BRONCHIAL

ASTHMA
SUBMITTED BY:
MELISSA D. DAVID
SUBMITTED TO:
VANESSA ONG-UMALI

GENERAL OBJECTIVES:
The general objective of the case study is to gain the comprehensive
knowledge about the disease to gain the practical exercise about the Adult
Health Problem and also to gain Practical experience working with a patient
having chronic kidney disease and to give holistic patient care according to
their need.

SPECIFIC OBJECTIVES:

Describe Bronchial Asthma

Recognize its clinical signs and symptoms
Identify causative factors of Bronchial Asthma
Identify diagnostic procedures used to determine the disease
Know the medical and surgical management

I.

INTRODUCTION

Asthma is a chronic inflammatory respiratory disorder that

causes recurrent episodes of wheezing, breathlessness, chest tightness
and cough, especially at night or in the early morning. These asthma
episodes are associated with airflow limitation or obstruction that is
reversible either spontaneously or with treatment. Asthma usually
begins in childhood or adolescence, but it also may first appear during
adult years. While the symptoms may be similar, certain important
aspects of asthma are different in children and adults.
Bronchial asthma is the more correct name for the common
form of asthma. The term 'bronchial' is used to differentiate it from
'cardiac' asthma, which is a separate condition that is caused by heart
failure. Although the two types of asthma have similar symptoms,
including wheezing (a whistling sound in the chest) and shortness of
breath, they have quite different causes.
Bronchial asthma is usually intrinsic (no cause can be
demonstrated), but is occasionally caused by a specific allergy (such as
allergy to mold, dander, dust). This case study is a thorough learning
about Bronchial Asthma, which contains a study about the normal
physiology of the respiratory system, pathological physiology of the
disease, a thorough assessment of the patient with said illness, applied
nursing care plans to patients having this kind or disease, and
discharge planning to a patient to limit the recurrence of the attack or
if not proper management and care to be given during the time of
asthma attack.

II.

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 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.
Mechanics of Breathing
To take a breath in, the external intercostal muscles contract, moving the
ribcage up and out. The diaphragm moves down at the same time, creating
negative pressure within the thorax. The lungs are held to the thoracic wall
by the pleural membranes, and so expand outwards as well. This creates
negative pressure within the lungs, and so air rushes in through the upper
and lower airways.
Expiration is mainly due to the natural elasticity of the lungs, which tend to
collapse if they are not held against the thoracic wall. This is the mechanism
behind lung collapse if there is air in the pleural space

III.

PATHOPHYSIOLOGY

Contributing Factors
Predisposing Factor
Causal Factors
-Respriratory infections
-Atopy
-Exposure to indoor and outdoor allergens-Air pollution
-Female gender
-Occupational sensitizers -Others: diet, small size
at birth

Inflammation
Hyperresponsiveness
of airways
-Risk Factors for
Exacerbations
-Allergens
-Respiratory infections
-Exercise and hyperventilation
-Weather changes
-Exposure to sulfur dioxide
-Exposure to food, additives,
medications

Airflow limitation

Symptoms
Wheezing
Cough
Dyspnea
Chest tightness

IV.

PATIENTS PROFILE
V.
VI.

VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
XVI.
XVII.

Patients Name:
Ward Rm:
Age:
Sex:
Civil Status:
Nationality:
Admission Date:
Physicians Diagnosis:
CC:

PATIENT TR
ER DEPT.
38 y/o
Female
Married
Filipino
11/28/2015
Chronic Kidney Disease
DOB

PHYSICAL EXAMINATION
VITAL SIGNS:
BP 140/100 PR 110 bpm

RR 18O2

Sat

100%
XVIII.

SKIN:

Good skin turgor, warm to touch, no lesion,

no rashes
HEENT:
CHEST/LUNGS:
XXI.
XXII.
HEART:

Anicteric Sclera, PERRLA

Symmetric chest expansion with no retractions,
Wheezes bilateral air entry
Adynamic
precordium,
tachycardic,
regular

rhythm, (-) murmurs

XXIII.
ABDOMEN:
XXIV.
EXTREMITIES:
XXV.
NEUROGICAL:

Flabby abdomen, NABS, soft, non-tender

Full and equal pulse, (+) edema
GCS 5

XIX.
XX.

XXVI.

XXVII.
XXVIII.
XXXIV.
XXXV.
XXXVI.
XXXVII.

XXXVIII.
XXXIX.

XL.
XLI.
XLII.
XLIII.

NURSING CARE PLAN

Assessm
XXIX.
ent
Subjective
XLIV.
:(none)
Objective:
wheezing
upon
inspiratio
n and
expiration
dyspnea
-chest
tightness
supraster
nal
retraction
restlessne
ss
-anxiety
-cyanosis
-loss of
conscious
ness

Nsg.
XXX.
Diagn
osis
Ineffec
XLV.
tive
breathi
ng
pattern
r/t
presen
ce of
secreti
ons
AEB
produc
tive
cough
and
dyspne
a

Plann
XXXI.
ing
Patien
XLVI.
t will
demo
XLVII.
nstrat
e
XLVIII.
purse
d-lip
XLIX.
breat
hing L.
and
diaphr
agmat
ic
breat LI.
hing.

LII.

LIII.

LIV.

InterventionXXXII.
1. Establish LVII.
rapport.
2. Assess pt.s
LVIII.
condition
3. VS monitorLIX.
and record
4. Auscultate LX.
breath sounds
and assess
airway pattern
5. Elevate
LXI.
head of the
bed and
change
LXII.
position of the
LXIII.
pt. every2
hours.
6. EncourageLXIV.
deep breathing
LXV.
and coughing
LXVI.
exercises.
7.
Demonstrate
diaphragmatic
LXVII.
and pursed-lip
LXVIII.
breathing.
8. EncourageLXIX.

Rationale
XXXIII.
1. To gain pt.s
LXXIII.
trust.
2. To obtain
baseline data
3. Serve to track
important
changes
4. To check for
the presence of
adventitious
breath sounds
5. To minimize
difficulty
inbreathing
6. To maximize
effort for
expectoration.

7. To decrease air
trapping and for
efficient
breathing.
8. To prevent
fatigue.

Evaluation
Patient was
able to
demonstrate
pursed-lip
breathing
and
diaphragmati
c breathing.

Indicatio
V.
Adverse
General
n (s)
Reaction
IV.
Purpose(
action
s
s)
X.
XII.
increase
in Replacem
LXX.
Enters target
XI.
XIII.9. To prevent
Vertigo,
fluid
intake
situations
that
cells and
ent
headache
LV.
9. Encourage
will aggravate
binds to
therapy
,
opportunities
the condition
cytoplasmic
in adrenal
paresthes
for rest and LXXI.
receptor; limit physical
cortical
ias,
LXXII.
10. To mobilize
initiates
insomnia,
activities. insufficie
secretions
many
ncy
seizures,
LVI.
10.Reinforce
complex
psychosis
low salt, low
fat diet as
reactions that
.
ordered
are
responsible
for its antiinflammatory,
immunosuppr
essive
(glucocorticoi
d), and saltretaining
(mineralocorti
coid) actions.
Some actions
maybe
undesirable,
depending on
drug use
acts relatively
XVI.
Relief and
XIX.
Inhaled
selectively at
preventio
salbutam
beta 2
n of
ol can
adrenergic
brochosp
cause
receptors to
asm in
tremor,
cause
patients
inner
bronchodilati
with
agitation,
on and
reversible
palpitatio
III.

I.

VI.
VII.

Name
of Drug
VIII.
HydrocoIX.
rtisone
100 g
TIV

LXXIV.
LXXV.
LXXVI.
LXXVII.
LXXVIII.

XIV.

SalbutaXV.
mol Neb

II.