UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNADr. Jose G.

Tamayo Medical University

Sto. Nio, Bian, Laguna
C O L L E G E

OF

N U R S I N G

CASE PRESENTATION OF

BRONCHIAL ASTHMA
IN PARTIAL FULFILLMENT FOR OUR REQUIREMENTS IN
COMPETENCY APPRAISAL 1

BACHELOR OF SCIENCE IN NURSING

4th YEAR A
GROUP 3

PREPARED BY:
GODINEZ, Leo Patrick V M.
LUNAS, Anna Carmela L.
MONGCAL, Joe Marie R.
PALMA, Charmaine J.
REYES, Ericka Jane P.
RITUALO, Philip Gerard A.
UNIDA, Rezelle C.
VALDEZ, Merry-Lhou F.
VERGARA, Bernadeth U.
VIRAY, Jessica May C.

August 03, 2012

INTRODUCTION
Asthma is a chronic inflammatory disease of the airways that causes airway
hyper-responsiveness mucosal edema, and mucus production. This inflammation
ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness,
wheezing and dyspnea.
In 1995 the international study of asthma and allergies in children conducted
phase 1 of a worldwide study to describe the prevalence and severity of asthma, rhinitis
and eczema among school children. One hundred fifty five centers in 56 countries
participated, including the Philippines. More than 450,000 children were interviewed
using a one-page written questionnaire or a video asthma questionnaire. The study
showed that the prevalence of asthma symptoms in children varied greatly in different
populations with differences ranging between 20 and 60 fold. The highest prevalence
was found from centers in the United Kingdom, Australia and New Zealand. Three
thousand two hundred and seven children in metro manila aged 13-14 years
participated in the ISAAC. Participants accomplished a 12 month prevalence of selfreported asthma symptoms from written questionnaires and from video questionnaires.
The results showed that approximately 12% and 8% prevalence based on responses to
the written questionnaires and to the video questionnaires respectively. In a subsequent
study, 12.3% of the same population reported wheezing.
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. Despite increased knowledge regarding the pathology of asthma and
the development of better medications and management plans, the death rate from
asthma continues to increase. For most patients it is a disruptive disease, affecting
school and work attendance, occupational choices, physical activity, and general quality
of life.
Allergy is the strongest predisposing factor for asthma. Chronic exposure to
airway irritants or allergens also increases the risk for developing asthma. Common
allergens can be seasonal (e.g. grass, tree and wood pollens) or perennial (e.g. mold,
dust, roaches, or animal dander). Common triggers for asthma symptoms and
exacerbations in patients with asthma include airway irritants (e.g. air pollutants, cold,
heat, weather changes, strong odors or perfumes, smoke), exercise, stress or emotional
upsets, sinusitis with postnasal drip, medications, viral respiratory tract infections and
gastroesophageal reflux. Most people who have asthma are sensitive to a variety of
triggers. A patients asthma condition will change depending upon the environment,
activities, management practice, and other factors.
On a pregnant woman with asthma, they will have difficulty pulling in air; on
exhalation, she has too much difficulty in releasing air that she makes a high pitched
whistling sound from air being pushed past the bronchial narrowing. Asthma has the
potential of reducing the oxygen supply to a fetus leading to preterm birth or fetal growth
restriction if a major attack should occur during pregnancy, although this is not likely
with well-managed asthma. Many women find that their asthma improves during

pregnancy because of the high circulating levels of corticosteroids that are present. A
woman should check with her physician or nurse-midwife about the safety of the
medication she routinely takes for this disorder before pregnancy to be certain it will be
safe to continue using them during pregnancy and breast feeding.

PATIENTS PROFILE
NAME

C. D. R.

ADDRESS

City of Sta. Rosa Laguna

GENDER

Female

AGE

21 years old

BIRTHDAY

December 19, 1990

CIVIL STATUS

Single

NATIONALITY

Filipino

RELIGION

Roman Catholic

FATHERS NAME :

R. C.

MOTHERS NAME :

F. R.

ADDRESS

City of Sta. Rosa Laguna

ADMISSION DATE :

July 02, 2012

ADMISSION TIME :

10:10 PM

HOSPITAL NAME :

UPH-DJGTMC

ADMITTING DOCTOR:

Dr. P

ATTENDING PHYSICIAN:

Dra. R

DIAGNOSIS
:
Respiratory Distress

PU 27-28 weeks AOG with Bronchial Asthma in Mild

PATIENTS HISTORY
HISTORY

ADMISSION
>Upon admission, the patient
complained difficulty of breathing and
is febrile.

History of Present Illness

Past Medical History

Family History

Past Social History

Obstetric History

Past Health History

No Past Medical History

>Mother is 46; Father is 49.
>Her mother has asthma.

>A Housewife.
>Shes taking cigarette.
>She does not exercise.
>Sleeps almost 8 hours a day.
>Taking medications but doesnt
remember the specific name.

>LMP: December 15, 2011

>AOG: 27- 28 Weeks
>EDC: Sept, 19, 2012
>G=1 P=0 (T=0 P=0 A=0 L=0)
>Cephalic presentation of fetus
>FHT located at RLQ

>Difficulty of breathing especially at

night since childhood.
>Immunizations taken during
childhood years.
>No problems at birth.
>No surgeries.

PHYSICAL ASSESSMENT
GENERAL SURVEY

SKIN, HAIR AND NAIL

HEAD AND NECK

EYE

EAR

MOUTH, NOSE, SINUS

THORAX AND LUNGS

ABDOMINAL

>Patient is slightly cooperative and actively

speaking.
>Patient appears weak and restless.
>Brown colored skin with no signs of dehydration
>Skin is smooth, soft and warm
>Good skin turgor. No presence of edema.
>Scalp is symmetrical, smooth and firm with no
signs of lesion
>Hair is black, adequate amount and equally
distributed.
>Nails are long, clean; black pigmented, pale,
O
presence of clubbing (>180 angle), round, hard,
and immobile, smooth, firm.
>Neck is smooth and has controlled movement.
>No presence of enlargement of lymph nodes.
>Eyelids and lashes is symmetrical and evenly
spaced.
>Blinking is symmetrical.
>Iris and pupil is round and equal.
>Lens is clear
>Conjuctiva and sclera has inconsistent color
(slightly red)
>Cornea is transparent and moist
>Pupils converge and constrict
>No abnormal movement of eyes
>Both eyes move with coordination.
>Presence of reflection of light on the eyes.
>Nontender auricle and tragus
>No presence of tenderness of mastoid process.
>No presence of discharge.
>Lips and surrounding tissue relatively
symmetrical with no lesions
>buccal mucosa is pink, smooth and without
lesions.
>Gums are pink.
>Tongue is pink, no lesions.
>Nose is smooth, firm and symmetrical.
>Sinuses are nontender.
>Color of thorax is pallor
>Intercostals spaces are retracting.
>Chest symmetry is equal
O
>Rib slope is less than 90 downward
>Respiration pattern is uneven and labored, >
20cpm
>Chest expansion is less than 3 inches.
>Vibration decreases over lung with consolidation
>Wheezing present during auscultation
>Presence of striae gravidarum and linea nigra
>No presence of lesions
>Enlargement of abdomen due to pregnancy

ANATOMY & PHYSIOLOGY

RESPIRATORY SYSTEM
Breathing is necessary because all living cells of the body require oxygen and
produce carbon dioxide. The respiratory system allows the exchange of these gases
between the air and the blood. And the cardiovascular system transports them between
the lungs and the cells of the body. The capacity to carry out normal activity is reduced
without healthy respiratory and cardiovascular systems.

Function:
1. Gas Exchange. The respiratory system allows oxygen from the air to enter the
blood and carbon dioxide to leave the blood and enter the air. The cardiovascular
system transports oxygen from the lungs to the cells of the body and carbon
dioxide from the cells of the body to the lungs. Thus, the respiratory and
cardiovascular systems work together to supply oxygen to all cells and to remove
carbon dioxide.
2. Regulation of blood pH. The respiratory system can alter blood pH by changing
blood carbon dioxide levels.
3. Voice Production. Air movement past the vocal folds makes sound and speech
possible.
4. Olfaction. The sensation of smell occurs when airborne molecules are drawn into
the nasal cavity.
5. Protection. The respiratory system provides protection against some
microorganisms by preventing their entry into the body and by removing them
from the respiratory surfaces.

Nose
A protuberance in vertebrates that houses the nostrils, or nares, which
admit and expel air for respiration in conjunction with the mouth. Behind the nose
are the olfactory mucosa and the sinuses. Behind thenasal cavity, air next
passes through the pharynx, shared with the digestive system, and then into the
rest of the respiratory system.

Nasal Cavity
Cavity between external nares and the pharynx. It is divided into two
chambers by the nasal septum and is bounded inferiorly by the hard and soft
palate.

 N
asal
Cavi
ty
C
avity
betw
een
exter
nal
nare
s
and
the
phar
ynx.
It is
divid
ed
into
two
cha
mbe
rs by
the
nasa
l
sept
um
and
is
boun
ded
inferi
orly
by
the
hard
and
soft
palat
e.
T
he

nasal cavity conditions the air to be received by the other areas of the respiratory
tract. Owing to the large surface area provided by the conchae, the air passing
through the nasal cavity is warmed or cooled to within 1 degree of body
temperature. In addition, the air is humidified, and dust and other particulate
matter is removed by vibrissae, short, thick hairs, present in the vestibule.
The cilia of therespiratory epithelium move the particulate matter towards
the pharynx where it passes into the esophagus and is digested in the stomach.

Oral Cavity
The mouth; consists of the space surrounded by the lips, cheeks, teeth,
and palate; limited posteriorly by the fauces.

Pharynx
The common passageway of both the digestive and respiratory systems. It
receives air from the nasal cavity and receives air, food, and drink from the oral
cavity. Inferiorly, the pharynx is connected to the respiratory system at the larynx
and to the digestive system at the esophagus. The pharynx is divided into three
regions:
o Nasopharynx - located posterior to the choanae and superior to the soft
palate, which is an incomplete muscle and connective tissue
partition separating the nasopharynxfrom the oropharynx.
- Air passes through them to equalize air pressure between
the atmosphere and the middle ear.
o Oropharynx - extends from the soft palate to the epiglottis, and the oral
cavity opens into the oropharynx. Thus, air, food, and drink all
pass through the oropharynx.
o Laryngopharynx - extends from the tip of the epiglottis to the esophagus
and passes posterior to the larynx.
- Foods and drink pass through the laryngopharynx to the
esophagus. A small amount of air is usually swallowed
with the food and drink.

Epiglottis
A flap of elastic cartilage tissue covered with a mucus membrane,
attached to the root of the tongue. It projects obliquely upwards behind the
tongue and the hyoid bone, pointing dorsally.
The epiglottis guards the entrance of the glottis, the opening between
the vocal folds. It is normally pointed upward during breathing with its underside
functioning as part of the pharynx, but during swallowing, elevation of the hyoid
bone draws the larynx upward; as a result, the epiglottis folds down to a more
horizontal position, with its superior side functioning as part of the pharynx. In this
manner it prevents food from going into the trachea and instead directs it to
the esophagus, which is posterior.

Larynx
Is located in the anterior part of the throat and extends from the base of
the tongue to the trachea. It is a passageway for air between the pharynx and the
trachea.
Fine manipulation of the larynx is used to generate a source sound with a
particular fundamental frequency, or pitch. This source sound is altered as it
travels through the vocal tract, configured differently based on the position of
the tongue, lips, mouth, and pharynx. The process of altering a source sound as
it passes through the filter of the vocal tract creates the many different vowel and
consonant sounds of the world's languages as well as tone, certain realizations
of stress and other types of linguistic prosody. The larynx also has a similar
function as the lungs in creating pressure differences required for sound
production; a constricted larynx can be raised or lowered affecting the volume of
the oral cavity as necessary in glottalic consonants.

Trachea
Is a tube that connects the pharynx or larynx to the lungs, allowing the
passage of air. It is lined with pseudostratified ciliated columnar
epithelium cells with goblet cells, which produce mucus. This mucus lines the
cells of the trachea to trap inhaled foreign particles, which the cilia
then waft upwards towards the larynx and then the pharynx where it can either be
swallowed into the stomach or expelled as phlegm.

Lungs
The Lungs are paired organs in the chest that perform respiration. Each
human has two lungs. Each lung is between 10 and 12 inches long. The two
lungs are separated by a structure called the mediastinum. The mediastinum
contains the heart, trachea, esophagus, and blood vessels. A protective
membrane called the pulmonary pleura covers the lungs.
The lungs oxygenate the body because air is breathed in via the nose or
mouth. When a person breathes in, the lungs expand and need assistance from
other muscles in order to function properly. When a person breathes out, or
exhales, the lungs do not need assistance.

Gas Exchange
Oxygen and Carbon Dioxide in partial pressure diffusion gradients between the
alveoli and the pulmonary capillaries and between the tissues and the tissue capillaries
are responsible for gas exchange.

Diffusion of Gases in the Lungs and in the Tissues

1. Oxygen diffuses into the arterial ends of pulmonary capillaries and CO2 diffuses
into the alveoli because of the differences in partial pressure.
2. As a result of diffusion at the venous ends of pulmonary capillaries, the PO2 in
the blood is equal to the PO2 in the alveoli and the PCO2 in the blood is equal to
the PCO2 in the alveoli.
3. The PO2 of the blood in the pulmonary veins is less than the pulmonary
capillaries because of mixing with deoxygenated blood from veins draining the
bronchi and bronchioles.
4. Oxygen diffuses out of the arterial ends of tissue capillaries and CO2 diffuses out
of the tissue because of the differences in partial pressures.

5. As a result of diffusion at the venous ends of tissue capillaries, the PO2 in the
blood is equal to the PO2 in the tissue and the PCO2 in the blood is equal to the
PCO2 in the tissue.

Major Regulatory Mechanisms of Ventilation

The major regulatory mechanisms that affect the rate and depth of ventilation are
shown. A plus indicates an increase in ventilation and minus sign indicates a decrease
in ventilation.

a. Higher centers of the brain (speech, emotions, voluntary control of breathing and
action potential in motor pathways).
b. Medullarychemoreceptors pH, CO2
c. Carotid and aortic body chemreceptors O2.
d. Hering-Breuer reflex (stretch receptors in lungs).
e. Proprioceptors in muscles and joints.
f. Receptors for touch, temperature and pain stimuli.

PATHOPHYSIOLOGY
Non-modifiable Factors:
Age
Gender
Immunity
Hereditary

Stimuli enters the

nasopharynx straight to
the trachea then travels
to the bronchial tree.

Modifiable Factors:
Environmental Factors
Pollution
Smoking
Cliamte
Alleregens
Occupation
Lifestyle
Exercise
SleepingPattern
ADL
Diet

Allergens enters the

tissue.

Allergens invades the

tissues.

Prostaglandins are
released.

Increased blood flow of

the bronchiole.

Increased vascular
permeability of the
bronchioles.
Narrowing of bronchioles
(vasoconstriction).

Wheezing sound
Secretions
Increase Respiratory
Rate
Dyspnea

MEDICAL MANAGEMENT
During pregnancy
Independent

Ensure optimal asthma control throughout pregnancy

Manage and control asthma triggers aggressively
Avoid delay in diagnosis and treatment
Assess medication needs and response to therapy frequently
Ensure adequate patient education and acquisition of self-management skills
Encourage smoking cessation
Monitor fetal movements daily after 28 weeks.
Treat rhinitis, gastric reflux, and other comorbidities adequately
Do not give flu vaccination until after 12 weeks of pregnancy
Be aware of the risk of pre-eclampsia and intrauterine growth retardation
Educate pregnant patients to develop a partnership in asthma management.
Dependent

Monitor mother's pulmonary function through a spirometry or a peak flow

meter(to measure your lung function) at least monthly
Ultrasound examination to check the babys growth and activity, and also the
amount of amniotic fluid around the baby.
Collaborative

Refer patient to an asthma specialist and an obstetrical provider.

During Labor and Delivery

Independent

Closely monitor the woman and assess fetal wellbeing continuously

Maintain oxygen saturation >95%
The patient's PEFR may be taken upon admission to labor and delivery and,
subsequently every 12 hours, if indicated.
Place woman in a left lateral position
The patient's regularly scheduled asthma medications should be continued
during labor and delivery.
Provide ample hydration with intravenous fluid (isotonic saline 125 ml/h) if
drinking is impossible

Avoid hypotension with adequate position, hydration, and treatment

Use adrenaline (epinephrine) only in the context of an anaphylactic reaction

Consider intubation earlier than usual and call an expert if intubation is required
as it can be more difficult in pregnant women owing to the edema of the
oropharyngeal mucosa

Continue medications and give short acting 2 agonists or corticosteroids, or

both, if asthma is not well controlled (Pre-Term Labor)

Provide ample hydration with intravenous fluid

Evaluate pulmonary status and oxygen saturation on admission, and later as

needed
Favor lumbar epidural analgesia to provide adequate pain relief (which
decreases bronchospasm) and to reduce oxygen consumption and minute
ventilation(Pain Control)
Avoid bronchoconstrictor agents for management of abortion or labour (such as
prostaglandin F2 ) or for postpartum haemorrhage (such as ergonovine,
methylergonovine (neither is licensed in the UK), and carboprost)

Postpartum Period
Education

Review asthma regularly after delivery.

Encourage breastfeeding.
Remind parents that passive smoking increases the risk of childhood asthma and
other respiratory conditions in their child.
Keep home as allergen-free
Keep baby's weight within a healthy range
Live in a place where air quality is good, such as limited car exhaust fumes and
smog
Manage stress, since maternal distress can increase asthma risk in children

DIAGNOSTIC EXAMINATIONS
URINALYSIS
-Is an array of tests performed on urine and one of the most common methods of
medical diagnosis. Using urine dipsticks, in which the results can be read as color
changes, can perform a part of a urinalysis.
Date:
TEST
a. Color
b.
Transparency/
Turbidity

PATIENTS
RESULT
Light Yellow
Clear

NORMAL
VALUE
Straw to Dark
Yellow
Clear to
Slightly Hazy

INTERPRETATION SIGNIFICANCE
Normal

Normal

Normal

Normal

Acidic

4.6- 6.5

Acidic

1.010

1.016- 1.022

Normal

May be caused
by excessive
dietary intake of
purines
---

Normal
------Normal

Normal
------Normal

c. Reaction
d. Specific
Gravity
e. Protein
f. Glucose
g. Pus Cells
h. RBC

Negative
14

few
i. Epithelial
Cells

0-2
0-1
Small
amounts of
Hyaline,
coarse fine
granular,
RBC, WBC,
waxy casts

DIAGNOSTIC HEMATOLOGY
- to check for blood diseases and disorders, infections in blood, oxygen levels in blood,
diabetes, kidney, and liver disease and a host of ailments.
Department of Pathology and Laboratory Hematology
July 02, 2012
COMPONENTS GENDER
Hemoglobin
Hematocrit
Red Blood
Cells
Erythrocyte
Sed Rate
White Blood
Cells
Platelets

M
F
M
F
M
F
M
F

NORMAL
VALUE
120- 150 gm/L
110- 140 gm/L
0.40- 0.54
0.37- 0.47
4.5-6 x10
4.5-5 x10
0- 10 mm/hr
0-20 mm/hr
5.0- 10 x 10
150- 400 x10

HbsAg: ( - )
PATIENTS
SIGNIFICANCE
RESULT
120 gm/L
Normal
0.36

Normal

4.1

Normal
---

---

8.4

Normal

204

Normal

SCHILLING DIFFERENTIAL BLOOD COUNT

-

A method of counting blood cells in which the polymorphonuclear neutrophils are

separated into four groups according to the number and the arrangement of the
nuclear masses in each cell.
NORMAL VALUE

PATIENTS RESULT SIGNIFICANCE

Basophils

0- 0.01

Normal

Eosinophils

0- 0.04

0.01

Normal

Stabs

0- 0.04

Normal

0.50- 0.70

0.84

0.20- 0.40

0.15

0- 0.05

COMPONENTS

Segmenters
Lymphocytes
Monocytes

May due to
inflammatory
diseases
Normal
Normal

ARTERIAL BLOOD GAS ANALYSIS

Objective:
To recognize the different acid base parameters.
Be able to define simple and mixed acid base abnormalities.
Be able to interpret ABG results.

Arterial blood sample analysis provides precise measurement of acid base

balance of the lungs ability to oxygenate the blood and remove excess carbon
dioxide.

Arterial blood sample obtained by inserting a needle into a major artery.

1. pH (Hydrogen Ion Concentration) a measurement of the hydrogen ion (H+)

concentration in the plasma. Normal value is 7. 35 7.45.
2. PaCO2 (Partial Pressure of Arterial CO2) reflection of the respiratory component
of acid base status. Normal value is 35 45 mmHg.
3. HCO3- (Arterial Blood Bicarbonate) reflection of the metabolic component of
acid base balance and is regulated by renal system. Normal value is 22 26
mEq/L.
4. PaO2 (Partial Pressure of O2 in Arterial blood) measurement of the pressure or
tension of oxygen in the plasma of the arterial blood. Normal value is 80 100
mmHg.
5. SaO2 (Oxygen Saturation) index of the actual amount of oxygen in hemoglobin
expressed as percentage of total capacity. Normal value is >95%.

ACID BASE DISORDERS

1. Simple Disorders
a. Respiratory Acidosis
-

An abnormal condition in which there is a primary reduction in alveolar ventilation

relative to the rate of CO2 production.

PaCO2 is elevated or when it is higher than the expected level of compensation.

One of the common causes of respiratory acidosis is COPD.

b. Respiratory Alkalosis
- An abnormal condition in which there is a primary increase in alveolar ventilation
relative to the rate of CO2 production.
- PaCO2 is below the expected level and indicates that the ventilation is exceeding
the normal level.
- One of the common causes of Respiratory Alkalosis is Pulmonary Fibrosis.
c. Metabolic Acidosis
- Identified when the plasma HCO3- or base excess falls below normal.
- Can occur when buffers are not produced in sufficient quantities or when they are
lost excessively.
- One of the common causes of Metabolic Acidosis is Ketoacidosis.
d. Metabolic Alkalosis
- Identified by an elevation of the plasma HCO3- above normal.
- Occurs whenever HCO3- ions in the blood or when an abnormal number of H + ions
are lost from the plasma.
- One of the common causes of Metabolic Alkalosis is Loss of gastric fluid (e.g.
Vomiting).

2. Mixed Acid Base Disorders

a. Respiratory and Metabolic Acidosis
- Can be identified by an elevated PaCO2 and a reduction in plasma HCO3-.
b. Respiratory and Metabolic Alkalosis
- Can be recognized by identifying an elevated plasma HCO 3- and a PaCO2 below
normal.
c. Respiratory Alkalosis and Metabolic Acidosis
- Metabolic acidosis usually occurs as a primary disorder and is compensated for by
a predictable degree of hypocapnea.
d. Respiratory Acidosis and Metabolic Alkalosis
- Can be identified by having an elevated plasma HCO 3- concentration together with
an elevated PaCO2.

ABG RESULT
PATIENTS
RESULT

NORMAL VALUE INTERPRETATION

pH

7.27

7.35 7.45

Acidemia / Acidosis

PaCO2

78 mmHg

35 45 mmHg

Respiratory Acidosis

HCO3-

26 mEq/L

22 26 mEq/L

Normal

PaO2

71 mmHg

80 100 mmHg

Mild Hypoxemia

SaO2

87%

>95%

---

Final Interpretation: Uncompensated respiratory acidosis with mild hypoxemia

DRUG STUDY

DRUG
NAME

BRAND NAME

INDICATION

ACTION

NURSING CONSIDERATION

Solucortef

Solucortef

Endocrine,
hematologic,
rheumatic and collagen
disorders;
dermatologic,ophth
GI,
resp
and
neoplastic
diseases. Allergies. Acute
exacerbations
of
TB
meningitis
with
subarachnoid
block,
trichinosis.
Multiple
scelorosis.

Glucocorticoid with antiinflammatory

effect
because of its ability to
inhibit
prostaglandin
synthesis,
inhibit
migration
of
macrophages, leucocytes
and fibroblasts at sites of
inflammation,
phagocytosis
and
lysosomal
enzyme
release. It can also cause
the reversal of increased
capillary permeability.

Do not confuse hydrocortisone with

hydrocodone (a narcotic agent).
Check
label
of
parenteral
hydrocortisone because IM and IV
preparations are not necessarily
interchangeable.
Give
reconstituted direct
IV
solution at a rate of 100mg / 30
sec. Doses larger than 500mg
shoud be infused over 10 mins.
Report worsening of condition, any
fever, sore throat, muscle aches,
slow healing, sudden weight gain,
or swelling of extremities.

Generic Name
hydrocortisone Na
succinate

Frequency
q 6 hrs.
3 days
Route
IV
Dosage
100mg

DRUG
NAME

BRAND NAME

INDICATIONS

Tums

Tums

Relief of acid ingestion;

heartburn, sour stomach and
upset stomach associated
with these symptoms; Ca
supplement.

Generic Name
Ca carbonate

Frequency
OD
Route
Oral
Dosage
2 Tab

ACTION

NURSING CONSIDERATIONS

Decreases total acid load of GI Take as directed. Increase fluid

tract. Increases esophageal
intake
and
bulk;
prevents
sphincter tone, strengthens
constipation.
gastric mucosal barrier and As a supplement take: 1 1 hr
reduce pepsis activity by
after meals; as an antacid take 1
elevating gastric pH.
hr after meals and bedtime.

DRUG
NAME

BRAND NAME

INDICATION

Bricanyl

Bricanyl

Brochospasm
in
bronchial
asthma,
chronic
bronchitis,
emphysema,
other
lung diseases where
bronchoconstriction is
a complicating factor.

Generic name:
terbutaline sulfate

Frequency:
OD (given at ER)
q 6 hours (given
at OB ward)

Route:
SC (ER)
Nebulization (OB)

Dosage:
0.25mg (SC)

ACTION

NURSING CONSIDERATION

Specific beta 2 receptor Take oral medication with meals to

stimulant,
resulting
to
minimize GI tract.
bronchodilation and relaxation Do not confuse terbutaline with
of
peripheral
vasculature.
terbinafine
(antifungal)
or
Minimum beta 1 activity.
tolbutamine (an oral hypoglycemic).
Action resembles that of Discard unused portion after single
isoproterenol.
client use.
Do not use if discoloured.
Review and demonstrate appropriate
method for administration. Review
use of spacer to administer therapy
and peak flow meter to assess
response to therapy.

DRUG NAME

BRAND NAME

INDICATIONS

Aminophylline
drip

Atlantic
Aminophylline

Symptomatic
treatment
of
bronchial
asthma,
bronchitis,
bronchospasm and
status asthmaticus.
Relieve
periodic
apnea. Adjunct in
treatment
of
pulmonary
edema
and
paroxysmal
nocturnal
dyspnea
caused by left heart
failure.

Generic Name
aminophylline

Frequency
--

Route
IV

Dosage
2 ampules D5W
gtts/min

ACTION

NURSING CONSIDERATION

Competitive
nonselective
phosphodiesterase inhibitor Monitor for S&S of toxicity (generally
which raises intracellular
related to theophylline serum levels
cAMP,
activates
PKA,
over 20 mg/mL). Observe patients
inhibits TNF-alpha and
receiving parenteral drug closely for
leukotriene synthesis, and
signs of hypotension, arrhythmias,
reduces inflammation and
and
convulsions
until
serum
innate
immunity
and
theophylline stabilizes within the
nonselective
adenosine
therapeutic range.
receptor antagonist. Less Note: High incidence of toxicity is
potent and shorter-acting
associated with rectal suppository use
than theophylline. Its most
due to erratic rate of absorption.
common use is in the Monitor & record vital signs and I&O.
treatment
of
bronchial
A sudden, sharp, unexplained rise in
asthma.
heart rate may indicate toxicity.
Lab tests: Monitor serum theophylline
levels.
Note: Older adults, acutely ill, and
patients with severe respiratory
problems,
liver dysfunction, or
pulmonary edema are at greater risk
of toxicity due to reduced drug
clearance.

DRUG
NAME
Clusivol
OB

BRAND NAME

Clusivol OB

Generic Name
Multivitamins

Frequency
OD

Route
Oral

Dosage
1 tablet

INDICATION

ACTION

Vitamin
and
mineral A dietary supplement.
supplement for use during
pregnancy,
post-partum
and lactation.

NURSING CONSIDERATION

May be taken with or without food

(May be taken w/ meals for better
absorption or if GI discomfort
occurs).

DRUG
NAME

BRAND NAME

INDICATION

ACTION

NURSING CONSIDERATION

Pulmoxel

Pulmoxel

Relief of bronchial asthma,

bronchitis, bronchospasm,
emphysema,
bronchiestasis, and other
obstructive
pulmonary
disease
where
bronchoconstriction is a
complicating factor.

Specific beta 2
receptor
stimulant,
resulting
to
bronchodilation
and
relaxation of peripheral
vasculature. Minimum
beta 1 activity.
Action resembles that
of isoproterenol.

Do not be confuse terbutaline with

terbinafine (antifungal) or
tolbutamine (an oral hypoglycemic).
Discard unused portion after single
client use.
Do not use if discoloured.
Review
and
demonstrate
appropriate
method
for
administration. Review use of
spacer to administer therapy and
peak flow meter to assess response
to therapy.

Generic Name
terbutaline sulfate

Frequency
q 4 hrs.

Route
Nebulization

Dosage
1cc + 2cc NSS