TABLE OF CONTENTS

CHAPTER I: INTRODUCTION

CHAPTER II: ASSESSMENT

A. HEALTH HISTORY

B. GENOGRAM

C. LABORATORY AND DIAGNOSTIC TEST

D. ASSESSMENT DIAGRAM

CHAPTER III: REVIEW OF ANATOMY AND PHYSIOLOGY

CHAPTER IV: CONCEPT MAP

CHAPTER V: MANAGEMENT

A. TEXT-BOOK BASED MEDICAL-SURGICAL MANAGEMENT

B. TEXT-BOOK BASED NURSING CARE

C. NURSING CARE PLAN

CHAPTER VI: REFERENCES

CHAPTER VII: APPENDIX

A. DRUG STUDY

B. NURSING JOURNALS
 CHAPTER I

INTRODUCTION

Bronchial asthma, often referred to simply as asthma, is a chronic respiratory condition

characterized by inflammation and constriction of the airways, resulting in symptoms such as wheezing,

coughing, shortness of breath, and chest tightness. The clinical manifestations of bronchial asthma can

vary in severity and frequency among individuals. It is a prevalent global health issue, affecting people of

all ages, races, and socioeconomic backgrounds.

The development of bronchial asthma involves a complex interplay of genetic predisposition and

environmental factors. Individuals with a family history of asthma or allergies are at a higher risk of

developing the condition. Furthermore, exposure to allergens such as pollen, dust mites, animal dander,

mold, and certain respiratory irritants like tobacco smoke, air pollution, and chemical fumes can trigger

asthma symptoms. Diagnosing bronchial asthma involves a thorough evaluation of the patient's medical

history, symptoms, and physical examination, supplemented by diagnostic tests.

 CHAPTER II
ASSESSMENT
A. HEALTH HISTORY

Vital information

Patient’s Name: Bob

Sex: Male

Age: 86 y/o

Birthdate: July 19, 1937

Marital Status: Married

Occupation: Retired Government Employee

Address: P-4 Poblacion,, City of Valencia, Bukidnon

Religion: Roman Catholic

Ethnicity: Bisaya

Nationality: Filipino

Race: Asian

Contact Person: Edna

Health Insurance: PhilHealth

Source & Reliability: S/0 & Patient’s chart

Date of Admission: February 18, 2024

Time of Admission: 06:24 AM

Date of Discharge:

Admitting Physician: Shane M.D.

Chief Complaints: Cough & Colds

Admitting Diagnosis: t/c BAIAE ; t/c URTI ; HTN Stage II Controlled

History of Present Illness
2 days prior to admission, Bob was just laying down watching tv early at night when he had onset
of nonproductive cough, shortness of breath, and fever. SO also claimed that 2 days prior to admission,
they noticed a decrease in Bob’s appetite. Patient was also unable to recall what he was doing earlier that
day, and claimed that he does not do chores at home.
Reason for Seeking Healthcare
Bob had the onset of a nonproductive cough, shortness of breath, and fever while lying down. SO
also claimed that two days prior to admission, they noticed a decrease in Bob’s appetite. Bob has
maintenance medications for BA; he took the medications, but symptoms persisted, thus his admission.
Current Health Status
Patient Bob is 86 years old, a retired government employee, was admitted last February, 18,
2024. He presented with productive cough, without shortness of breath and fever, with improved appetite.
Past Medical History
Hospitalization – he was hospitalized last November 2023 at AMCV due to lose bowel
movement and vomiting. He was also diagnosed with Hypertension and Cardiac Arrhythmia, unrecalled
hospitalizations but diagnoses were diagnosed on different times of hospitalization.
Surgeries- no history of any surgery/injuries.
Immunizations – Complete childhood vaccines, complete Covid – 19 Vaccines.
B. GENOGRAM
B.1. HEMATOLOGY

HEMATOLOGY (02/18/2024) at AMCV

Lab Result Normal Value Interpretation Significance

RBC 4.33 3.69-5.90 Normal

Hematocrit 43.0 41.00-53.00% Normal

Hemoglobin 14.0 13.50-17.50 g/dL Normal

MCV 100 80 – 100 fL Normal -

MCH 32 26.10-33.30 pg Normal

MCHC 33 31.00-37.00% Normal

RDW 10.4 11.50-14.50% decreased Possible macro/microcytic

anemia

WHITE BLOOD 5.74 4.50-11.00 x 107 / L Normal -

CELLS

Neutrophils 83 37.00-72.00% Increased Bacterial Infection

Lymphocytes 6 20.00-50.00% Decreased Risk for Infection

PLATELET 171 150-390 Normal

COUNT

Monocytes 10 8.00-14.00 Normal

Eosinophils 0 0.00-6.00 Normal

 Basophils 1 0.00-1.00 Normal

CLINICAL CHEMISTRY (02/18/2024) at AMCV

Lab Normal Value Interpretation Significance

Result

Random Blood 141.68 90-130 Increased -

Sugar

Creatinine 1.06 0.6-1.4 mg/dL Normal

Sodium 135.3 135-155 mmol/L Normal

Potassium 2.81 3.6-5.5 mmol/L Decreased Hypokalemia-

HBA1C 6.1 5.7-6.4 Pre-diabetic

CHEST PAL
FINDINGS:
The lungs are hyperinflated with lowest hemidiaphragm.
Reticular densities are seen in both lungs.
Tracheal air column is at the middle
The heart is not enlarged.
Aortic Knob is calcified
Both hemidiaphragms and costophrenic sulci are intact.
Marginal spurs are seen in the thoracic spine
The rest of the included osseous structures are unremarkable.

IMPPRESSION:
BILATERAL PULMONARY HYPERAERATION
INTERSTITIAL PNEUMONIA
ATHEROSCLEROTIC AORTA
THORACIC SPONDYLOSIS
D. ASSESSMENT DIAGRAM

Psychological Developmental Socio-cultural

Client is euthymic, responsive and Integrity vs. Despair Client is a Roman Catholic; Views his
cooperative with treatment regimen. Proud of accomplishment that he was able illness as punishment for abusing his body
to let 2 of his children finish their in his younger years; does not utilize any
education. herbal medicine and only utilizes health
facilities nearby in times of illness
 E.

Patient Information
Name: Bob
Cardiovascular Age/Sex: 86/Male Respiratory
S: No family hx recalled. Complaints of minor Civil Status: Married S: Client has a history of smoking; hx of TB
activity intolerances, hx of chest pains “kalit Chief Complaints: Cough, Colds, @65 y/o, diagnosed with asthma 30 years ago
lang” as verbalized; “usahay gapahulay lang Decreased appetite and was given maintenance medication.
ko”. No complaints of chest pain during shift, Admitting Dx: T/C BAIAE, T/C O: Eupneic, RR (19-22); O2saturation (91-96);
reports of awakening at night with SOB. URTI, HTN II Controlled with productive cough, clear mucus, (+)
O: BP ranging from 120/70-130/90; PR Final Dx: wheezing upon exhalation, symmetrical lung
ranging from 80-94 bpm. No adventitious expansion
sound noted upon assessment of cardiac Medications:
boarders, regular peripheral pulses, no neck Hematology Acetylcysteine 600mg 1 pack in ½ glass of H20
vein distention noted. S: No bleeding disorders/ tendencies Salmeterol+Fluticasone 25/125mg MDI 2 puffs
Lab/Dx Tests: as claimed. BID gargle with water after use.
ECG: Sinus tachycardia with nonspecific ST-T O: Salbutamol Neb Q8
wave elevation. Medications: Management:
X-ray: Atherosclerotic aorta Lab/Dx Tests: Nebulization & Chest Physiotherapy
Medications: RBC: 4.33 Lab/Dx Tests:
Amlodipine (Vasalat) 5 mg 1 tab OD PO Hematocrit: 43 Chest X-ray – Bilateral pulmonary
Gerontologic considerations: Hemoglobin: 14 hyperaeration, interstitial pneumonia.
There is a progressive degeneration of the MCHC: 33 Rapid Antigen Test – Negative
cardiac structures with a loss of elasticity, Platelet Count: 171 Gerontologic considerations:
fibrotic changes in the valves of the heart, and Gerontologic considerations: The cough reflex may be less effective in
Aging leads to a decrease in bone clearing respiratory secretions, increasing the
infiltration with amyloid. The pumping marrow mass and cellularity and an risk of respiratory infections. Ciliary function in
capacity of the heart is reduced with age due to increase in bone marrow fat. the respiratory tract may decline, affecting
a variety of changes affecting the structure and mucociliary clearance and increasing the risk of
function of the heart muscle.
respiratory infections.
Immunologic
S: complete immunizations including
Neurologic childhood vaccinations, complete
S: Family Hx of Alzheimer’s disease; SO covid-19 vaccine but with no booster,
reports that client had hx of frequent vertigo. according to s/o.
SO also reports that sometimes the client will Integumentary
O: swollen bilateral cervical lymph S: Used to work in the cornfield.
have difficulty recognizing him. nodes, afebrile; Temperature (36.6-
O: Client is awake and alert; GCS: 15, able to O: white sparse hair, white brows, lashes and
37.1) beard. Clean and well-trimmed nails; (+)
follow instruction upon PA such as stand up Medications:
and walk. Pt also had difficulty hearing the Vitiligo: Warm, dry, saggy skin. Brown iris,
Cetirizine (Alnix) 10mg 1 tab OD PC white sclera, pink conjunctiva.
student nurse, incomprehensible speech. Dinner
Gerontologic Considerations: Gerontological considerations:
Montelukast 10mg 1 tab OD PC With aging, dysfunction of this system may
With aging, there is a gradual reduction in Dinner
brain size and weight.Most prominent in the occur, resulting in increased dryness of the skin,
Lab/Dx Tests: thinning, age spots, wrinkles, and decreased
frontal and temporal lobes and may be WBC: 5.74
associated with mild declines in memory and skin elasticity.
Gerontologic considerations:
processing speed. Loss of adaptive immunity and the
gain of nonspecific innate immunity,
leaving older individuals susceptible
to infection and cancer and
unprotected from chronic tissue
inflammation.
 Genitourinary Musculoskeletal
S: No prior complaints from pt according to S/O S:No reported joint pains, no recalled injuries
O: With diaper, no reports of discomfort upon urination, O:Muscle atrophy evident on all extremities, normal gait,
eliminates 4-5 times daily. kyphotic posture, able to do ADLS but with minimal assistance.
Intake & Output: no limitations to ranges of motion, muscle strength score on
Date I O extremities:
2-19-2024 1,950 ml 2,300 ml 5 5
2-20-2024 1,880 ml 2,120 ml

Laboratory tests: 5 5
Creatinine: 1.06 mg/dl Diagnostic Test:
Gerontologic considerations: X-ray – Thoracic spondylosis
Aging increases the risk of kidney and bladder problems such Gerontologic considerations:
as: Bladder control issues, such as leakage or urinary Muscles may become rigid with age and may lose tone, even with
incontinence or urinary retention. Bladder or urinary tract regular exercise. Bones become more brittle and may break more
infection, and even AKD or CKD. easily. Overall height decreases, mainly because the trunk and
spine shorten. Breakdown of the joints may lead to inflammation,
pain, stiffness, and deformity.

Reproductive/Sexuality Gastrointestinal/Digestive
S: Client is not sexually active, has 3 children. S: Hx of heavy drinking; no strict food preferences, good appetite.
O: Defacates one to twice daily
Medications: O: Moist mucous membranes, incomplete canine and molars,
Lab/Dx Tests: with black discoloration on the back of the teeth and on the hard
Nursing Dx: and soft palate. Flat abdomen, normoactive bowel sounds on all
Gerontologic considerations: quadrants. No pain upon palpation and percussion.
Hormone production, spermatogenesis, and testes undergo Gerontologic considerations:
changes as a man ages. These small changes lead to decrease in The walls of the small intestines atrophy with age. This alters the
both the quality and quantity of spermatozoa. shape of the villi and reduces the surface area across which
absorption occurs. Along with the atrophy there is a decrease in
the production of digestive enzymes.

Metabolism-Endocrine
S: No family hx of metablic/endocrine disorders known.
O: Height:152.4 cm ; Weight: 46.2
Medications:
Lab/Dx Tests:
HBA1C – 6.1%
TSH – 0.06
Free T4 – 17.54
Free T3 – 3.97
RBS – 141.68
Na – 135.5
K – 2.81
Gerontologic considerations:
Decreased levels of growth hormone may lead to decreased
muscle mass and strength. Decreased melatonin levels may
play an important role in the loss of normal sleep-wake cycles
(circadian rhythms) with aging.
 CHAPTER III
REVIEW OF ANATOMY AND PHYSIOLOGY

Normal Functioning:
In a healthy individual, the respiratory system functions efficiently to bring oxygen into the body and
remove carbon dioxide. Here's how it works:
Inhalation: The diaphragm contracts and moves downward, while the intercostal muscles contract,
expanding the chest cavity. This creates negative pressure in the lungs, causing air to rush in.
Gas Exchange: Oxygen from the inhaled air diffuses into the bloodstream across the alveolar walls,
while carbon dioxide from the bloodstream diffuses into the alveoli to be exhaled.
Exhalation: The diaphragm and intercostal muscles relax, allowing the chest cavity to decrease in size.
This increases pressure in the lungs, causing air to be pushed out.
Asthma and its Effects:
Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways,
leading to symptoms such as wheezing, shortness of breath, chest tightness, and coughing. Here's how it
affects the respiratory system:
Airway Inflammation: In asthma, the airways become inflamed due to various triggers such as
allergens, irritants, or infections. This inflammation causes swelling of the airway lining, increased mucus
production, and sensitivity to triggers.
Bronchoconstriction: In response to inflammation and triggers, the smooth muscles surrounding the
airways may contract excessively, leading to bronchoconstriction. This narrows the airways, making it
difficult for air to flow in and out of the lungs.
Mucus Production: Increased inflammation triggers the production of thick mucus in the airways,
further obstructing airflow and contributing to coughing and wheezing.
Air Trapping: During an asthma attack, air may become trapped in the lungs due to narrowed airways
and difficulty exhaling fully. This can lead to hyperinflation of the lungs and increased work of breathing.

IMMUNE SYSTEM
The Organization of Immune Function
The immune system is a collection of barriers, cells, and soluble proteins that interact and
communicate with each other in extraordinarily complex ways. The modern model of immune function is
organized into three phases based on the timing of their effects. The three temporal phases consist of the
following:

 Barrier defenses such as the skin and mucous membranes, which act instantaneously to prevent
pathogenic invasion into the body tissues

 The rapid but nonspecific innate immune response, which consists of a variety of specialized cells
and soluble factors

 The slower but more specific and effective adaptive immune response, which involves many cell
types and soluble factors, but is primarily controlled by white blood cells (leukocytes) known as
lymphocytes, which help control immune responses
The cells of the blood, including all those involved in the immune response, arise in the bone marrow
via various differentiation pathways from hematopoietic stem cells (Figure 1). In contrast with embryonic
stem cells, hematopoietic stem cells are present throughout adulthood and allow for the continuous
differentiation of blood cells to replace those lost to age or function. These cells can be divided into three
classes based on function:

 Phagocytic cells, which ingest pathogens to destroy them

 Lymphocytes, which specifically coordinate the activities of adaptive immunity

 Cells containing cytoplasmic granules, which help mediate immune responses against parasites
and intracellular pathogens such as viruses
 CHAPTER IV: CONCEPT MAP

ENVIRONMENTAL ALLERGEN HX OF HEAVY SMOKING

EXPOSURE TO ALLERGEN
Cetirizine (Alnix) 10mg 1 tab
OD PC Dinner
Montelukast 10mg 1 tab OD
ALLERGIC REACTION PC Dinner

EARLY RESPONSES DELAYED RESPONSES

-↑ MUCOUS MIGRATION OF EOSINOPHILS TO:
-↑VASCULAR
PERMEABILITY
EYES NOSE AIRWAY
-BRONCHIAL SM

AIRWAY OBSTRUCTION

Salmeterol+Fluticason
e 25/125mg MDI 2
puffs BID gargle with
water after use.
Acetylcysteine 600mg 1 pack Salbutamol Neb Q8
in ½ glass of H20
ASTHMA BRONCHIOLE
CONSTRICTION
-CHEST
PHYSIOTHERAPY
RHINITIS WHEEZING

CONJUNCTIVITIS
 CHAPTER V: MANAGEMENT

A. TEXT-BOOK BASED MEDICAL-SURGICAL MANAGEMENT

Textbook-based Nursing Care
Asthma
Assessment:
 Evaluate patient’s asthma severity based on symptoms, frequency of exacerbations, and lung
function tests (spirometry, peak flow meter)
 Identify triggers (e.g., allergens, exercise, cold air, smoke) and assess patient’s understading of
trigger management.
 Assess patient’s current medications, adherence, and any side effects experienced.

Medication Management:
 Administer bronchodilators (e.g., albuterol) as prescribed for acute symptom relief.
 Educate patient on proper use of inhalers and spacers.
 Ensure compliance with controller medications (e.g., inhaled corticosteroids) to reduce airway
inflammation and prevent exacerbations.
Environmental Control:
 Educate patient on identifying and avoiding triggers.
 Recommend measures to reduce exposure to allergens (e.g., dust mites, pet dander).
 Advise patient on smoking cessation and avoidance of secondhand smoke.
Breathing Techniques:
 Teach deep breathing exercises and pursed-lip breathing to promote effective breathing pattern.
 Instruct patient on techniques to control dyspnea during exacerbations.
Anxiety Management:
 Assess patient's anxiety level regularly.
 Implement relaxation techniques (e.g., guided imagery, progressive muscle relaxation).
 Encourage open communication and provide emotional support.
Education and Support:
 Provide comprehensive education on asthma triggers, medications, and self-management
strategies.
 Develop an asthma action plan with patient, including steps for symptom recognition, medication
use, and when to seek medical help.
 Offer resources for support groups or counseling services.

Evaluation:
 Monitor patient's respiratory status, including oxygen saturation, lung function tests, and
frequency of exacerbations.
 Assess patient's adherence to medication regimen and effectiveness of environmental control
measures.
 Evaluate patient's understanding of asthma management and ability to implement self-care
strategies.
Follow-up:
 Schedule regular follow-up appointments to assess progress, adjust treatment plan as needed, and
reinforce education.
 Encourage patient to contact healthcare provider if experiencing worsening symptoms or
difficulties adhering to treatment regimen.

Textbook-based Medical- Surgical Management

Medical-Surgical Management for Asthma

Asthma is a chronic respiratory condition characterized by reversible airway obstruction,
inflammation, and bronchial hyper responsiveness. The medical-surgical management of
asthma aims to control symptoms, reduce exacerbations, improve lung function, and enhance
quality of life. Below is a textbook-based approach to managing asthma:
1. Pharmacological Therapy:
a. Bronchodilators: - Short-acting β2-agonists (SABAs) such as albuterol provide quick
relief of bronchospasm during acute exacerbations. - Long-acting β2-agonists (LABAs) like
salmeterol are used for maintenance therapy in conjunction with inhaled corticosteroids (ICS)
in moderate to severe asthma.
b. Anti-inflammatory Agents: - Inhaled corticosteroids (ICS) are the cornerstone of asthma
therapy for reducing airway inflammation and preventing exacerbations. Examples include
fluticasone, budesonide, and beclomethasone. - Oral corticosteroids (e.g., prednisone) are
reserved for severe exacerbations or when ICS/LABA therapy is insufficient.
c. Leukotriene Modifiers: - Montelukast and zafirlukast block leukotriene receptors,
reducing inflammation and bronchoconstriction. They are used as adjunctive therapy in
persistent asthma.
d. Monoclonal Antibodies: - Omalizumab targets immunoglobulin E (IgE) to decrease
allergic response in severe allergic asthma not controlled by other medications. -
Mepolizumab, reslizumab, and benralizumab target interleukin-5 (IL-5) for severe
eosinophilic asthma.
2. Non-pharmacological Management:
a. Allergen Avoidance: - Identify and minimize exposure to allergens triggering asthma
exacerbations, such as dust mites, pet dander, pollen, and mold.
b. Smoking Cessation: - Encourage smoking cessation in patients with asthma and
avoidance of secondhand smoke.
c. Physical Activity: - Encourage regular physical activity tailored to individual capabilities,
as exercise-induced asthma is common. Pre-exercise use of SABAs can help prevent
symptoms.
3. Patient Education:
a. Asthma Action Plan: - Provide patients with a written asthma action plan that includes
instructions for daily management, recognition of worsening symptoms, and steps for
initiating rescue therapy or seeking medical assistance.
b. Medication Technique: - Demonstrate proper inhaler technique, including spacer use for
metered-dose inhalers, and ensure patient understanding and competency.
c. Self-Monitoring: - Educate patients on monitoring peak expiratory flow rate (PEFR) at
home using a peak flow meter to assess lung function and recognize early signs of
exacerbations.
4. Monitoring and Follow-up:
a. Regular Follow-up: - Schedule follow-up appointments to assess asthma control, adjust
medication dosages as needed, and reinforce education.
b. Lung Function Tests: - Perform spirometry and/or peak flow measurements regularly to
evaluate lung function and response to therapy.
c. Assessment for Complications: - Monitor for complications such as exacerbations
requiring hospitalization, medication side effects (e.g., oral thrush with ICS), and
psychological effects of chronic illness.
5. Emergency Management:
a. Acute Exacerbations: - Administer oxygen therapy to maintain oxygen saturation above
90%. - Administer SABAs via nebulization or metered-dose inhaler with spacer for rapid
bronchodilation. - Consider systemic corticosteroids for severe exacerbations. - Initiate early
transfer to the emergency department if symptoms worsen despite initial treatment or if the
patient exhibits signs of respiratory distress.

6. Surgical Options:
a. Bronchial Thermoplasty: - Considered for severe asthma uncontrolled by maximal
medical therapy, bronchial thermoplasty involves delivering controlled thermal energy to the
airways to reduce smooth muscle mass and bronchoconstriction.
 b. Lung Transplantation: - Considered in end-stage refractory asthma when all other
treatment options have failed.
7. Psychological Support:
a. Psychosocial Assessment: - Assess for anxiety, depression, or other psychosocial factors
impacting asthma management and quality of life.
b. Referral to Mental Health Services: - Refer patients to mental health professionals for
counseling or cognitive-behavioral therapy if needed to address psychological issues related
to asthma.
8. Coordinated Care:
a. Interprofessional Collaboration: - Collaborate with respiratory therapists, allergists,
pulmonologists, and primary care providers to ensure comprehensive asthma management
and continuity of care.
b. Patient Engagement: - Involve patients in shared decision-making regarding treatment
options, goals of care, and self-management strategies.

B. NURSING CARE PLAN

 CHAPTER VI: REFERENCES

Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International

Guidelines for Management of Sepsis and Septic Shock: 2017. Intensive Care Med. 2018

Mar;43(3):304-377.

Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International

Guidelines for Management of Severe Sepsis and Septic Shock, 2021. Intensive Care Med. 2023

Feb;39(2):165-228.

AACN. (2018). AACN Practice Alert: Reducing the Risk of Infection in Mechanically

Ventilated Adults. American Association of Critical-Care Nurses.

Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2018). Medical-Surgical Nursing:

Concepts for Interprofessional Collaborative Care (9th ed.). Elsevier.

LeMone, P., Burke, K., Bauldoff, G., Gubrud, P., & Levett-Jones, T. (2019). Medical-

Surgical Nursing: Critical Thinking for Person-Centered Care (2nd ed.). Pearson