Case Study on bronchial Asthma

8/10/2019 Case Study on bronchial Asthma

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A Case Study on


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INTRODUCTION

A. BACKGROUND OF THE STUDY

Asthma is a chronic disease of the airways that causes airway

hyperresponsiveness, mucosal edema and mucus production. Thisinflammation, 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

I choose the case of bronchial asthma because it would help me to have a

focus study regarding this casemore nursing care would be given. Added to

that, I choose the client because of the fact that he is cooperative in the sense

that he always try to answer the questions asked in his full knowledge and tryto verbalize anything that he wants to say.


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I. NURSING HEALTH HISTORY

A. DEMOGRAPHICPROFILE

Name: Faisal Younis

Age: 30 years oldSex: Male

Civil Status: Married

Address: Tabuk, KSA

Date Admitted: November 2, 2014

Time Admitted: 9:00 AM

B. CHIEF COMPLAINT AND HISTORY OF PRESENT ILLNESS

Three days prior to admission, the patient has already suffering from slight

difficulty of breathing that is usually relieved when resting. Two hours prior

to admission, the patient still suffering from difficulty of breathing with

continuous cough and cannot be relieved even when resting. This prompted

him to seek medical help at King Khalid Civilian Hospital and thus

recommended for admission.


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C. PHYSICAL ASSESSMENT

GENERAL

APPEARANCE

NORMS ACTUAL FINDINGS INTERPRETATION AND

ANALYSIS

1. Posture/Gait Relaxed, erect

posture; coordinated

movement

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

Slouched/bent

posture

Interpretation: Not

normal

Analysis:

This observation is

most seen with

dyspnea, advance

chronic lung disease

and air trapping,

acute and chronic

2. Skin Color Healthy appearance

Skin color may be

pink, tan, brown,

olive or yellowishdepends on the race.

With a normal

supply of oxygen, the

nail beds, the tongue

and the lips appear

pinkish-red in color

Pallor; weakness;

obvious illness

Interpretation: Not

normal

Analysis:

Skin color andtemperature

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. The color

and appearance of

the skin and nails may

reflect insufficient

delivery of

oxygenated blood to


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GENERAL

APPEARANCE


ANALYSIS

the tissue because of

respiratory

dysfunction (

3. Personal

Hygiene/

Grooming

Clean, neat No foul body odor,

neat

Interpretation:

Normal

Analysis:

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 andnasal cavities, eyes,

ears, and perineal-

genital areas. Hygiene

is the observance of

health rules relating

to these self-care

4. Nutritional

Status

The state of nutrition

is often reflected in apersons

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

Malnourished;

generalappearance 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.


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GENERAL

APPEARANCE


ANALYSIS

exhibition of thought

association; logical

sequence; makesense; has sense of

reality

though, has a sense

of reality and able

to understand

Analysis:

Verbal

communication islargely 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

7. Non-verbal

behavior

No distress noted in

facial expression; the

clients affect/mood

is appropriate to

situation

The clients

affect/mood is

appropriate in the

situation.

Interpretation:

Normal

Analysis:

Nonverbal

communication

includes gestures,

body movement, use

of touch and physical

appearance,adornment.

Nonverbal behavior is

controlled less

consciously than

verbal behavior


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MEASUREMENTS NORMS ACTUAL FINDINGS INTERPRETATION AND

ANALYSIS

Temperature Normal adult

temperature axillary:35.8 C to 37.0 C

As of November 20

20068:00pm 36.5 C

Interpretation: Normal

Analysis: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.

Pulse Rate The normal pulse

rate of an adult: 60-

100 beats per minute

8:00pm 80 beats

per minute


Analysis:

The normal range of

the pulse in an adult is60 to 100 beats per

minute. As the age

increases, the pulse

rate gradually decrease

Respiratory

Rate

The normal

respiratory rate of an

adult: 12-20 breaths

per minute

8:00pm 21

breaths per minute

Interpretation: Not

Normal

Analysis:

Normal breathing isautomatic 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


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MEASUREMENTS NORMS ACTUAL FINDINGS INTERPRETATION AND

ANALYSIS

respiratory rate

(usually above 20

breaths per minute inadult)

Blood

Pressure

Systolic

Diastolic

90-140 60-90

8:00pm 130/70

mmHg


Analysis:

In adults, the trend is

toward gradually

increasing systolic and

diastolic 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 vesseldisease. The increase

in systolic pressure is

proportionally greater

than the increase in

diastolic pressure

BODY PARTS NORMS ACTUAL FINDINGS INTERPRETATION AND

ANALYSIS

Skin Varies from light to

deep brown; from

ruddy pink; from

yellow overtones to

olive

Pallor Interpretation: Not

Normal

Analysis:

Pallor is the result of

inadequate circulating

blood or hemoglobin

and subsequent

reduction in tissue


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BODY PARTS NORMS ACTUAL FINDINGS INTERPRETATION AND

ANALYSIS

oxygenation

Mouth/ OralCavity

Lips

-Uniform pink color-Soft, moist, smooth

texture

-Symmetry of

contour

-Ability to purse lips

- lips has visiblemargins

- symmetrical

- pale in color

- no edema

Interpretation: NotNormal

Analysis:

Pallor is the result of

inadequate circulating

blood or hemoglobin

and subsequent

reduction in tissue

Thorax

Anterior

Thorax

-Quite rhythmic and

effortless

respirations

-tachypnea

-wheezes at right

lung field

Interpretation: Not

Normal

Analysis:

Dyspnea is a sign of

serious disease of the

airway, lungs, or heart.

(www.medterms.com)

Tachypnea may be

necessary for asufficient gas-exchange

of the body

(www.wrongdiagnosis

com)

Possible cause of air

passing through a

constricted bronchus

as a result of secretion,

swelling or tumor


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D. LABORATORY AND DIAGNOSTIC EXAMINATION

DIAGNOSTIC

EXAM

NORMS ACTUAL RESULTS INTERPRETATION AND ANALYSIS

Urinalysis Reference Values

Color: light straw

to dark amber

Appearance: clear

Odor: aromatic

pH: 4.5-8.0

Specific Gravity:

1.005-1.030

Protein: 2-8

mg/dl; negative

reagent strip test;

trace

Glucose: negative

Ketones: negative

(Handbook of

Laboratory and

Diagnostic Testwith Nursing

Inplication, 5th

edition, pg. 343)

Microscopic

Examination:

RBC: 0-2/high

power field

WBC: 0-5/highpower field

Epithelial cells: 0-

5/high power field

(Handbook of

Diagnostic Test,

3rd

edition, pg.

329)

Actual Findings

Color: Yellow

Appearance:

slightly hazy

Odor: aromatic

pH: acidic

Specific Gravity:

1.015

Protein: trace

Glucose: negative

Microscopic

Examination:

RBC: 2-3/hpf

Pus: 3-5/hpf

Epithelial cells:

many

Mucus threads:light

Bacteria: few

Interpretation: The urine

color, appearance, pH and

microscopic examination

are considered not normal

while the odor, specific

gravity, protein and

glucose are considered

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 theurine. 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 bodyexceeds 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


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DIAGNOSTIC

EXAM


presence of volatile acids.

It is not generally

offensive. Fresh urine frommost 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, AManual 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 tovigorous exercise or

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
http://www.intensivecaring.com/http://www.intensivecaring.com/


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DIAGNOSTIC

EXAM


infections, parasitic

infections including

malaria, obstructions inthe 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-

0.60

Lymphocytes:

0.20-0.40

(Diagnostic

Testing and

Nursing

Implications, 4th

edition)

Actual Findings:Neutrophils: 0.79

Lymphocytes: 0.13

Interpretation: Not normalAnalysis:

Increase in Neutrophils:

severe bacterial disease,

diabetic acidosis,

infarctions, increase in

acute, severe

inflammation,

malignancies (Diagnostic

Testing and NursingImplications, 4

thedition)

Decreased in

Lymphocytes: indicates

lymphopenia.

(Medical Surgical Nursing

by Bare and Smeltzer pg

876)

Possible cause of sepsis

and immunodeficiency


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DIAGNOSTIC

EXAM


disease.

(Fundamentals of Nursing

by Kozier pg. 759)

A. Conclusion and Recommendations

Reducing exposure to allergens that can trigger broncho-constriction

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.

E. 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 andpassageways 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.


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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 thealveoli. 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.

BronchiolesThe 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.


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18/29

Figure 1-1 Pathophysiology of Asthma

Predisposing Factors

Atopy

Female Gender

Causal Factors

Exposure to indoor and

outdoor allergens

Occupational sensitizers

Contributing Factors

Respiratory infections

Air pollution

Active/passive smoking

Other (diet, small size at birth)

Inflammation

Hyperrensponsiveness of

airways

Airflow limitation

Risk Factors for exacerbations

Allergens

Respiratory infections

Exercise and hyperventilation

Weather changes

Exposure to sulfur dioxide

Exposure to food, additives,

medications

Symptoms

Wheezing

Cough

Dyspnea

Chest tightness


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G.DRUG STUDY

GENERIC NAME ACTION BRAND NAME CLASSIFICATION INDICATION CONTRAINDICATIONS SIDE EFFECTS/

ADVERSE

REACTIONS

NURSING

RESPONSIBILITY

ALBUTEROL Synthetic

sympathomime

tic amine andmoderately

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)

receptors.

Minimal or no

effect on

alpha-

Salbutamol autonomic

nervous system

agent; beta-adrenergic agonist

(sympathomimeti

c); bronchodilator

(respiratory

smooth muscle

relaxant)

To relieve

bronchospasm

associated withacute or

chronic

asthma,

bronchitis, or

other

reversible

obstructive

airway

diseases. Also

used to

prevent

exercise-

induced

bronchospasm.

Pregnancy

(category C),

lactation. Use oforal syrup in

children


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21/29


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ADVERSE

REACTIONS

NURSING

RESPONSIBILITY

producing

strains exceeds

that of first

generation

cephalosporins

. Antimicrobial

spectrum of

activity

resembles that

of cefonicid.

Preferentially

binds to one or

more of the

penicillin-

binding

proteins (PBP)

located on cell

walls of

susceptible

organisms. This

inhibits thirdand final stage

of bacterial cell

wall synthesis,

thus killing the

bacterium.

Partial cross-

allergenicity

between other

beta-lactam

antibiotics and

gonorrhea, and

otitis media

and for

perioperative

prophylaxis

(e.g., open-

heart surgery),

early Lyme

disease.

antibiotic-

associated

colitis. Skin:

Rash, pruritus,

urticaria.

Urogenital:

Increased

serum

creatinine and

BUN,

decreased

creatinine

clearance.

culture and

sensitivity tests

before initiation of

therapy and

periodically during

therapy if indicated.

Therapy may be

instituted pending

test results. Monitor

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


23/29


ADVERSE

REACTIONS

NURSING

RESPONSIBILITY

cephalosporins

has been

reported.

any significant

changes.

Patient & Family

Education

Report loose stools

or diarrhea

promptly.

Report any signs or

symptoms of

hypersensitivity


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A. NURSING CARE PLAN

CUES NURSING DIAGNOSIS ANALYSIS/HEALTH

IMPLICATION

GOALS AND

OBJECTIVES

NURSING

INTERVENTIONS

RATIONALE EVALUATION

INTERACTION

The client

verbalized, Hindi

ko mailabas angplema ko ngayon

Nakakahinga

naman ako pero

medyo hirap

OBSERVATION

Difficulty

vocalizing

Wheezes at right

lung field

Pale

MEASUREMENT

Respiratory Rate:

21 breaths perminute

Ineffective airway

clearance related

to secretions in

the bronchi

IMMEDIATE

CAUSE

Secretions in the

bronchi

INTERMEDIATE

CAUSE

Contraction of the

bronchial smooth

muscle that

encircles the

airways

(bronchospasm)

ROOT CAUSE

Diffuse airway

inflammation

HEALTHIMPLICATION

Retained

secretions

increased the

work breathing

and may

contribute to

atelectasis and

hypoxemia.

(Fundamentals of

GOAL:

After 8 hours of

shift, Mrs.

Ventura will beable 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 clients

input and output

Adequate

hydration thins

secretions, which

prevents mucus

from plugging

airways.

(Fundamentals of

Nursing by Cravenand Hirnle, 4

th

edition page 861)

Evaluate

hydration status

of client

(Fundamentals of

Nursing by Craven

and Hirnle, 4th

edition page 861)

EFFECTIVENESS

1. Was the client

able to promote

systemic fluid

hydration?

yes __no why?

2. Was the client

able to cough to

mobilize thesecretions

yes __no why?

3. Was the client

able to be monitor

regarding to his

respiratory

functioning?

yes __no why?


25/29


IMPLICATION

GOALS AND

OBJECTIVES

NURSING

INTERVENTIONS


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,

7

th

edition page1301)

Mucus that is

hard to

expectorate

promotes

infection because

the bacteria it

traps have time to

multiply. Mucous

plugs in the

(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

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 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)

EFFICIENCY

Was the

interventions done

within the time

frame?

yes __no why?

APPROPRIATENESS

Were the

interventions

suitable to the

client?

yes __no why?

ACCESSIBILITY

Were the

interventions

acceptable to the

client?

yes __no why?

ADEQUACY

Were the

interventions

adequate to meet

the clients needs?

yes __no why?


26/29


IMPLICATION

GOALS AND

OBJECTIVES

NURSING

INTERVENTIONS


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

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

edition page

1327)

Permits deep

inspiration and

forceful

abdominal

contractions

necessary for

coughing

(Fundamentals of

Nursing by Cravenand Hirnle, 4th

edition page 861)

Provide basis for

evaluating

adequacy of

ventilation

(Fundamentals of

Nursing by Kozier,

7th

edition page


27/29


IMPLICATION

GOALS AND

OBJECTIVES

NURSING

INTERVENTIONS


(3) Respiratory

monitoring

a. Monitor rate,

rhythm, depth,

and effort of

respirations

b. Monitor clients

ability to cough

effectively

1327)

Respiratory tract

infections alter

the amount and

character of

secretions. An

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 maybe used to open

constricted

airways and

liquefy secretions

(Fundamentals of

Nursing by Kozier,

7th

edition page

1328)


28/29


IMPLICATION

GOALS AND

OBJECTIVES

NURSING

INTERVENTIONS


c. Institute

respiratory

therapy

treatments (e.g.

nebulizer) as

needed


29/29

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Case Study on bronchial Asthma

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