SISTERNIVEDITAGOVERNMENT

COLLEGE OF NURSING

IGMC,SHIMLA

SUBJECT:ADVANCEDNURSINGPRACTISE

CASESTUDYON:ASTHMA

SUBMITTEDTO: SUBMITTEDBY:

Mrs.PoojaSood SheetanshuPatiyal

Lecturer(ObstetricsandGynaecologicalNursing) MSC(N)1stYear

SNGNC,IGMC SNGNC,IGMC

Shimla Shimla

SUBMITTEDON:

1
  HISTORYTAKING
 Biographicdata/Identificationdata

Name: Smt. Aruna Devi

CR.NO:20230849800

Age: 54years

Sex:FemaleAdult

Wardno.:RespiratoryICU(RICU)

Bedno.:2

Languageknown:Pahari,hindi

Marital Status: Married

Religion: Hindu

Nationality: Indian

EducationalStatus:10thclass

Occupation: Housewife

Monthlyfamilyincome:75,000/-

2
Informant:Patientherself

Address:Vill.GhiyanaP.O.BrahampukarTeh.SadarDistt.Bilaspur

Contactnumber:6230876212

Dateofadmission:02-12-2023at6:40am Date

of history taking: 02-12-2023 Diagnosis:

Asthma

Durationofcare: 1day

Doctor’sName:Dr.Rakesh

 CHIEFCOMPLAINTS:Smt.ArunaDevi, aged54yearswasadmittedinIGMCHospital, Shimlawiththechiefcomplaintsof-

 Severecoughsince15days
 Shortnessofbreathsince 1month
 Tightnessinthechestsince1month
 HISTORYOFPRESENT ILLNESS:
 PresentMedicalHistory: A54 yearold lady, Smt. ArunaDeviwaspresented inIGMCHospital, Shimla becauseshewas havingsevere cough
since 15 days, shortness of breath since 1 month and tightness in chest since 1 month.

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 Vitalsonadmission-
Sr.no. Vitals Name PatientValue NormalValue
1. Temperature 98.80F 98.60F
2. Bloodpressure 152/96mmHg 120/80mmHg
3. Respiration 26b/min 12-20b/min
4. Pulserate 116b/min 60-100b/min

 Presentsurgicalhistory:NothingSignificant
 HISTORYOFPAST ILLNESS:
 Pastmedicalhistory:16yearsago,ArunaDeviwasdiagnosedwithasthmaandsheisonmedicationssince then.
 Pastsurgicalhistory:Nothing Significant
 Historyofanychronicillnessin thefamily:Thereisnosuchhistoryofillnessinthefamily.
 Historyofanycommunicableandhereditarydisease:Thereisnosuchhistoryofcommunicableandhereditarydisease.
 PERSONALHISTORY:
 Habits:Thepatientlovestolistenradioandbhajans
 Sleeppattern:Thepatienthasasoundsleeppattern.
 Exercisepattern:Thepatientdoeslightexerciseswithhisparents.
 Nutritionalpattern:Patientis vegetarianandhasagoodnutritionalstatus
 Boweland bladderhabits:Regularboweland bladderhabits
 PersonalHygiene:Theclienthasgoodpersonalhygiene.
 Sexualhistory:Thereisnosexrelatedproblems

4
  Contraceptivehistory:Thepatienthashashadtubectomyafterher 2ndchild
 Psychologicalhistory:Thepatienthasgoodandsoundrelationswiththefamilymembersandrelatives.
 Menstrualhistory:Shehashadhermenopauseattheageof48years.
 FAMILYHISTORY:
 Typeoffamily:Nuclearfamilywith4members
 Headofthefamily:Sh. AmitKhatri
 Anymedicalhistoryinthefamily-nothing significant
 Anysurgicalhistoryinthefamily- nothingsignificant
 IMMUNIZATIONHISTORY: Thepatienthasbeenimmunizedwithallthevaccines.Herimmunizationscheduleiscomplete.
 FAMILYTREE: KEY-
FEMALEPATIENT

Sh.AmitKhatri, 59years Smt.ArunaDevi,54years

MALE
Rohan,26years(Son) Krish,23years(Son)

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  FAMILYCOMPOSITION:
Sr. Nameoffamily Age Sex Relationship EducationalStatus OccupationalStatus HealthStatus
No. member with the
client
1. Sh.Amit Khatri 59 MaleAdult Husband Msc.M.Ed Teacher Healthy
years
2. Smt. Aruna 54 Female Patient 10thclass Housewife Healthy
Devi years Adult
3. Rohan 26 MaleAdult Son B.tech Student Healthy
years
4. Krish 23 MaleAdult Son MBBS Student Asthma
years

 SOCIOECONOMICSTATUS
 House:Thepatientstaysinapuccahouse
 Ventilation:Thereisproper ventilation
 Socialrelationship:Thepatienthassoundandhealthyrelationshipswiththesociety
 MonthlyIncome:75,000/-
 Environmentalhygiene:Goodenvironmentalhygiene
 Drinkingwater:Tapwaterandgroundwatersupply
 Environmentalpollution:Noenvironmentalpollution

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 Socialsupportsystem:Socialsupportsystemisprovided
 Anypsychologicalstressors:Nopsychologicalstressorspresentindaytodaylife
 Spousegeneralhealth:Nothing significant
 Numberofchildren:Twochildren,twosons
 PHYSICALASSESSMENT:
1. GeneralAppearance-
 Sensorium:Alertandconscious
 EmotionalState:Stable
 Activity:Active
 Foulbody odor:Not present
 Foulbreath:Notpresent
 Bodybuilt:Thin
 Grooming: Wellgroomed
 Nourishment:Wellnourished
 Posture:Normal
 Gait:Normal
2. AnthropometricAssessment:
 Height:160cm
 Weight:52kg
 Bodymassindex(BMI):weight(kg)/height(m)2
52kg/1.6m2

7
 16.75kg/m2
3. VITALSIGNS:
DATE TEMPERATURE PULSE RESPIRATION BLOODPRESSURE
04-12-2023 97.60F 122b/min 12b/min 130/90mmHg

4. HEADTOTOEEXAMINATION:

ORGAN ASSESSMENT FINDINGS

GENERALAPPERANCE Health Looks pale

Built Weakenedandlazy
Behaviorpattern Listenscarefullybutlethargic
Mentalalertness Semiconscious
SKIN AND MUCUS Color looks pale
MEMBRANES Temperature Thepatientdoesnothavenothavefever no
Lesions lesions on skin
ScarsEdema noscarspresent
Birthmark no edema
moleonleftupperextremity
HEAD Size,shapeand position Round
Symmetry Symmetrical

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 Skulldeformities Noskulldeformities
Nodulesandmasses No massesandnodulespresent
HAIRANDSCALP Hair color blackincolor
Distributionofhair normalandsymmetricaldistributionofhair no
Texture alopecia present
Dandruff/Parasites no dandruffpresent
Sclaplesions nolesions
NAILS Shape normal
Color slightlypink
Clubbing noclubbingpresent
FACE Symmetry Symmetricalface
Appearance Pale
Lesions Nolesions
Facial hair Absent
Periorbitaledema Absent
Anxiety Present
EYES ShapeColor Symmetricalshape
Movements Brown
Eyelids Symmetricalandnormaleyemovements
Eyelashes Normal scaling
Equaldistributionofhair

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 Conjunctiva Normal,noinflammation
Sclera White in color
Pupil Normalreactiontolightand accommodation
Vision Normal6/6
EARS Alignment normal
Discharge alignmentnodischar
Swelling gepresent no
Wax swelling
Hearing nodischarge
hearing isnormal
NOSEANDSINUSES Symmetry Symmetrical
Discharge Nodischarge
Septum Normal,noDNS
Mucus Intact
Nasalflaring Not present
MOUTHANDPHARYNX Lips Dried
Teeth 30teethpresent
Tongue Pinkish
Gums Nobleeding
Palate Intact
Buccalmucosa Soft,pinkandnolesions
Colorofteeth Slightlyyellow

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 Trauma Notrauma
THROATAND NECK Trauma notrauma
Neckmovements normalmovementsROMpresent no
Lymph nodes enlargement
Neck muscles symmetricalneckmuscles,normalROM
Gag reflex present
Thyroidgland normal, no enlargement
BREAST Sizeandsymmetry Normalsymmetry
Contour or shape Nomasses,retractionordimplingpresent No
Color redness present
Nippleand areola Nodischargepresent,nippleandareolanormal No
Breast tissue masses present
Lymphnodes Absent
BACK Inspection
ShapeScar Normalshape
Auscultation No scars
Breath sounds
Adventitioussounds S1andS2soundsheard
Wheezing sound heard
ABDOMEN Inspection noscarspresent
Auscultation normalbowelsounds

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 Palpation no enlargementof liver
Percussion noextrasoundsofaccumulatedfluid orair
UPPEREXTREMITIES InspectionRange Normal upper extremities
ofmotion NormalROMonbothsides
Lesions No lesions present
Anydeformity No deformitypresent
GENITALIA Externalgenitalia Normal
Discharge Nodischarge
Vulva Normal,noinflammation No
Anydeformity deformity present
ANUSAND RECTUM Skin Intact
Bowelhabit NormalNot
Malena present No
Anyscar/fistula scar
Valsalvamaneuver Notrecommended
LOWEREXTREMITIES InspectionRange lowerextremitiesnormal
ofmotion normal ROM
Lesions Nolesionspresent
Anydeformity No deformitypresent

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5. SYSTEMATICEXAMINATION

SYSTEM ASSESSMENT FINDINGS

RESPIRATORYSYSTEM Inspection-
Rate/depth/pattern Shallowbreath,deepbreathe,hypoventilated Present
Useofaccessorymuscles Symmetrical
Shape and symmetry Normalmovement
Movement Normal
Sternum Normalskincolor,nolesions
Skincolor Normal
Spinal curvature
Palpation- Symmetricalposition
Position of trachea Absent
Tactile fremitus Absent
Ronchial fremitus Present
Thoracicexcursion
Percussion- Resonancepresent
Resonant/dullness
Auscultation- S1andS2presentwithwheezing sounds
Normalandabnormalsounds
CARDIOVASCULARSYSTEM Pulserate 122b/min

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 Heart sounds NormalS1andS2present.
Abnormalsounds Wheezing sounds
Anycardiovasculardisease Nocardiovasculardisease
Edema No edema
Murmur Nomurmur
GASTROINTESTINALSYSTEM AnyfamilyhistoryofGIdiseases nofamilyhistoryofGIdiseases
Inspection-
Skin color normalskincolor
Edema noedemapresent
Lesions nolesionspresent
Distensions noabdominaldistension
Scars noabdominalscars
Palpation-
Lightpalpation
Tenderness notenderness
Reboundtenderness absent
Deeppalpation
Enlargedorgans noenlargementisseeninliver,spleen,kidneys,gall
bladder.Theorgansarenormal
PERCUSSION
Directpercussion flatsoundspresentinall4quadrants.

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 Indirectpercussion flatsoundspresentinall4quadrants.
AUSCULTATION
Bowelsounds Normalbowelsounds
Renal bruits Absent
Liver bruits Absent
Aorta Present
MUSCULOSKELETALSYSTEM Body Normalgait
gaitSpinecurvat Normalspinecurvature Normal
ure Negative
Musclestrength Normalmovements,normalshape,ROMperformed
Homan’s sign Normal gait, flexion and extension normal
Upper limbs
Lowerlimbs
NERVOUSSYSTEM Level of consciousness Semiconscious
Awarenessofplace/person/time Orientedtoplace,personandtime
Verbal response Normal
Abilitytofollowcommands Followscommands
Intellectual activity Intact
Language Normal
Memoryandjudgement Intact
Longandshorttermmemory Intact
Reflexes Normal

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ENDOCRINESYSTEM Heat intolerance Patientisabletotolerateheat
Cold intolerance Patientisabletotoleratecold
Irregular menses Patienthashadher menopauseat48years No
Thyroidenlargement enlargement
Weight changes Nosuchcomplaints
INTEGUMENTARYSYSTEM Inspection Normalcolor
Skinturgor Good
Texture Softanddehydrated
Color Normal color
Skintemperature Nocomplaintsoffever Skin
Moisture level is hydrated
Pressure injuries Nocomplaintsofpressureinjuries No
Lesions,rashesandbruises lesions, rashes and bruises Capillary
Capillary refill refill time 2-3 sec
Edema Noedemapresent
GENITOURINARY SYSTEM Urinary output 1200ml/day
Voidingpattern Normal
Color of urine Dark color
Urinary pattern Passesurine3-4timesperday
Bowel pattern Normalpattern
REPRODUCTIVESYSTEM Externalgenitalia

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 Urethral orifice Nopolypspresent
Vaginal introitus Nolesions,edema,inflammation
Internal genitalia
Cervicalexamination Normal
Cervicaltest Normal

6. LABINVESTIGATIONS:
Sr.No. Investigations Patient’svalue Normalvalue Remarks
1. Haemoglobin 16.4g/dl 12-14gm% High
2. RBC 5.6x106/ul 4.2-5.4x106ul High
3. ESR 25 5-15mm/hr High
4. WBC 1500mm2 4000-11000mm2 High
5. Neutrophils 5430/ul 2500-7000/ul Normal
6. Eosinophils 160/ul 30-350/ul Normal
7. Lymphocytes 1670/ul 1000-4800/ul Normal
Otherfindings-

 CVS-S1S2+
 RS- Wheeze+
 CNS-NFND+
 P/A-Soft

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 7. MEDICAL MANAGEMENT:
SR.No. Nameofthedrug,dose,route Indications Contraindications Mechanismof Sideeffects Nurses responsibility
andfrequency action
1. Tab. Theophylline 14mg/kg PO -Cough -hypersenstivity Itrelaxesthe -chest pain -monitorthepatient’s
BD -Prevent wheezeing -CVSdisorders smoothmuscles -chest plasma levels
-Shortnessof breath -Cysticfibrosis locatedinthe discomfort
-chesttightness bronchial -fainting -monitor patient
-asthma airways and -irregular response to the drug
-chronicbronchitis pulmonary heartbeat
-emphysema blood vessels -light -monitor for adverse
headedness effects
-persistant
vomiting
2. Inj.Augmentin1.2gmIVBD -Bacterial -hypersensitivity It stops by -severestomach -Observe for adverse
infections -allergicreactions to working the pain effects
-Sinusitis penicillin growth of -paleskin
-Pneumonia bacteria -loss ofappetite -Observe IV site
-Earinfections -anuria carefully during
-Bronchitis -easy bleeding administration
-UTI
-Skininfections -Observeforsignsof

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 renalorhematological
dysfunction
3. Tab.MontakLC4+2.5mgPO BD -Chronicasthma -hypersenstivity It causes -diarrhea -monitor for mood or
-Wheezing inhibition of -high behavior changes
-dyspnea airway temperature
-chesttightness cysteinyl -headaches -It is usually takenonce
leukotriene -stomachpain a day with or without
receptors -feelingsick food.
-mildrash
4. NEB.Ipravent1respParentral -lung disease -hypersenstivity It works by -headache -assesstherespiratory
nutrition TDS -asthma relaxing the -dizziness status of patient
-chronicbronchitis bronchialtubes -throatirritation
thatcarryair in -cough -auscultate patient’s
and out of the -nausea breath sounds
lungs -vomiting
-constipation -monitor the oxygen
-diarrhra saturation of patient
-drymouth
-assesstheBPofthe
patient
5. Tab.Lycolut1tabPOOD -cancer -hypersenstivity Ittrapssinglet -abdominal -selfmedicationcanbe

19
 -skindiseases oxygen and cramps dangerous
-CVS diseases reduce -allergic
-eyediseases mutagenesis reactions -check the status of the
-metabolic -diarrhea patient
disorders -chills
-vomiting -monitor for side
-indigestion effects
-dizziness
6. Tab. Cefixime200mgPOBD -bacterialinfections -fever It works by -stomachpain -monitor for side
-gram negative -bloodystools inferring with -vomiting effects
infections -hypersenstivity bacterial cell -diarrhea
-UTIinfections -coagulation wall synthesis -dizziness -watchforseizures
-diarrhea effects and inhibiting -rash
-enteric fever -darkurine crosslinkingof -seizures -check the status of the
-itching the -headache patient.
-kidneyfailure peptidoglycan. -fever

MANAGEMENT
 Torelievesymptoms
 Topreventdiseaseprogression
 Toimproveexercisetolerance
 Toimproveoverallhealthstatus

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  Topreventandcure asthma
 Topreventandtreatcomplicationssuchas breathlessness

ANATOMYANDPHYSIOLOGYOFRESPIRATORY SYSTEM

Respiratory system is the organ and structures in the body that allow us to breathe. It includes our lung nose mouth and the tube life structures
that connect them we also have muscles and blood vessels that support the respiratory system and ribs to protect it these parts work together to
bring oxygen into the bodywhen we inhale and get rid ofcarbon dioxide when we exhale. The main function ofthe respiratorysystem is to pull in
oxygen for our body cells and get rid of carbon dioxide orwaste product we do this by breathingin and out and through gas exchange
betweenthesmallair sacsofthe lungscalled alveoliand the blood vesselrunning nearbytherespiratorysystemalso warmsand adds moistureto air we
breathe in, Protectsthe body fromparticles we breathe in, Allows us to talk, Helps to smell, Balances levelofacidity in the body

ANATOMY

The main organsofthe respiratorysystemare the lungs but the respiratorysystemhas manydifferent partsthat worktogetherto help usbreathe. Saved
respiratory system include the following-

 Noseand nasalcavity
 Mouthandoralcavity
 Sinuses
 Pharynxcalledthe throat
 Larynxcalled thevoicebox
 Tracheaalsoknownaswindpipe
 Bronchialsoknownas largeAirways

21
  Lungs
 Diaphragm

Theupper respiratorytract bringsair into thebodyand helps move it towardsthe lungs. It addsmoistureto theair we breathe in. Therespiratory tract
starts with the nose andmouth where we pull airinto our body other parts of the upper respiratory track include our nasal cavity, sinuses and
larynx.

The lower respiratory track consists of the trachea, bronchi and lungs. Trachea, bronchi and Bronchioles make up the tracheobronchial tree a
series of increasingly smaller tubes that transport air from your upper respiratorytract to small air sacks in the lungs.

The cellsneed oxygen to create energy.Making energy releases carbon dioxide as a waste product which can harm the body if too much built up.
Main job of the respiratory system is to bring oxygen into the lungs and move carbon dioxide out of the lungs it works closely with the
circulatory system that is our heart blood and blood vessels

Think of the oxygen in the air as passengers on millions of planes flying into the lungs every time we breathe in the diaphragm pulls down
creating more space in the chest which pulls air into the lungs the air travels through the mouth or nose and downthe tray here, and bronchioles
like airport runways. Then the passengers arrive at the airport gates the alveoli.

There the oxygen moves throughthe membrane surrounding the lungs into the small blood vessel we can imagine it like the oxygen passengers
getting picked up bya taxiat the airport. Lead a taxitravels out to the tissues, dropping ofoxygen to give the cells theenergy

When sells use energy, they produce carbon dioxide. The oxygen gets out ofthe taxi in the tissues carbon dioxide molecules hop in. Fromthere
they travel through the bloodstream and to the airport gates in the lungs. Out of the lungs when you die from moves back upwards making the
chest cavitysmaller and causing to push the air out the way it came.

22
PHYSIOLOGY

The major functionoftherespiratorysystem isto supplythe bodywithoxygenand to disposeofcarbondioxide. To do this,at least four distinct events,
collectively called respiration, must occur.

Respiration

 Pulmonaryventilation Air must move into andoutofthe lungsso that gasses intheairsacsarecontinuouslyrefreshed, andthisprocess is
commonly called breathing.
 Externalrespiration.Gasexchangebetweenthepulmonarybloodandalveolimusttake place.
 Respiratorygastransport. Oxygen andcarbon dioxidemustbetransported toandfrom thelungsandtissuecellsof thebody viathe
bloodstream.
 Internalrespiration.Atsystemiccapillaries,gasexchangesmustbe made betweenthebloodandtissuecells.

MechanicsofBreathing

 Rule.Volumechanges leadtopressurechanges, whichleadtotheflowofgassestoequalize pressure.

 Inspiration. Airisflowinginto thelungs; the chestis expandedlaterally,the rib cageis elevated, andthe diaphragm is depressedand
flattened; lungs are stretched to the larger thoracic volume, causing the intrapulmonarypressure to fall and air to flow into thelungs.
 Expiration. Airisleavingthelungs;thechestisdepressedandthelateraldimensionisreduced,theribcageisdescended,andthe diaphragm is
elevated and dome-shaped; lungs recoilto asmaller volume, intrapulmonary pressure rises, and air flows out ofthe lung.
 Intrapulmonaryvolume.Intrapulmonaryvolumeisthevolumewithinthelungs.

23
  Intrapleural pressure. The normal pressure within the pleural space, the intrapleuralpressure, is always negative, and this is the major
factor preventing the collapse of the lungs.
 Nonrespiratory air movements. Nonrespiratory movements are a resultof reflex activity,butsome may be produced voluntarily such as
coughing, sneezing, crying, laughing, hiccups, and yawning.

RespiratorySounds

 Bronchialsounds.Bronchialsoundsareproducedbyairrushingthroughthelargerespiratorypassageways(tracheaandbronchi).
 Vesicularbreathing sounds. Vesicularbreathing soundsoccurasairfillsthealveoli,andtheyaresoftandresemblea muffled breeze.

ExternalRespiration,GasTransport,andInternalRespiration

 External respiration. Externalrespirationor pulmonarygasexchange involves oxygen being loaded and carbondioxide being unloaded
from the blood.
 Internalrespiration. Ininternalrespirationorsystemic capillarygas exchange oxygen is unloaded and carbondioxide is loaded intothe
blood.
 Gas transport. Oxygen is transported in the blood in two ways: most attaches to hemoglobin molecules inside the RBCs to form
oxyhemoglobin, or a very small amount of oxygen is carried dissolved in the plasma; while carbon dioxide is transported in plasma as
bicarbonate ion, or a smaller amount (between 20 to 30 percent of the transported carbon dioxide) is carried inside the RBCs bound to
hemoglobin.
ControlofRespiration

Neural Regulation

24
 Phrenic and intercostals nerves - These two nerves regulate the activity of the respiratory muscles, the diaphragm, and external
intercostals.
 Medulla and pons- Neural centers that control respiratory rhythm and depth are located mainly in the medulla and pons; the medulla,
which sets the basic rhythm of breathing, contains a pacemaker or self-exciting inspiratory center, and an expiratory center that inhibits
the pacemaker in a rhythmic way; pons centers appear to smooth out the basic rhythm of inspiration and expiration set bythe medulla.
 Eupnea.Thenormalrespiratoryrateisreferred toaseupnea,anditismaintainedatarate12to15respirations/minute.
 Hyperpnea. During exercise, we breathe more vigorously and deeply because the brain centers send more impulses to the respiratory
muscles, and this respiratory pattern is called hyperpnea.

Non-neural Factors Influencing Respiratory Rate and Depth

 Physical factors. Although the medulla’s respiratory centers set the basic rhythm of breathing, there is no question that physical factors
such as talking, coughing, and exercising can modify the rate and depth of breathing, as well as an increased body temperature, which
increases the rate of breathing.
 Volition (conscious control). Voluntarycontrolof breathing is limited, and the respiratorycenters will simply ignore messages fromthe
cortex (our wishes) when the oxygen supply in the blood is getting low or blood pH is falling.
 Emotional factors. Emotional factors also modify the rate and depth of breathing through reflexes initiated by emotional stimuli acting
through centers in the hypothalamus.
 Chemical factors. The most important factors that modify respiratory rate and depth are chemical- the levels of carbon dioxide and
oxygen in the blood; increased levels of carbon dioxide and decreased blood pH are the most important stimuli leading to an increase in
the rate and depthofbreathing, while a decrease in oxygen levels become important stimuli when the levels are dangerously low.

25
  Hyperventilation. Hyperventilation blows off more carbon dioxide and decreases the amount of carbonic acid, which returns blood
pHto the normal range when carbon dioxide or other sources of acids begin to accumulate in the blood.
 Hypoventilation.Hypoventilation or extremely slow or shallow breathing allows carbon dioxide to accumulate in the blood and brings
blood pH back into normal range when blood starts to become slightly alkaline.

Etiology

BOOK PICTURE PATIENTPICTURE

Airborneallergens Absent
Respiratoryinfections Absent
Physicalactivity Absent
Coldair Absent
Airpollutants Airpollutionpresent
Certainmedications Absent
Strongemotionsandstress Absent
Somecertain foods Patientisnotallergictoanyfoods
GERD Absent

26
Riskfactors

BOOK PICTURE PATIENTPICTURE

Environmentalfactors Airpollutionpresent
Genetics Nogeneticpredisposition
Obesity Thepatientisnot obese
Stress Absent
Allergies Noallergiespresent

Pathophysiology

Duetoetiologicalfactorslikeairpollution

Airwayinflammation

Hypersecretionofthemucus Airwaymuscleconstruction swellingofbronchialmembranes

Narrowbreathingpassages

27
 Wheezing,cough,shortnessofbreath,tightnessin chest

DiagnosticEvaluation

BOOK PICTURE PATIENTPICTURE

Historytaking Done
Physicalexamination Done
ChestXRay Done
Serumimmunoglobulin Ig Notdone
Nitricoxide test Notdone
Pulmonaryfunctiontest Notdone
Spirometry Notdone
Methacolinechallengetest Notdone
EvacuationofheartburnandGERD Notdone
CTScan Done
Sputum eosinophilias Notdone

28
Signs andSymptoms

BOOK PICTURE PATIENTPICTURE

Veryrapidbreathing Thepatient’spulsehas122b/min
Coughingespeciallyin night Present
Wheezing Present
Paleface Present
Shortness ofbreath Present
Bluenailsandfingernails Absent
Chesttightness Present
Troublesleeping Absent
Paininchest Absent

Management

BOOK PICTURE PATIENTPICTURE

PHARMACOLOGICAL
Bronchodilators Tab.Thephylline
Steroids Notrecommended
Antiimflammatorydrugs Notrecommended
Nebulisation Neb.Ipraventgiven
Multivitamins Tab.Lycolutgiven

29
Antibiotics Tab.Cefixime
Inj. Augmentin
Leukotrienereceptor antagonists Tab.Montak given

NONPHARMACOLOGICAL

BreathingExercises Thepatienthas beenadvisedtodo

breathingexercises.
Diet Thepatienthas beenprescribedadiet
includinganti-oxidants,vitaminD, vitamin
E
Weightloss Notrecommended

Allergenavoidance Thepatienthas beentoldtohaveasless

exposuretoair pollutants
Cessationofsmoking Notrecommended

Influenzavaccination Thepatientisimmunizedwithall
vaccines

30
NURSINGMANAGEMENT

 NURSINGASSESSMENT
 Gatherinformationaboutpatient’ssymptoms.
 Assesspatient’srisk factors.
 Assesspatient’sfamilyunderstandingaboutthediagnose.
 Identifypatient’sandfamily levelofanxietyanduseofappropriatecopingmechanisms
 Checkvitalsigns
 Evaluatepatient’smedicalhistoryfor condition

 NURSINGDIAGNOSIS
 Ineffectiveairwayclearancerelatedtopulmonarysecretionsasevidencedbywheezingsounds.
 Ineffectiveairwaypatternofthe patientrelatedtonarrowing ofbronchiasevidencedbydyspnea
 Anxietyrelatedprogressionofthediseaseasevidencedbyfacialexpressionsofthepatient
 FatigueRelatedtorespiratoryeffortsfor breathingasevidencebyexhaustionandlethargy
 Knowledgedeficitrelatedtotheprogressionofdiseaseandmedicationsasevidencedbyaskingregularquestionsfromphysician.

31
 SHORTANDLONG TERMGOALS
SHORT TERM GOALS LONGTERMGOALS
To clear the airway of the patient To reducethefatigue ofthe patient

To improve the breathing pattern Toimprovetheknowledgeofthepatient

To reduce the anxiety -

32
 NURSINGCAREPLAN

NURSING NURSING GOAL INTERVENTION IMPLEMENTATION RATIONALE EVALUATION

ASSESSMENT DIAGNOSE
SubjectiveData: Ineffective To clear the Assessthevitalsigns of BP-130/90mmofHg It provides the Theairwayofthe
The patient says airway airwayofthe the patient Pulse- 122b/min baselinedataand patient has been
that when she clearance patient Respiration-12b/min of the patient. cleared up to
breathes she related to some extent.
hears different pulmonary
kinds of sounds secretions as Assessthebreathing Normal S1 and S2 Wheezingsounds
evidencedby sounds ofthepatient soundsandwheezing are heard in case
wheezing sounds heard of asthma
ObjectiveData: sounds
The nurse
observed that Providecomfortable Providedsemifowler It makes
wheezingsounds position to the positionto thepatient breathingeasier.
are produced patient

Performsectioning Performedsuctioning Toremovethe

of the patient every 4 hourly pulmonary
secretions

Tell the family Told the family It helps loosen

membersaboutthe members about mucus,makingit
steps of chest cupping, tapping, easier to expel
physiotherapy percussion, vibration from the lungs
techniquesinvolvedin
chest physiotherapy.

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NURSING NURSING GOAL INTERVENTION IMPLEMENTATION RATIONALE EVALUATION
ASSESSMENT DIAGNOSE
SubjectiveData: Ineffective To maintain Assessthegeneral The airway of the It access the The breathing
The patient said airwaypattern the normal condition of the patient is not clear, the ABCDEpattern pattern of the
that she cannot of the patient breathing patient breathingpatternisalso patienthasbeen
breathe properly due to patternofthe altered. restored up to
narrowing of patient some extent.
Objective data: bronchi as
The nurse evidenced by Provide Bronco Tab.Theophylline It makes
observedthatthe dyspnea dilatorstothepatient 720mg given breathing easier
patient has byrelaxinglung
alteredbreathing muscles
pattern as
evidence by
cough Provide oxygen Oxygenisgivenby To maintain the
supporttothepatient nasal mask. oxygensaturation
of the patient.

Assess the Respiratoryrate= To monitor

respiratorystatusof 12b/min asthmaandseeif
the patient medications are
working

Instructedthe Instructedthepatientto To confirm

patienttoperform perform spirometry asthmaanditalso
spirometry three times a day. helpsasbreathing
exercises

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NURSING NURSING GOAL INTERVENTION IMPLEMENTATION RATIONALE EVALUATION
ASSESSMENT DIAGNOSE
SubjectiveData: Anxiety related Toreducethe Assessthegeneral Thepatientseems It provides the Theanxietyofthe
The patient said to progression anxietyofthe condition of the anxious. baseline patient has been
thatsheisfeeling of the patient patient informationofthe reduced to some
anxious due to diseaseasevide patient extent
the disease ncedby facial
condition expressions of
the patient Assessthelevelof The patient has Ithelpsinthe
Objective data: anxiety moderateanxiety treatment of
The nurse anxiety
observedthatthe
patient feels
anxious as Explain about the Explainedthepatient Thepatientgains
evidence by diseaseconditionto about the sign and confidence in
facialexpressions the patient symptomsthecauses relation to her
and the treatment of diagnosis
asthma

Provide diversional Provided bronchial The diversional

therapytothepatient thermoplastytopatient therapieshelpin
and encouraged for reducinganxiety
deep breathing of the patient
exercises

Promote rest and Encouragethepatentto Itcreatesavitrous

sleepofthepatient have rest and sleep for cycle for
at least 7 hours a day. managing asthma
andfighting
anxiety.

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HEALTHEDUCATION

 Rest-
 Totake at least7hoursofsleep aday
 Toreduceletharyandlaziness
 Have plentyofrest
 Avoidanytriggeringfactorsthathindersthesleep
 Avoidthesituationsthatcreateanxiety.

 Nutrition-
 Haveadietthatisrichinfruitsandvegetables,lowinfatandhelpstomaintainhealthyweight
 Takemore liquidsindiet.
 Stayhydratedanddrinkplentyofwater
 Avoidanyfoodthatis allergic
 Useinhalereveryday
 AvoideatingfoodsthatcauseheartburnandGERD

 Medication-
 Preventcessationofmedicationinbetween
 Continuemedicationinprescription
 Takemedicationsasprescribed
 Donottakeanyadditionalmedicinewithoutprescription
 Consultthe doctorincaseofanysubstitute medicine
 Rememberthemedicationanditsdoseofyourmedicineincaseofemergency
 Keeptheinhalerwithyou always

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 Hygiene-
 Maintainpersonal hygiene
 Cutnailsand maintainmoistureofskin
 Maintainyour oralcare
 Abstainfromanysmokingactivityortobaccouse
 Avoidgoinginplacesthathavefireworksthatcanbeinjurioustothehealthandcanharmthelungs

 Medicalhelp-
 Approachhospitalwhenever needed
 Earlytreatment help insurvival
 Incase ofanycomplicationconsultthe doctor
 Incase ofshortnessofbreathimmediatelyrefertothehospital

 Followup-
 Adviseforroutinelyfollowup
 Incaseofanydoubtoremergencyhaveregular followups
 Incasethesituationworsensfollowupshouldbeafteraweek

 Activity-
 AllowthepatientfortheROMexercises.
 Exerciseregularly
 Deepbreathingexercisesshouldbeencouraged.

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SUMMERIZATION

 MypatientMrs.Arunawasadmittedinthehospitalforthetreatment ofasthmaon02-12-2023at 6:40 am.

 Shewasadmitted inRICUwiththe chiefcomplaintsofsevere cough,shortnessofbreathandchesttightness.

 Afterhistorycollection, Iassessedthepatient byphysicalexamination, noteddownher labinvestigations andadvisedtotakerest and

low fat diet and the diet that is rich in fruits and vegetables.

 ThenI madethenursing careplanbasedonhercondition.

 Igavethepatient andher familymembershealtheducationonvariousaspectslikerest,medication,nutrition,hygiene, medicalhelp, follow

up and activity.

 Nowtheconditionofthepatienthasbeen improveduptosomeextent.

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BIBLIOGRAPHY
 BOOK REFERENCES
 Lippincott“ManualofMedicalSurgicalNursing SouthAsianed”10thedition.published by WoltersPublicationspageno.785-815
 SuddharthandBrunner“MedicalSurgicalNursing”2ndedition.JaypeePublishers.Pageno.350-385

 INTERNETREFERENCES
 http://www.scribd.com/document/454854849/1585564206708-case-study-asthma-docx
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8860889
 http://www.youtube.com/live/wek96A_8pGT?si=90-zxX-89jTGNKm
 http://www.slishare.net/slideshow/presentation-on-asthma/72081554

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