Submitted by:

Rojina Kadariya

ACKNOWLEDGEMENT

The completion of the undertaking could not have been possible without the participation and assistance of so many people whose name may not all be enumerated. The contributions are sincerely appreciated and gratefully acknowledge. However. I would like to express my deep appreciation and indebtedness to all my colleagues and my patients and the family who gave their valuable time for providing necessary information and kind cooperation during the period.

Finally, I would like to thank all of them who gave me their precious, valuable time and suggestions directly or indirectly while preparing this case study.

BACKGROUND

Asthma is the chronic disease of the airway that cause airway hyper responsiveness, mucosal edema and mucus production. This inflammation, ultimately leads to recurrent episode of asthmas symptoms: cough, wheezing, chest tightness and dyspnea. It is a multifactorial disease process associated with genetic, allergic, environmental, infectious, emotional and nutritional components. Because of the symptomatology the majority of individuals with asthma experience a significant number of missed work of school days. This can create a severe disruption in quality of life, often leading to depressive episodes. It also disrupts then lives of caregivers and family members of the affected individual. Asthma patient who have increased symptomatology at night also tend to have disturbed sleep patterns and impaired daytime attention, concentration and memory.

OBJECTIVES

• To explore patients past health history prior to bronchial asthma
• To review the body system involve in bronchial asthma
• To review the disordered function of the body related to bronchial asthma
• To review the laboratory results and compare it to normal and the implication of the abnormal
• To make a list of nursing problems
• To prioritize listed nursing problems
• To make nursing care plan for prioritized problems
• To make a health teaching to the client and other potential candidates regarding about bronchial asthma

Chief Complain

Patient complain for severe vertigo, vomiting, chest pain and dyspnea.

History of present illness

The patient was not feeling well from chest pain, vomiting and obstruction.

History of past illness

Past medical history: Diabetic Mellitus Hypertensive

Past Surgical History: Nothing significant

Lab Investigation

Medications

Physical Examination

General appearance

Nourishment: well nourished

Body Build: Thin

Health: unhealthy

Active: Dull

Mental Status

Consciousness: Conscious

Look: Worried Depressed

Height: 5’11

Weight: 75kg

Color: Dark appearance

Lesion: No lesion

Head and scalp: Normal

Eye

Eye brow: Normal

Eye lid: Normal

Redness: No

Ear

External ear: Normal

Hearing: Normal

Nose

External Nose: Normal

Mouth: Normal

Teeth: Clean

Neck

Lymph Nodes: No enlargement

Thyroid Gland: Normal

Range of Motion: Normal

Abdomen

Ascultation: Bowel sound

Palpitation: Palpable spleen

Extremities

Upper: Normal

Lower: Normal

DISEASE CONDITION

Asthma is a long-term disease of the lungs. It causes your airways to get inflamed and narrow, and it makes it hard to breathe. Severe asthma can cause trouble talking or being active. You might hear your doctor call it a chronic respiratory disease. Some people refer to asthma as “bronchial asthma.”

Asthma is a serious disease that affects about 25 million Americans and causes nearly 1.6 million emergency room visits every year. With treatment, you can live well. Without it, you might have to go to the ER often or stay at the hospital, which can affect your daily life.

Pathophysiology

Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children. The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyper responsiveness.

Pathogenesis of asthma. Antigen presentation by the dendritic cell with the lymphocyte and cytokine response leading to airway inflammation and asthma symptoms.

Symptoms:

Asthma is marked by inflammation of the bronchial tubes, with extra sticky secretions inside the tubes. People with asthma have symptoms when the airways tighten, inflame, or fill with mucus.

There are three major signs of asthma:

• Airway blockage. When you breathe as usual, the bands of muscle around your airways are relaxed, and air moves freely. But when you have asthma, the muscles tighten. It’s harder for air to pass through.
• Inflammation. Asthma causes red, swollen bronchial tubes in your lungs. This inflammation can damage your lungs. Treating this is key to managing asthma in the long run.
• Airway irritability. People with asthma have sensitive airways that tend to overreact and narrow when they come into contact with even slight triggers.

These problems may cause symptoms such as:

• Coughing, especially at night or in the morning
• Wheezing, a whistling sound when you breathe
• Shortness of breath
• Tightness, pain, or pressure in your chest
• Trouble sleeping because of breathing problems

Causes

• Infections like sinusitis, colds, and the flu
• Allergens such as pollens, mold, pet dander, and dust mites
• Irritants like strong odors from perfumes or cleaning solutions
• Air pollution
• Tobacco smoke
• Exercise
• Cold air or changes in the weather, such as temperature or humidity
• Gastroesophageal reflux disease (GERD)
• Strong emotions such as anxiety, laughter, sadness, or stress
• Medications such as aspirin
• Food preservatives called sulfites, found in things like shrimp, pickles, beer and wine, dried fruits, and bottled lemon and lime juices

Risk Factor

Things that might make you more likely to have asthma include:

• Things in the world around you before you’re born or while you’re growing up
• Whether your parents have asthma, especially your mother
• Your genes
• Your race. Asthma is more common in people of African American or Puerto Rican descent.
• Your sex. Boys are more likely to have asthma than girls. In teens and adults, it’s more common in females.
• Your job
• Other conditions like lung infections, allergies, or obesity

Diagnosis

• History and Physical Examination
• Routine Analysis
• CBC
• Serum uric acid
• LTF
• RFT
• Chest X-ray
• Administration of o2

MANAGEMENT

Collaboration Therapy

• Patient and caregiver teaching
• Asthma action Plan
• Assess for control
• Avoid or elimination of trigger

Medical Management

• Fluid Therapy
• Nebulizers
• Patient teaching related to drug therapy
• Nonprescription combination drugs
• Inhalation devices for drug delivery

Nursing Diagnosis

• Chest pain related to disease condition as evidence by shortness of breath.
• Activity intolerance related to disease condition as evidence by easily fatigue and weakness.
• Altered nutritional pattern related to disease condition as evidence by vomiting, nausea and vertigo.
• Anxiety related to hospitalization as evidence by facial expression.
• Knowledge deficit related to disease process as evidence by frequent questioning.

NURSING CARE PLAN

Health Teaching

• Take your asthma medicines exactly as your provider tells you. Do this even if you feel that your asthma is under control.
• Learn how to monitor your asthma. Some people watch for early changes of symptoms getting worse. Some use a peak flow meter. Your healthcare provider may decide to give you an asthma action plan.
• Be sure to always have a quick-relief inhaler with you. If you were given a prescription, make sure you go to a pharmacy to get it filled as soon as possible.

Dust or dust mites are a common asthma trigger. To avoid a dust mites, do the following:

• Use dust-proof covers on your mattress and pillows. Wash the sheets and blankets on your bed once a week in very hot water.
• Don’t sleep or lie on cloth-covered cushions or furniture.
• Ask someone else to vacuum and dust your house.
• If you do vacuum and dust yourself, wear a dust mask. You can buy them from the hardware store.
• Use a vacuum with a double-layered bag or HEPA (high-efficiency particulate air) filter.
• Pets with fur or feathers are triggers for some people. If you must have pets, take these precautions:
• Keep pets out of your bedroom and off your bed. Keep the bedroom door closed.
• Cover the air vents in your bedroom with heavy material to filter the air.
• Don’t use carpets or cloth-covered furniture in your home. If this is not possible, keep pets out of rooms with these items. Have someone bathe your pets every week. And brush them often

If you smoke, do your best to quit.

• Enroll in a stop-smoking program to increase your chance of success.
• Ask your healthcare provider about medicines or other methods to help you quit.
• Ask family members to quit smoking as well.
• Don’t allow anyone to smoke in your home, in your car, or around you.

Others

• Make sure you know what to do if exercise is a trigger for you. Many people use quick-relief inhalers before exercise or physical activity.
• Get a flu shot every year and get pneumonia shots as advised by your healthcare provider.
• Try to keep your windows closed during pollen seasons and when mold counts are high.
• On cold or windy days, cover your nose and mouth with a scarf.
• Try to stay away from people who are sick with colds or the flu. Wash your hands often or use a hand sanitizer. If respiratory infections like colds or flu trigger your asthma, use your quick-relief medicines as soon as you begin to notice respiratory symptoms. They may include a runny or stuffy nose, sore throat, or a cough.

SUMMARIZATION

Asthma is a long-term disease of the lungs. It causes your airways to get inflamed and narrow, and it makes it hard to breathe. Severe asthma can cause trouble talking or being active. You might hear your doctor call it a chronic respiratory disease. Some people refer to asthma as “bronchial asthma.”

• Pathophysiology
• Symptoms
• Risk Factor
• Causes
• Diagnosis
• Management
• Nursing Diagnosis
• Nursing Care Plan
• Health Teaching
• Biography

Bibliography

Medical Surgical Nursing – I

Medical Surgical Nursing – II

Fundamental of Nursing