BICOL UNIVERSITY POLANGUI CAMPUS NURSING AND HEALTH SCIENCES DEPARTMENT POLANGUI, ALBAY

CASE STUDY
(BRONCHIAL ASTHMA WITH ACUTE EXACERBATION)

Submitted by: DANILYN R. CENITA BSN - IV

Submitted to: BINONDO G. REVIDAD JR., RN, MAN Clinical Instructor

PATIENTS PROFILE
Hospital Number: Ward: Name: Age: Date of Birth: Gender: Civil Status: Address: Fathers Name: Mothers Name: Religion: Nationality: Occupation: Chief Complaint: Admission Date: Type of Admission: Allergic to: Health Insurance: 2013-07-15,025 Pediatric Ward Ranico Arsega Bisco Jr. (Mr. RB) 15 years old September 29, 1997 Male/Child Single Brgy. Layon, Ligao City Ranico Bisco Sr. Donabelle Rossun Roman Catholic Filipino N/A Difficulty of Breathing July 18, 2013/12 HN New None PhilHealth

Attending physician: Dr. Quiones Admitting Diagnosis: Bronchial Asthma with Acute Exacerbation

MEDICAL HISTORY
Present Medical History In the present medical history of Mr. RB, he mentioned that he had episodes of difficulty of breathing upon admission. He also mentioned that he feel dizzy and pain at the back. The severity of it, is tolerable according to Mr. RB and had a score of 5 out of 10 in the pain scale. There is no other complaint that Mr. RB experiencing. Vital Signs: T: 37.2 C P: 75 BPM R: 25 BPM BP: 100/70

Past Medical History Problems at Birth: None Childhood Illnesses: Fever, cold, cough Adult Illnesses: Bronchial Asthma Surgeries: None Accidents: None Allergies: None

Family Medical History In regards to Mr. BJs family, his father and mother is presently taking care of him. He stated that his Grandmother(side of her mother) has also asthma and one of his sisters has asthma.

Lifestyle Practices Mr. RB is now 15 years old, due to difficulty of breathing he was not able to perform his daily activity such as doing household chores, going to school, he eats food like vegetables, fruits, rice and sometimes meat. 24-Hour Dietary Intake: Milk and biscuit during breakfast, rice and vegetables during lunch, sometimes meat, rice and vegetables during dinner

Who purchases and prepares meals: Parents Activities on a typical day: Walking inside the house, watching television or listening to radio and eating

Sleep rest habits and patterns: Wakes up at around 6 am and sleeps at around 9 pm Self care responsibilities: Takes a bath once a day and eat 3 times a day without the assistance Social activities for fun and relaxation: Listening to the radio or watching television and talking together with his family, and friends, and playing basketball.

Social activities contributing to society: Cleaning the surroundings of their house Relationships with family, SO: Harmonious Stressors in life: During hospitalization and lack of financial support Coping mechanism: Expressed his emotion about the problem to his family and friends

Psychosocial Environment Mr. RBs family lives in a harmonious environment, talking to their other relatives and friends during reunion or any occasion, and participate to their community activity.

CEPHALO-CAUDAL ASSESSMENT
HEAD/SKULL: is proportional to the size of the body, round, with prominences in the frontal and the occipital area, has dizziness SCALP: is white, clean and free from masses, lumps and scar, nits, dandruff and any lesions HAIR: is white and some are black in color and thinning, hair strands are fine and evenly distributed FACE: is round-shaped, symmetrical, and no involuntary muscle movements EYES: are parallel and evenly placed, symmetrical, non-protruding, both eyes are brown and clear, able to move in all direction, able to see/read, Pupils are Equal, Round and Reactive to Light and Acuity EARS: are parallel, symmetrical, proportional to the size of the head, bean-shaped, skin is same color as the surrounding area, clean with minimal amount of serumen NOSE: is located in midline, symmetrical and patent, with few cilia and clean, can smell properly MOUTH: LIPS: are slightly black and dry, symmetrical, lip margin well-defined, smooth GUMS: pinkish, smooth, moist, no swelling, no retraction, no discharges. TEETH: complete and no dental caries TOUNGE: pinkish color, moist, shiny and freely movable UVULA: at the center, symmetrical and freely movable.

NECK: is proportional to the size of the body and head, symmetrical and straight, no palpable lumps, masses, or areas of tenderness, free movable without difficulty, symmetrical and able to resist force THORAX and LUNGS: chest contour is symmetrical, spine is slightly bent forward, chest wall moves symmetrically during respiration no lumps, masses, areas of tenderness, sides of the thorax expand symmetrically

ABDOMEN: no scar, color is uniform, symmetrical movements caused by respiration, and color is the same as the surrounding skin soft abdomen, no lumps or masses

HEART: apical pulse is visible and palpable, HR of 92 BPM SKELETAL: muscle weakness UPPER EXTREMITIES: ARM: skin color is Tan, symmetrical, thin of hairs, there are visible veins, fingers are symmetrical warm, moist and there is loss of elasticity, there are no areas of tenderness PALM: warm

NAILS: convex curvature, smooth texture, pale nail beds and it takes more than 3 seconds before it turns back to its original color LOWER EXTREMETIES: LEGS: skin is tan, dry, length symmetrical TOES: five toes in each foot, sole have rough surface

LABORATORY DIAGNOSTIC EXAM

HEMATOLOGY

URINALYSIS

ANATOMY & PHYSIOLOGY

The human respiratory system consists of the lungs and tubes associated with the lungs. It is located in the thorax or chest. The thorax is surrounded by the ribs. The diaphragm forms the base of the thorax. Contractions of the diaphragm and the intercostals muscle change the size of the thorax and, thus, cause air to move in and out of the lungs. The main job of the respiratory system is to get oxygen into the body and get waste gases out of the body. It is the function of the respiratory system to transport gases to and from the circulatory system. The Nose or Nasal Cavity As air passes through the nasal cavities it is warmed and humidified, so that air that reaches the lungs is warmed and moist. The Nasal airways are lined with cilia and kept moist by mucous secretions. The combination of cilia and mucous helps to filter out solid particles from the air, warm and moisten the air, which prevents damage to the delicate tissues that form the Respiratory System. The moisture in the nose helps to heat and humidify the air, increasing the amount of water vapor the air entering the lungs contains. This helps to keep the air entering the nose from drying out the lungs and other parts of our respiratory system. When air enters the respiratory system through the mouth, much less filtering is done. It is generally better to take in air through the nose. The Pharynx

The pharynx is also called the throat. As we saw in the digestive system, the epiglottis closes off the trachea when we swallow. Below the epiglottis is the larynx or voice box. This contains 2 vocal cords, which vibrate when air passes by them. With our tongue and lips we convert these vibrations into speech. The area at the top of the trachea, which contains the larynx, is called the glottis. The Trachea The trachea filters the air we breathe and branches into the bronchi.

The Lungs The lungs are spongy structure where the exchange of gases takes place. Each lung is surrounded by a pair of pleural membranes. Between the membranes is pleural fluid, which reduces friction while breathing. The bronchi are divided into about a million bronchioles. The ends of the bronchioles are hollow air sacs called alveoli. There are over 700 million alveoli in the lungs. This greatly increases the surface area through which gas exchange occurs. Surrounding the alveoli are capillaries. The lungs give up their oxygen to the capillaries through the alveoli. Likewise, carbon dioxide is taken from the capillaries and into the alveoli. GAS EXCHANGE Body cells use the inhaled oxygen gotten from the alveoli of the lungs. In turn, they produce carbon dioxide and water, which is taken to the alveoli and then exhaled. These exchanges occur as a result of diffusion. In each case the materials move from an area of high concentration to an area of lower concentration. The alveoli are well suited for the important job they have. There are about 300,000,000 alveoli per lung! That means there is a great surface area for gas exchange. Also, the walls of the alveoli as well as the capillaries are very thin so that the gases can diffuse readily. When the blood picks up the diffused gases the gases are carried to their destinations. Most of the oxygen is carried by the hemoglobin in the red blood cells with only a small % dissolved in the plasma. Carbon dioxide and water are carried in the plasma of the blood. THE MECHANISM OF BREATHING Inspiration or inhalation is said to be an active process because it involves muscle contraction. The diaphragm and intercostal muscles contract. The contracting diaphragm flattens and stretches the elastic lungs downward. The contracting intercostals pull the ribcage up and out causing the elastic lungs to stretch. The expanding lungs cause the air inside to expand (a gas will always fill its container). The expansion of air causes a drop in air pressure in the lungs. The air in the lungs is at a lower pressure than the air outside. Air flows from higher to lower pressure so air flows into the lungs from outside. Expiration or exhalation is said to be a passive process because it does not involve muscle contraction. The diaphragm and the intercostal muscles relax. The deforming force on the elastic lungs has been removed. The lungs recoil elastically reducing their volume a passive process. The volume of air in the lungs decreases causing an increase in the air pressure. The air in the lungs is at a higher pressure than the air outside. Air flows from higher to lower pressure so the air flows out of the lungs. The elastic recoil of the lungs pulls up the adhering diaphragm and drags in the adhering ribcage. Breathing is normally under unconscious control. We dont have to think about breathing. Exercise increases the rate of breathing. The brain detects a large increase in carbon dioxide and increases the rate of breathing. Now, exhalation, which is normally passive, becomes active. Other times when we control our breathing rate is in speaking, singing, or swimming. Breathing is always controlled by the brains detection of carbon dioxide in the blood. When carbon dioxide is in the blood the pH of the blood is slightly lowered. The brain detects this slight drop and sends impulses to the diaphragm and intercostal muscles. Thus, our breathing mechanism is

controlled by rising levels of carbon dioxide, not low levels of oxygen. Just as the level of carbon dioxide controls the stomata opening in leaves it also controls our breathing.

PATHOPHYSIOLOGY