Santiago City, Philippines

College of Nursing

A Case Study of

Bronchial Asthma In
Acute Exacerbation
(BAIAE)
Submitted by:

Orlando Dexter T. Rodriguez

SN-NC 3rd Year Block A

Submitted to:

Clinical Instructor
A. Significance of the study

Lower airway problems directly affect gas exchange and have serious consequences.

Many of these problems are chronic and progressive, requiring major changes in person’s

lifestyles. Such airway problem includes Bronchial Asthma which is a serious problem and could

probably lead to death if proper precautions are not observed. This study is made so that every

reader or listener of the case study and research will gain enough knowledge and understand

Bronchial asthma, its cause, manifestations, treatment, and preventions. This study points and

focuses on the significance of reaching out to the awareness of every individual who may have

this kind of disease and to the member of the health care team and share to them the proper ways

on how to effectively care to patients suffering from this problem.

B. Objectives of the Study

At the end of the case-presentation the student will be able to:

1. To identify what Bronchial Asthma is all about.

2. Apply the knowledge that they have learned in the floor.

11 Gordon’s Functional Health Pattern
1. Health Perception-Health Management

She is a very active and playful child. She doesn’t have any allergies on any

foods.

2. Nutritional-Metabolic

She doesn’t have any special diet but she is taking Celeen for her vitamin. At

home, as verbalized by the mother, she can eat all of the food served. She didn’t

have difficulty of swallowing, and started solid food as the main composition of

the food of the patient.

3. Elimination Pattern

She did not experience any decrease in defecating or difficulty of urinating. Her

bowel elimination pattern is once a day even during her stays at the hospital. Her

way of breathing is better than she is at home, and she could go to comfort room

with assistance of mother (with IV), read books, and eat all food served.

4. Activity-Exercise Pattern

Our patient loves to play bahay - bahayan and running. She independently wears

her dress but with assistance from her mother. She can go to the bathroom,

whenever she wants to urinate and defecate but her mother still washes her anus

after defecating. She goes schooling in prep-school and playing or socializing,

talking, mingling with her classmates.

5. Sleep-Rest Pattern

She experience difficulty of sleeping while admitted in the hospital. Before her

admission, she sleeps as early as 10 in the evening and wakes at 8 in the morning.

During her hospitalization, she sleeps at 10 and wakes at 8 in the morning. She
 also sleeps one hour in the afternoon. During night when her asthma attacks, she

can’t breathe normally usually having a hard time of breathing so her sleep during

night is disturbed during her hospitalization period.

6. Sexuality-Reproductive Pattern

She is a girl

7. Cognitive-Perceptual

She neither has hearing difficulties nor eye problems. She has a good memory for

learning activities in school like problem solving and her mother makes decisions

for her during medications, treatments, etc. and she also learns easily.

8. Self Perception – Self Concept

She’s feeling better every time she is asked how she feels. Her illness makes her

feel worthless because she cannot do anything. She is very anxious every time her

asthma attacks.

9. Role relationship

She lives with her family and depends on her parents for her needs. She misses

her siblings and likes to talk about them. In their house she can easily express

what she wants or needs but during her hospitalization time her parents didn’t

knew what are the needs that she wanted or needed because of her condition.

10. Coping – Stress Tolerance

She always wants her mother to be beside her because she provides all that she

needs and she cries whenever she can’t get something that she wants. She always

wanted to go home right away but because of the doctors order they can’t go

home right away, so the only thing she can do is to cry.

11. Value and Beliefs

They are Roman Catholic. She verbalized that she knows God loves her and He

will wash her illness away so that she can go home. The parents react patiently to

their daughters needs, and they supported all what their child needs.
Definition

A condition of the lungs characterized by widespread narrowing of the airways due to spasm of
the smooth muscle, edema of the mucosa, and the presence of mucus in the lumen of the bronchi and
bronchioles. Bronchial asthma is a chronic relapsing inflammatory disorder with increased responsiveness
of tracheobroncheal tree to various stimuli, resulting in paroxysmal contraction of bronchial airways
which changes in severity over short periods of time, either spontaneously or under treatment.

Causes
Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or
allergens can be seasonal such as grass, tree and weed pollens or perennial under this are the molds, dust
and roaches. Common triggers of asthma symptoms and exacerbations include air way irritants like air
pollutant, cold, heat, weather changes, strong odors and perfumes. Other contributing factor would
include exercise, stress or emotional upset, sinusitis with post nasal drip , medications and viral
respiratory tract infections.
Most people who have asthma are sensitive to a variety of triggers. A person’s asthma changes
depending on the environment activities, management practices and other factor.

Clinical Manifestation
The three most common symptoms of asthma are cough, dyspnea, and wheezing. In some instances
cough may be the only symptoms. An asthma attack often occurs at night or early in the morning,
possibly because circadian variations that influence airway receptors thresholds.
An asthma exacerbation may begin abruptly but most frequently is preceded by increasing symptoms
over the previous few days. There is cough, with or without mucus production. At times the mucus is so
tightly wedged in the narrow airway that the patient cannot cough it up.

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

Medical Management
There are two general process of asthma medication: quick relief medication for immediate
treatment of asthma symptoms and exacerbations and long acting medication to achieve and maintain
control and persistent asthma. Because of underlying pathology of asthma is inflammation, control of
persistent asthma is accomplish primarily with the regular use of anti inflammatory medications.
• Long-acting control Medication

Corticosteroid are the most potent and effective anti inflammatory currently available. They are
broadly effective in alleviating symptoms, improving air way functions, and decreasing peak flow
variability. Cromolyn sodium and nedocromil are mild to be moderate anti-inflammatory agents that are
use more commonly in children. They also are effective on a prophylactic basis to prevent exercise-
induced asthma or unavoidable exposure to known triggers. These medications are contraindicated in
acute asthma exacerbation.
`Long acting beta-adrenergic agonist is use with anti-inflammatory medications to control asthma
symptoms, particularly those that occur during the night these agents are also effective in the prevention
of exercise-induced asthma.
• Quick relief medication
Short acting beta adrenergic agonists are the medications of choice for relief of acute symptoms and
prevention of exercise-induced asthma. They have the rapid onset of acton. Anti-cholinergic may have an
added benefit in severe exacerbations of asthma but they are use more frequently in COPD.

Nursing Management
The main focus of nursing management is to actively assess the air way and the patient response to
treatment. The immediate nursing care of patient with asthma depends on the severity of the symptoms. A
calm approach is an important aspect of care especially for anxious client and one’s family.
• This requires a partnership between the patient and the health care providers to determine the
desire outcome and to formulate a plan which include;
• the purpose and action of each medication
• trigger to avoid and how to do so
• when to seek assistance
• the nature of asthma as chronic inflammatory disease
 Assessment Nursing Planning Interventions Rationale Evaluation
Diagnosis
Subjective: Risk for After 8 hours of 1. Monitor VS. 1. For baseline data. Goal met
(none) Activity nursing 2. To identify causative
Intolerance intervention the 2. Assess motor factors. Patient participated
r/t decrease patient will function. 3. To identify willingly in
3. Note contributing precipitating factors. necessary/ desired
Objective: oxygenation participate factors to fatigue. 4. To identify severity.
willingly in activities such as
4. Evaluate degree of
• Immobility necessary/ desired deep breathing
deficit. 5. To identify necessity
• Weakness activities such as 5. Ascertain ability to of assistive devices. exercises.
deep breathing stand and move 6. Stress and/or
exercises. about. depression may
6. Assess emotional or increase the effects of
psychological illness.
factors 7. To reduce fatigue
7. Plan care with rest
periods between 8. Minimizes muscle
activities atrophy, promotes
8. Increase circulation, helps to
activity/exercise prevent contractures
gradually such as 9. To replenish energy.
assisting the patient
in doing PROM to 10. To promote
active or full range independence and
of motions. increase activity
9. Provide adequate tolerance
rest periods. 11. Promotes venous
10. Assist client in 12. Maintains functional
doing self care position
needs
11. Elevate arm and
hand
12. Place knees and
hips in extended
position
 Assessment Nursing Planning Interventions Rationale Evaluation
Diagnosis
Subjective: Ineffective After 4-5 hours 1. Establish rapport. 1. To gain pt.’s trust. Goal met
breathing of nursing 2. assess pt.’s condition 2. To obtain baseline
“Nahihirapan pattern r/t intervention 3. VS monitor and data Patient
akong huminga” presence of record 3. Serve to track demonstrated
as verbalized by Patient will important changes pursed-lip
secretions 4. Auscultate breath 4. to check for the
the patient AEB manifest signs sounds and assess breathing and
presence of
productive of decreased airway pattern diaphragmatic
adventitious breath
cough and respiratory 5. Elevate head of the sounds breathing.
Objective: dyspnea effort AEB bed and change 5. To minimize
absence of position of the pt. difficulty in breathing
• wheezing dyspnea every 2 hours.
upon 6. To maximize effort for
6. Encourage deep expectoration.
inspiration breathing and
and coughing exercises. 7. To decrease air
expiration 7. Demonstrate trapping and for
• dyspnea diaphragmatic and efficient breathing.
• tachycardia pursed-lip breathing. 8. To prevent fatigue.
• chest 8. Encourage increase in
tightness 9. To prevent situations
fluid intake that will aggravate the
• suprasternal 9. Encourage condition
retraction opportunities for rest
• restlessness and limit physical 10. To mobilize
activities. secretions.
10. Reinforce low salt,
low fat diet as
ordered.
 Assessment Nursing Planning Interventions Rationale Evaluation
Diagnosis
Subjective: Ineffective After 5-6 hours 1. Adequately hydrate the1.pt. Systemic hydration keeps Goal met
airway of nursing secretion moist and easier
“Nahihirapan clearance RT intervention 2. Teach and encourage the to expectorate. By
akong bronchoconstri the use of diaphragmatic verbalization
huminga” as breathing and coughing
2. These techniques help to of the
ction, exercises.
verbalized by increased Patient will improve ventilation and patient of
the patient mucus maintain/impro mobilize secretions “Ok na po
production, ve airway 3. Instruct pt to avoid without causing ang aking
and respiratory clearance AEB bronchial irritants such as breathlessness and fatigue. paghinga,
Objective: infection AEB absence of cigarette smoke, aerosols, hindi na ako
signs of extremes of temperature,3. Bronchial irritants cause nahihirapan”
wheezing, and fumes. bronchoconstriction and
• wheezing dyspnea, and respiratory
upon 4. Teach early signs of increased mucus
cough distress
infection that are to be production, which then
inspiration reported to the clinician
and interfere with airway
immediately.
expiration clearance.
• Increases sputum
• dyspnea production 4. Minor respiratory
• tachycardia • Change in color of sputum
• Increased thickness of infections that are of no
• chest consequence to the person
sputum
tightness with normal lungs can
• Increased SOB, tightness
• suprasternal of chest, or fatigue produce fatal disturbances
retraction • Increased coughing in the lungs of an
• productive • Fever or chills asthmatic person. Early
cough recognition is crucial.
1. If indicated, perform
postural drainage with
percussion and vibration in
the morning and at night as
prescribed.
Anatomy and Physiology

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 of inspiration 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.
• helping to maintain respirations (through peripheral chemoreceptors) when hypoxia
occurs.
The normal functions of respiration O2 and CO2 tension and chemoreceptors are similar in
children and adults. however, children respond differently than adults to respiratory disturbances;
major areas of difference include:
• 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.
Patient’s Profile

Name:
Age:
Sex:
Location:
Admitting diagnosis:
Chief complaint:
Date of admission:
Attending Doctor: