Acknowledgement

We would like to thank the following persons that made this case study possible. First of all, to our case advisor Mr. John Eric Salvador for giving us more courage and advices. To Ms. CJ Tonog, for her patience and willingness in helping us finished this case. To our panels; though we know it is not easy to finish a case study, still you have given us much time to do more research. To our group mates, thank you for your cooperation and perseverance to know this case study, without this, it will be impossible for us to defend it today. For some, who thought that this is not a serious matter, thank you; because you inspired us a lot to study more. To the family of our group mates, Almario, Pantig, Morales, Martin and the Castro family, thank you. To Mr. X and family, thank you for the cooperation and sharing us the information we need to finished this case study. To our family; for their financial and spiritual support, thank you. And most of all, to God our Father, for the knowledge and for keeping on motivating us for the times that we feel we cant finish this case presentation. Thank you so much.

Emphysema (pink puffers) is a lung disease that involves damage to the air sacs (alveoli) in the lungs. The air sacs are unable to completely deflate, and are therefore unable to fill with fresh air to ensure adequate oxygen supply to the body. Emphysema is among a group of lung disorders classified as chronic obstructive pulmonary disease (COPD). The most common cause of emphysema is cigarette smoking, but other risk factors, air pollution or work-related exposure, may also play a part in the development of emphysema. A naturally occurring substance in the lungs called alpha-1 antitrypsin may protect against this damage. People with alpha-1 antitrypsin deficiency are at an increased risk for this disease. The type of emphysema caused by A1AD is known as panacinar emphysema (involving the entire acinus) as opposed to centrilobular emphysema, which is caused by smoking. Symptoms includes dyspnea, chronic cough with tapioca like plug, wheezing, tachypnea, barrel chest, decrease exercise tolerance and loss of appetite leading to weight loss.
Currently, there are no drug treatments available that have proven successful in modifying the rate of decline in lung function for those who have emphysema. There are, however, common medications used in the treatment of stable COPD include the following Bronchodilators, Glucocorticoids (limited to specific indications), Antibiotics (only during infectious exacerbations). Influenza (flu) vaccines and Pneumovax (pneumonia vaccine) are recommended for people with emphysema. These tests help confirm the diagnosis, Pulmonary function tests, Chest x-ray, Arterial blood gases showing low levels of oxygen in the blood (hypoxemia), and high levels of carbon. Low-flow oxygen can be used during exertion, continuously, or at night. Pulmonary rehabilitation can improve exercise tolerance and quality of life in the short-term. Lung transplantation is an option for patients with severe disease. Carefully selected patients may be eligible for lung reduction surgery. This procedure removes the damaged portions of the lung, which allows the normal portions of the lung to expand more fully and take advantage of increased aeration. And smoking cessation is the most important and effective treatment. Nursing Responsibilities: Establish rapport. Monitor vital signs, ABG, laboratory and diagnostic result. Assist the patient to keep head, neck, and chest in body alignment. Perform bronchial hygiene (suction) open obstructed airways. Reduce or eliminate the pt. exposure to possible irritants. Teach coughing exercise (abdominal/ diaphragmatic breathing and pursed lip breathing technique. Maintain side lying position with head elevated 30 degree angle. Administer low-flow oxygen 2-3 L/min. Instruct to increase fluid intake 2L of water. Encourage the pt. to quit smoking.

 Medication compliance on time.

General Data
Name: Mr. X Age: 57years.old Gender: Male Status: Married Height: 58 Weight: 170 lbs. Address: San Nicolas Florida Blanca Pampanga Number of Children: four siblings (3 boys and 1 girl)

Chief Complaint
(+) difficulty of breathing (+) chest tightness 7/10 Pain Scale Subjective: Nahihirapan akong huminga at sumisikip din minsan ang dibdib ko. as verbalized by the patient. Objective: Received pt. on hi-fowlers position on bed, conscious and coherent, with O2 via nasal cannula regulated @ 2 LPM, with ongoing D5W 1L regulated @ 10-15 gtts./min. (KVO) @ 780 ml. level infusing well @ right metacarpal vein. My Assessment to the pt. are as follows: (+) difficulty of breathing (+) chest tightness (7/10 pain scale) (+) body weakness (+) has fast and shallow breathing (+) pallor (+) wheezing upon auscultation (+) tapioca like plug (+) barrel chest Vital Signs: BP: 110/80 mmHg PR: 102 bpm (tachycardia) RR: 27 cpm (tachypnea) Temp: 36.3 C

History of the Past Illness

Mr. X was been confined before due to asthma attack last September 2, 2009. He told us that he feels difficulty of breathing with productive cough and minimal excretion upon walking. Though Mr. X was taking his medicines like salbutamol syrup and predisone regularly, still, he never follows his doctors advice to quit smoking. During his confinement, Mr. X told us that he received oxygen via nasal cannula (2x daily) and nebulizer like salbutamol sulfate (1 or 2 x daily) that ease his breathing. And upon his confinement he told us that he sometimes feels body weakness whenever he was trying to walk or go to comfort room. He was been confined for about 4 days (Sept. 2- Sept. 6, 2009).

History of the Present Illness

Three days prior to admission, he told us that while he was watching his grand daughter playing, he was also smoking. He said that he consumed 2 packs or 40 pcs. of cigarette sticks everyday (39 yrs. of smoking). He told us that he already feels difficulty of breathing at that moment, but he never told his family about it because he dont want to be on the sick bed again. He told us that he always feels difficulty of breathing and chest tightness whenever he was trying to do house chores. One day prior to admission, he told us that while he was playing cards and smoking with his friends he feels sudden difficulty of breathing and chest tightness that made his friends worried and call his family and bring him into the hospital at Romana Pangan District Hospital last January 8, 2010 at around 6:00 P.M and discharged last January 14, 2010 (6 days of confinement).

Personal and Social History

Mr. X was a navy man working in a engine of a ship. He said he was working in ship for more than 23 yrs. Though he doesnt have much time for his family, he makes sure that he communicates with them. His wife, Mrs. X was a teacher and they have four siblings (1 girl and 3 boys working here and abroad). He said that he was been addicted to cigarette smoking at the age of 18 yrs. old and also due to influence of his co-worker. He admits that while they have a free time, they play cards and smoking just to get away from stress and to get away from bored while on sea. Though he really smokes, Mr. X was not fond of drinking alcohol, but he drink occasionally.

Complete Physical Assessment

Date Assessed: January 11, 2010 Time Assessed: 10:30 A.M Initial Vital Signs: Temperature: 36.3 C Pulse Rate: 102 bpm (tachycardia) Respiratory Rate: 27 cpm (tachypnea) Blood Pressure: 110/80 mmHg General Appearance: The pt. is awake in hi-fowlers position on bed, conscious and coherent, with ongoing O2 via nasal cannula regulated @ 2 LPM, with ongoing IVF of D5W regulated @ 10-15 gtts./min. (KVO) @ 780 ml. level infusing well @ right metacarpal vein. My Assessment to the pt. are as follow: (+) difficulty of breathing (+) chest tightness (7/ 10 pain scale) (+) body weakness (+) has fast and shallow breathing (+) pallor (or hypoxia) (+) wheezing upon auscultation (+) tapioca like plug (+) barrel chest

Area Assessed
SKIN Color Texture Turgor

Technique Used
Inspection Palpation Palpation

Normal Findings
Tan Smooth, soft Skin snaps back immediately when pinched Evenly distributed Warm to touch Dry, skin folds are normally moist Pink and clear

Actual Findings
Pale Smooth, soft Skin does not snap back when pinched. Evenly distributed Warm to touch Dry, skin folds are normally moist Slightly pink and clear

Analysis
Due to decrease oxygen supply. Normal Due to decrease oxygen supply. Normal Normal Normal

Hair Distribution Temperature Moisture NAILS Color of Nail bed

Inspection Palpation Palpation

Inspection

Due to decrease

oxygen supply. Texture Shape Nail base Capillary refill time HAIR Color Distribution Moisture Texture HEAD Scalp symmetry Skull size Shape Nodules/ masses FACE Symmetry Facial movement Skin color EYES Eyebrows Eyelashes Eyelids Palpation Inspection Inspection Blanch test Smooth Convex curvature Firm 2-3 seconds Smooth Convex curvature Firm 4 sec. (delayed capillary refilled) Black (varies) Evenly distributed Neither excessively dry nor oily Silky, resilient Symmetrical Normocephalic Round Absence of nodules and masses Symmetrical Symmetrical Pale Symmetrically aligned, equal movement Slightly curved upward Smooth, tan, do not cover pupil as sclera, close symmetrically Blinks voluntarily and bilaterally. 20 blinks per min. Eye moves Normal Normal Normal Due to decrease oxygen supply. Normal Normal Normal Normal Normal Normal Normal Normal

Inspection Inspection Inspection Inspection Inspection Inspection Inspection and Palpation Palpation

Black (varies) Evenly distributed Neither excessively dry nor oily Silky, resilient Symmetrical Normocephalic Round Absence of nodules and masses Symmetrical Symmetrical Tan Symmetrically aligned, equal movement Slightly curved upward Smooth, tan, do not cover pupil as sclera, close symmetrically Blinks voluntarily and bilaterally 20 blinks per min. Eye moves

Inspection Inspection Inspection

Normal Normal Due to decrease oxygen supply. Normal Normal Normal

Inspection Inspection Inspection

Ability to blink Frequency of blinking Ocular movement

Inspection Inspection Inspection

Normal Normal Normal

Position Size Texture CONJUCTIVA Color Texture Presence of lesions APPARATUS Cornea Color Texture PUPILS Color Reaction to light

Inspection Inspection Palpation Inspection Inspection Inspection

freely Drawn from lateral angel Medium Mobile, firm and non-tender Transparent with light color Shiny and smooth No lesions

freely Drawn from lateral angel Medium Mobile, firm and non-tender Transparent with light color Shiny and smooth No lesions

Normal Normal Normal Normal Normal Normal

Inspection Inspection Inspection Inspection

Black Shiny and smooth Black Pupils Equally Round and React to Light Accommodation (PERRLA) Equal Round and constrict briskly Equal in size Able to real new print. When looking straight ahead, client can see objects in periphery Eyes move freely Symmetrical, smooth and tan Reddish to pinkish Oval, symmetrical No discharge

Black Shiny and smooth Black Pupils Equally Round and React to Light Accommodation (PERRLA) Equal Round and constrict briskly Equal in size Able to real new print. When looking straight ahead, client can see objects in periphery Eyes move freely Symmetrical, smooth and tan Reddish to pinkish Oval, symmetrical No discharge

Normal Normal Normal Normal

Size Shape Symmetry Visual Acuity Visual Fields

Inspection Inspection Inspection Inspection Inspection

Normal Normal Normal Normal Normal

Ocular NOSE Symmetry, shape, size and color Mucosa color NASAL SEPTUM Nares

Inspection Inspection Inspection

Normal Normal Normal

Inspection Nasal discharge Inspection

Normal Normal

10

Sinuses MOUTH Secretion

Inspection Inspection

Not tender (Neutral in color) without mucus production Clear Pinkish to slightly brown Symmetrical Soft, moist, Soft and moist

Not tender With mucus production. Tapioca like plug. Dark and brown and cracking lips Symmetrical Dry Dry

Normal Due to loss of elasticity of the alveoli Due to destruction of the alveoli. Due to decrease oxygen level Normal Due to decrease oxygen supply. Due to decrease oxygen. Due to decrease oxygen level. Normal Due to decrease oxygen level. Normal Normal Due to decrease oxygen level. Normal Normal Normal Normal Normal Normal Normal Normal Due to tooth decay (teeth extraction)

Color Lips Color Symmetry Texture Moisture GUMS Color Moisture BUCCAL MUCOSA Color Texture Moisture Tongue Color Size Symmetry Mobility UVULA Location Symmetry TONSILS Color Discharges TEETH Color Number of teeth NECK

Inspection Inspection Palpation Palpation Palpation

Inspection Palpation Inspection Palpation Palpation Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection

Pinkish Moist Glistening pink Soft Moist Pinkish Medium Symmetrical Moves freely At the midline Symmetrical Pinkish No discharges Ivory/yellowish 32

Pale Moist Slightly pale Soft Moist Slightly pinkish Medium Symmetrical Moves freely At the midline Symmetrical Pinkish No discharges Yellowish 28

11

Position Movement Range of motion Consistency HEART Heart rate

Inspection Inspection Inspection Inspection Auscultation

Head-centered Moves freely Full range No enlargement 60-100bpm

Head-centered Moves freely Full range No enlargement 102 bpm

Heart sounds Lung field THORAX & LUNGS POSTERIOR THORAX Symmetry

Auscultation Auscultation

Clear, without crackles Resonant

Clear, without crackles Wheezing

Normal Normal Normal Normal Due to increase muscle contraction of the heart. Normal Due to retained secretions.

Inspection

Symmetrical

Barrel chest

Respiratory rate

Inspection

12-21cpm

27 cpm

Spinal Alignment Skin integrity ANTERIOR THORAX Breathing pattern

Inspection Inspection Auscultation

Spine vertically align Skin intact Breathing is automatic and effortless, regular and even and produces no noise Bronchiavesicular Flat Smooth Audible; soft gurgling sound occur irregularly and rages from

Spine vertically align Skin intact Feeling of dyspnea with effort in breathing.

To accommodate the decreased surface area, thoracic cage expansion. Due to decrease ability for gas exchange. Normal Normal Due to blockage in the airways.

Lung/ breath sounds ABDOMEN Contour Texture Frequency and character

Auscultation

Wheezing

Due to retained secretions. Normal Normal Normal

Inspection Palpation Auscultation

Flat Smooth Audible; soft gurgling sound occur irregularly and rages from

12

5-30 mins UPPER EXTREMITY Skin color Inspection Tan

5-30 mins Pale Due to decrease oxygen level. Due to body weakness. Normal

Movement Size (arms)

Inspection Inspection

With ROM Equal

With no ROM Equal

Symmetry Hair distribution LOWER EXTREMITY Skin color

Inspection Inspection

Symmetrical Evenly distributed

Symmetrical Evenly distributed

Normal Normal

Inspection

Tan

Pale

Due to decrease oxygen level. Due to body weakness. Normal Normal Normal Normal

Movement Size (legs) Symmetry Hair distribution NEUROLOGICAL Level of consciousness Behavioral and appearance Mood

Inspection Inspection Inspection Inspection Interview Interview Interview

With ROM Equal Symmetrical Evenly distributed Can follow instructions and commands Makes eye contact with the examiner Expresses feelings which corresponds to the examiner

With no ROM Equal Symmetrical Evenly distributed Can follow instructions and commands Makes eye contact with the examiner Expresses feelings which corresponds to the examiner

Normal Normal

MANNERISMS & ACTIONS LANGUAGE Voice inflection

Interview

Clear and strong

Weak

Tone

Interview

Fluent and articulated

Fluent and articulated

Due to presence of secretions on the respiratory airway. Normal

13

Manner and speech MENTAL STATUS Orientation TIME Recall recent and remote memory

Interview

Can give appropriate answer to questions Oriented with time Recall events readily, immediate recall of remote information Can make logical decisions

Can give appropriate answer to questions Oriented with time Recall events readily, immediate recall of remote information Can make logical decisions

Normal

Interview Interview

Normal Normal

Judgments and thoughts

Interview

Normal

Cranial Nerve 14

Date Done

Normal Result

Actual Result

Interpretation

Olfactory Nerve Optic Nerve

January 11, 2010

Can smell on both nostrils. With 20/20 vision

Can smell on both nostrils. With 20/20 vision.

Normal Normal

Occulomotor Nerve Abducens Nerve

PERRLA Lateral movement.

PERRLA Lateral movement.

Normal Normal

Trochlear Nerve

Up and down movement.

Up and down movement.

Normal

Trigeminal Nerve

For touch and pain.

For touch and pain sensation.

Normal

Facial Nerve

Can smile, frown, puff the cheek and can feel the cotton. Can hear on both ears.

Can smile, frown, puff the cheek and can feel the cotton. Can hear on both ears.

Normal

Acoustic Nerve

Normal

Glossopharengeal

Can swallow.

Can swallow.

Normal

Vagus Nerve

Check for gag reflex

With gag reflex.

Normal

Accessory Nerve Hypoglossal Nerve

With strength on both shoulder. Sense of taste.

With no muscle strength. With sense of taste.

Due to body weakness. Normal

Laboratory Procedures
15

Laboratory Procedure

Date Done
9, 2010

Normal Values
Hemoglobin 120-170g/l

Result
119 g/l

Nursing Interpretatio n
Abnormal due to decrease hemoglobin in blood.

Nursing Responsibilities
Pretest: Explain the procedure to the patient. Instruct the patient to wear easily manipulated clothing to get blood samples easily. Tell the pt. to relax because the procedure is painless. Intra-test: Instruct the patient to look away when the needle is being inserted. Post-test: Put cotton balls on the puncture site to avoid bleeding. Tell the patient to rest after the test.

Hematology January

Erythrocyte 4.0-5.0 x 10 g/l Hematocrit 0.37-0.54 g/l Leucocytes 5-10 x 10 g/l Platelets 150-450 x 10/l

5.3 x g/l 0.46 g/l

Abnormal due to presence of infection Normal

21.1 x 10 g/l 252 x 10/l

Abnormal due to presence of infection Normal

16

Diagnostic Procedure Chest X-ray

Date Done January 4, 2010

Result Hyper inflated lung densities in the right upper lobe. Hazy infiltrates in the right lower lung zones. The heart is in normal size. Aorta is unremarkable. Enlarged anteroposterior chest diameter.

Impression Emphysema, right upper lobe.

Nursing Responsibilities Pretest: Inform the client prior to the exam if you are pregnant, may be pregnant or have an IUD inserted. Remove all jewelry and wear hospital gown because certain metal or clothing can obscure the image. Intra-test: Provide privacy. Post-test: Provide time for the client to change his clothing.

17

18

Anatomy and Physiology of the Respiratory System

Lungs

The lungs are the body's major organs of respiration. The two vital parts that make up the lungs are located on each side of the chest within the rib cage. They are separated by the heart and other contents of the mediastinum - the tissues and organs of the middle chest (e.g., the heart and large vessels, windpipe, etc.). The lungs are shaped rather like an upside-down butterfly. The top, or apex, of each lung extends into the lowest part of the neck, just above the level of the first rib. The bottom, or base, of each lung extends down to the diaphragm, which is the major breathing-associated muscle that separates the chest from the abdominal cavity. Each lung is divided into upper and lower lobes, although the upper lobe of the right lung contains another triangular subdivision known as the middle lobe. The right lung is larger and heavier than the left lung, which is somewhat smaller in size because of the position of the heart. At birth, the lungs are pinkish-white in color; however, with age, the lungs darken to gray or mottled black because of deposits of carbon and other particles that are inhaled over the years. Alveoli An alveolus (alveoli is plural) is a tiny air sac located within the lungs. The exchange of oxygen and carbon dioxide takes place within this sacs.The basic structure of the respiratory system can be envisioned as an upside-down tree. Air is breathed into the trachea, which is the tree trunk, and thus the broadest part of the respiratory tree. The trachea divides into two major tree limbs, the right and left bronchi, each of which branches off into multiple smaller bronchi, which course through the tissue of the lung. Just as a tree's limbs branch off into ever-smaller branches and twigs, so each bronchus divides into tubes of smaller and smaller diameter, finally ending in the terminal bronchioles. The air sacs of the lung, in which oxygen-carbon dioxide exchange actually takes place, are clustered at the ends of the bronchioles like the leaves of a tree at the ends of the smallest twig-like branches, and are called alveoli.

19

20

Explanation of Pathophysiology (Pt. Base)

Mr. X was 57 yrs. of age, with an occupation of engine man in ship for more than 20 yrs. and with a lifestyle of cigarette smoking who consumed more than 40 pcs. of stick/ day. He was been diagnosed of emphysema last Jan. 5, 2010. Mr. Xs work was exposed to gas and fumes like carbon monoxide and nitrogen oxides aside from the fact that he also smoked. As this air pollutant enters the nose or mouth for a long period of time, cilia in the respiratory unit will be destroyed. These are important along with the goblet cell, which secretes mucin, to protect the lung from foreign air pollutant. If the blood ph will be affected, there will be sympathetic response which will stimulate the aortic and carotid bodies chemoreceptors primarily respond to changes in blood oxygen levels. Changes in blood oxygen levels can become important when they decline to low level called hypoxia. They send action potentials to the medullary chemoreceptor and produce an increase in the rate and depth of respiration called tachypnea. One factor recently implicated to the development of emphysema is the damage to the elastic fiber network of the alveolar wall by the enzyme elastase. Normally the lung are protected against such damage by a circulating antielastase. However, in cigarette smokers, there is imbalance between elastase and antielastase activity, as a result of suppression of antielastase activity, more neutrophils (which release elastase) in the lung and secretion of elastase by macrophages (does of non-smoker do not secretes this enzyme.) the likelihood of bronchiolar obstruction is increase in cigarette smokers because terminal bronchioles narrowed by hyperplasia and secretions of mucus is increase. Plugging of bronchioles with mucus often traps air in the alveoli, causing them to become overextended (+) wheezing, and, if an individual happen to cough, the sudden rise in pressure may rupture alveolar walls, especially those damage by the action of elastase. The physiological effect of emphysema includes increase airway resistance, with increase effort expended in breathing (+) DOB/ barrel chest due to continues diaphragm contraction and greatly decrease diffusing capacity. As this happen, there will be positive chest tightness stimulated by nociceptor by increase action of prostaglandin.

21

22

Explanation Pathophysiology (Book Base)

In normal breathing, air is drawn in through the bronchi and into the alveoli, which are tiny sacs surrounded by capillaries. Alveoli absorb oxygen and then transfer it into the blood. When toxicants, such as cigarette smoke, are breathed into the lungs, the harmful particles become trapped in the alveoli, causing a localized inflammatory response. Chemicals released during the inflammatory response (e.g., elastase) can eventually cause the alveolar septum to disintegrate. This condition, known as septal rupture, leads to significant deformation of the lung architecture. These deformations result in a large decrease of alveoli surface area used for gas exchange.To accommodate the decreased surface area, thoracic cage expansion (barrel chest) and diaphragm contraction (flattening) take place. Expiration increasingly depends on the thoracic cage and abdominal muscle action, particularly in the end expiratory phase. Due to decreased ventilation, the ability to exude carbon dioxide is significantly impaired. In the more serious cases, oxygen uptake is also impaired. Patients with alpha 1antitrypsin deficiency (A1AD) are more likely to suffer from emphysema. A1AD allows inflammatory enzymes (such as elastase) to destroy the alveolar tissue. Most A1AD patients do not develop clinically significant emphysema, but smoking and severely decreased A1AT levels (10-15%) can cause emphysema at a young age. The type of emphysema caused by A1AD is known as panacinar emphysema (involving the entire acinus) as opposed to centrilobular emphysema, which is caused by smoking. Panacinar emphysema typically affects the lower lungs, while centrilobular emphysema affects the upper lungs. A1AD causes about 2% of all emphysema. Smokers with A1AD are at the greatest risk for emphysema. Mild emphysema can often develop into a severe case over a short period of time (12 weeks).

23

Drug Study
Drugs
Generic Name: Combivent Brand Name: Albuterol

Classification Indication
Bronchodilator Combivent Inhalation Aerosol is indicated for use in patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and who require a second bronchodilator.

Side Effect
Can produce paradoxical bronchospasm that can be lifethreatening. If it occurs, the preparation should be discontinued immediately and alternative therapy instituted. It should be recognized that paradoxical bronchospasm, when associated with inhaled formulations, frequently occurs with the first use of a new canister.

Nursing Responsibilities
Monitor blood pressure. Monitor respiratory rate.

Generic Name: Hydrocortisone Brand Name: Solu-cortef

Anti-inflammatory

Treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic

Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis;

Monitor Bp.

24

diseases, allergic paresthesias; states, allergic psychosis. and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders (idiopathic thrombocytopenic purpura), neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases (ulcerative colitis and sprue), multiple sclerosis, tuberculous meningitis, trichinosis with neurologic or myocardial involvement. Generic Name: Terbutaline Brand Name: Brethine Bronchodilator Palpitation, hypertension, . in the mother, these include increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial Monitor blood pressure. Monitor respiratory and heart rate.

Terbutaline sulfate injection is indicated for the prevention and reversal of bronchospasm in patients 12 years of age and older with asthma and reversible bronchospasm

25

associated with bronchitis and emphysema.

Generic Name: Aspirin Brand Name: Zorprin

Anti-thrombosis

Treatment of mild to moderate pain; fever; various inflammatory conditions; reduction of risk of death or MI in patients with previous infarction or unstable angina pectoris or recurrent transient ischemia attacks or stroke in men who have had transient brain ischemia caused by platelet emboli.

ischemia. Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration. Nausea, vomiting, tinnitus, dizziness, respiratory alkalosis, metabolic acidosis, hemorrhage, convulsions.

Take Aspirin by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Swallow Aspirin whole. Do not break, crush, or chew before swallowing. Take Aspirin with a full glass of water (8 oz/240 mL).

Generic Name: Clarithromycin Brand Name: Biaxin

Antibiotic

Upper and lower respiratory tract infections and otitis media due to S. Pneumonea, Mycoplasmas Pneumonea, Legionella pneumophila,

Nausea, Abdominal pain and Diarrhea

Perform Skin
Test before administering any brand of antibiotic.

Generic Name: Budesonide

Bronchodilator

For the maintenance treatment of asthma as

Hypertension, migraine, palpitations, syncope,

Monitor blood pressure.

Monitor
respiratory

26

prophylactic

tachycardia, dizziness, fatigue.

Brand Name: Entocort EC

therapy in adults and children and for patients requiring oral corticosteroid therapy for asthma.

and heart rate.

Generic Name: Epinephrine Brand Name: Adrenaline Chloride

Bronchodilator

Relief of respiratory distress due to bronchospasm, to provide rapid relief of hypersensitivity reactions to drug and other allergens.

Palpitation, hypertension, in mother, these include increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia. Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration.

Monitor blood pressure. Monitor respiratory and heart rate.

27

SOAPIE (actual)
Subjective
Nahihirapan akong huminga paminsan-minsan, as the pt. verbalized.

Objective
Received pt. on hi-fowlers position, conscious and coherent, with ongoing O2 via nasal cannula regulated @ 2 LPM, with ongoing D5W 1L regulated @ 10-15 gtts/min. @ 780 ml. level infusing well @ right metacarpal vein. (+) DOB (+) chest pain (pain scale 7/10) (+) Body weakness (+) Wheezing upon auscultation (+) pale due to hypoxia (+) tapioca-like plug Barrel chest Vital Signs: RR: 27cpm (tachypnea) PR: 102 bpm (tachycardia)

Assessment
Impaired gas exchanged related to alveolar capillary membrane destruction.

Planning
After 4 hrs. of N.I, the pt. verbalized understanding of causative factors and appropriate intervention.

Interventions
Established rapport. Monitored and recorded vital signs. Reduced or eliminated the pt. exposure to possible irritants. Thought coughing exercise (abdominal/ diaphragmatic breathing and pursed lip breathing techniqued. Administered low-flow oxygen 2-3 L/min. Instructed to drink 2-3 L of water. Encouraged the pt. to quit smoking. Medication compliance on time.

Evaluation
Goal partially met AEB the clients respiratory and heart rate are slightly beyond normal. RR: 22 cpm PR: 97 bpm P/S 4/10

28

SOAPIE (potential)
Subjective:

Objective
Received pt. on hi-fowlers position, conscious and coherent, with ongoing O2 via nasal cannula regulated @ 2 LPM, with ongoing D5W 1L regulated @ 10-15 gtts/min. @ 780 ml. level infusing well @ right metacarpal vein.

Assessment
Risk for infection related to retained secretions in the lung.

Planning
After 2hrs. of N.I, the client verbalized understanding and techniques on how to avoid or reduce infections.

Interventions
Established rapport. Monitored and recorded vital signs. Provided comfort and safety. Instructed the pt. to increase fluid intake. Educated the pt. about proper using and disposing of tissue. Thought the pt. and relative about proper hand washing. Instructed the pt. to avoid cigarette smoking.

Evaluation
Goal partially met AEB the clients respiratory condition became slightly good.

29