BRONCHIAL ASTHMA

INTRODUCTION

Asthma is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing and dyspnea. Asthma differs from the other obstructive lung disease is that it is largely reversible, either spontaneously or with treatment. Patients with asthma may experience symptom-free periods alternating with acute exacerbations, which last from minutes to hours or days. Asthma can occur at any age and is the most common chronic disease in the childhood.

PATIENTS PROFILE

Name:B.C.L Chief Complaint: DOB Room: 401 A Date Admitted: Sex: Female February 13, 2012 Age: 49 years old Attending Physician: Dr. B.A Address: Soro-Soro, Bian, Laguna Initial Diagnosis: Acute Marital Status: Married Respiratory Failure secondary to Occupation: Housewife Bronchial Asthma in Religion: Roman severe exacerbation Catholic Nationality: Filipino

MEDICAL HISTORY

General Data This is a case of B.C.L , 49 years of age, presently residing at Soro-Soro, Bian, Laguna, admitted for the first time in this institution, on February 12, 2011 at 3:20 in the afternoon Chief complaint: Difficulty of Breathing History of Present Illness: The patient was previously diagnosed with Bronchial Asthma during her childhood and was given Salbutamol Inhaler as a maintenance medication but was never admitted in any medical institution until her present hospitalization. Hours prior to hospitalization, the patient continuously experienced severe difficulty of breathing which prompted admission. Past Medical History: The patient has no past medical history. Personal and Social History: She is a non-smoker and non-alcoholic beverage drinker. Past Medical History Fathers Side: History of Hypertension Mothers Side: History of Hypertension and Breast Cancer

PHYSICAL ASSESSMENT

Skull -Generally round, with prominences in the frontal and occipital area. Scalp -Lighter in color than the complexion. -No scars noted. -Free from lice, nits and dandruff. -No lesions noted. Hair -black, thick and brittle

Face -Oval in shape. -Symmetrical. -No involuntary muscle movements. -Can move facial muscles at will. Eyebrows - Symmetrical and in line with each other - Black - Evenly distributed. Eyes -Evenly placed and in line with each other. Eyelashes -Color dependent on race. -Evenly distributed.

Ears -The ear lobes are bean shaped, parallel, and symmetrical. -The upper connection of the ear lobe is parallel with the outer canthus of the eye. -Skin is same in color as in the complexion. -No lesions noted on inspection. -The ear canal has normally some cerumen of inspection. -No discharges or lesions noted at the ear canal. Nose -Nose in the midline -No Discharges. -No tenderness noted on palpation of the paranasal sinuses. Neck -No visible and palpable mass or lumps.

Abdomen -Presence of scar in midline

Extremities -Both extremities are equal in size. -No involuntary movements. -No edema noted -Color is even. -Temperature is warm and even.

ANATOMY AND PHYSIOLOGY

PATHOPHYSIOLOGY

Nonmodifiable Factors:

Gender Immunity Hereditary Age

Stimuli enters the nasopharynx straight to the trachea then travels to the bronchial tree. Allergens enters the tissue. Allergens invades the tissues. Prostaglandins are released.

Modifiable Factors:
Allergens

Compromised ventilatory pattern Decreased diffusion of O2 into the arterial ends of the pulmonary capillaries.

Increased blood flow of the bronchiole.

Increased vascular permeability of the bronchioles. Inrease RR Dyspnea

S/Sx Wheezing Secretions

ACUTE RESPIRATORY FAILURE SECONDARY TO BRONCHIAL ASTHMA IN SEVERE EXACERBATION

MEDICAL MANAGEMENT

Date

Order

Nursing Responsibilities

February 12, 2012 3:20 pm BP: 130/90 CR: 120bpm Temp: 36.5

>Please admit under the service of Dr. BA >Please secure consent for patient >NPO temporarily >TPR with shift and record >IVF PNSS 500cc x 8hrs Labs: CBC with platelet count CXR AP

>monitor patient >Make sure to enlighten patient about procedures and other management > prevent aspiration > makes sure to obtain baseline data and monitor patients status for accuracy >to rehydrate patient and prevent loss of electrolytes >ask for patients consent >Make sure patient receives proper amount of drug. >Make sure procedure is done at right time >advice patient to do bladder exercises >make sure the IVF to follow is prepared ahead of time. >make sure the side drip to follow is prepared ahead of time

February 13, 2012 7:00 am > Creatinine: 106-124 > ABG: pO2=252

> Start Aminophylline drip at 10gtts/min >Repeat ABG at 6pm today >Start bladder training *IVF to follow: D5IMB 1L x 80 cc/hr *Aminophylline drip to follow: D2W 250 cc +1 amp aminophylline

DRUG STUDY

NURSING CARE PLAN