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A Case Study of a Patient with Bronchial Asthma

A Case Study of a Patient with Bronchial Asthma. Prepared by: Airen L. Jamago LTI - Male Department. I. DEMOGRAPHIC DATA. Name: Patient X Age: 47 years old Sex: Male Nationality: Saudi Date of Admission: Dec. 7, 2011. II. PHYSICAL ASSESSMENT.

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A Case Study of a Patient with Bronchial Asthma

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  1. A Case Study of a Patientwith Bronchial Asthma Prepared by: Airen L. Jamago LTI- Male Department

  2. I. DEMOGRAPHIC DATA Name: Patient X Age: 47 years old Sex: Male Nationality: Saudi Date of Admission: Dec. 7, 2011

  3. II. PHYSICAL ASSESSMENT • SKIN - warm, slightly dry, hair evenly distributed • HEAD - symmetric skull, no flaking of scalp, no lesions and tenderness • EYES - no redness and discharges, sclera white and clear, pupils reactive to light and accommodation • NOSE AND SINUSES - nasal septum straight, not perforated, no discharged, NGT present

  4. MOUTH - dry lips, no gum bleeding, tongue and uvula in midline position, oral cavity slightly pale, no ulcers, no swelling and palpable masses NECK - no palpable lymph nodes, trachea on midline position, Tracheostomy tube present BREAST - nipples at the same level, no palpable masses and discharge

  5. THORAX AND LUNGS - thorax is symmetric, chest expansion is decrease due to muscle weakness, bony prominences are marked, there is loss of subcutaneous tissue, no tenderness, wheezes audible upon auscultation • UPPER EXTREMITIES - decorticate position, arms are unable to abduct and adduct • NAILS - convex in curvature, rough, with slightly delayed capillary refill

  6. ABDOMEN - not distended, ( + ) bowel sounds LOWER EXTREMITIES - unable to flex, abduct and adduct GENITALIA - skin of the glans penis is smooth, no ulceration, urethral meatus located ventrally on the end of the penis, no discharge and palpable masses

  7. III. PATIENT HISTORY

  8. A. Past Medical History

  9. B. Present Medical History

  10. IV. TOPIC PRESENTATION

  11. V. ANATOMY AND PHYSIOLOGY

  12. V. ETIOLOGY inflammation Asthma symptoms

  13. VI. ETIOLOGY

  14. VII. Signs and Symptoms Common Symptoms: Coughing, especially at night Wheezing Shortness of breath Chest tightness, pain, or pressure

  15. Signs of Pending Asthma Attack • Frequent cough, especially at night • Losing your breath easily or shortness of breath • Feeling very tired or weak when exercising • Wheezing or coughing after exercise • Feeling tired, easily upset, grouchy, or moody • Decreases or changes in lung function as measured on a peak flow meter • Signs of a cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache) • Trouble sleeping

  16. Symptoms of Asthma Attack • Severe wheezing when breathing both in and out • Coughing that won't stop • Very rapid breathing • Chest pain or pressure • Tightened neck and chest muscles, called retractions • Difficulty talking • Feelings of anxiety or panic • Pale, sweaty face • Blue lips or fingernails

  17. VIII. INTERVENTIONS The four parts of continually managing asthma are: Identify and minimize contact with asthma triggers. Understand and take medications as prescribed. Monitor asthma to recognize signs when it is getting worse. Know what to do when asthma gets worse.

  18. Nursing Interventions Maintain respiratory function and relieve broncho-constriction while allowing mucus plug expulsion. Control exercise-induced asthma by having the patient sit down, rest, and use diaphragmatic and pulse-lip breathing until shortness of breath subsides. Supervise the patient’s drug regimen.

  19. Demonstrate the proper use of metered dose inhaler properly. Reassure the patient during an asthma attack and stay with him. Place the patient in semi-fowler’s position and encourage diaphragmatic breathing

  20. Assist him to relax as much as possible. • Administer oxygen via nasal cannula to ease breathing and to increase arterial oxygen saturation during an acute asthma attack. • Adjust oxygen according to the patient’s vital functions and ABG measurements. • Administer drugs and I.V. fluids as ordered.

  21. Combat dehydration with I.V. fluids until the patient can tolerate oral fluids, which will help loosen secretions. Encourage the patient to express his fears and concerns about his illness. Encourage the patient to identify and comply with care measures and activities that promote relaxation.

  22. IX. TREATMENT Good asthma control will: Prevent chronic and troublesome symptoms, such as coughingand shortness of breath Reduce your need for quick-relief medicines Help you maintain good lung function Let you maintain your normal activity level and sleep through the night Prevent asthma attacks that could result in an emergency room visit or hospital stay

  23. Long-Term Control Medicines Inhaled corticosteroids Cromolyn Omalizumab Inhaled long-acting beta2 agonists Leukotriene modifiers Theophylline

  24. Quick-Relief Medicines Proventil Ventolin Xopenex

  25. X. COMPLICATIONS • Decreased ability to exercise and take part in other activities • Lack of sleep due to night time symptoms • Permanent changes in the function of the lungs • Persistent cough • Trouble breathing that requires breathing assistance (ventilator) • DEATH

  26. XI. PRIORITIZATION OF NURSING PROBLEMS Ineffective airway clearance related to mucus accumulation. Impaired Gas Exchange related to altered oxygen supply, obstruction of airways by secretions, bronchospasm. Ineffective breathing pattern related to decreased lung expansion. Hyperthermia related to underlying infection in the lungs. Impaired nutrition less than body requirements related to inadequate intake.

  27. NURSING CARE PLAN NO. 1

  28. NURSING CARE PLAN 2

  29. NURSING CARE PLAN 3

  30. XIV. CONCLUSION • Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. • The bronchial narrowing is usually either totally or at least partially reversible with treatments. • The most common chronic illness in children, affecting one in every 15. • It involves only the bronchial tubes and usually does not affect the air sacs or the lung tissue. • The narrowing that occurs in asthma is caused by three major factors: inflammation, bronchospasm, and hyperreactivity.

  31. Allergy can play a role in some, but not all, asthma patients. Many factors can precipitate asthma attacks and they are classified as either allergens or irritants. • Symptoms include shortness of breath, wheezing, cough, and chest tightness.It is usually diagnosed based on the presence of wheezing and confirmed with breathing tests. • Chest X-rays are usually normal in asthma patients. • Avoiding precipitating factors is important in the management of asthma. • Medications can be used to reverse or prevent bronchospasm in patients with asthma.

  32. XV. BIBLIOGRAPHY nursingfile.com/.../nursing-interventions-for-asthma.htm www.nhlbi.nih.gov/health/prof/lung/asthma/nurs_gde.pdf www.webmd.com/asthma/guide/asthma-symptoms www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001196 www.medicinenet.com/asthma/article.htm Murray, J. and J. Nadel. Textbook of Respiratory Medicine. Third edition. Philadelphia: W.B. Saunders Company, 2000.Peters, et al. "Tiotropium Bromide Step-Up Therapy for Adults With Uncontrolled Asthma." NEJM363 (2010): 1715-1726. Medically reviewed by: Ellen Reich, MD, Board Certified in Allergy and Immunology, Board Certified in Pediatrics

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