St.

Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

NURSING HEALTH HISTORY

BIOGRAPHIC DATA: Patients name: G.T.S.S. Address: South Bantayan, Dumaguete City Age: 25 years old Birth date: October 20, 1985 Civil Status: Married Religion: Roman Catholic Nationality: Filipino Date and time of admission: April 17, 2011 Source of information: Patient: 60 %; S.O: 20%; Chart: 20% Healthcare financing: Phil health

Chief complaint: nag huot aqng dughan og lisud e ginhawa, as verbalized by the patient.

History of Present Illness: Hours prior to admission the patient had work-out and afterwards he took a rest but then experienced a sudden onset of chest tightness which was accompanied with fast and difficulty breathing. He medicated it with his own maintenance medication but then the signs and symptoms worsened. The patient was immediately brought to holy child and subsequently admitted.

Past Health History: Patient GTS had experienced childhood illnesses such as fever, mumps, colds, and managed it with OTC medications like paracetamol and neozep. The patient had received complete immunization, which includes 1 BCG at birth, he had 3 OPV, 3 Hep B, 3 DPT, polio vaccine and measles. His past hospitalizations were as follows: last 2008 - admitted due to dyspnea and last november 1010 - admitted due to hypertension with. He is not allergic to any food, medications and other allergen. He did not experience any major accidents or injuries.

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

Family History: Patient verbalized that maternal grandparents died due to complication of hypertension while his paternal grandparents died due to respiratory problems. His father is also hypertensive. His other siblings are asthmatic. Genogram:
N.I 56 y.o J. I 68 y.o

N.I 56 y.o

J. I 68 y.o

A. I 37 y.o

J. I 68 y.o

P.I 9 y.o

M.I 10 y.o

N.I 44 y.o

N.I 56 y.o

Legend:

- Female

- Male

- Patient

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

Lifestyle Patients diet is composed of meat, fish and vegetables. He is an occasional drinker and does not smoke. He also drinks coffee every morning and afternoon. he usally sleeps 7-8 hours a day. Her usual time of sleep is between 8-9 PM and wakes up at around 4 in the morning because of hunger. he also takes naps in the afternoon. During his leisure time he would be spending it with his wife and family.

Social Data The patient lives in concrete house with his father, siblings, her wife and there baby. She has a good relationship with her family and has a clean and peaceful environment. His wife is a housewife and the primary caregiver of the patient. Patient is a graduate of engineering and pursued his career by working in a motor shop in which he was exposed with chemicals for painting.. Patterns of Healthcare For them also consultation to medical practitioner is effective and efficient. If they experienced minor illnesses such as fever, colds, and cough that are not immediately relieved, they go seek for clinical check-up or consultation in the hospital.

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

LABORATORY RESULTS
Urinalysis The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders URINALYSIS COLOR TRANSPARENCY UROBILINOGEN GLUCOSE KETONE BILIRUBIN PROTEIN NITRITE PH BLOOD SPECIFIC GRAVITY LEUKOCYTES MICROSCOPIC EXAM MUCUS RBC WBC EPITHELIAL CELLS BACTERIA April , 2011 YELLOW CLEAR NORMAL NEGATIVE +1 NEGATIVE NEGATIVE NEGATIVE 8.0 NEGATIVE 1.015 NEGATIVE April , 2011 RARE 0-1 02 FEW FEW INTERPRETATION Normal color of urine

Normal INTERPRETATION

Normal

Ketones in urine can give an early indication of insufficient insulin in a person who has diabetes. Severe exercise, exposure to cold, and loss of carbohydrates, such as with frequent vomiting, can also increase fat metabolism, resulting in ketonuria.

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

Complte Blood Count The CBC is used as a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood. COMPLETE BLOOD COUNT HEMOGLOBIN HEMATOCRIT WBC RBC DIFFERENTIAL COUNT NEUTROPHIL LYMPHOCYTE MONOCYTE EOSINOPHIL PLATELET COUNT RESULTS 14.8 % 43.2 % 11.7T/ cumm 5.45 REF.RANGE 15 17 % 47 54 % 5-10T/cumm 4.5 - 6 INTERPRETATION Decrease Decrease Increase Normal

66% 25% 7% 2% 147,000/cumm

50-80% 20-35% 2-10% 0-5% 150-400T/cumm

Increase Normal Normal Normal Decrease

y y

Slight decrease Hemoglobin which means a decrease in amount of oxygen-carrying protein in the blood. WBC may be increased with infections, inflammation

Electrolytes It is used to screen for an electrolyte or acid-base imbalance and to monitor the effect of treatment on a known imbalance that is affecting bodily organ function. Electrolytes Potassium Sodium RESULTS 3.3 mmo/L 140 mmo/L REF.RANGE 3.5 5.1 136 145 mmo/L INTERPRETATION Decrease Normal

Hypokalemia can occur if you have diarrhea and vomiting or if you are sweating excessively. Potassium can be lost through your kidneys in urine; in rare cases, potassium may be low because you are not getting enough in your diet.

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

THEORETICAL BACKGROUND
y Hypertension
Hypertension is the term used to describe high blood pressure. Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body. Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high. The top number is your systolic pressure.
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It is considered high if it is over 140 most of the time. It is considered normal if it is below 120 most of the time.

The bottom number is your diastolic pressure.

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It is considered high if it is over 90 most of the time. It is considered normal if it is below 80 most of the time.

Pre-hypertension may be considered when your:

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Top number (systolic blood pressure) is between 120 and 139 most of the time, or Bottom number (diastolic blood pressure) is between 80 and 89 most of the time

If you have pre-hypertension, you are more likely to develop high blood pressure. If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions. Causes, incidence, and risk factors Many factors can affect blood pressure, including:
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How much water and salt you have in your body The condition of your kidneys, nervous system, or blood vessels The levels of different body hormones

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death. You have a higher risk of high blood pressure if you:
y y y y

Are African American Are obese Are often stressed or anxious Eat too much salt in your diet

St. Paul University Dumaguete College of Nursing

y y y

Case Study on HPN and Asthma

Have a family history of high blood pressure Have diabetes Smoke

Most of the time, no cause is identified. This is called essential hypertension. High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary hypertension may be due to:
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Alcohol abuse Atherosclerosis Autoimmune disorders such as periarteritis nodosa Chronic kidney disease Coarctation of the aorta Cocaine use Diabetes (if it causes kidney damage) Endocrine disorders, such as adrenal tumors (pheochromocytoma, aldosteronism), thyroid disorders, and Cushing syndrome Medications o Appetite suppressants o Birth control pills o Certain cold medications o Corticosteroids o Migraine medications Renal artery stenosis

Symptoms Most of the time, there are no symptoms. Symptoms that may occur include:
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Confusion Ear noise or buzzing Fatigue Headache Irregular heartbeat Nosebleed Vision changes

If you have a severe headache or any of the symptoms above, see your doctor right away. These may be signs of a complication or dangerously high blood pressure called malignant hypertension. Signs and tests Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your health care provider may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be confirmed. If you monitor your blood pressure at home, you may be asked the following questions:
y y y y

What was your most recent blood pressure reading? What was the previous blood pressure reading? What is the average systolic (top number) and diastolic (bottom number) reading? Has your blood pressure increased recently?

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

Other tests may be done to look for blood in the urine or heart failure. Your doctor will look for signs of complications in your heart, kidneys, eyes, and other organs in your body. These tests may include:
y y y y y

Blood tests Echocardiogram Electrocardiogram Urinalysis Ultrasound of the kidneys

Treatment The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you. There are many different medicines that can be used to treat high blood pressure, including:
y y y y y y y y y

Alpha blockers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARBs) Beta blockers Calcium channel blockers Central alpha agonists Diuretics Renin inhibitors, including aliskiren (Tekturna) Vasodilators

Your health care provider may also tell you to exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your health care provider will recommend the same lifestyle changes to bring your blood pressure down to a normal range. Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication. In addition to taking medicine, you can do many things to help control your blood pressure, including:
y y y y y y y

Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. Exercise regularly -- at least 30 minutes a day. If you smoke, quit -- find a program that will help you stop. Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men. Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day. Reduce stress -- try to avoid things that cause stress for you. You can also try meditation or yoga. Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.

Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you. Your health care provider may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. Expectations (prognosis) Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

Complications
y y y y y y y y y y y

Aortic dissection Blood vessel damage (arteriosclerosis) Brain damage Congestive heart failure Chronic kidney disease Heart attack Hypertensive heart disease Peripheral artery disease Pregnancy complications Stroke Vision loss

Calling your health care provider If you have high blood pressure, you will have regularly scheduled appointments with your doctor. Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure. Call your health care provider right away if home monitoring shows that your blood pressure remains high or you have any of the following symptoms:
y y y y y y y y

Chest pain Confusion Excessive tiredness Headache Nausea and vomiting Shortness of breath Significant sweating Vision changes

Prevention Adults over 18 should have their blood pressure checked routinely. Lifestyle changes may help control your blood pressure:
y y y

y y y y

Avoid smoking. (See: Nicotine withdrawal) Do not consume more than 1 drink a day for women, 2 a day for men. Eat a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and saturated fat intake (the DASH diet is one way of achieving this kind of dietary plan). (See: Heart disease and diet) Exercise regularly. If possible, exercise for 30 minutes on most days. If you have diabetes, keep your blood sugar under control. Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed. Try to manage your stress.

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

y Asthma
Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. This makes the airways swollen and very sensitive. They tend to react strongly to certain inhaled substances. When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways may make more mucus than normal. Mucus is a sticky, thick liquid that can further narrow your airways. This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are inflamed.
Asthma

Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms. Sometimes, asthma symptoms are mild and go away on their own or after minimal treatment with an asthma medicine. Other times, symptoms continue to get worse. When symptoms get more intense and/or more symptoms occur, you're having an asthma attack. Asthma attacks also are called flareups or exacerbations

Causes and Risk Factors

Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by.

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers). Common asthma triggers include:
y y y y y y y y y y

Animals (pet hair or dander) Dust Changes in weather (most often cold weather) Chemicals in the air or in food Exercise Mold Pollen Respiratory infections, such as the common cold Strong emotions (stress) Tobacco smoke

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) provoke asthma in some patients. Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies.

Symptoms
Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom. Asthma attacks can last for minutes to days, and can become dangerous if the airflow is severely restricted. Symptoms include:
y y y y

Cough with or without sputum (phlegm) production Pulling in of the skin between the ribs when breathing (intercostal retractions) Shortness of breath that gets worse with exercise or activity Wheezing, which: o Comes in episodes with symptom-free periods in between o May be worse at night or in early morning o May go away on its own o Gets better when using drugs that open the airways (bronchodilators) o Gets worse when breathing in cold air o Gets worse with exercise o Gets worse with heartburn (reflux) o Usually begins suddenly

Emergency symptoms:
y y y y y y

Bluish color to the lips and face Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack Extreme difficulty breathing Rapid pulse Severe anxiety due to shortness of breath Sweating

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

Other symptoms that may occur with this disease:

y y y y y

Abnormal breathing pattern --breathing out takes more than twice as long as breathing in Breathing temporarily stops Chest pain Nasal flaring Tightness in the chest

Signs and tests

Allergy testing may be helpful to identify allergens in people with persistent asthma. Common allergens include:
y y y y y

Cockroach allergens Dust mites Molds Pet dander Pollens

Common respiratory irritants include:

y y y

Fumes from burning wood or gas Pollution Tobacco smoke

The doctor will use a stethoscope to listen to the lungs. Asthma-related sounds may be heard. However, lung sounds are usually normal between asthma episodes. Tests may include:
y y y y y

Arterial blood gas Blood tests to measure eosinophil count (a type of white blood cell) and IgE (a type of immune system protein called an immunoglobulin) Chest x-ray Lung function tests Peak flow measurements

Treatment
The goal of treatment is to avoid the substances that trigger your symptoms and control airway inflammation. You and your doctor should work together as a team to develop and carry out a plan for eliminating asthma triggers and monitoring symptoms. There are two basic kinds of medication for treating asthma:
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Control drugs to prevent attacks Quick-relief drugs for use during attacks

Control drugs for asthma control your symptoms if you don't have mild asthma. You must take them every day for them to work. Take them even when you feel okay. The most common control drugs are:
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Inhaled corticosteroids (such as Azmacort, Vanceril, AeroBid, Flovent) prevent symptoms by helping to keep your airways from swelling up.

St. Paul University Dumaguete College of Nursing

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Case Study on HPN and Asthma

Long-acting beta-agonist inhalers also help prevent asthma symptoms. Do not take longacting beta-agonist inhaler drugs alone. These drugs are generally used together with an inhaled steroid drug. It may be easier to use an inhaler that contains both drugs.

Asthma quick-relief drugs work fast to control asthma symptoms:

y y y

You take them when you are coughing, wheezing, having trouble breathing, or having an asthma attack. They are also called "rescue" drugs. They also can be used just before exercising to help prevent asthma symptoms that are caused by exercise. Tell your doctor if you are using quick-relief medicines twice a week or more to control your asthma symptoms. Your asthma may not be under control, and your doctor may need to change your dose of daily control drugs.

Quick-relief drugs include:

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Short-acting bronchodilators (inhalers), such as Proventil, Ventolin, and Xopenex Your doctor might prescribe oral steroids (corticosteroids) when you have an asthma attack that is not going away. These are medicines that you take by mouth as pills, capsules, or liquid. Plan ahead. Make sure you do not run out of these medications.

A severe asthma attack requires a check-up by a doctor. You may also need a hospital stay, oxygen, and medications given through a vein (IV). Asthma action plans are written documents for anyone with asthma. An asthma action plan should include:
y y y

A plan for taking asthma medications when your condition is stable A list of asthma triggers and how to avoid them How to recognize when your asthma is getting worse, and when to call your doctor or nurse

A peak flow meter is a simple device to measure how quickly you can move air out of your lungs.
y

It can help you see if an attack is coming, sometimes even before any symptoms appear. Peak flow measurements can help show when medication is needed, or other action needs to be taken. Peak flow values of 50% - 80% of a specific person's best results are a sign of a moderate asthma attack, while values below 50% are a sign of a severe attack.

Support Groups
You can often ease the stress caused by illness by joining a support group, where members share common experiences and problems.

Complications
The complications of asthma can be severe. Some include:
y y y y y

Death Decreased ability to exercise and take part in other activities Lack of sleep due to nighttime symptoms Permanent changes in the function of the lungs Persistent cough

St. Paul University Dumaguete College of Nursing

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Case Study on HPN and Asthma

Trouble breathing that requires breathing assistance (ventilator)

Prevention
You can reduce asthma symptoms by avoiding known triggers and substances that irritate the airways.
y y y y y y

Cover bedding with "allergy-proof" casings to reduce exposure to dust mites. Remove carpets from bedrooms and vacuum regularly. Use only unscented detergents and cleaning materials in the home. Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold. Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks in some people. If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair -- this can trigger asthma symptoms.

Persons with asthma should also avoid air pollution, industrial dusts, and other irritating fumes as much as possible.

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

PHARMACOLOGY
y Iterax Generic Name: Indication: H yd rox yzine Treatment of anxiety, preoperative sedation, antiemetic, antipuritic, may becombined with opioid anagesics antianxiety agents, antihistamines, sedative

Drug classification:

Mechanism of action: Competes with histamine for H1-receptor sites on effector cells in the GIT, blood vessels, and respiratory tract Dosage: Adult anxiety: 25mg bid-qid or 50-100mgmg at night, premed general anesthesia 100-200mg the night before the surgery symptomatic treatment of pruritus and allergic origin 30100mg/day Children 30 mos 15 yr 1mg/kg/day in divided doses severe hepatic dysfuncti

Special precaution:

Pregnancy risk category: C Adverse reaction: CNS: drowsiness, agitation, ataxia, dizziness, headache, weakness Resp:wheezing GI: dry mouth, bitter taste, constipation, nausea Derm: flushingOthers : pain and abscesses at IM site, chest tightness, urinary retention hypersensitivity, pregnancy Tablets 10mg, Capsules 10mg, syrup 10mg/5ml, oral suspension 25mg/5ml, injection 25mg/ml

Contraindicated to: Form:

Nursing responsibilities: Assess client for dizziness and drowsiness Assess client with kidney disease Assess clients for allergic reactions

St. Paul University Dumaguete College of Nursing

Case Study on HPN and Asthma

Norvasc Generic Name: Indications: Amlodipine Alone or with other agents in the management of Hypertension, Angina Pectoris, and Vasospastic (Prinzmetals) Angina.

Drug Classification: Therapeutic: Antihypertensives ; Calcium Channel Blockers Mechanism of Action: Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation contraction coupling and subsequent contraction. Systematic Vasodilation resulting in decreased blood pressure. Coronary Vasodilation resulting in decreased frequency and severity of attacks of Angina. 5-10mg once daily; antihypertensive in fragile or small patients or patients already receiving other antihypertensives initiate at 2.5mg/day, increase as required/tolerated (up to 10mg/day) as an antihypertensive therapy with 2.5mg/day in patients with hepatic insufficiency. Category:C CNS: headache, dizziness, fatigue CV: Peripheral Edema, Angina, Bradycardia, Hypotension, and PalpitationsGI: Gingival Hyperplasia, Nausea. Derm:Flushing Hypersensitivity; Blood Pressure <90 mmHg Tab 5mg x 100s; 10mg x 100s

Therapeutic Effects:

Dosage: PO (Adults):

Pregnancy Risk Adverse Reactions:

Contraindications: Form: Nursing Responsibilities:

General Info: Monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy, Monitor ECG periodically during prolonged therapy. Monitor intake and output ratios and daily weight. Assess for signs of CHF. Angina: Assess location, duration, intensity, and precipitating factors of patients anginal pain