Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
ASTHMA
INTRODUCTION
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 B
Age: 56 years old
Birth date: May 9, 1950
Birth place: Samar, Leyte
Sex: Female
Religion: Roman Catholic
Civil Status: Married
Address: K.V. D.D
Occupation: vendor
Room & bed #: Female Medical Ward 364B
Date Admitted: November 15, 2006
Time 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
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.
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
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”
2. Interaction Pattern
According 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.
3. Cognitive Pattern
The 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”
4. Self Concept
The 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.”
5. Emotional Pattern
According 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.
1. Cultural pattern
According 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.
2. Significant relationship
According to the client, her family is the significant persons in
her life. They have harmonious relationship with her family and
relatives
3. Recreational Pattern
The 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. Environment
The 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.”
5. Economic
According 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.”
J. IMPRESSION/DIAGNOSIS
The admitting diagnosis is Bronchial Asthma in Acute
Exacerbation
A. ECOLOGIC MODEL
(1) Hypothesis
There 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 Factors
A. Host
a. Age: 54 years old
b. Sex: Female
c. Race: Asian
d. 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. Environment
Physical: exposure and inhalation of pollutants and fume of
insecticides; exposure to smoke from cigarette
B. Ecologic Model
Host
(susceptible host)
Agent: Environment:
(Allergens) Exposure to indoor
and outdoor allergens
Analysis
Predisposing Factors
Atopy Causal Factors Contributing Factors
Female Gender Exposure to indoor and Respiratory infections
outdoor allergens Air pollution
Occupational sensitizers Active/passive smoking
Other (diet, small size at birth)
Inflammation
Symptoms
Wheezing
Risk Factors for exacerbations Cough
Allergens Dyspnea
Respiratory infections Chest tightness
Exercise and hyperventilation
Weather changes
Exposure to sulfur dioxide
Exposure to food, additives, medications
N.DRUG STUDY
Patient &
Family
Education
• Review
directions
for correct
use of
medicatio
n and
inhaler
• Avoid
contact of
inhalation
drug with
eyes.
• Do not
increase
number or
frequency
of
GENERIC ACTION BRAND CLASSIFICATION INDICATION CONTRAINDICATIO SIDE EFFECTS/ NURSING
NAME NAME NS ADVERSE RESPONSIBILITY
REACTIONS
inhalations
without
advice of
physician.
• Notify
physician
if albuterol
fails to
provide
relief
because
this can
signify
worsening
of
pulmonary
function
and a
reevaluati
on of
condition/t
herapy
may be
indicated.
• Note:
Albuterol
can cause
dizziness
or vertigo;
take
necessary
precaution
s.
GENERIC ACTION BRAND CLASSIFICATION INDICATION CONTRAINDICATIO SIDE EFFECTS/ NURSING
NAME NAME NS ADVERSE RESPONSIBILITY
REACTIONS
• Do not use
OTC drugs
without
physician
approval.
Many
medicatio
ns (e.g.,
cold
remedies)
contain
drugs that
may
intensify
albuterol
action.
Patient &
Family
Education
• Report
loose
stools or
diarrhea
promptly.
• Report any
signs or
symptoms
of
hypersensi
tivity
III. NURSING PROCESS
A. PROBLEM LIST
OBSERVATION:
On and off
difficulty of
breathing
(DOB).
Patient looks
restlessness,
pale weak
MEASUREMENT
Respiratory
Rate: 23
breaths per
minute
RATE NURSING PROBLEMS CUES JUSTIFICATION
IDENTIFIED
OBSERVATION
Difficulty
vocalizing
Wheezes at
right lung field
Pale
MEASUREMENT
Respiratory
Rate: 21
breaths per
minute
B. NURSING CARE PLAN
Provide basis
for evaluating
adequacy of
ventilation
b. Monitor (Fundamental
client’s ability s of Nursing
to cough by Kozier, 7th
effectively edition page
1327)
Respiratory
tract
infections
alter the
amount and
character of
secretions. An
ineffective
cough
compromises
airway
CUES NURSING ANALYSIS/ HEALTH GOALS AND NURSING RATIONALE EVALUATION
DIAGNOSIS IMPLICATION OBJECTIVES INTERVENTIONS
clearance and
prevent
mucus from
c. Institute being
respiratory expelled
therapy (Fundamental
treatments s of Nursing
(e.g. by Kozier, 7th
nebulizer) as edition page
needed 1327)
A variety of
respiratory
therapy
treatments
may be used
to open
constricted
airways and
liquefy
secretions
(Fundamental
s of Nursing
by Kozier, 7th
edition page
1328)
C. DISCHARGE PLANNING
MEDICATION
Θ Continue medications prescribed by the physician
Θ 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
Θ Deep breathing and Coughing Exercise
TREATMENT
Θ Continue medications prescribed by the physician.
Θ Provide adequate rest periods
HEALTH TEACHINGS
Θ Teach the client to do purse-lip breathing and relaxation
techniques
Θ Maintain a dust-free environment
Θ Reduce exposure to pollen
OUT PATIENT FOLLOW-UP
Θ Notify the health care provider when respiratory infection
occurs
Θ Make appropriate referrals to home health agencies for
assistance in obtaining medical and assistive equipment
DIET
Θ Hypoallergenic Diet
Θ Increased fluid intake to thin bronchial secretions