5. Hospitalization

--According to the client, she never been hospitalized but she consulted health center when her asthma attacked.

6. Medicines --Her medicine is salbutamol

7. Foreign Travel--According to the client she doesn’t have travels outside the

country.

8. General Health Status> Adolescent

--The client verbalized “Bata pa lang ako may asthma na ako. Ginagamot naman ng salbutamol kaya kahit papano ayos ayos na. Tapos nawala rin siya.” > Adulthood

-- The client verbalized “Matagal din ang panahon bago ako inatake ulit ng asthma. Ngayon na nga lang ulit sumumponmg ng ganitong katindi ang asthma ko. Bago kasi ako isugod dito sa ospital, nakalanghap ako ng pamatay sa ipis tapos sa bahay, nag-insenso sila kaya intake ako ng asthma ko. Siguro isama na rin natin na pagod din ako. Tapos nanikip na ang dibdib ko tapos sinugod na nila ako dito sa ospital.”

9. Operation--According to the client, she doesn’t gone any operations

D.FAMILIAL HISTORY

--According to the client, they have family history of Bronchial Asthma in her father’s side

E. PHYSICAL ASSESSMENT

GENERAL APPEARANCE

NORMS ACTUAL FINDINGS

INTERPRETATION AND ANALYSIS

1. Posture/Gait

Relaxed, erect posture; coordinated movement(pg. 531, Fundamentals of Nursing by Kozier, 7th edition)Older adults (middle age) assume a stooped forward bent posture, hips and knees are some what flexed. Arms are raised because arms are bent at the elbow. A person normally walks with arms swinging freely at the sides with head and face leading the body (pg. 519, Fundamentals of Nursing by Potter and Perry)

Slouched/bent posture

Interpretation: Not normalAnalysis:This observation is most seen with dyspnea, advance chronic lung disease and air trapping, acute and chronic (Luckmann and Sorensen Medical-Surgical Nursing, pg. 650)Slouched posture and a slow shuffling gait suggested depression or physical discomfort(Fundamentals of Nursing, 7th edition, Barbara Kozier, pg 425)

2. Skin Color Healthy appearance

Pallor; weakness;

Interpretation: Not normal

GENERAL APPEARANCE



Skin color may be pink, tan, brown, olive or yellowish depends on the race. With a normal supply of oxygen, the nail beds, the tongue and the lips appear pinkish-red in color(Fundamentals of Nursing, 7th edition, Barbara Kozier, pg 538)

obvious illness Analysis:Skin color and temperature particularly that of the lips and nail beds. The color of the lips and nail beds is an indicator of tissue perfusion (passage of blood through the vessels) Pale, cyanotic, cool and moist skin may be a sign of circulatory problems (pg. 914, Fundamentals of Nursing by Kozier. 7th edition). The color and appearance of the skin and nails may reflect insufficient delivery of oxygenated blood to the tissue because of respiratory dysfunction (pg. 419, Fundamentals of Nursing by

GENERAL APPEARANCE



Craven and Hirnle, 4th edition)

3. Personal Hygiene/ Grooming

Clean, neat No foul body odor, neat

Interpretation: NormalAnalysis:Personal hygiene is the self care by which people attend to such functions as bathing, toileting, general body hygiene, and grooming. Hygiene is highly personal matter determined by individual values and practices. It involves care of the skin, hair, nails, teeth, oral and nasal cavities, eyes, ears, and perineal-genital areas (pg. 698, Fundamentals of Nursing by Kozier, 7th edition)Hygiene is the observance of health rules relating to these

GENERAL APPEARANCE



self-care activities (pg. 704, Fundamentals of Nursing by Craven and Hirnle, 4th edition)

4. Nutritional Status

The state of nutrition is often reflected in a person’s appearance. Although the most obvious physical sign of good nutrition is a normal body weight with to respect to height, body frame, and age, other tissues can serve as indicators of good nutritional status and adequate intake of specific nutrients; these include the hair, skin, teeth, gums, mucous membranes, mouth and tongue, skeletal

Malnourished; general appearance is listless, appears acutely or chronically ill

Interpretation: Not NormalAnalysis: Loss of weight may be generalized as a result of inadequate caloric intake or may be seen in loss of muscle mass with disorders that affect protein synthesis. (pg. 68)Nutritional problems in the elderly often occur or are precipitated by such illnesses as pneumonia and urinary tract infections. Acute and chronic diseases may affect the

GENERAL APPEARANCE



muscles, abdomen, lower extremities, and thyroid gland.General appearance is alert and responsive (pg. 71-72, Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Volume 1, 10th edition by Smeltzer and Bare)

metabolism and utilization of nutrients, which already are altered by the aging process (pg. 75) (Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Volume 1, 10th edition by Smeltzer and Bare)

5. Age Appropriateness

Adulthood ages ranges from 25 to 66 years. According to Erik Erikson’s Theory, the central task is generativity versus stagnation. The indicators of positive resolution are creativity, productivity and concern for others. The indicators of negative resolution are

The age of the client is 56 years old. As a middle adult, she has concern with others, talks with the patients in the same ward

Interpretation: NormalAnalysis:Erikson believes that the greater the task achievement, the healthier the personality of the person(Fundamentals of Nursing, 7th edition, Barbara Kozier, pg 357)

GENERAL APPEARANCE



self-indulgence, self-concern, lack of interests and commitments. (Fundamentals of Nursing, 7th edition, Barbara Kozier, pg 357)

6. Verbal Behavior

Understandable, moderate pace; exhibition of thought association; logical sequence; make sense; has sense of reality(Fundamentals of Nursing, 7th edition, Barbara Kozier, pg 531)

The client has logical sequence of though, has a sense of reality and able to understand

Interpretation: NormalAnalysis:Verbal communication is largely conscious because people choose the words they use. The words use varies among individuals according to culture, socioeconomic background, age and education. Countless possibilities exist for the way ideas are exchanged. An abundance of words can be used to form messages (pg. 423, Fundamentals of

GENERAL APPEARANCE



Nursing by Kozier, 7th edition)

7. Non-verbal behavior

No distress noted in facial expression; the client’s affect/mood is appropriate to situation

The client’s affect/mood is appropriate in the situation.

Interpretation: NormalAnalysis:Nonverbal communication includes gestures, body movement, use of touch and physical appearance, adornment. Nonverbal behavior is controlled less consciously than verbal behavior

MEASUREMEN

TS



Temperature Normal adult temperature axillary: 35.8° C to 37.0° C(pg. 444, Fundamentals of Nursing by Craven and Hirnle, 4th edition)

As of November 20 20068:00pm 36.5° C

Interpretation: NormalAnalysis:Normal adult temperature ranges from 35.8° C to 37.0° C. it is not uncommon for adult/elderly persons to have body temperature less than 36.4° C because normal temperature drops as persons ages. (pg. 414-415, Fundamentals of Nursing by Craven and Hirnle, 3rd edition)

Pulse Rate The normal pulse rate of an adult: 60-100 beats per minute (pg. 485, Fundamentals of Nursing by Kozier, 7th edition)

8:00pm 80 beats per minute

Interpretation: NormalAnalysis:The normal range of the pulse in an adult is 60 to 100 beats per minute (p. 424, fundamentals of Nursing by Craven and Hirnle, 3rd

MEASUREMEN

TS



edition). As the age increases, the pulse rate gradually decrease (p. 496, Fundamentals of Nursing by Kozier, 7th edition)

Respiratory Rate

The normal respiratory rate of an adult: 12-20 breaths per minute (pg. 444, Fundamentals of Nursing by Craven and Hirnle, 4th edition)

8:00pm 21 breaths per minute

Interpretation: Not NormalAnalysis:Normal breathing is automatic and involuntary. At rest, the normal adult respiratory rate is 12 to 20 breaths per minute. Respiratory rate changes with age. Tachypnea is an abnormally fast respiratory rate (usually above 20 breaths per minute in adult)

Blood Pressure

Systolic Diastolic90-140 60-

90(pg. 444, Fundamentals of Nursing by Craven and

8:00pm 130/70 mmHg

Interpretation: NormalAnalysis:In adults, the trend is toward gradually increasing systolic and diastolic

MEASUREMEN

TS



Hirnle, 4th edition)

blood pressure with aging. In part, this trend is due to increased systematic vascular resistance, reflecting arterial narrowing and decreased vessel elasticity due to atherosclerotic vessel disease. The increase in systolic pressure is proportionally greater than the increase in diastolic pressure(pg. 463, Fundamentals of Nursing by Craven and Hirnle, 4th edition)

BODY PARTS



Skin Varies from light to deep brown; from ruddy pink; from yellow overtones to olive(pg. 538, Fundamentals of Nursing by

Pallor Interpretation: Not NormalAnalysis: Pallor is the result of inadequate circulating blood or hemoglobin and subsequent reduction in tissue

BODY PARTS



Kozier, 7th edition)

oxygenation (pg. 535, Fundamentals of Nursing by Kozier, 7th edition)

Mouth/ Oral Cavity

Lips

-Uniform pink color-Soft, moist, smooth texture-Symmetry of contour-Ability to purse lips(Fundamentals in Nursing, Barbara Kozier, pg. 563)

- lips has visible margins- symmetrical - pale in color- no edema

Interpretation: Not NormalAnalysis:Pallor is the result of inadequate circulating blood or hemoglobin and subsequent reduction in tissue oxygenation (pg. 535, Fundamentals of Nursing by Kozier, 7th edition)

ThoraxAnterior Thorax

-Quite rhythmic and effortless respirations(Fundamentals in Nursing, Barbara Kozier, pg. 578)

-tachypnea-wheezes at right lung field

Interpretation: Not NormalAnalysis:Dyspnea is a sign of serious disease of the airway, lungs, or heart. (www.medterms.com)Tachypnea may be necessary for a sufficient gas-exchange of the body

BODY PARTS



(www.wrongdiagnosis.com)Possible cause of air passing through a constricted bronchus as a result of secretion, swelling or tumor (Fundamentals in Nursing, Barbara Kozier, pg. 575)

F. PATTERNS OF FUNCTIONING

I. Psychological Health

1. Coping Pattern According to the client, whenever she has problems, solving it

right away is the solution. “Gusto ko kasi kapag may problema ako nilulutas ko na kaagad hindi pinatatagal pa”

ANALYSIS: Coping maybe described as dealing with problems and situations, or contending with them successfully. Coping strategies varies among individuals and are often related to the individual’s perception of stressful events. A person’s coping strategies often change with a reappraisal of a situation. (Fundamentals of Nursing by B. Kozier, 7th edition, p 1020) INTERPRETATION: Effective Coping Pattern

2. Interaction PatternAccording to the client, they are six in the family—she, her

husband and 4 siblings. Their relationship, she described, is harmonious. If there are problems in the family, they solve it all together and they communicate well to each of the family members.

ANALYSIS: Interaction patterns involve ways of expressing affection, love, sorrow, anger and other feelings and thought in most significant family in person and life. Openness of communication with all family members develops the family’s ability to function as a cooperative, growth producing unit. (Fundamentals of Nursing by B. Kozier, 7th edition, p 671)

INTERPRETATION: Effective Interaction Pattern

3. Cognitive PatternThe highest formal education of the client was 2nd year high

school. She stated that she has short term memory gap. She verbalized “Madali akong makalimot. Minsan sasabihin ko na lang makakalimutan ko pa. Matanda na kasi. Pero mabilis naman ako maka pick up kapag tiuturuan ako”

ANALYSIS: Changes in the cognitive function of middle adults are rare except with trauma or illness. The middle aged adults are able to continue learning new skills and can reflect on the past and current experience and can imagine, anticipate, plan and hope. (Fundamentals of Nursing by Potter and Perry, 3rd edition, Vol.1 p 821)INTERPRETATION: Proper cognitive pattern

4. Self ConceptThe client verbalized “Matagal din bago ako intake ulit ng

asthma ko. Ngayon may asthma na ako ulit, limitado na ang galaw ko kasi mahirap na baka umatake ulit at lumala.” She also added that after discharge, she will continue her work as a vendor, “Pero siyempre hindi na ako dapat tulad ng dati kasi nga may limitasyon na.”

ANALYSIS: Self concept is an individual’s perception of self. It includes self esteem (an individual’s perception of self worth) and body image (perception of physical self). Self concept influences individual’s health behaviors in that people think highly themselves will tend to take care of themselves. On the other hand, a person with a negative self concept will engage in reckless or self destructive behaviors that endanger health. Persons with a low self concept frequently ignore their own

needs because they are perceived to be less important than the needs of other people. (Nursing Fundamentals by R. Daniels p 854)INTERPRETATION: Healthy Self Concept

5. Emotional PatternAccording to the client she is bored upon hospitalization but it

somehow relieved by visitations of her relatives and talking to the other patients in the ward.

ANALYSIS: Cooperative or friendly, expressive feelings appropriate to the situation, verbalizes positive things regarding others and the future. Express positive coping mechanism. (Nurses Handbook of Health Assessment, Janet Weber, pg. 513) Emotional states such as depression and anger affect a client’s perception and degree of risk taking behavior. These emotional states alter a client’s thinking pattern and reaction time (Nursing Fundamentals by R. Daniels p 874)INTERPRETATION: Effective Emotional Pattern

6. Family Coping PatternsThe client verbalized that if there are any misunderstandings,

her family talks it over and the last word will be coming from the head of the family, her husband. When there are sick family members, they see to it that they attended the need of the sick member.

ANALYSIS: Family coping mechanisms are the behaviors families use to deal with stress or changes imposed from either within or without. (Fundamentals of Nursing by B. Kozier, 7th edition, p 193) Because chronic illness lasts longer than acute illness, it can influence the family to a greater extent. People with chronically ill children, parents, or other family members may express negative feelings about themselves such as guilt, inadequacy, failure, rejection and helplessness. The family may be in denial initially as members struggle with the shock of the illness. (Fundamentals of Nursing by Craven and Hirnle, 4th

edition, p 1282)INTERPRETATION: Effective Family Coping Pattern

II. Socio Cultural Health

1. Cultural patternAccording to the client, the social values she was brought up

to were respect, sense of responsibility, fear of God. The traditions in her family are Christmas, Birthday, New Year and Holy week.

ANALYSIS: The value placed on children and elders within a society is culturally derived. (Fundamentals of Nursing by Craven and Hirnle, 4th edition, p212) The family passes on patterns of daily living and lifestyles to offspring. Cultural rules, values, and beliefs give people a sense of being stable and able to predict others (Fundamentals of Nursing by Kozier, 7th edition p 178)INTERPRETATION: Proper Cultural Pattern

2. Significant relationshipAccording to the client, her family is the significant persons in

her life. They have harmonious relationship with her family and relatives

ANALYSIS: Family influences on health care because health is defined uniquely by each client’s culture. Family is often major care givers of their relatives. Lack of social support from family or significant others results in psychological and spiritual isolation, which negatively impacts a person’s physiological state. Thus, it is important to help clients identify, strengthen, and use their social support systems. Sometimes, families need guidance to optimize health behaviors. (Nursing Fundamentals by R. Daniels p849-851)INTERPRETATION: Effective Significant Relationship

3. Recreational PatternThe client verbalized “Kapag wala akong trabaho, nood lang

ako ng TV o kaya naman naglilinis ng bahay. Iyan lang naman ang kadalasang ginagawa ko kapag nasa bahay ako. Minsan nakikipagkwentuhan sa mga kapitbahay.”

ANALYSIS: Leisure time is important for normal social development and adjustment (Nursing assessment and Health Promotion by Murray and Zentner, 5th edition, p 386)INTERPRETATION: Proper Recreational Pattern

4. EnvironmentThe client verbalized, “Sa bahay kasi naninigarilyo din ang

asawa ko.” She also added “Kasi ugali na kasi ng anak kong babae na maglagay ng insenso sa altar kapag gabi, di ko lang pinapansin pero nitong nakaraan kapag naaamoy ko yung usok medyo nahihrapan akong huminga tapos kapag nangyari iyon, iinom ako ng gamot.”

ANALYSIS: A safe environment is one which people can function safely and in one in which they obtain a sense of security. (Fundamentals of Nursing by Kozier, 7th edition p 480)INTERPRETATION: Poor Environment

5. EconomicAccording to the client when she was still strong, she was

working. She worked as a vendor. “Sapat naman ang kinikita naming mag-asawa. Nakakakain naman kami 3 beses isang araw at saka ngayong may sakit ako, nakakabili naman kami ng gamot na kailangan ko.”

ANALYSIS: Financial resources increase the ability to provide the necessary commodities for health and well being. (Nursing Fundamentals by R. Daniels p 855)INTERPRETATION: Adequate Economic Finances

III. SPIRITUAL PATTERN

1. Religious beliefs and practicesAccording to the client, praying is her religious practice since

she is at the hospital.

ANALYSIS: In middle age, people tend to be less dogmatic about religious beliefs and religion often offers more comfort to the middle aged person than it did previously. People in this age group often relies on spiritual beliefs to help them deal with illness, death and tragedy (Fundamentals of Nursing by Kozier, 7th edition p 400)INTERPRETATION: Proper practice of religious beliefs

2. Values and valuingAccording to the client God and family are the most important

persons in her life.

ANALYSIS: Values can be described as the outcome of an individual‘s effort to apply universal moral laws to his everyday life. Values are more personal, and provide meaning and direction. (Fundamentals of Nursing practice by Narrow and Buschle, 2nd edition p 84)INTERPRETATION: Proper valuing

G.ACTIVITIES OF DAILY LIVING

ACTIVITIES OF DAILY LIVING

BEFORE HOSPITALIZATION

DURING HOSPITALIZATIO

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Nutrition The client verbalized, “Kadalasan isda at gulay ang kinakain namin. Minsan may karne din.” She also added that she eats 3 meals per day and drinks 7 to 8 glasses everyday

The client verbalized, “Kung ano ung binibigay na pagkain dito sa hospital, un ang kinakain ko pero di ko rin nauubos. Sabi ng doktor bawal sa akin ung mga gatas at itlog kasi makati iyon.” She also added that she drinks 1.5 liters of water everyday.

Interpretation: NormalAnalysis:The middle-aged adult should continue to eat a healthy diet, following the recommended portions of the five food groups with special attention to protein, calcium and limiting cholesterol and caloric intake. Two or three liters of fluid should be included in the daily diet. During the late middle age, they may determine that certain foods disagree with them. Clients should be advised to develop sensible eating habits and avoid fried or fatty foods (p. 1181,




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Fundamentals of Nursing by Kozier, 7th edition) Allergies induced by a hypersensitiveness of the individual. Allergies reaction is a process that is injuries and renders the individuals sensitivity to the antigens. (p.492, Williams, Jesse F. 1950. Personal Hygiene Applied,)

Elimination The client verbalized that she defecates and urinates regularly and there is no burning or foul smell in her urine. She also added that she doesn’t take any medications to increase her bowel movement

The client verbalized that she urinates 3 times to 6 times a day and defecates 2 times a day. She also verbalized, “Buo naman ang dumi ko.”

Interpretation: NormalAnalysis:Elimination from the urinary and intestinal tracts is essential to rid the body of wastes and materials in excess of bodily needs. Healthy adults excrete 1200ml-1700ml of urine in each 24 hour period. However, this amount may vary, depending on




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several factors. Regular elimination of bowel wastes products is essential for normal body functioning. Because bowel function depends on the balance of several factors, elimination pattern and habits vary among individuals (p. 356 and p. 366, Fundamentals of Nursing by Eliner V. Fuerst & p. 1437, Fundamentals of Nursing by Potter and Perry, 5th edition)The normal color of the stool is brown, formed soft, and semi-solid, moist, in consistency, cylindrical in shape. (Fundamentals of Nursing by Kozier, page 1227)




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Exercise and Physical Activities

The client verbalized that walking and working is her form of exercise

The client verbalized, “Wala ako masyadong exercise dito kasi lagi lang ako dito sa higaan. Minsan naglalakad ako kapag papunta ng CR. Stretching lang minsan ang ginagawa ko”

Interpretation: NormalAnalysis:For exercise to be effective. It should be regular and sustained. Generally, exercising at least thrice a week is advised. (p. 104, Fundamentals of Nursing by Kozier). Limitations to movement may be medically prescribed for some health problems (p. 1067, Fundamentals of Nursing by Kozier, 7th edition) Many middle-aged adults may not include exercise in their lifestyle because many of the activities or routine chores that provided exercise in the past have been stream lined by




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modern devices that save time and require little if any energy.(Fundamentals of Nursing by Kozier , p 635)

Hygiene The client verbalized that she takes a bath everyday, brush her teeth twice a day.

She has sponge baths everyday and brushes her teeth twice a day. The client verbalized “Kaya ko naman punasan ang sarili ko pero nagpapatulong din ako sa anak ko.”

Interpretation: NormalAnalysis:Behaviors of mankind that produce improve and maintain health and that protects and defends health or prevent diseases are the forced and persuaded practices of hygiene. (p. 3, Principles of Hygiene by Thomas Storey, 1935) bathing provides relaxation and comfort and it gives most people a sense of well being (p. 704, Fundamentals of Nursing by Craven and Hirnle, 4th




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edition) Cleaning baths are given chiefly for hygiene purposes (p. 705, Fundamentals of Nursing by Kozier, 7th edition) Proper diet and tooth and mouth care should be evaluated and reinforced to adolescents and adults. Thorough brushing of the teeth is important in preventing tooth decay (p. 726, Fundamentals of Nursing by Kozier, 7th edition)

Substance Abuse

The client verbalized that she is an occasional smoker but stopped for ten years. She also drinks alcohol 2 to 3 times a week consuming only 1 bottle.

She don’t drink alcoholic beverages and don’t smoke

Interpretation: NormalAnalysis:Drugs or substance use is appropriately taken as prescribed or generally recommended as its intended physiological or psychological effects.




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(Fundamentals of Nursing by Potter and Perry pg. 1574)

Sleep and Rest

The client verbalized that she sleeps 4 to 5 hours. “Vendor kasi ako kaya minsan puyat o kaya naman kulang sa tulog pero nababawi ko rin kapag wala ako masyado ginagawa sa bahay.”

The client verbalized, “Nakakatulog naman ako ng mataga-tagal. Nagigising ako minsan tuwing gabi pero nakakatulog din naman ako kaagad

Interpretation: NormalAnalysis: Sleep requirements and patterns vary with individual and change with age (Community Health Nursing by Stantope and Lancaster p. 607). Middle aged adult generally maintain sleep pattern established at younger age. They usually sleep 6 to 8 hours per night (Fundamentals of Nursing by Kozier, 7th edition, p. 1116)

H.PATIENT’S CONCEPT OF HEALTH, ILLNESS AND HOSPITALIZATION

The ideal health status is one in which people are successful in achieving their full potential regardless of any limitations they might have. The person with a chronic illness or disability may still be able to achieve a desirable level of wellness. The key to wellness is to function at the highest potential within the limitations over which there is no control.

The client views her role as a sick person as a vulnerable person who seek help and proper care. She expects support and proper care management and calmness to those people who care for her. She said that her illness should be treated with the help of medicines and proper care management. She wants to know the things that are necessary for her and health promotion. She also verbalized, “Alam ko naman na may asthma ako kasi simula pa bata ako meron na ako noon. Mahirap nga lang kasi ngayon limitado na ang gagawin ko kasi baka atakihin ulit ako. Marami na namang bawal.”

Her hospitalization now at Pres. Diosdado Macapagal Memorial Medical Center is her major hospitalization because she’s been staying there for almost a week and her past check ups in health center are not a form of hospitalization.

ANALYSIS: The patients expect the nurse to be thoughtful, understanding and accepting of him. Patients are critical of behavior that is primitive or judgmental. He expects the nurse to orient him in the health agency. Nearby everyone is afraid of the unknown and to be left alone without orientation can be a frightening experience. He also expects the nurse to provide an explanation of his care. Health practitioners who ignore this aspect of care are often referred to as cruel and unkind (Fundamentals of Nursing, 7th edition, pp. 277-278)

I. LABORATORY AND DIAGNOSTIC EXAMINATION

DIAGNOSTIC EXAM

NORMS ACTUAL RESULTS


Urinalysis Reference ValuesColor: light straw to dark amberAppearance: clearOdor: aromatic

Actual FindingsColor: YellowAppearance: slightly hazyOdor: aromaticpH: acidicSpecific

Interpretation: The urine color, appearance, pH and microscopic examination are considered not normal while the odor, specific gravity, protein and glucose are considered

DIAGNOSTIC EXAM



pH: 4.5-8.0Specific Gravity: 1.005-1.030Protein: 2-8 mg/dl; negative reagent strip test; traceGlucose: negativeKetones: negative(Handbook of Laboratory and Diagnostic Test with Nursing Inplication, 5th

edition, pg. 343)

Microscopic Examination:RBC: 0-2/high power fieldWBC: 0-5/high power fieldEpithelial cells: 0-5/high power field(Handbook of Diagnostic Test, 3rd edition, pg. 329)

Gravity: 1.015Protein: traceGlucose: negativeMicroscopic Examination:RBC: 2-3/hpfPus: 3-5/hpfEpithelial cells: manyMucus threads: lightBacteria: few

normal.Analysis:

Color of the urine changes can results from diet, drugs and many diseases (pg. 395, Diagnostic Test). Color is affected by concentration of urine. Tea colored urine is due to blood in the urine. Bright yellow urine may be secondary to vitamin intake. Dark yellow urine is a sure indicator that there is dehydrated indicated and that the fluid consumption must be increased. When water loose from the body exceeds water intake, the kidneys need to consume water making the urination more concentrated with waste products and subsequently dark in color. Yellow colored urine is possible of pyuria, and infection. (Medical Surgical Nursing by Bare and Smeltzer pg.1263) Turbid urine may contain red or white

DIAGNOSTIC EXAM



cells, bacteria, fat or chyle and may reflect renal infection (pg. 395, Diagnostic Test, 2004 by Lippincott Williams and Wilkins). Urine turbidity may result from urinary tract infections (pg. 180, A Manual of Laboratory and Diagnostic Test, 7th edition). A normal pH is 7. A pH < 7 indicates acid urine and > 7 indicates alkaline urine. Acid urine ph is associated with renal tuberculosis, pyrexia, phenylketonuria, alkaptonuria and acidosis. (Diagnostic Tests, A Prescriber’s Guide to Selection and Interpretation by Lippincott Williams and Wilkins, p.395) Due to carbohydrate malabsorption, fat malabsorption and disaccharides deficiency. (A Manual of Laboratory and Diagnostic Tests, 7th edition by Lippincott William and Wilkins, p.279)Normally, freshly

DIAGNOSTIC EXAM



voided urine has a faint odor owing to the presence of volatile acids. It is not generally offensive. Fresh urine from most persons has a characteristic aromatic odor (pg. 396, Diagnostic Test). Specific gravity is an indication of the relative proportions of dissolved solid components to the total volume of the specimen and reflects the relative degree of concentration or dilution of the specimen. (www.intensivecaring.com) In a healthy renal and urinary tract system, urine contains no protein or only trace amount (pg. 191, A Manual of Laboratory and Diagnostic Test). Sugar, usually absent from the urine, may appear under normal conditions (pg. 329, Handbook of Diagnostic Test, 3rd edition)

Red blood cells in the urine can be due to vigorous exercise or

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http://www.intensivecaring.com/

DIAGNOSTIC EXAM



exposure to toxic chemicals. Bloody urine can also be a sign of bleeding in the genitourinary tract as a result of systemic bleeding disorders, various kidney diseases, bacterial infections, parasitic infections including malaria, obstructions in the urinary tract, scurvy, subacute bacterial endocarditis, traumatic injuries, and tumors.

A high number of white blood cells in the urine is usually a symptom of urinary tract infection. A large number of cells from tissue lining (epithelial cells) can indicate damage to the small tubes that carry material into and out of the kidneys. (www.healthatoz.com)

Hematology Reference Values:Neutrophils: 0.40-0.60Lymphocytes: 0.20-0.40

Actual Findings:Neutrophils: 0.79Lymphocytes: 0.13

Interpretation: Not normalAnalysis:

Increase in Neutrophils: severe bacterial disease,

DIAGNOSTIC EXAM



(Diagnostic Testing and Nursing Implications, 4th edition)

diabetic acidosis, infarctions, increase in acute, severe inflammation, malignancies (Diagnostic Testing and Nursing Implications, 4th edition) Decreased in Lymphocytes: indicates lymphopenia.(Medical Surgical Nursing by Bare and Smeltzer pg. 876)Possible cause of sepsis and immunodeficiency disease.(Fundamentals of Nursing by Kozier pg. 759)

J. IMPRESSION/DIAGNOSIS

The admitting diagnosis is Bronchial Asthma in Acute Exacerbation

K.COURSE IN THE WARD

The patient was admitted in Female Medical Ward 364 bed letter B. She has intravenous fluid (Balanced Multiple Maintenance Solution 5% Dextrose) hooked, laboratory works up done (urinalysis, hematology and radiological report). She was given salbutamol as nebulizer and Cefuroxime Sodium as antibiotics

II.CLINICAL DISCUSSION OF THE DISEASE

A.ECOLOGIC MODEL

Host(susceptible host)

Environment: Exposure to indoor

and outdoor

Agent:(Allergens)

(1) HypothesisThere are many unanswered questions about the role of host factors in disease. A potentially harmful change in any of the components of the system may not lead to detectable diseases.

(2) Predisposing FactorsA. Host

a. Age: 54 years oldb. Sex: Femalec. Race: Asiand. Nationality: Filipino e. Behaviors: f. Heredity: they have family history of Bronchial Asthma in her father’s side

B. Agent Allergens—pollutants and fume of insecticides

C. EnvironmentPhysical: exposure and inhalation of pollutants and fume of insecticides; exposure to smoke from cigarette

B. Ecologic Model

The Epidemiological Triangle

Analysis

In medicine, we focus on the human and the forces within him and within the environment that influence his state of health. From this viewpoint, the human is the host organism; other organisms are considered only as they relate to human health. However, the organism alone is not sufficient to account for the outbreak and cannot therefore be considered “the cause”. An additional set of factors, environmental conditions, also determine whether effective transmission of disease can occur in any given situation. These factors include degree of contact, level of hygienic practices, and presence of other organisms.

When a factor must be present for a disease too occurs, it is called the agent of that disease. Many, but not all, of he known agents of disease are located in the biologic environment. In keeping with the ecological view presented above, an agent is considered to be a necessary but not sufficient cause of disease because suitable conditions of the host and environment must also be presented for disease to develop. It is customary to divide the factors affecting the development of disease into two groups, host factors (intrinsic) and factors in the environment (extrinsic). Host factors affect susceptibility to disease; factors in the environment influence exposure and sometimes indirectly affect susceptibility as well. The interactions of these two sets of factors determine whether or not disease develops. . (Mausner and Bahn Epidemiology—An Introductory Text by Judith Mausner and Shira Kramer, 2nd

edition pages 27-28)

Specific substances that cause allergic responses can affect respirations, sometime severely. The body attempts to rid itself of substances perceived as harmful by releasing chemical mediators that cause an inflammatory response. Substances that trigger an inflammatory response are called allergens. Almost any substance can be allergen: pollens, dust, and foods are common allergy triggers. The allergic response precipitates a series of events that lead to tissue damage.

Hay fever is the result of allergies confined to the nose and upper airways. Symptoms include dripping nose, itchy eyes and swollen mucous membrane; they are annoying and uncomfortable but not life-threatening. When allergic responses take place in the lungs, breathing difficulties are far more severe. Small airways became edematous, mucous production increases, and inflammatory chemical mediators cause bronchospasm. These are the hallmarks of common allergic asthma. Severe and uncontrolled allergic asthma can be fatal. (Fundamentals of Nursing by Craven and Hirnle, 4th

edition page 813)=Healthy people exposed to air pollution often experience

stinging of the eyes, headache, dizziness, coughing and choking. People who have a history of existing lung disease and altered respiratory function experience varying degrees of respiratory difficulty in a polluted environment. Some are unable to perform self-care in such an environment. (Fundamentals of Nursing by Kozier, 7th edition page 1295-1296)

C. Conclusion and RecommendationsReducing exposure to allergens that can trigger

bronchoconstriction and inflammation is an important preventive measure. Nurses can be instrumental in working with the client and family to identify individual asthma triggers and motivate the family to restructure the environment to limit allergen exposure. (Fundamentals of Nursing by Craven and Hirnle, 4th edition page 826)

L. ANATOMY AND PHYSIOLOGY

The respiratory system is situated in the thorax, and 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 respiratory system is an intricate arrangement of spaces and passageways that conduct air from outside the body into the lungs and finally into the blood as well as expelling waste

gasses. This system is responsible for the mechanical process called breathing, with the average adult breathing about 12 to 20 times per minute.

When engaged in strenuous activities, the rate and depth of breathing increases in order to handle the increased concentrations of carbon dioxide in the blood. Breathing is typically an involuntary process, but can be consciously stimulated or inhibited as in holding your breath.

Nostrils/Nasal Cavities During inhalation, air enters the nostrils and passes into the

nasal cavities where foreign bodies are removed, the air is heated and moisturized before it is brought further into the body. It is this part of the body that houses our sense of smell. Sinuses

The sinuses are small cavities that are lined with mucous membrane within the bones of the skull. Pharynx

The pharynx or throat carries foods and liquids into the digestive tract and also carries air into the respiratory tract. Larynx

The larynx or voice box is located between the pharynx and trachea. It is the location of the Adam's apple, which in reality is the thyroid gland and houses the vocal cords. Trachea

The chest and conducts air between the larynx and the lungs. Lungs

The lungs are the organ in which the exchange of gasses takes place. The lungs are made up of extremely thin and delicate tissues. At the lungs, the bronchi subdivides, becoming progressively smaller as they branch through the lung tissue, until they reach the tiny air sacks of the lungs called the alveoli. It is at the alveoli that gasses enter and leave the blood stream. The lungs are divided into lobes; The left lung is composed of the upper lobe, the lower lobe and the lingula (a small remnant next to the apex of the heart), the right lung is composed of the upper, the middle and the lower lobes.Bronchi

The trachea divides into two parts called the bronchi, which enter the lungs. Bronchioles

The bronchi subdivide creating a network of smaller branches, with the smallest one being the bronchioles. There are more than one million bronchioles in each lung. Alveoli

The alveoli are tiny air sacks that are enveloped in a network of capillaries. It is here that the air we breathe is diffused into the blood, and waste gasses are returned for elimination.

M. PATHOPHYSIOLOGY/SCHEMATIC DIAGRAM OF THE DISEASE

The underlying pathology of asthma is reversible and diffuse airway inflammation. The inflammation leads to obstruction from the following: swelling of the membranes that line the airways (mucosal edema), reducing the airway diameter; contraction of the bronchial smooth muscle that encircles the airways (bronchospasm), causing further narrowing; and increased mucus production, which diminishes airway size and may entirely plug the bronchi.

The bronchial muscles and mucus glands enlarge; thick tenacious sputum is produced; and the alveoli hyperinflate. Some patients may have airway subbasement membrane fibrosis. This is called airway “remodeling” and occurs in response to chronic inflammation. The fibrotic changes in the airway lead to airway narrowing and potentially irreversible airflow limitation.

Cells that play a key role in the inflammation of asthma are mast cells, Neutrophils, eosinophils, and lymphocytes. Mast cells, when activated, release several chemicals called mediators. These chemicals, which include histamine, bradykinin, prostaglandins and leukotrienes, perpetuate the inflammatory response, causing increased blood flow, vasoconstriction, fluid leak from vasculature, attraction of white blood cells to the area and bronchoconstriction. Regulation of these chemicals is the aim of much of the current research regarding pharmacologic therapy for asthma.

Further, alpha- and beta2-adrenergic receptors of the sympathetic nervous system are located in the bronchi. When the alpha-adrenergic receptors are stimulated, bronchoconstriction occurs; when the beta2-adrenergic receptors are stimulated, bronchodilation results. The balance between alpha and beta2 receptors is controlled primarily by cyclic adenosine monophosphate (cAMP). Alpha-adrenergic receptor stimulation results in a decrease in cAMP, which leads to an increase of chemical mediators released by the mast cells and bronchoconstriction. Beta2-receptor stimulation results in increased levels of cAMP, which inhibits the release of chemical

mediators and causes bronchodilation. (Medical-Surgical Nursing Volume 1 by Smeltzer and Bare page 588)

Figure 1-1 Pathophysiology of Asthma

Predisposing FactorsAtopyFemale Gender

Causal FactorsExposure to indoor and outdoor allergensOccupational sensitizers

Contributing Factors Respiratory infectionsAir pollutionActive/passive smokingOther (diet, small size at birth)

Inflammation

Hyperrensponsiveness of airways

Airflow limitation

Risk Factors for exacerbationsAllergensRespiratory infectionsExercise and hyperventilationWeather changesExposure to sulfur dioxideExposure to food, additives, medications

SymptomsWheezingCoughDyspneaChest tightness

N.DRUG STUDY

GENERIC NAME

ACTION BRAND NAME

CLASSIFICATION INDICATION CONTRAINDICA

TIONS

SIDE EFFECTS/ ADVERSE

REACTIONS

NURSING RESPONSIBILITY

ALBUTEROL Synthetic sympathomimetic amine and moderately selective beta2-adrenergic agonist with comparatively long action. Acts more prominently on beta2 receptors (particularly smooth muscles of bronchi, uterus, and vascular supply to skeletal muscles) than on beta1 (heart)

Salbutamol

autonomic nervous system agent; beta-adrenergic agonist (sympathomimetic); bronchodilator (respiratory smooth muscle relaxant)

To relieve bronchospasm associated with acute or chronic asthma, bronchitis, or other reversible obstructive airway diseases. Also used to prevent exercise-induced bronchospasm.

Pregnancy (category C), lactation. Use of oral syrup in children <2 y.

Body as a Whole: Hypersensitivity reaction. CNS: Tremor, anxiety, nervousness, restlessness, convulsions, weakness, headache, hallucinations. CV: Palpitation, hypertension, hypotension, bradycardia, reflex tachycardia. Special Senses: Blurred

Assessment & Drug Effects Monitor therapeutic effectiveness which is indicated by significant subjective improvement in pulmonary function within 60–90 min after drug administration. Monitor for: S&S of fine tremor in fingers, which may interfere with precision handwork; CNS stimulation, particularly in children 2–6 y, (hyperactivity, excitement, nervousness,

GENERIC NAME

ACTION BRAND NAME


TIONS


REACTIONS


receptors. Minimal or no effect on alpha-adrenergic receptors. Inhibits histamine release by mast cells.

vision, dilated pupils. GI: Nausea, vomiting. Other: Muscle cramps, hoarseness

insomnia), tachycardia, GI symptoms. Report promptly to physician. Lab tests: Periodic ABGs, pulmonary functions, and pulse oximetry. Consult physician about giving last albuterol dose several hours before bedtime, if drug-induced insomnia is a problem.

Patient & Family Education Review directions for correct use of medication and inhaler Avoid contact of inhalation drug with eyes. Do not

GENERIC NAME

ACTION BRAND NAME


TIONS


REACTIONS


increase number or frequency of inhalations without advice of physician. Notify physician if albuterol fails to provide relief because this can signify worsening of pulmonary function and a reevaluation of condition/therapy may be indicated. Note: Albuterol can cause dizziness or vertigo; take necessary precautions. Do not use OTC drugs without physician approval. Many medications (e.g., cold remedies) contain drugs

GENERIC NAME

ACTION BRAND NAME


TIONS


REACTIONS


that may intensify albuterol action.

CEFUROXIME SODIUM

Semisynthetic second-generation cephalosporin antibiotic with structure similar to that of the penicillins. Resistance against beta-lactamase-producing strains exceeds that of first generation cephalosporins. Antimicrobial spectrum of activity resembles that of cefonicid.

Kefurox, Zinacef

antiinfective; antibiotic; second-generation cephalosporin

Infections caused by susceptible organisms in the lower respiratory tract, urinary tract, skin, and skin structures; also used for treatment of meningitis, gonorrhea, and otitis media and for perioperative prophylaxis (e.g., open-heart surgery), early Lyme disease.

Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation

Body as a Whole: Thrombophlebitis (IV site); pain, burning, cellulitis (IM site); superinfections, positive Coombs' test. GI: Diarrhea, nausea, antibiotic-associated colitis. Skin: Rash, pruritus, urticaria. Urogenital: Increased serum creatinine and BUN, decreased

Assessment & Drug Effects Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor

GENERIC NAME

ACTION BRAND NAME


TIONS


REACTIONS


Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium. Partial cross-allergenicity between other beta-lactam antibiotics and cephalosporins has been reported.

creatinine clearance.

periodically BUN and creatinine clearance. Inspect IM and IV injection sites frequently for signs of phlebitis. Report onset of loose stools or diarrhea. Monitor for manifestations of hypersensitivity. Discontinue drug and report their appearance promptly. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

Patient & Family

GENERIC NAME

ACTION BRAND NAME


TIONS


REACTIONS


Education Report loose stools or diarrhea promptly. Report any signs or symptoms of hypersensitivity

III. NURSING PROCESS

A.PROBLEM LIST

DATE OF ONSET

NURSING PROBLEM

DATE IDENTIFIED

DATE RESOLVED

DATE INACTIVE

November 15, 2006

Ineffective airway clearance related to diffuse airway inflammation

November 15, 2006

November 15, 2006

November 15, 2006

November 20, 2006

Ineffective airway clearance related to secretions in the bronchi

November 20, 2006

November 20, 2006

November 20, 2006

RATE NURSING PROBLEMS IDENTIFIED

CUES JUSTIFICATION

1 Ineffective airway clearance related to diffuse airway inflammation

INTERACTION:The client verbalized “Bago ako isugod dito sa ospital, nakalanghap ako noon ng pamatay ng ipis tapos sa bahay nag-insenso sila kaya inatake ako ng asthma ko. Nanikip na ang dibdib ko tapos ayun na, sinugod na nila ako dito”

OBSERVATION:On and off difficulty of breathing (DOB).Patient looks restlessness, pale weak

MEASUREMENTRespiratory Rate: 23 breaths per minute

This is an actual problem that requires immediate attention. It is the chief complaint of the patient and the other nursing problems occur in relation to the presence of this problem.

RATE NURSING PROBLEMS IDENTIFIED

CUES JUSTIFICATION

2 Ineffective airway clearance related to secretions in the bronchi

INTERACTIONThe client verbalized, “Hindi ko mailabas ang plema ko ngayon”“Nakakahinga naman ako pero medyo hirap”

OBSERVATIONDifficulty vocalizingWheezes at right lung fieldPale


This is an actual problem which is an effect of the prioritized problem above. Interventions are available and possible for this problem

B.NURSING CARE PLAN

CUES NURSING DIAGNOSIS

ANALYSIS/ HEALTH

IMPLICATION

GOALS AND OBJECTIVES

NURSING INTERVENTIONS

RATIONALE EVALUATION

INTERACTIONThe client verbalized, “Hindi ko mailabas ang plema ko ngayon”“Nakakahinga naman ako pero medyo hirap”

OBSERVATIONDifficulty vocalizingWheezes at right lung fieldPale


Ineffective airway clearance related to secretions in the bronchi

IMMEDIATE CAUSE Secretions in the bronchi

INTERMEDIATE CAUSEContraction of the bronchial smooth muscle that encircles the airways (bronchospasm)

ROOT CAUSEDiffuse airway inflammation

HEALTH IMPLICATIONRetained secretions increased the work breathing and may contribute to atelectasis and hypoxemia.

GOAL:After 8 hours of shift, Mrs. Ventura will be able to expectorate/ clear secretions readily

OBJECTIVES

(1) Provide and teach the client the importance of adequate hydration

a. Encourage fluid (2,000-3,000ml/day) within level of cardiac tolerance

b. Monitor client’s input and output

Adequate hydration thins secretions, which prevents mucus from plugging airways. (Fundamentals of Nursing by Craven and Hirnle, 4th

edition page 861)

Evaluate hydration

EFFECTIVENESS1. Was the client able to promote systemic fluid hydration? yes __no why?

2. Was the client able to cough to mobilize the secretionsyes __no why?

3. Was the client able to be monitor regarding to his respiratory functioning?yes __no why?


ANALYSIS/ HEALTH

IMPLICATION




(Fundamentals of Nursing by Craven and Hirnle, 4th edition page 828)Shallow respirations inhibit both diaphragmatic excursion and lung distensibility. The result of inadequate chest expansion is pooling of respiratory secretions, which ultimately harbor microorganisms and promote infection(Fundamentals of Nursing by Kozier, 7th edition page 1301)Mucus that is hard to

(2) Position and encourage client to cough to promote mobilization of secretions

c. Avoid milk and milk products

a. Deep breathing every 2 hours

b. Huff coughing

status of client(Fundamentals of Nursing by Craven and Hirnle, 4th

edition page 861)

Milk products tend to thickens secretions

To facilitate lung aeration, thereby preventing atelectasis and pneumonia (Fundamentals of Nursing by Kozier, 7th edition page 903)

Prevent airway collapse (Fundamentals of Nursing

EFFICIENCYWas the interventions done within the time frame? yes __no why?

APPROPRIATENESSWere the interventions suitable to the client? yes __no why?

ACCESSIBILITYWere the interventions acceptable to the client? yes __no why?

ADEQUACYWere the interventions adequate to meet the client’s needs? yes __no why?


ANALYSIS/ HEALTH

IMPLICATION




expectorate promotes infection because the bacteria it traps have time to multiply. Mucous plugs in the airways can lead to atelectasis and decreased oxygenation (Fundamentals of Nursing by Craven and Hirnle, 4th edition page 827)

c. Assist client to a sitting position with head slightly flexed, shoulders relaxed, and knees flexed

by Craven and Hirnle, 4th

edition page 861)This technique helps keep your airway open while moving secretions up and out of the lungs.(Fundamentals of Nursing by Kozier, 7th edition page 1303)

Lying flat causes the abdominal organs to shift toward the chest, crowding the lungs and making it more difficult to breathe (Fundamentals of Nursing by Kozier, 7th


ANALYSIS/ HEALTH

IMPLICATION




(3) Respiratory monitoring

a. Monitor rate, rhythm, depth, and effort of respirations

b. Monitor client’s ability to cough effectively

edition page 1327)Permits deep inspiration and forceful abdominal contractions necessary for coughing (Fundamentals of Nursing by Craven and Hirnle, 4th

edition page 861)

Provide basis for evaluating adequacy of ventilation(Fundamentals of Nursing by Kozier, 7th edition page 1327)

Respiratory tract infections alter the amount and character of secretions. An


ANALYSIS/ HEALTH

IMPLICATION




c. Institute respiratory therapy treatments (e.g. nebulizer) as needed

ineffective cough compromises airway clearance and prevent mucus from being expelled (Fundamentals of Nursing by Kozier, 7th edition page 1327)

A variety of respiratory therapy treatments may be used to open constricted airways and liquefy secretions (Fundamentals of Nursing by Kozier, 7th edition page 1328)

C.DISCHARGE PLANNING

MEDICATION

Continue medications prescribed by the physician Salbutamol: Adult: PO 2–4 mg 3–4 times/day, 4–8 mg sustained release 2 times/day Inhaled 1–2 inhalations q4–6h

EXERCISE

Deep breathing and Coughing ExerciseTREATMENT

Continue medications prescribed by the physician. Provide adequate rest periods

HEALTH TEACHINGS

Teach the client to do purse-lip breathing and relaxation techniques Maintain a dust-free environment Reduce exposure to pollen

OUT PATIENT FOLLOW-UP

Notify the health care provider when respiratory infection occurs Make appropriate referrals to home health agencies for assistance in obtaining medical and assistive equipment

DIET

Hypoallergenic Diet Increased fluid intake to thin bronchial secretions

bronchial asthma: a case presentation

Documents

asthma na ako

asthma patients

study asthma

asthma attack

case of bronchial asthma

bronchial asthma anatomy

kapag inaatake ako ng

nakalanghap ako ng pamatay