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 persons

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 Gordons Functional Health Pattern
1. Health Perception-Health Management
She is a very active and playful child. She doesnt have any allergies on any

foods.
2. Nutritional-Metabolic
She doesnt 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 didnt

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

cant 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
Shes 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 didnt

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 cant get something that she wants. She always

wanted to go home right away but because of the doctors order they cant 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 persons 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 ones 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

Diagnosis
Subjective: Risk for After 8 hours of 1. Monitor VS.
(none) Activity nursing
Intolerance intervention the 2. Assess motor function.
3. Note contributing
Objective: r/t decrease patient will
factors to fatigue.
Immobility oxygenation participate 4. Evaluate degree of
Weakness willingly in deficit.
necessary/ desired
5. Ascertain ability to
activities such as stand and move about.
deep breathing 6. Assess emotional or
exercises. psychological factors
7. Plan care with rest
periods between
activities
8. Increase
activity/exercise
gradually such as
assisting the patient in
doing PROM to active
or full range of
motions.
9. Provide adequate rest
periods.
10. Assist client in doing
self care needs
11. Elevate arm and hand
12. Place knees and hips in
extended position
1. For baseline data. G
2. To identify causative
factors. P
3. To identify precipitating w
factors. n
4. To identify severity. a
d
5. To identify necessity of
assistive devices. e
6. Stress and/or depression
may increase the effects
of illness.
7. To reduce fatigue
8. Minimizes muscle
atrophy, promotes
circulation, helps to
prevent contractures
9. To replenish energy.
10. To promote
independence and
increase activity
tolerance
11. Promotes venous
12. Maintains functional
position
 Assessment Nursing Planning Interventions Rationale
Diagnosis
Subjective: Ineffective After 4-5 hours 1. Establish rapport. 1. To gain pt.s trust.
Nahihirapan breathing of nursing 2. assess pt.s condition 2. To obtain baseline dat
akong huminga pattern r/t intervention 3. VS monitor and 3. Serve to track importa
record changes
as verbalized by presence of Patient will
4. Auscultate breath 4. to check for the prese
the patient secretions manifest signs of adventitious breath
sounds and assess
AEB of decreased sounds
airway pattern
Objective: productive respiratory 5. To minimize difficult
5. Elevate head of the
wheezing cough and effort AEB breathing
bed and change
upon dyspnea absence of
position of the pt. 6. To maximize effort fo
inspiration dyspnea
every 2 hours. expectoration.
and 6. Encourage deep
expiration breathing and 7. To decrease air trappi
dyspnea coughing exercises. and for efficient breat
tachycardia 7. Demonstrate 8. To prevent fatigue.
chest diaphragmatic and
tightness 9. To prevent situations
pursed-lip breathing.
suprasternal will aggravate the
8. Encourage increase in
condition
retraction fluid intake
restlessness 9. Encourage 10. To mobilize secretion
opportunities for rest
and limit physical
activities.
10. Reinforce low salt,
low fat diet as
ordered.
 Assessment Nursing Planning Interventions Rationale
Diagnosis
Subjective: Ineffective After 5-6 hours 1. Adequately hydrate the pt. 1. Systemic hydr
Nahihirapan airway of nursing keeps secretion m
akong clearance RT intervention 2. Teach and encourage the use and easier to
of diaphragmatic breathing
huminga as bronchoconstri the expectorate.
and coughing exercises.
verbalized by ction, Patient will 2. These techniqu
the patient increased maintain/impro 3. Instruct pt to avoid bronchial help to improve
mucus ve airway irritants such as cigarette ventilation and
Objective: production, clearance AEB smoke, aerosols, extremes of mobilize secretion
wheezing and respiratory absence of temperature, and fumes. without causing
upon infection AEB signs of 4. Teach early signs of infection breathlessness and
wheezing, respiratory that are to be reported to the fatigue.
inspiration
clinician immediately.
and dyspnea, and distress 3. Bronchial irrita
Increases sputum
expiration cough cause
production
dyspnea Change in color of sputum bronchoconstrictio
tachycardia Increased thickness of and increased muc
chest sputum production, which
tightness Increased SOB, tightness then interfere with
suprasterna of chest, or fatigue airway clearance.
l retraction Increased coughing 4. Minor respirat
productive Fever or chills infections that are
cough no consequence to
5. If indicated, perform postural person with norm
drainage with percussion and lungs can produce
vibration in the morning and at
fatal disturbances
night as prescribed.
the lungs of an
asthmatic person.
Early recognition
crucial.
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.
Patients Profile

Name:

Age:

Sex:

Location:

Admitting diagnosis:

Chief complaint:

Date of admission:

Attending Doctor: