University of Perpetual Help System Laguna Dr.

Jose G, Tamayo Medical University Sto Nio, City of Bian, Laguna

COLLEGE OF NURSING

BRONCHIAL ASTHMA, ACUTE EXACERBATION

Aguilar, Dan Joseph V. Submitted By:

Thelma De Mesa RN, MAN Submitted To:

Description: Asthma is a chronic lung disorder that causes airways (the tubes that carry air into and out of the lungs) to become inflamed, which means that they swell and produce lots of thick mucus. The muscles surrounding the airways also tend to tighten, which makes the already clogged airways even narrower. This results in asthma symptoms, which can include coughing, wheezing, and shortness of breath. In a person with asthma, the airways are overly sensitive to certain things (such as allergies, viral infections, cold air, exercise, and smoke) that can "trigger," or bring on, asthma symptoms. People with asthma often find that their symptoms come and go - when the symptoms are present, it's known as a flare, flare-up, episode, exacerbation, or attack. Patients Profile Name: Marcellana, Alberto delos Santos Age: 59y/o Gender: Male Religion: Roman Catholic Date of Admission: January 12, 2014 Admission Time: 11:01am Diagnosis: Bronchial Asthma, Acute Exacerbation Attending Physician: Felicitos Obillo

History of Present Illness Chief Complaint: Difficulty of Breathing 2 days prior to admission, the patient experienced Difficulty of Breathing, no associated cough, colds, no fever, no dizziness, no body weakness. The patient selfmedicate with ventolin neb which offered temporary relief of DOB. 1 day prior to admission due to presence of DOB due to asthma as claimed by the patient still with no other associated signs and symptoms. Patient sought consult for management. Initial Vital Signs: BP 120/70 mmHg PR 86bpm RR 24cpm T 36.5c

Familial History (+) Diabetes Mellitus in maternal side

Physical Assessment Sensorium: Consient, coherent Skin: Warm to touch, good skin turgor HEENT: Head symmetrical and round, sclera clear, no tenderness or pain when ears are palpated, no signs of enlarged lymph nodes Chest/Lungs: Full chest expansion, no dyspnea upon auscultation, no wheezes and crackles present Abdomen: No abdominal distention, No movementor sligh peristalsis visualized Extremities: Full equal pulse, good capillary refill

PATHOPHYSIOLOGY

Predisposing Factors Atopy Gender

Clinical Factors Exposure to indoor and outdoor allergens Occupational sinsitizers

Contributing Factors -Respiratory infections -Air pullotion -Active//Passive smoking

Inflammation

Hyperresponsive of illness

Airflow limitation

Symptoms Wheezing cough dyspnea Cough Dyspnea Chest tightness

Risk Factors for exacerbations Allergens Respiratory infections Exercise and hyperventilation Wheather changes Exposure to food, additives, medications

MEDICATIONS NUELIN Generic Name: Theophylline Dosage/Frequency/Route: 125mg BID OP Classification: Bronchodilators Indication: Maintenance treatment in severe asthma and chronic obstructive airways disease. Contraindication: Hypersensitivity Mechanism of action: bronchial smooth muscle relaxation; anti-inflammatory effects; increase in diaphragm contractility and CNS stimulation Side Effects: Nausea, vomiting, headache, insomnia, irritability, tachycardia, palpitations, tremors Adverse: Seizure, Cardiac arrhythmias Nursing Consideration: 1.) Inform patient that they will feel palpitations 2.) Instruct patient to report for unusual side effects FLUIMUCIL Generic Name: Acetylcysteine Dosage/Frequency/Route: 600mg 1tab in 75cc H2O OD Classification: Mucolytics Indication: Acute & chronic respiratory tract infections with abundant to acute bronchitis, chronic bronchitis & its exacerbation, emphysema, mucoviscidosis & bronchiectasis. Contraindication: Hypersensitivity Mechanism of action: Decrease viscosity as non-purulent and purulent mucus and other secretions Side Effects: Nausea Adverse: Bronchospasm, rhinitis & Stomatitis Nursing Consideration: 1.) Give meds with meals. 2.) Instruct patient to discontinue if bronchospasm is present. 3.) Provide suction of secretions CEFTRIAXONE Generic Name: Rocephin Dosage/Frequency/Route: 1g IV, q 12 OD Classification: Antibiotics, Cephalosporins Indication: Bacterial infections Contraindication: Hypersensitivity to cephalosporins

Mechanism of action: Works by interfering with the formation of the bacterias cell wall so that the wall ruptures, resulting in the death of the bacteria. Side Effects: Mild diarrhea, nausea, mild pain Adverse: Stomach pain/cramps Nursing Consideration: 1.) Take drug with meals

Patients Name: Marcellana, Alberto de los Santos Age/Gender: 59y/o Male Date of Admission: January 12, 2014 Medical Diagnosis: Bronchial Asthma, Acute Exacerbation Nursing Diagnosis: Impaired gas exchange related to chronic airway limitation Short term goal: After 8 hours of nursing interventions, the patient will be able to maintain airway patency Long term goal: After 2 weeks of nursing interventions, the patient will have clear airway

CUES S> Nahihirapan akong huminga as verbalized by the patient, O -Wheezes present upon auscultation -Dyspnea upon exertion -Tachypnea (RR=24cpm) V/S taken: BP 120/70 PR 86 RR 24 T 36.5c

PROBLEM Difficulty of breathing

SCIENTIFIC REASON Inflammation of the bronchioles causes bronchoconstriction therefore increasing mucous production and produces wheezing sounds

NURSING INTERVENTIONS 1.) Monitor respirations and breathe sounds, noting rate and sounds 2.) Elevate head of the bed and change position every 2 hrs and prn.

RATIONALE - indicative of respiratory distress or accumulation of secretions - To take advantage of gravity decreasing pressure on the diaphragm and enhancing drainage - To maximize effort

EVALUATION STANDARD CRITERIA Normal The patient is respiratory able to rate breathe with ease Able to breathe Absence of without effort wheezing sounds upon No auscultation adventitious sounds Respiratory present rate has reduced to normal at 20cpm

3.) Encourage deep-breathing and coughing exercises 4.) Increase fluid

intake within cardiac tolerance

- Hydration can help liquefy viscous secretions and improve secretion clearance - To ascertain status and note progress

5.)Auscultate breath sounds and assess air movement 6.) Assist client with postural drainage and percussion if not contraindicated by condition 7.) Instruct patient to limit activities and have adequate rest

-To mobilize secretions

- To decrease oxygen demand and prevent aggravation of the condition - To enhance breathing capacity
- To improve or

8.) Give bronchodilators as ordered

9.) Give oxygen 1-2lpm as

ordered

correct existing deficiencies