2NF - Grand Case Presentation Written Output

A GRAND CASE PRESENTATION OF A 1-YEAR-OLD CHILD
DIAGNOSED WITH BRONCHIAL ASTHMA IN ACUTE EXACERBATION
Presented to the Faculty of the College of Nursing
Xavier University-Ateneo de Cagayan
In Partial Fulfillment of the Requirements of
Nursing Care Management 109:
Related Learning Experience
Submitted to
Jennifer O. Asio, RN, MN
Roviech John M. Echeveria, RN, MAN
Ivy Royo Go, RN, MAN, DScN
Clinical Instructors
April 16, 2021

Submitted by
BSN - 2 NF
Acut, Louella B.
Ali, Sittie Jobaisah T.
Banaag, Ma. Venus Caress T.
Bantol, John Louise T.
Banza, Khrisna Nymph P.
Carlos, Jude Mariano Jr. A.
Cubillas, Franczhes A.
Danseco, Danna Francesca S.
Datu-Ramos, Dimapuno T.
Del Rosario, Carylle M.
Ebio, Dynn M.
Famacion, Kyra Bianca R.
Go, Clarke Nathaniel Sean E.
Laid, Althia Crizza J.
Langeras, Howard S.
Mah, Chloe Gwyneth R.
Maribao, Dylan Sean Ezekiel
Miñoza, Ana Rose Anthony E.
Nagac, Ailene Grace C.
Olarita, Venisse A.
Ragpala, Fide Lynn C.
Ravacio, Earl Christoffer C.
Romorosa, Christine Marie Pauline C.
Samoya, Abigail Kim T.
Sio, Zoe Nicole C.

Telow, Jered Brae V.
Torion, Zenn Pauline M.
Torre, Carlos Joseton Paolo S.
Vallecer, Matthew Orlando IV V.
Waga, Mikayla Martina C.
Yongco, Sheila Adrianne S.

ACKNOWLEDGEMENT
The Block NF would like to express their sincere appreciation and indebtedness to
the people who made the completion of this case study possible. The development and
success of this paper would not have been possible without the contributions of the following
people:
To Mrs. Jennifer O. Asio, RN, MN, Mr. Roviech John M. Echeveria, RN, MAN,
and Mrs. Ivy R. Go, RN, MAN, DScN, the Clinical Instructors for NCM 109 RLE, for
providing proper guidance, dedication and patience to the student nurses throughout the
entire preparation of this case presentation. Their passion and commitment towards being a
Clinical Instructor for the student nurses has brought them to their fullest potential and
expanded their capabilities as a student nurse.
To Mrs. Mary Grace M. Paayas, RN, MAN, Dean of the College of Nursing, for
being a true inspiration to every student nurse, for leading the Clinical Instructors to be
competent in all aspects and to be the true example of a dedicated nurse.
To the patient and parents, for their trust in allowing the Clinical Instructors to use
the patient's documents as a tool for student nurses to learn through the procedures that
have been made. The student nurses commend them for taking this into consideration as
this is a major part for the student nurses in expanding their knowledge and becoming a
better version of themselves.
To the Maria Reyna - Xavier University Hospital, for entrusting the data to the
student nurses which is handled with confidentiality. The private documents they provided
were essential for the completion of this paper.
To the Block NF, the researchers of this case study, for their dedication and
commitment to produce a competent paper with the best of their abilities. The time and
effort spent from Block F was very much appreciated.

To the families of the researchers, for their unwavering support throughout their
children’s nursing career. The financial and spiritual support they provided were greatly
appreciated.
Lastly, to God the Almighty Father, for the gift of knowledge and wisdom He has
bestowed upon the student nurses for the completion of this paper.
TABLE OF CONTENTS
Page Number
Acknowledgements
I. General Objectives………………………………………………………………………..1
II. Specific Objectives ……………………………………………………………………….2
III. Significance of the Study…………………………………………………………………4
IV. Scope and Limitations…………………………………………………………………….6
V. Definition of Terms………………………………………………………………………...7
VI. Introduction………………………………………………………………………………...11
VII. ASSESSMENT…………………………………………………………………………….13
a. Narrative Assessment………………………………………………………...13
b. Assessment Tool………………………………………………………………16
VIII. Laboratory Results………………………………………………………………………...22
IX. Pathophysiology…………………………………………………………………………...28
a. Narrative Pathophysiology…………………………………………………..28
b. Schematic Diagram…………………………………………………………..33
X. Drug Study…………………………………………………………………………………40
XI. Nursing Care Management……………………………………………………………….57
a. Nursing Care Plan 1………………………………………………………….57
b. Nursing Care Plan 2………………………………………………………….61
c. Nursing Care Plan 3………………………………………………………….65
d. Nursing Care Plan 4………………………………………………………….68
e. Nursing Care Plan 5………………………………………………………….71
XII. Discharge Plan…………………………………………………………..………………...73
XIII. Prognosis…………………………………………………………………………………..76
XIV. Conclusion………………………………………………………………………………....80
XV. Recommendation………………………………………………………………………….82
XVI. BIBLIOGRAPHY…………………………………………………………. ………………84
XVII. APPENDICES……………………………………………………………………………..88
A. Doctor’s Orders………………………………………………………………88
B. Nurse’s Notes………………………………………………………………...91
C. Consent………………………………………………………………………..92
I. GENERAL OBJECTIVES
At the end of the grand case presentation, the group will be able to provide a
detailed and in-depth discussion of the physiologic processes involved in the disease
state of the client along with its related factors. The group will be capable of applying
basic nursing skills with ease and competence as well as demonstrate the requisite
positive and desirable attitudes. In this grand case presentation, the group will be
able to gather significant information and exhibit expertise related to the patient's
health condition, as well as improve critical thinking skills to become competent and
patient-centered healthcare professionals in the future. Furthermore, effective
communication with the group will be established in order to efficiently manage time,
create teamwork and unity among student nurses, and improve competence in
handling potential cases. The student nurses will also be able to uphold and embody
the Ignatian values of becoming men and women for others and doing all things for
the greater glory of God.
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II. SPECIFIC OBJECTIVES
At the end of the 2 hours of the grand case presentation, the group will be
able to:
Knowledge
● Describe the illness condition of the patient and interpret its general
manifestations;
● Thoroughly discuss the pathophysiology of the condition of the patient to fully
understand the etiology, methods of prevention, pathologic processes, signs
and symptoms, and the appropriate treatment and nursing interventions;
● Identify the priority problems in the respective nursing care plan formulated
based on the assessment findings of the patient;
● Explain the relevance and rationale of the nursing interventions presented
with regards to alleviating the condition of the patient;
● Discuss the importance and indications of the medications prescribed by the
physician through the presentation of the drug study;
● Explain the final prognosis based on the categories that the patient is being
evaluated; and
● Provide recommendations for further case studies prior to concluding the
presentation
Skills
● Exercise proper time management in the presentation of the case;
● Constructively introduce the case and diagnosis of the patient in a manner
that it can be easily understood;
● Present the information of the patient and the complete data gathered in the
case in an organized and systematic manner;
● Apply the knowledge learned in class in determining the priority problem and
the appropriate nursing interventions for the patient; and
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● Exemplify mastery and comprehension of the case through answering the
questions with confidence and competence
Attitude
● Display confidence and assertiveness throughout the case presentation;
● Maintain decency and professionalism throughout the presentation;
● Show a sense of collaboration and teamwork throughout the program; and
● Show a positive attitude towards constructive criticism and comments given
by the panel
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III. SIGNIFICANCE OF THE STUDY
The aim of this research is to provide knowledge and understanding about bronchial
asthma in acute exacerbation. The results will help people at all stages in addressing this
issue in order to have a healthy future. Furthermore, the findings of this analysis can be seen
as a learning aid, which would be beneficial to the following groups:
Patients with bronchial asthma especially to those who inherit this genetic
makeup. In fact, it's thought that three-fifths of all asthma cases are hereditary. This can
supplement new ideas and knowledge since it is considered as a common condition. The
study can give patients an overview about the disease’s predisposing and precipitating
factors, its treatment, as well as some important measures in controlling and monitoring
asthma signs and symptoms during an attack or exacerbation.
Level two nursing students. This could improve their critical thinking skills in order
for them to become competent and patient-centered health care professionals in the future.
They can apply all their learnings throughout their journey as student nurses. Doing further
research and study about this disease, its processes, and pathophysiology would ultimately
lead to new ideas and solutions that could guide them in caring for their patients.
For the healthcare team, this could provide new knowledge and methods on how to
render care to patients of similar situations. There is also an enhancement of skills and
abilities in providing care, as well as attitude when working with patients like this in different
areas of duty. As health educators, this may be an excellent ground for inquiry, study, and
interpretation that can also be introduced to their students who benefit from their
experiences.
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Lastly, for the future nursing students, this could be a source of additional
research that could be used to further subsequent studies. Since illnesses progress with
time, future nursing students are encouraged to stay ahead of the curve in order to improve
people's lives as what they are sworn to do.
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IV. SCOPE AND LIMITATION
The study focuses on a 1-year-old male child who had a final diagnosis of Bronchial
Asthma in Acute Exacerbation with a chief complaint of cough, who was admitted at Maria
Reyna - Xavier University Hospital, Inc. (MRXUHI) last December 1, 2020 at 11:27 pm to
December 4, 2020 at 6 pm.
Different Instruments were used in the data gathering of the said study as follows:
● Personal Data
● Travel History
● Emergency Room Admission Sheet
● Consent for Admission, Hospital Care, Diagnostic Procedures and Collection
and Processing of Personal Information
● Vital Signs Sheet
● Intake and Output Sheet
● Physician’s Notes
● Doctor’s Order
● Nurse’s Notes
● Laboratory Result
● Medication Sheet
● Intravenous Fluid Sheet
This study’s data is limited only to the instruments mentioned due to the arising
pandemic and general community quarantine. The students were not able to personally
assess and evaluate the patient and the information available is limited to what the hospital
has given. Nonetheless, the students were able to uphold solidly notice and regard the
patient’s right to privacy and confidentiality.
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V. DEFINITION OF TERMS
Acute. Disease or condition characterized by the rapid onset of severe symptoms.
Airway Obstruction. A type of respiratory dysfunction that produces reduced airflow,
usually on expiration; the obstruction can be localized or generalized.
Allergic Rhinitis. An inflammation of the nasal passages caused by allergic reaction to
airborne substances.
Asthma. Asthma is a chronic disease that causes the airways of the lungs to swell and
narrow. It leads to breathing difficulty such as wheezing, shortness of breath, chest
tightness, and coughing.
Aspiration. Pulmonary aspiration is the medical term for a person accidentally inhaling an
object or fluid into their windpipe and lungs. This can lead to coughing, difficulty breathing,
discomfort, and sometimes choking.
Bilateral Rales. It refers to the presence of crackles in both lungs.
Bronchial Asthma. Bronchial asthma is a medical condition which causes the airway path
of the lungs to swell and narrow. Due to this swelling, the air path produces excess mucus
making it hard to breathe, which results in coughing, shortness of breath, and wheezing.
Bronchial Hyperresponsiveness. An increase in sensitivity to a wide variety of airway
narrowing stimuli. In asthma, in particular, this hypersensitivity is accompanied by excessive
degrees of airway narrowing.
Bronchitis. Bronchitis is an inflammation of the air passages between the nose and the
lungs, including the windpipe or trachea and the larger air tubes of the lung that bring air in
from the trachea (bronchi).
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Bronchoconstriction. Bronchoconstriction is a condition in which the smooth muscles of
the bronchus contract. The bronchus is the pathway that moves air to and from your lungs.
This muscle contraction causes the bronchus to narrow and restrict the amount of air
passing into and out of your lungs.
Chest X-RAY. A chest radiograph, called a chest X-ray, or chest film, is a projection
radiograph of the chest used to diagnose conditions affecting the chest, its contents, and
nearby structures.
Complete Blood Count (CBC). The complete blood count (CBC) is a group of tests that
evaluate the cells that circulate in blood, including red blood cells (RBCs), white blood cells
(WBCs), and platelets (PLTs). The CBC can evaluate your overall health and detect a variety
of diseases and conditions, such as infections, anemia and leukemia.
Cyanosis. A bluish color of the skin and the mucous membranes due to insufficient oxygen
in the blood.
Dyspnea. Breathlessness or shortness of breath; labored or difficult breathing. It is a sign of
a variety of disorders and is primarily an indication of inadequate ventilation or of insufficient
amounts of oxygen in the circulating blood.
Edema. Edema is a condition of abnormally large fluid volume in the circulatory system or in
tissues between the body's cells (interstitial spaces).
Exacerbation. It refers to an increase in the severity of a disease or its signs and symptoms.
Hypercarbia. Hypercapnia, or hypercarbia, is when you have too much carbon dioxide
(CO2) in your bloodstream. It usually happens as a result of hypoventilation, or not being
able to breathe properly and get oxygen into your lungs.
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Hypoxemia. An abnormally low amount of oxygen in the blood, the major consequence of
respiratory failure, when the lungs no longer are able to perform their chief function of gas
exchange.
Hypoxia. Deficiency in the amount of oxygen delivered to the body tissues.
Interrupted Family Processes. A normally supportive family experiences or is at risk to
experience a stressor that challenges its previously effective functional ability.
Mucosal Edema. Mucosal edema or swelling is the build-up of edema (tissue fluid) within
the mucosa, the layer of tissue that lines the body’s interior.
Nebulization. The conversion of a liquid into a fine mist or spray, especially for inhalation
therapy; also called atomization.
Non-productive Cough. A dry cough and does not produce sputum.
Parental Stress. Perceptions of an imbalance between the demands of parenting and
available resources, is one of the many factors that contribute to the effectiveness of
parenting.
Pulse Oximetry. A noninvasive method of indicating the arterial oxygen saturation of
functional hemoglobin, using a pulse oximeter.
Retraction. The area between the ribs and in the neck sinks in when a person with asthma
attempts to inhale. Retractions are a sign someone is working hard to breathe.
Urinalysis. A test of urine. A urinalysis is used to detect and manage a wide range of
disorders, such as urinary tract infections, kidney disease and diabetes. A urinalysis involves
checking the appearance, concentration and content of urine.
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Ventilation-Perfusion Mismatch. Defects in total lung ventilation perfusion ratio. It is a
condition in which one or more areas of the lung receive oxygen but no blood flow, or they
receive blood flow but no oxygen due to some diseases and disorders.
Wheezing. A high-pitched whistling sound made while breathing.
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VI. INTRODUCTION
Asthma is a chronic inflammatory disease of the airways, characterized by recurrent
episodes of airflow obstruction resulting from edema, bronchospasm, and increased mucus
production. Seasonal allergies (allergic rhinitis) and eczema (atopic dermatitis) are
commonly associated and these three conditions form what is known as the atopic triad.
Patients who have asthma can have a variety of respiratory problems, including wheezing,
shortness of breath, coughing, and chest tightness. The severity and frequency of symptoms
vary, but untreated asthma and acute exacerbations may result in respiratory failure and
death. (Lizzo & Cortes, 2020)
Asthma is one of the most prevalent non-communicable disorders, and for many, has
a significant impact on many people's quality of life. It is ranked 16th among the leading
causes of years lived with disability and 28th among the leading causes of burden of
disease, as measured by disability-adjusted life years. Patterns in asthma incidence and
prevalence differ between children and adults. It is well-known that asthma often begins in
childhood but can occur at any time throughout life. (Dharmage et al., 2019)
In the nursing profession, pediatric nursing is a specialization where the focus of
medical care and attention is to the children, from infancy to teenage years. It is a vital field
as the health of children is different from adults due to the development that occurs during
the course of childhood. (Smith, 2019)
This study is intended for the case of a 1-year-old patient admitted with chief
complaints of cough with a final diagnosis of Bronchial Asthma in Acute Exacerbation. The
patient is a 1 year and 3 month old male and is a resident of Cagayan de Oro City. He is a
Roman Catholic and his nationality is Filipino. He was admitted in the emergency room on
December 01, 2020 at 11:27P.M. Patient had a non-productive cough with clear nasal
discharge 1 day prior to admission and was given salbutamol syrup for self medication. The
role of the pediatric nurse was to assess vital signs, collaborate with other health care
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professionals, administer prescribed medications, and provide safety and comfort to the
patient during their course of stay in the hospital.
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VII. ASSESSMENT
a. Narrative Assessment
Patient X is a 1-year-and-3-month-old male infant from Indahag, Cagayan de Oro
City. On December 1, 2020, at 3:30 PM, Patient X was admitted to Maria Reyna - Xavier
University Hospital with a chief complaint of cough and colds and an admitting diagnosis of
pediatric community-acquired pneumonia with asthma.
Upon physical examination, the patient was conscious and was not lethargic nor
drowsy. His vital signs upon admission were a temperature of 36.6 degrees Celsius,
respiratory rate of 44 breaths per minute, heart rate of 188 beats per minute, and oxygen
saturation of 97%. Rales were heard in both lungs upon auscultation and intercostal
retraction was evident. Upon assessment, he weighed 11.5 kilograms and was noted to be
formula-fed. He was delivered via normal spontaneous delivery (NSD) without any
complications at JRB Hospital, Cagayan de Oro City. Immunizations received by Patient X
include BCG, DPT 3, OPV 3, and HIB 3. The mother is the primary caregiver. At 1 year old,
the patient is able to walk alone and able to say “mama” and “papa.” Patient X has a family
history of bronchial asthma from the maternal side. In the past two weeks, Patient X
presented with the following symptoms: vomiting, dry cough, runny nose, and shortness of
breath. His RT-PCR test result came in negative for COVID-19 Infection.
One day prior to admission, Patient X had a sudden onset of a non-productive cough,
with clear nasal discharge; but without fever, LBM, and vomiting. He was given salbutamol
syrup (self-medicated) 0.5mL x 3 doses. Morning prior to admission, Patient X had a
recurrence of symptoms associated with fast breathing, with decreased appetite and
decreased milk formula intake (6oz from normal intake of 180z), and post-tussive vomiting.
On the day of admission, he was seen by the attending physician, which prompted
admission.
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On the second day of admission, December 2, 2020, upon assessment at 6:30 AM,
Patient X was afebrile, had decreased tachypnea with a respiratory rate of 50-52 breaths per
minute, and decreased intercostal retractions. Rales were still heard upon auscultation.
Heart rate was 150 beats per minute and oxygen saturation was at 97%. Patient X was
reported to be eating better. Diet for age was allowed but with strict aspiration precaution
and continuation of medications was ordered. At 3:00 PM, IVF rate was ordered to be
decreased to a rate of 50 cc/hr with an additional order of IVF to follow D5IMB (balanced
multiple maintenance solution) at 50 cc/hr in cycles until further notice. At 7:40 PM, Patient X
remained afebrile with a respiratory rate of 50 beats per minute. Heart rate was 120 beats
per minute and oxygen saturation was at 98%. Bilateral rales were still heard upon
auscultation and chest retraction was still present with an occasional wheeze. Chest tapping
after every nebulization was then instructed along with the continuation of his treatment with
Ceftriaxone D1.
On December 3, 2020, Patient X was placed safely at the center of the bed, with side
rails raised. The mother was instructed not to leave the patient unattended due to
medications given, kept watch for any unusualities. At 9:40 AM, assessment of Patient X
revealed that he was afebrile and had a good appetite. His vital signs that time were: heart
rate - 110, respiratory rate - 20, SPO2 - 98% - room air (RA), tolerated well. Bilateral rales
were still positive upon auscultation and audible wheeze was still present, however, there
were no observable retractions upon examination. He continued his course of antibiotic
therapy (Ceftraixone D1+1). Patient X’s oxygen was ordered to be discontinued with the
order to refer if with desaturation (<95% sat). His IV fluid was ordered to be decreased to a
rate of 45cc/hr with IV fluid to follow (D5IMB at 45 cc/hr). Nebulization interval was
decreased to q4. At 4:00 PM, Patient X’s follow-up assessment revealed that the audible
wheeze was still present, however, no retractions were observed. His vital signs were: blood
pressure - 90/60 mm/Hg, heart rate - 114 bpm, respiratory rate - 30 cpm, and SPO2 - 99% at
room air.
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On the last day of admission, December 4, 2020, at 9AM, no wheezing was noted
upon auscultation and retractions were not evident. His vital signs were as follows: blood
pressure - 90/60, heart rate - 114 BPM, respiratory rate - 28-38 CPM, and oxygen saturation
- 98%. Patient was advised to do chest tapping every after nebulization and was encouraged
to increase oral fluid intake (OFI). At 11 AM, Patient X was afebrile, no wheezing and
retractions were noted, and oxygen saturation was at 97% at room air (RA). Patient was
ordered to consume the remaining ceftriaxone 600 mg and was ordered to shift to
co-amoxiclav (Natravox) 250 mg/62.5 mg every 5 mL, 2.5 mL TID. The physician instructed
not to reinsert IV line once dislodged. IVF rate was decreased to 30cc/hour and salbutamol +
ipratropium was discontinued. Salbutamol was increased to 1 nebule q4h and
hydrocortisone was continued. At 11:30 AM, Patient X was discharged with the final
diagnosis of bronchial asthma in acute exacerbation. The following were the take-home
medications: salbutamol 1 nebule q6h for 5 days, co-amoxiclav 250 mg/62.5 mg, prednisone
20mg/5mL, and phenylpropanolamine HCl + Brompheniramine maleate (Nasatapp) drops 1
mL OD. Patient X was instructed to have a follow-up check-up on December 14, 2020 in
Maria Reyna Xavier University Hospital clinic at 12 NN.
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b. Assessment Tool
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VIII. LABORATORY RESULTS
Legend:
Below normal range
Above normal range
HEMATOLOGY
Date of Result: 12-02-2020
Examination Normal Range Actual Result Interpretation
White Blood Cell 6.00 — 17.00 11.6 x10^9/L This indicates a normal number
Count x10^9/L of White Blood Cells in the
bloodstream.
Red Blood Cell 3.69 — 5.90 4.33 x 10^12/L This indicates a normal number
Count x10^12/L of Red Blood Cells in the
bloodstream.
Platelets 150 — 390 352 x10^9/dL This indicates a normal platelet

x10^9/dL count in the bloodstream.
Hgb 10.50 — 13.50 10.9 g/dL This indicates a normal number

g/dL of hemoglobin in the
bloodstream.
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Hct 33.00 — 39.00 % 32.2% (Low) Hematocrit measures how much
of the blood is made up of red
blood cells. Low hematocrit levels
may indicate conditions like blood
disorders, nutritional deficiency
(iron, vitamin B12, folate) or other
medical conditions. Iron is
important for the production of
hematocrit which is the protein is
the transferrin that binds to iron
and transports it throughout the
body; prior to admission, the
patient experienced decreased
appetite and decreased milk
formula intake, (6 oz) from usual
intake of 18 oz, during the last
two weeks which indicates a risk
for iron and vitamin B12
deficiency.
Neutrophils 37.00 — 72.00% 65% This indicates a normal number

of neutrophils in the bloodstream.
Lymphocytes 20.00 — 50.00% 26% This indicates a normal number

of lymphocytes in the
bloodstream.
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Monocytes 8.00 — 14.00% 6% (Low) Monocytes are a major part of the
inflammatory system. Low levels
of monocytes may indicate
medical conditions such as bone
marrow disorder and infection
that reduces the total white blood
cell count that weaken the
immune system. Respiratory
infection includes cough/colds
that can affect the lungs when
having asthma, which can cause
inflammation (swelling) and
narrowing of the airways. The
patient’s medication,
hydrocortisone, is indicated for
reducing inflammation in the lung,
which may cause monocyte level
reduction.
Eosinophils 0.00 — 6.00% 0% This indicates a normal number

of eosinophils in the bloodstream.
Basophils 0.00 — 1.00% 0% This indicates a normal number

of basophils in the bloodstream.
RDW 11.50 — 14.50 % 15.7% (High) The red blood cell distribution
width indicates the size and
volume of the red blood cells in
the system. High levels of RDW
may indicate nutrient deficiency
such as iron, folate, and vitamin
B12. These results could also
indicate macrocytic anemia, a
condition in which the body does
not produce sufficiently normal
red blood cells and the cells it
does produce are larger than
normal which can be due to a
deficiency of folate or vitamin
B-12.
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Interpretation:
The table shows Patient X’s hematology test done last December 2, 2020. Results
show low levels of hematocrit and monocyte count. An implication for low hematocrit count
may be due to nutrient deficiency, specifically iron, folate and vitamin B12 in which the
patient was noted to manifest the condition. An implication for the low monocyte count may
be due to the presence of infection that triggered the asthmatic condition of the patient. On
the other hand, there is a high level of RDW count which may indicate nutritional deficiency.
Prior to the admission, Patient X experienced decreased appetite, and decreased milk
formula intake which indicate the risk for deficiency of the following nutrients (iron, folate and
vitamin B12).
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URINALYSIS
Date of Result: 12-02-2020
Examination Reference Range Results Interpretation
Color Yellow Light Yellow This indicates a typical,

healthy urine.
Transparency Clear Clear Although normal, this may

indicate excess water intake
Specific Gravity 1.003 - 1.030 1.030 This indicated that the urine
gravity is within the normal
range
pH 4.5 - 8.0 6.0 This indicates a normal urine

acidity.
Sugar NEGATIVE NEGATIVE This indicates negative test

result which means that
there is no detectable amount
of sugar in the urine at the
time of testing
Protein NEGATIVE NEGATIVE This indicates negative test

result which means that
there is no detectable amount
of protein in the urine at the
time of testing
WBC 0-11 6 This indicates a normal WBC

count in the urine
RBC 0-11 6 This indicated a normal RBC

count in urine
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Epithelial Cells 0-11 RARE This indicates that the urine
has a small amount of
epithelial cells which is
considered as normal.
Bacteria 0-11 RARE This indicates that the the

urine has a small amount of
bacteria which is still
considered as normal
Interpretation:
The table shows Patient X’s urinalysis test results done last December 2, 2020. The
results are generally unremarkable which indicates that the patient has absence of infection
and a normal renal function. A urinalysis test is usually administered to rule out renal
dysfunction or determine the presence of an infection.
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IX. PATHOPHYSIOLOGY
a. Narrative Pathophysiology
Bronchial asthma is an inflammatory disease with manifestations of recurrent attacks
of breathlessness and wheezing. It is due to the inflammation of the air passages in the
lungs and affects the sensitivity of the nerve endings in the airways so they become easily
irritated. When an attack occurs, the lining of the passages swell which causes the airways
to narrow thus reducing the flow of air in and out of lungs. Episodes are variable in severity,
and the changes in airflow are often reversible.
In the case of Patient X, we identified the following predisposing factors. The patient
has a family history of bronchial asthma specifically from his maternal aunt. Having a family
member with asthma increases the risk of developing the disease. Gender may also play an
important role as childhood asthma occurs more frequently in boys than in girls. It is
unknown why this occurs, although some experts find a young male's airway size smaller
compared to the female's airway, which may contribute to increased risk of wheezing after a
cold or other viral infection.
For the precipitating factor, the child’s environment is a big factor in asthma onset
and exacerbation. Depending on their environment, Patient X may have been exposed to
triggers such as allergens, dusts, chemical fumes and vapors, molds, cold air, tobacco
smoke, and environmental contamination. All of these may provoke allergic reactions or
irritate the airways.
The strongest risk factors for developing asthma are a combination of genetic
predisposition with environmental exposure. This leads to atopy or the tendency to develop
allergic response and allergic diseases such as allergic rhinitis, asthma and atopic dermatitis
(eczema). Atopy is typically associated with heightened immune responses to common
allergens, especially inhaled allergens and food allergens.
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Once there is a trigger or stimulus such as upper respiratory tract infections (URTIs)
or inspiration of animal dander, cigarette smoke, drugs, weather, and allergens, this initiates
the airway inflammatory response in asthma. After inspiration of the stimuli, the response
results in the sensitization of helper T cells which further causes the stimulation of B-cells to
produce Immunoglobulin E (IgE). There are two types of T helper cells (Th lymphocytes)
designated Th1 and Th2. Th1 cells tend to promote cell-mediated immune responses by
producing interferon-gamma, interleukin-2 (IL-2), and TNF-β. In contrast, Th2 cells promote
the production of IgE antibodies by producing IL-4 and IL-13, which are interleukins that act
on B lymphocytes (B cells) to promote the production of IgE antibodies to a specific antigen.
People who are atopic are believed to have a higher ratio of Th2/Th1 cells which is an
important factor in their tendency to produce allergy-mediating IgE antibodies. The
production of IgE causes its cross‐linking on the mast cell surface. The increased levels of
inflammatory and bronchoconstrictive mediators then arise.
The principal cells involved in this process include mast cells, eosinophils, epithelial
cells, macrophages, and activated T lymphocytes. Activated Helper T-cells play a role in
regulating airway inflammation through the release of cytokines. Cytokines induce
maturation of the granular white blood cells. A type of white blood cell called eosinophils are
then stimulated to migrate into the airways. Eosinophils are proinflammatory and they play a
part in the body’s inflammatory processes. Their migration to the airways results in
bronchoconstriction.
Mast cells are allergy-causing cells that release histamine, leukotrienes, and other
inflammatory mediators, which causes nasal stuffiness, airway constriction, and itchiness in
skin allergy. The production of these mediators leads to airflow obstruction which can be
caused by a variety of physiologic changes, including acute bronchoconstriction, airway
inflammation, chronic mucus plug formation, and airway remodeling. The increased amount
of the inflammatory mediators results in mucus plug formation accumulated in the goblet
cells at the mucosa which causes the goblet cell hyperplasia, leading to increased mucus
secretion due to the accumulation of mucus. As part of the inflammation process which is
29
caused by the inflammatory mediators, dilation of vessels at the lower respiratory tract then
occurs. As a result, the vasodilation produces airway edema that further contributes to the
airway obstruction.
Another consequence of the inflammatory process is airway remodelling which
occurs as there are structural changes to the shape on the pathway of air such as the
pharynx, trachea, primary, secondary, and tertiary bronchi, bronchioles and alveoli. It is due
to long-standing inflammation and may profoundly affect the extent of reversibility of airway
obstruction.
Chronic inflammation of the airways is associated with increased bronchial
hyperresponsiveness, which leads to bronchospasm. With triggered bronchospasm, there
will be unequal alteration of airflow resistance that results in uneven distribution of air. Along
with this, the hyperinflation occurs as compensation for airflow obstruction but it causes
increased intra-alveolar pressure which results in changes in circulation. All of this leads to
ventilation-perfusion mismatch.
Following the disease process, the main signs and symptoms of asthma were
present in the assessment of Patient X. He had shortness of breath, tightness of chest,
tachypnea, wheezing, excessive coughing, bilateral rales, and positive intercostal
retractions. These are all indicative of the diagnosis of bronchial asthma in acute
exacerbation.
Diagnostic procedures were performed in order to diagnose bronchial asthma. These
include chest x-ray, complete blood count (CBC), and urinalysis. A chest X-ray is the initial
imaging evaluation of bronchial asthma, which reveals any complications or any causes of
wheezing in the diagnosis of asthma and its exacerbations. CBC is performed to evaluate
blood cells and provide information on infection and inflammation. Lastly, urinalysis is done
to rule out infection and ensure that the level of medication received helps manage the
illness better and prevent future exacerbations.
30
Immediate medical treatment was done to address Patient’s X condition. He is
prescribed salbutamol through a nebulizer to control and prevent any airway obstruction
caused by asthma. Phenylpropanolamine HCl + brompheniramine maleate drops were also
given for the relief of nasal congestion and hypersecretion. Hydrocortisone was prescribed to
reduce airway inflammation. Early treatment of ceftriaxone is initiated in the case that
bacterial infection is suspected.
Main medical management provided for Patient X is oxygen therapy (oxygen at 2
LPM via cannula) in order to elevate blood oxygen levels. Due to ineffective breathing
patterns related to swelling and spasms, chest physiotherapy is indicated after every
nebulization for the removal of retained or profuse airway secretions. Oxygen therapy is also
increased to 3 LPM from 2 LPM with nothing by mouth. As Patient X is at risk for aspiration,
a chest X-ray is acquired in order to determine any pulmonary infiltrates on the chest, which
would indicate some level of aspiration. He is also placed on a diet for his age with strict
aspiration precaution to reduce said risk.
Nursing interventions done to alleviate Patient X’s condition included close
monitoring and assessment of his respiratory status, such as respiratory rate, depth, breath
sounds, peak flow and pulse oximetry. Any changes in respiratory status must be dealt with
immediately as these could suggest retention of secretions, which could lead to airway
obstruction. Effective coughing and deep breathing is encouraged to mobilize secretions and
clear the airway, and nasotracheal suctioning may be performed if necessary. Suctioning is
performed, especially if coughing alone is ineffective. Measures of comfort, such as
elevating the head of the bed, and safety, such as raising the rails of the bed, are provided
for comfort, safety, better chest expansion, and ventilation. As fatigue is common with the
increased work of breathing, periods of rest for Patient X are planned.
31
Family dynamics in handling their ill child is assessed, including the facilitation of
communication between members of the family. Stable and secure family relationships
better the consistency in the disease management. Health education is also provided for
various breathing techniques, relaxation techniques, medication education, and proper
positioning. These measures allow for full participation of Patient X’s parents in maintaining
health status and improving condition.
32
b. Schematic Diagram
CONCEPT MAP/PATHOPHYSIOLOGY OF BRONCHIAL ASTHMA
Patient’s Name: Patient X Age: 1 year and 3 months Sex: Male
Patient’s Diagnosis/ Impression: Bronchial asthma in acute exacerbation
33
34
35
36
37
38
39
X. DRUG STUDY
Generic Name Date/Time Classification Indications Mechanism of Action Side Effects Nursing Considerations
(Brand Name) Ordered,
Dosage,
Timing
and Route
Ceftriaxone 12/1/20 Pharmacologic Treatment of the It binds to 1 or more CNS: Seizures ● Assess for infection (vital
(Viatrex) 5 PM Class: following penicillin-binding (high doses), signs,sputum, urine, and
600 mg, x Third- infections proteins inhibiting the headache. stool; WBC) at beginning
1 hr q12h, generation caused by final transpeptidation CV: of and throughout
IV drip cephalosporin susceptible step of peptidoglycan Hypotension, therapy
NST organisms: skin synthesis in bacterial palpitations, ● Before initiating therapy,
Therapeutic and skin cell wall, leading to chest pain, obtain a history to
12/2/20 Class: structure bacterial cell lysis and vasodilation determine previous use
7:40 PM Anti-infectives infections, death. EENT: Hearing of and reactions to
D1 urinary and loss penicillins or
gynecologic GI: cephalosporins. Persons
12/3/20 infections, Pseudomembran with a negative history of
9:40 AM respiratory tract ous colitis, penicillin sensitivity may
D1+1 infections. diarrhea, still have an allergic
Intra-abdominal nausea, response.
12/4/20 infections and vomiting, ● Obtain specimens for
11 AM septicemia. cholelithiasis, culture and sensitivity
Available cramps. before initiating therapy.
stacks Hemat: First dose may be given
then shift Agranulocytosis, before receiving results.
to bleeding, ● Observe patients for
co-amoxicl eosinophilia, signs and symptoms of
av hemolytic anaphylaxis (rash,
anemia, pruritus, laryngeal
lymphocytosis, edema, wheezing) , do
neutropenia, necessary preparations
40
thrombocytopeni and actions (discontinue
a, drug, notify physician
thrombocytosis. immediately, keep
GU: Hematuria, epinephrine and
vaginal resuscitation equipment
moniliasis. close by).
Local: Phlebitis ● Assess newborns for
at IV site. jaundice and
Misc: Allergic hyperbilirubinemia as it is
reactions contraindicated.
including ● Monitor injection site
anaphylaxis and frequently for phlebitis
serum sickness, (pain, redness, swelling).
superinfection, Change sites every
chills, fever. 48-72 hrs. Dilute in at
least 1 g/10 mL. Avoid
direct IV administration.
Do not use preparations
containing benzyl alcohol
for neonates.
● Instruct parents of
patients to take
medication around the
clock and to finish the
medication completely,
even if feeling better.
Take missed doses as
soon as possible unless
almost time for the next
dose; do not double
doses.
● Advise parents of
patients to report signs of
superinfection (furry
41
overgrowth on the
tongue, vaginal itching or
discharge, loose or
foul-smelling stools) and
allergy.
● Instruct parents of the
patient to notify
healthcare professional if
fever and diarrhea
develop, especially if
stool contains blood, pus,
or mucus. Advice to not
treat diarrhea without
consulting a healthcare
professional.
Co-amoxiclav 12/4/20 Amoxicillin Treatment of a Amoxicillin inhibits CNS: Reversible ● Assess for infection (vital
(Natravox) 4 AM Pharmacologic variety of transpeptidase, hyperactivity, signs; appearance of
250mg/62. Class: infections preventing dizziness, wound, sputum, urine,
5mg/5ml, Aminopenicillins including: Skin cross-linking of headache and and stool; WBC) at
2.5ml, Therapeutic and skin bacterial cell walls and convulsions (high beginning of and
after Class: structure leading to cell death. doses). throughout therapy.
consuming Anti-infectives, infections, otitis Addition of clavulanate GI: ● Obtain a history before
ceftriaxone antiulcer agents media, sinusitis, increases the drug's Pseudomembran initiating therapy to
stacks respiratory tract resistance to ous colitis, determine previous use
available, Clavulanic Acid infections, GU beta-lactamase. diarrhea, of and reactions to
TID, PO Pharmacologic tract infections. indigestion, penicillins or
Class: Beta nausea, gastritis, cephalosporins. Persons
lactamase stomatitis, with a negative history of
inhibitors glossitis, black penicillin sensitivity may
Therapeutic “hairy” tongue, still have an allergic
Class: vomiting and response.
Anti-infectives mucocutaneous ● Observe for signs and
42
candidiasis. symptoms of anaphylaxis
GU: Soreness, (rash, pruritus, laryngeal
discharge edema, wheezing).
Hemat: ● Obtain specimens for
Transient culture and sensitivity
leukopenia, prior to therapy. First
thrombocytopeni dose may be given
a, hemolytic before receiving results.
anemia, ● Monitor bowel function.
prolongation of Diarrhea, abdominal
bleeding time cramping, fever, and
and prothrombin bloody stools should be
time. reported to a health care
Derm: Skin professional promptly as
rashes, urticaria. a sign of
Respiratory: pseudomembranous
Wheezing. colitis. May begin up to
several weeks following
Misc: cessation of therapy.
Superinfections ● Instruct parents of
(oral and rectal patients that medication
candidiasis), should be taken round
fever, the clock and to finish the
anaphylaxis. drug completely as
directed, even if feeling
better.
patients to report the
signs of superinfection
(furry overgrowth on the
tongue, vaginal itching or
discharge, loose or
foul-smelling stools) and
allergy.
43
patients to notify health
care professionals
immediately if diarrhea,
abdominal cramping,
fever, or bloody stools
occur and not to treat
with antidiarrheals
without consulting health
care professionals.
patients to notify health
care professionals if
symptoms do not
improve or if nausea or
diarrhea persists when
drug is administered with
food.
● Teach parents to
calculate and measure
doses accurately.
Reinforce the importance
of using measuring
devices supplied by
pharmacies or with
products, not household
items.
44
D5 0.3 NaCl 12/1/20 Therapeutic It is used for It is more concentrated CV: Tachycardia ● Monitor for possible
(dextrose + 5 PM Class: Mineral replacement or than extracellular fluid. Bradycardia, intravascular fluid volume
sodium 500 cc and electrolyte maintenance of It allows movement of Thrombophlebitis overload and pulmonary
chloride) 65cc/hr, IV replacements/s fluid and fluid from cells into the , Phlebitis. edema.
upplements electrolytes. bloodstream, causing Respi: Breathing ● Monitor serum
the cells to shrink thus difficulties, electrolytes and assess
increasing the pulmonary for signs and symptoms
extracellular fluid edema. of hypervolemia.
volume. Derm: Damage ● Assess for IV site
to skin and tissue irritation and damage,
around IV site, also for thrombosis of
itching around blood vessels.
area of IV site. ● Instruct parents to notify
nurses if an infant has
breathing difficulties or
very fast heart beat.
D5LR 12/1/20 Therapeutic It is indicated in Sodium takes control of CNS: Headache, ● Assess for any
(dextrose + 5 PM Class: Mineral adults and water distribution, fluid anxiety. hypersensitivity
sodium lactate 1L and electrolyte pediatric patients balance and osmotic CV: Bradycardia, reactions.
solution) 60cc/hr, replacements/s as a source of pressure of body fluids. tachycardia, ● Frequency laboratory
TF D5 0.3 upplements electrolytes, hypotension. determinations and
NaCl, IV calories, and Potassium functions in Respiratory: clinical evaluation are
water for carbohydrate utilization Respiratory essential in monitoring
hydration. and protein synthesis distress, the changes in the blood
and it is a critical part of laryngeal edema, glucose and electrolyte
nerve conduction and
sneezing. concentrations, and fluid
muscle contraction,
GI: Nausea, and electrolyte balance.
specifically in the heart.
abdominal pain, ● If adverse reaction
Chloride deals with the diarrhea, throat occurs, discontinue the
metabolism of sodium irritation, infusion and evaluate the
and changes in the hypoaesthesia patient. Facilitate
acid-base balance of the oral, dysgeusia. appropriate therapeutic
45
body. Calcium, when in Local: Phlebitis, countermeasures and
ionized form, is extravasation,inf have the remainder of
essential in the ection. the fluid examined if
mechanism of blood Misc: necessary.
clotting, normal cardiac Hypervolemia, ● Hypertonic solutions
function, and regulation hyperkalemia, should be administered
of neuromuscular hypernatremia. peripherally and it must
irritability. be slowly infused through
a small bore needle.
● Before administering
Sodium lactate is a
parenteral drug products,
racemic salt containing
both the levo form,
it should be inspected
which is oxidized by the visually for any particular
liver to bicarbonate, and matter or discoloration.
the dextro form, which is ● Frequent monitoring of
converted to glycogen. the electrolyte levels is
significant since
Dextrose provides a symptoms may result
source of calories and from an excess or deficit
when it is readily of one or more ions
metabolized, it may present in the solution.
decrease losses of body ● Rate of administration
protein and nitrogen, should be adjusted
promotes glycogen according to tolerance
deposition and since rapid infusions of
decreases or prevents hypertonic solutions may
ketosis if sufficient cause local pain and
doses are provided. venous irritation.
It produces a metabolic
alkalinizing effect.
D5IMB 12/2/20 Therapeutic Treatment in Since it is a hypertonic CNS: Headache. ● Assess patient’s vital
(balanced 3 PM Class: Mineral replacing solution, it has a Respiratory: signs, lung sounds, heart
multiple 50 cc/hr, and electrolyte electrolytes, to greater concentration Tachypnea. sounds, and edema
46
maintenance IV replacements/s treat hypotonic of solutes around 375 GI: Diarrhea. status before infusion.
solution in 5% upplements dehydration, mEq/L or greater than Local: Phlebitis. ● Monitor and observe the
dextrose) 12/3/20 and, to treat plasma. It causes fluids Misc: patient during
9:40 AM certain types of to move out of the cells Hypervolemia, administration.
45 cc/hr, shock. and into the hyperglycemia, Hypertonic solutions
IV extracellular fluid in cramping, should be administered
order to normalize the edema. only in high acuity areas
concentration of with constant nursing
particles between two surveillance for potential
compartments. With complications.
this effect, the cells will ● Verify the order. The
shrink and may disrupt specific hypertonic fluid
their function. that needs to be infused
should be stated in the
They draw water out of prescription along with
the intracellular space the total volume to be
which will lead to an infused, the infusion rate
increasing extracellular and the length of time to
fluid volume. continue the infusion.
● Assess health history.
Patients with heart or
kidney disease and those
who are dehydrated
should not receive
hypertonic IV fluids.
● Prevent fluid overload.
Ensure that the
administration of
hypertonic fluids does
not result in a fluid
volume excess or
overload.
● Monitor blood glucose
closely. Rapid infusion of
47
this type of solution can
lead to hyperglycemia.
Hydrocortisone 12/1/20 Pharmacologic Management of Inhibits accumulation CNS: ● Assess patients for signs
5:25 PM Class: adrenocortical of inflammatory cells at Depression, of adrenal insufficiency
45 mg, Corticosteroids insufficiency, inflammation sites, euphoria, (hypotension, weight
now then (systemic) anti-inflammator phagocytosis, headache, ICP loss, weakness, nausea,
q6h, IVTT Therapeutic y, and it is lysosomal enzyme (Children only), vomiting, anorexia,
Class: immunosuppres release, synthesis personality lethargy, confusion,
12/4/20 Antiasthmatics, sive. In terms of and/or release of changes, restlessness) before and
11 AM corticosteroids topical mediators of psychoses, periodically during
continue management, it inflammation. This fatigue, therapy.
is used to treat prevents/suppresses restlessness, ● Monitor intake and output
inflammatory cell-mediated immune insomnia. ratios and daily weights.
dermatoses, reactions and CV: Arrhythmias Observe patients for
adjunctive decreases/prevents (from peripheral edema, steady
treatment of tissue response to hypokalemia), fat weight gain,
ulcerative colitis, inflammatory process. embolism, heart rales/crackles, or
atopic dermatitis, failure, dyspnea. Notify health
inflamed hypertension, care professionals if
hemorrhoids. hypotension, these occur.
thromboembolis ● Children should have
m, periodic evaluations of
thrombophlebitis. growth.
GI: Abdominal ● Monitor daily pattern of
distention, bowel activity, stool
hiccups, consistency.
increased ● Monitor electrolytes, B/P,
appetite, nausea, weight, serum glucose.
pancreatitis, ● Monitor for hypocalcemia
peptic ulcer, (muscle twitching,
rectal cramps), hypokalemia
abnormalities (weakness, paresthesia,
(bleeding, nausea/vomiting,
48
blistering, irritability, EKG changes).
burning, itching, ● Assess for emotional
or pain (rectal status, and ability to
form)), ulcerative sleep.
esophagitis, ● Corticosteroids cause
vomiting. immunosuppression and
GU: Glycosuria, may mask symptoms of
perineal burning infection. Instruct parents
or tingling. of patients to avoid
Hemat: people with known
Thromboembolis contagious illnesses and
m, to report possible
thrombophlebitis, infections immediately.
easy bruising, ● Report fever, sore throat,
leukocytosis. muscle ache, sudden
Metab: Weight weight gain, swelling,
gain. visual disturbances, and
Derm: Acne, behavior changes.
decreased ● Do not take aspirin or
wound healing, any medication without
ecchymoses, consulting a physician.
fragility, ● Do not cover or use
hirsutism, occlusive dressings
petechiae. unless ordered by a
MS: Muscle physician; do not use
wasting, tight diapers, plastic
osteoporosis, pants, and coverings.
aseptic necrosis
of joint, muscle
pain.
Misc:
Anaphylaxis,
hypocalcemia,
hypokalemia,
49
hypokalemic
alkalosis,
impaired wound
healing.
Paracetamol 12/1/20 Therapeutic Used for the Inhibits the synthesis of GI: Hepatic ● Assess overall health
(Tempra) 5 PM Class: treatment of prostaglandins that failure, status and alcohol usage
1.2 mL Antipyretics, fever, headache, may serve as hepatotoxicity before administering
drops, q4h nonopioid muscular aches mediators of pain and (overdose). acetaminophen. They
PRN, PO analgesics & pain, fever, primarily in the GU: Renal failure are at higher risk of
toothache, colds, CNS. Has no (high developing hepatotoxicity
and ear ache significant doses/chronic with chronic use of usual
anti-inflammatory use). doses of this drug.
Mild pain. Fever. properties or GI Hemat: ● Assess amount,
toxicity. It leads to Neutropenia, frequency, and type of
analgesia and pancytopenia, drugs taken in patients
antipyresis. leukopenia. self-medicating,
Derm: Rash, especially with OTC
urticaria. drugs. Prolonged use of
acetaminophen
increases the risk of
adverse renal effects. For
short-term use,
combined doses of
acetaminophen and
salicylates should not
exceed the
recommended dose of
either drug given alone.
● Fever: Assess fever, note
presence of associated
signs (diaphoresis,
tachycardia, and
malaise).
50
● When combined with
opioids do not exceed
the maximum
recommended daily
dose.
● Administer with a full
glass of water. Must be
taken with food or on an
empty stomach.
patients to check
concentrations of liquid
preparations. Errors have
resulted in serious liver
damage.
● Caution parents to check
labels on all OTC
products. Advise to avoid
taking more than one
product containing
acetaminophen at a time
ato prevent toxicity.
Phenylpropano 12/1/20 Phenylpropanol Indicated for The antihistamine CNS: ● Assess allergy symptoms
lamine HCl + 5 PM amine allergic and action of Drowsiness, (rhinitis, conjunctivitis,
Brompheniram 1 mL Pharmacologic vasomotor or brompheniramine sedation, hives) before and
drops, class: other reduces or diminishes dizziness, periodically throughout
ine maleate
TID, PO Sympathomimet hyperactive the allergic response of excitation (in therapy.
(Nasatapp) ic Agent nasal disorders nasal tissues. It is children), ● Monitor pulse and blood
(Nonselective and acute complemented by the lassitude, pressure before initiating
adrenergic coryza, relief of mild vasoconstrictor giddiness, and throughout IV
receptor agonist nasal congestion action of increased therapy.
and and phenylpropanolamine, irritability and ● Assess lung sounds and
norepinephrine hypersecretion. which provides a nasal excitement, character of bronchial
51
reuptake Relief of nasal decongestant effect. headache, secretions.
inhibitor) congestion in Therefore, this insomnia ● Inform parents of
Therapeutic infants up to combination reduces EENT: Blurred patients that drowsiness
class: children 12 excessive vision, Mydriasis may occur.
Decongestant years of age. nasopharyngeal CV: ● Instruct the parents of
and appetite secretion and Hypertension, the patient to contact a
suppressant diminishes arrhythmias, health care professional
inflammatory mucosal hypotension, if symptoms persist.
edema and congestion palpitations.
Bromphenirami in the upper respiratory GI: Dry mouth,
ne tract. constipation,
Pharmacologic obstruction,
class: Phenylpropanolamin nausea
H1-receptor-blo e: Acts directly on GU: urinary
cking agent alpha- and, to a lesser retention and
Therapeutic degree, hesitancy.
class: beta-adrenergic Derm: Sweating.
Antihistamine receptors in the
mucosa of the
respiratory tract.
Stimulation of
alpha-adrenergic
receptors produces
vasoconstriction,
reduces tissue
hyperemia, edema,
and nasal congestion,
and increases nasal
airway patency. PPA
indirectly stimulates
beta-receptors,
producing tachycardia
and a positive inotropic
effect.
52
Brompheniramine: As
an antihistamine,
competes w/ histamine
for H1-receptor sites on
effector cells and
therefore provides
symptomatic relief of
allergic symptoms
(rhinitis, urticaria)
caused by histamine
release.
Salbutamol 12/1/20 Pharmacologic Used as a Binds to beta CNS: ● Assess lung sounds,
5 PM Class: bronchodilator to 2-adrenergic receptors Nervousness, pulse, and blood
1 neb, now Adrenergics control and in airway smooth restlessness, pressure before
then q4h, Therapeutic prevent muscle, leading to tremor, administration and during
nebulizatio Class: reversible airway activation of adenylyl headache, peak of medication. Note
n Bronchodilators obstruction cyclase and increased insomnia (occurs amount, color, and
caused by levels of cyclic-3’, more frequently character of sputum
5:25 PM asthma or 5’-adenosine in young children produced.
1 neb x 2 COPD. Used as monophosphate than adults), ● Monitor pulmonary
doses, a quick-relief (cAMP). Increases in hyperactivity in function tests before
now, agent for acute cAMP activate kinase, children. initiating therapy and
nebulizatio bronchospasm which inhibits the CV: Chest pain, periodically during
n and for phosphorylation of palpitations, therapy to determine
prevention of myosin and decreases angina, effectiveness of
8:25 PM exercise-induced intracellular calcium arrhythmias, medication.
1 neb, bronchospasm. therefore relaxes hypertension. ● Observe for paradoxical
q3h, smooth muscle GI: Nausea, bronchospasm
nebulizatio airways. vomiting. (wheezing). If a condition
53
n Endo: occurs, withhold
Hyperglycemia. medication and notify
10:40 PM F and E: physician or other health
1 neb, Hypokalemia. care professional
alternatew/ Neuro: Tremor. immediately.
salbutamol ● Protect solution from
+ipratropiu light. Store unused vials
m q3h, in a foil pouch.
nebulizatio ● Instruct parents of
n patients to contact a
health care professional
12/4/20 immediately if shortness
11 AM of breath is not relieved
1 neb, by medication or is
q4h, accompanied by
nebulizatio diaphoresis, dizziness,
n palpitations, or chest
pain.
Salbutamol + 12/1/20 Salbutamol Used as adjunct Salbutamol:activates CNS: Headache ● Assess patient’s history
Ipratropium 10:40 PM Pharmacologic treatment to adenylyl cyclase, the Eye: Mydriasis, for hypersensitivity to
1 neb, Class: anti-inflammator enzyme that stimulates blurred vision, atropine, soybean,
q3h, Adrenergics y therapy & the production of cyclic narrow-angle peanuts (aerosol
alternate bronchodilators adenosine-3’,5’-monop glaucoma, eye perspiration).
with Therapeutic in asthma to hosphate (cAMP). pain. ● Assess patient’s history
salbutamol Class: prevent Increased cAMP leads CV: Palpitations, for acute
, Bronchodilators exacerbations. to activation of protein tachycardia. bronchospasms,
nebulizatio Also in kinase A, which inhibits GI: Dry mouth, narrow-angle glaucoma,
n Ipratropium maintenance phosphorylation of nausea. prostatic hypertrophy,
Pharmacologic treatment of myosin and lowers bladder neck obstruction,
12/4/20 Class: COPD including intracellular ionic pregnancy, lactation.
11 AM Anticholinergics chronic calcium ● Assess for skin color,
discontinu bronchitis & concentrations, lesions, texture,
e Therapeutic emphysema. resulting in smooth orientation, reflexes,
54
Class: muscle relaxation bilateral grip strength,
Bronchodilators affect, ophthalmic
Ipratropium: Causes examination, pulse,
bronchodilation by blood pressure,
blocking the action of respiration, adventitious
acetylcholine-induced sounds, bowel sounds,
stimulation of guanylyl normal output, prostate
cyclase, hence palpation.
reducing formation of ● Assess lung sounds,
cyclic guanosine pulse, and blood
monophosphate pressure before
(cGMP) at administration and during
parasympathetic site. peak of medication. Note
amount, color, and
character of sputum
produced.
● Monitor pulmonary
function tests before
initiating therapy and
periodically during
therapy to determine
effectiveness of
medication.
● Observe for paradoxical
bronchospasm
(wheezing). If a condition
occurs, withhold
medication and notify
physician or other health
care professional
immediately.
● Protect solution from
light. Store unused vials
in a foil pouch.
55
● Use a nebulizer
mouthpiece instead of
facemask to avoid
blurred vision or
aggravation of
narrow-angle glaucoma.
patients to contact a
health care professional
immediately if shortness
of breath is not relieved
by medication or is
accompanied by
diaphoresis, dizziness,
palpitations, or chest
pain.
56
XI. NURSING CARE MANAGEMENT
Nursing Care Plan 1
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

(cite sources)
Subjective cues: Ineffective airway Short Term: Independent: Short Term:

(none) clearance r/t At the end of 4 hours, 1.Monitor respiratory
1.Changes in At the end of 4 hours:
bronchospasms, client will be able to: rate and depth; note
respirations, use of
Objective cues: increased pulmonary ease of breathing.accessory muscles, >Patient’s respiratory
secretions, ineffective >Return to normal Auscultate breath
and pres- rate was 34cpm.
+ rales bilateral cough, mucosal respiratory rate sounds. Investigate
ence of crackles or
+ wheezing edema secondary to (20-40cpm). restlessness, dys-wheezes suggest >Patient was able to
+ retraction,IC disease condition pnea, and
retention of maintain clear open
Dry,non-productive AEB wheezing, >Maintain clear, open development of
secretions. airways as evidenced
cough changes in airways as evidence cyanosis. Airway obstruction by normal breath
Shortness of Breath respiratory rate, by normal breath (even partial) can sounds.
Runny nose cough, dyspnea, and sounds. lead to ineffective
RR:44cpm - on retained secretions breathing patterns >Patient had the
admission >Have the ability to and impaired gas ability to effectively
02 sat - 94% taken effectively cough up exchange, resulting cough up secretions
on 10:00 PM - secretions after in after treatments and
12/02/2020 treatments and deep complications, such deep breaths.
breaths. as pneumonia and
respiratory arrest >O2 sat returned to
>Return to normal (Doenges, et al., normal range (99%)
O2 saturation rate 2010).
(95%-100%). Long Term:
2.Elevate head of 2.Facilitates drainage At the end of 48
Long Term: bed 30 to 45 of secretions, work of hours:
At the end of 48 degrees. breathing, and lung
hours, client will be Expansion (Doenges, >Client was able to
able to: et al., 2010). classify methods to
57
enhance secretion
>Classify methods to removal
enhance secretion 3.Encourage 3.Prevents pooling of
removal. swallowing, if client is oral secretions,
>Client was able to
able. reducing risk of
recognize the
>Recognize the aspiration (Doenges, significance of
significance of et al., 2010). changes in sputum to
changes in sputum to include color,
include color, 4.Encourage 4.Mobilizes character, amount,
character, amount, effective coughing secretions to clear and odor.
and odor. and deep breathing. the airway and helps
prevent respiratory >Patient was able to
>Identify and avoid complications identify and avoid
specific factors that (Doenges, et al., specific factors that
inhibit effective 2010). inhibit effective
airway clearance. airway clearance.
5.Change nasal 5.Prevents
>Maintain normal cannula, as accumulation of >Patient’s respiratory
respiratory rate and indicated. Instruct secretions and thick rate was 38cpm,
02 saturation with no client’s parents in mucous plugs from O2sat is 98% with no
assistance of oxygen cleaning procedures. obstructing the assistance of oxygen
administration. airway (Doenges, et administration.
al., 2010).
6.Perform 6.Suctioning is
nasotracheal needed when
suctioning as patients are unable to
necessary, especially cough out secretions
if cough is ineffective. properly due to
weakness, thick
mucus plugs, or
excessive or
tenacious mucus
production (Doenges,
58
et al., 2010).
Collaborative:
1.Provide 1.Normal
supplemental physiological (nasal
humidification, such passages) means of
as compressed air filtering and
or oxygen mist collar humidifying air are
and increased fluid bypassed.
intake. Supplemental
humidity decreases
mucous crusting and
facilitates coughing
or suctioning of
secretions (Gil,2019).
2.Administer and 2.Increases the

monitor oxygen amount of oxygen
therapy (Oxygen at 2 your lungs receive
LPM via cannula) as and deliver to your
ordered by the blood (Gil,2019).
physician.
3.Medication 3.Ensuring that

administration as medications are
prescribed by the given safely,
physician. accurately and to
avoid any additional
complications
(Doenges, et al.,
2010).
4.Coordinate with a 4.Chest

respiratory therapist physiotherapy
59
for chest includes the
physiotherapy and techniques of
nebulizer postural drainage
management as and chest percussion
indicated. to mobilize secretions
from smaller airways
that cannot be
eliminated by means
of coughing or
suctioning (Gil,2019).
60
Nursing Care Plan 2

(cite sources)
Subjective cues: Ineffective breathing Short Term: Independent: Short Term:

None pattern r/t swelling At the end of 2 hours, 1.Monitor vital signs 1.These signs, which At the end of 2 hours,
and spasm client will be able to: every 4 hours. should be looked at client:
Objective cues: secondary to disease in total, are checked
● V/S 8:25 PM condition AEB >Show improved to monitor functions >Showed improved
12/1/2020: non-productive respiratory rate (RR of the body. The respiratory rate (RR
RR = 60 cpm cough, tachypnea, = <60 cpm) with signs reflect changes = 50 cpm) with
use of accessory decreased in function that decreased
● V/S 6:30 AM muscles retractions. otherwise might not retractions.
12/2/2020: be observed (Scribd,
RR = 50-52 Long Term: 2021). Long Term:
cpm At the end of 3 days, At the end of 3 days,
the client will be able 2.Assess respiratory 2.Respiratory rate the client:
● + SL/IC retractions to: rate, rhythm, and and rhythm changes
depth. are early warning >Maintained optimal
● Patient had >Maintain optimal signs of impending breathing pattern, as
non-productive breathing pattern, as respiratory difficulties evidenced by relaxed
cough evidenced by relaxed (Scribd, 2021). breathing, normal
breathing, normal respiratory rate or
respiratory rate or 3.Auscultate breath 3.To detect pattern (RR = 28-38
pattern (RR = <60 sounds at least every decreased or cpm), and absence of
cpm), and absence of 4 hours. adventitious breath retractions.
retractions. sounds (Padula,
C.A., et al., 2009). >Remained
respiratory rate within
>Remain respiratory established limits.
4.Note muscles used 4.This signifies an
rate within
for breathing and increase in work of
established limits.
retractions. breathing (Scribd,
>Demonstrated
2021).
feeling of comfort
>Demonstrate feeling
61
of comfort when 5.Assist the patient to 5.These measures when breathing.
breathing. a comfortable promote comfort,
position, such as by chest expansion, and
supporting upper ventilation of basilar >Performed
>Perform extremities with lung fields (Padula, diaphragmatic
diaphragmatic pillows, providing an C.A., et al., 2009). pursed-lip breathing.
pursed-lip breathing. overbed table with a
pillow to lean on, and
elevating the head of
bed.
6.Plan for periods of 6.Fatigue is common

rest between with the increased
activities. work of breathing
from the ineffective
breathing pattern.
Activity increases
metabolic rate and
oxygen requirements
(Martin, 2020).
7.Teach the parents 7.These measures

about: allow the patient and
>pursed-lip breathing parents to participate
>abdominal in maintaining health
breathing status and improve
>performing ventilation (Padula,
relaxation techniques C.A., et al., 2009).
>taking prescribed
medications
(ensuring accuracy of
dose and frequency
and monitoring
adverse effects)
62
>scheduling activities
to avoid fatigue and
provide for rest
periods.
Collaborative:
1.Perform chest 1.Chest
tapping every after physiotherapy is a
nebulization as group of physical
ordered by the techniques that
physician. improve lung function
and help you breathe
better. Chest PT, or
CPT expands the
lungs, strengthens
breathing muscles,
and loosens and
improves drainage of
thick lung secretions
(Spader, 2020).
2.Increase oxygen 2.Supplemental

therapy to 3 LPM oxygen helps reduce
from 2 LPM via hypoxemia and
cannula as ordered relieve respiratory
by the physician. distress (Padula,
C.A., et al., 2009).
3.Nothing by mouth 3.The patient will

as ordered by the have difficulty eating
physician. when he is in
respiratory distress.
4.Medication 4.Ensuring that
63
administration as medications are
ordered by the given safely,
physician. accurately and to
avoid any additional
complications.
64
Nursing Care Plan 3

(cite sources)
Subjective cues: Impaired gas Short Term: Independent: Short Term:

(None) exchange r/t At the end of 6 hours, 1.Monitor >Manifestations of At the end of 6 hours,
ventilation-perfusion client will be able to: respirations: quality, respiratory distress client:
Objective cues: imbalance AEB >Show improved rate, rhythm, depth, are indications of the
V/S upon admission: SaO2 <95%, oxygenation (SaO2 and any use of degree of lung >Showed improved
HR:188 bpm dyspnea, tachypnea >95%) with less accessory muscles. involvement. Rapid, oxygenation O2 sat
RR: 44 cpm and tachycardia symptoms of shallow breathing (99%) with less
O2 saturation: 97% respiratory distress: patterns and symptoms of
less wheezing, RR < hypoventilation respiratory distress:
Shortness of breath 40 cpm, HR directly affects gas occasional wheezing,
Wheezing <140bpm, SaO2 exchange. Flaring of RR 34 cpm, HR 121
>95% after providing the nares, dyspnea, bpm, SaO2 99%.
V/S 10:00 PM - nursing interventions. use of accessory
12/02/2020 muscles, tachypnea Long Term:
RR: 40cpm Long Term: and/or apnea are all At the end of 2 days,
HR: 140 bpm At the end of 2 days, signs of severe client:
O2 saturation: 94% client will be able to: respiratory distress
that require>Exhibited adequate
>Maintain adequate immediate gas exchange
gas exchange intervention (Vera,
maintained at a
(oxygen saturation 2020). normal level: O2 sat
>95%) with no (97%) with no
supplemental oxygen 2.Continue to strictly >To follow disease supplemental oxygen
therapy and show monitor oxygen progression. Pulse therapy and showed
absence of saturation; pulse Oximetry: SaO2 absence of
symptoms of oximetry every 2 should be >95% symptoms of
respiratory distress. hours. (Prenhall, 2021). respiratory distress:
no wheezing, RR 38
3.Periodically assess > When oxygenation cpm, HR 108 bpm.
for cyanosis; observe and perfusion
65
skin color, mucous weaken, peripheral
membranes, and nail tissues become
beds. cyanotic. Cyanosis of
nail beds (peripheral
cyanosis) may
indicate
vasoconstriction or a
response to
fever/chills; however,
cyanosis of the
mucous membranes,
and skin around the
mouth (circumoral/
central cyanosis)
indicates systemic
hypoxemia (Vera,
2020).
4.Continue to monitor >Tachycardia is a

heart rate and present as a
rhythm. response to
hypoxemia (Vera,
2020).
5.Monitor >Restlessness,
restlessness, and irritation, confusion,
changes in level of and somnolence may
consciousness. reflect hypoxemia
and decreased
cerebral oxygenation
(Vera, 2020).
6.Educate parents on >Prevents over

how to maintain exhaustion which
66
patient in a depletes oxygen
comfortable, rested demand to facilitate
state. resolution of
decreased oxygen
level (Vera, 2020).
7.Teach parents >Promotes maximum

proper positioning to chest expansion
ensure the patient's which improves
head is elevated. ventilation (Vera,
2020).
Collaborative:
1.Maintain and >Supplemental
monitor oxygen oxygen improves gas
therapy as ordered exchange and
by the physician: oxygen saturation
oxygen at 2 LPM via (RNLessons, 2021).
cannula.
67
Nursing Care Plan 4

(cite sources)
Risk for aspiration r/t Short Term: Independent: Short Term:

Subjective cues: decreased ability to At the end of 3 hours, At the end of 3 hours,
(none) clear airway the patient will be 1. Assess airway >Maintaining an open client:
able to: patency and clear airway is
secretions secondary
Objective cues: vital to retain airway >Showed improved
Chief complaint: to disease condition >Show less clearance and reduce respiratory function.
Cough and colds symptoms of risk for aspiration
respiratory distress; (Wayne, 2017). >O2 sat maintained
V/S upon admission: maintain a good at a normal level
T: 36.6°C SpO2: >95% and >Signs of aspiration (>95%).
HR:188 bpm have a respiratory 2.Monitor respiratory should be identified
RR: 44 cpm rate of less than 40 rate, depth, and as soon as possible At the end of 2 hours,
SpO2: 97% cpm. effort. Note any signs to prevent further the family of the
of aspiration such as aspiration and to patient was able to:
V/S 12/2/20 10:00pm At the end of 2 hours, dyspnea, cough, initiate treatment that
T: 36.2°C the family of the cyanosis, wheezing, can be life-saving >Explain and return
HR: 140 bpm patient will be able to: or fever. (Wayne, 2017). demonstrate the
RR:40 cpm steps in preventing
SpO2: 94% >Know the steps in >Abnormal lung aspiration in the
preventing 3.Auscultate for sounds associated instance that it may
aspirations. abnormal respiratory with aspiration will be happen.
Physician’s notes: sounds. that of crackles
>Know the (rales) and wheezing >Understand and
12/1/20 8:25am connection of the (Ausmed, 2017). fully grasp the
disease condition of connection between
RR: 60 cpm the patient and risk >Nausea or vomiting disease and risk of
(+) SC/IC retractions for aspiration. 4.Assess for places patients at the patient.
presence of nausea great risk for
12/2/20 6:30am or vomiting. aspiration, especially
Long Term: if the level of Long Term:
68
RR: 50-52 cpm At the end of 3 days, consciousness is At the end of 3 days,
spO2: 97% at 2lpm the patient will be compromised. the patient was able
(+) rales able to: Antiemetics may be to:
required to prevent
12/2/20 7:40pm >Maintain a aspiration of >Maintain a
respiratory rate of regurgitated gastric respiratory rate of 34
(+) occasional 30-40 cpm and an contents (Wayne, cpm and an oxygen
wheezing oxygen saturation of 2017). saturation of 97%
(+) rales, bilateral greater than 95% indicating improved
>Maintaining a sitting respiratory function.
12/3/20 9:40am >Show no signs of 5.Keep the head of position after meals
respiratory distress. bed elevated when may help decrease >Show absence of
(+) wheezing feeding and for at aspiration retractions during
(+) rales, bilateral >Display recovery by least half an hour pneumonia. (Wayne, inhalation and
having no abnormal afterwards. 2017). exhalation.
lung sounds
(wheezing, crackles). >Displayed recovery
Collaborative: >Early intervention by showing no signs
1.Inform the protects the patient’s of abnormal lung
physician or other airway and prevents sounds, particularly
health care provider aspiration. Anyone wheezing and
instantly of noted identified as being at crackles, upon
decrease in high risk for auscultation.
cough/gag reflexes or aspiration should be
difficulty in kept NPO (nothing by
swallowing. mouth) until further
evaluation is
completed (Wayne,
2017).
A chest x-ray helps to

2.Acquire chest x-ray. differentiate the
patient with
aspiration as to
69
whether they have
acquired pneumonia
or not. Pulmonary
infiltrates on chest
x-ray films indicate
some level of
aspiration has
already occurred
(Wayne, 2017).
>Having smaller and

3. Place on diet for more frequent
age with strict feedings reduces the
aspiration precaution risk of aspiration
as ordered by greatly. The elevation
physician. of the head to greater
than 30 degrees
during feeding
facilitates movement
of food into the GI
(Carrera, 2012).
70
Nursing Care Plan 5

(cite sources)
Objective Cues: Interrupted family Short Term: Independent: Short Term:

● Child processes r/t sick At the end of 2 hours, 1.Assess family >Stable, secure, and At the end of 2 hours,
diagnosed child AEB parental family will be able to:dynamics in handling mutual family family has:
with bronchial stress from current their ill child and to relationships
asthma in situation >Openly facilitate enhance consistent >Openly
acute communicate and communication disease management communicated and
exacerbation discuss their between members. behavior by discussed their
● Emergency thoughts and feelings permitting a sharing thoughts and feelings
hospitalization about disease and of the burdens about disease and
(child hospitalization. associated with hospitalization.
admitted for 3 disease (Berkowitz,
days) >Acknowledge their et al., 2001). >Acknowledged their
emotional and emotional and
personal needs. 2.Provide information >Patient’s personal needs.
about the child’s hospitalization is not
Long Term: condition. Show a pleasant thing for Long Term:
At the end of 3 days, empathy and any individual in the At the end of 3 days,
family will be able to: support. family, since it can family has:
cause crisis due to
>Cope with the dysfunction and >Coped with the
situation regarding instability. Information situation regarding
the child’s illness. provided by the child’s illness.
healthcare
>Engage in social professionals should >Engaged in social
support and be reliable and support and
educational activities. sincere, it is required educational activities.
at frequent repetition,
71
so that family can
comprehend the
conditions (Bellou &
Gerogianni, 2014).
Collaborative:
1. Collaborate with >Coping support
community resources interventions can
for the family after improve parent
discharge: supportive emotional outcomes.
counselling and These are effective
psychoeducational for improving parents’
programs. anxiety and stress
symptoms burden
(Doupnik et. al.,
2017).
72
XII. DISCHARGE PLAN
M-E-T-H-O-D-S RATIONALE/NURSING CONSIDERATIONS
Medications
● Salbutamol nebule 1 neb ● Used as a quick-relief agent for acute

every 6 hours bronchospasm and for prevention of
(3am-9am-3pm-9pm) for exercise-induced bronchospasm. Perform chest
for 5 days tapping every after nebulization as ordered by the
physician to help improve lung function and help
breathe better. Instruct parents of patients to
contact a health care professional immediately if
shortness of breath is not relieved by medication or
is accompanied by diaphoresis, dizziness,
palpitations, or chest pain.
● Co-amoxiclav 250mg/62.5 ● Treatment of a variety of infections including: Skin

mcg/5ml suspension 2.5 ml and skin structure infections, otitis media, sinusitis,
3x/day for 5 days resp tract infections, GU tract infections. Instruct
parents of patients that medication should be taken
round the clock and to finish the drug completely as
directed, even if feeling better.
● Prednisone (Pred 20) 20 ● Suppresses the immune system by reducing

mg/5ml suspension 2.5 ml activity and volume of the lymphatic system;
once a day (Give 1st dose suppresses adrenal function at high doses.
today 12-4-2020) for 5
days
● Phenylpropanolamine HCl ● Indicated for allergic and vasomotor or other

+ Brompheniramine hyperactive nasal disorders and acute coryza, relief
maleate (nasatapp) drugs of nasal congestion and hypersecretion. Relief of
1 ml once a day at hours of nasal congestion in infants up to children 12 years
sleep for 3 days of age. Inform parents of patients that drowsiness
may occur. Instruct the parents of the patient to
contact a health care professional if symptoms
persist.
Exercise
● Advise parents to make ● Such exercises are aimed at increasing expiratory

their child perform simple function and tightening the abdominal muscles.
exercises like bending side
to side, bending forward,
touching the left foot with
the right hand (vice versa),
and abdominal breathing.
Treatment
● Do not stop taking the drug ● To ensure full recovery and alleviation of
without consulting your discomfort.
healthcare provider.
73
Health Teachings
● Advise the parents to keep ● This will help identify asthma triggers so you can
a diary of their child's keep your child away from them.
asthma symptoms.
● Nicotine and other chemicals in cigarettes and

● Instruct the parents to cigars can make your child's asthma worse. Smoke
distance their child from from e-cigarettes or smokeless tobacco still contain
smoke. nicotine.
● Tell the parents to avoid ● To avoid exacerbation of asthma.

allergens by environmental
control
● Instruct the parents to ● In 2 to 3 days, if your child is not getting better,

observe the child and please make an appointment at your clinic. When
contact physician if their your child feels better, schedule a time to discuss
child has trouble breathing, asthma control with your doctor.
medication doesn’t work,
and the condition gets
worse, appears blue or
pale, won’t drink or can’t
keep down liquids, has
severe pain, goes more
than 8 hours without
urinating/peeing, has dry
mouth or sleepier than
usual.
● Avoid exposure to
infections. ● Prednisone is an immunosuppressant drug which
may put the client prone to infection.
Out-patient; Follow up Visit
● Instruct the parents to ● Teach parents that the child will need to return to
come back for a follow-up make sure the medicine is working and that his or
visit on 12-14-2020, 12 her symptoms are being controlled. Child may be
noon. referred to an asthma specialist. Bring a diary of
the child's peak flow numbers, symptoms, and
possible triggers to the follow-up appointments.
Instruct to write down questions to remember to
ask them during the child's visit.
74
Diet
● Place on diet for age with ● Having smaller and more frequent feedings
strict aspiration precaution reduces the risk of aspiration greatly.
as ordered by physician.
● The patient is advised to ● This is done to promote proper nutrition. This can
eat adequate amounts of help support healthy lung function, reduce lung
vegetables and fruits, milk, inflammation, and increase airflow to help make
proteins from whole grain, breathing easier.
omega-3 from fish, and
foods rich in vitamin C, E
and bioflavonoids.
.
● Avoid any processed food, ● This is done to prevent inflammation in the lungs,
sugar, and keep fast food too much sugar which can lead to weight gain, and
meals to a bare minimum. processed foods can result in exacerbated asthma
symptoms.
Spirituality
● Pray daily, read the bible if ● These help in absorbing positivity through beliefs
needed, and go to church and practices that could contribute to a healthy
every Sunday. mind and fast recovery.
75
XIII. PROGNOSIS
Legend:
(5) Excellent — Patient performs excellently; is cooperative, independent and responds

actively to nursing interventions.
(4) Good — The patient is independent in some ways, performs well and responds actively
to nursing interventions.
(3) Fair — Patient performs weakly and is somewhat dependent; responds minimally to
nursing interventions.
(2) Poor — Patient performs poorly and is very dependent; does not respond to some
nursing interventions.
(1) Very Poor — Patient does not perform and is very dependent; does not respond to the
nursing interventions at all.
Criteria 5 4 3 2 1 Justification
A. Physiologic / The physiologic response of the

response of the body is responding to the infection
through an immune reaction
patient to the
however has not sufficiently gotten
disease process rid of the infection in the bronchi
which is mainly the reason for the
asthma. Furthermore the patient
displays bilateral retraction which
indicates inadequate breathing
which has affected the amount of
oxygen available for his body as
indicated by the need for oxygen
therapy. We decided to rate the
patient with fair because his
condition was exacerbated by
natural phenomenon but his
recovery has steady throughout the
following two days, being afebrile
only a few hours after with no
recurrence as well as lowered
retractions and tachypnea by the
next day.
B. Relief of the signs / Upon admission, the patient

presented with tachypnea but has
76
and symptoms later on improved throughout his
associated with stay. The patient was afebrile
throughout the admission period. His
disease condition
appetite improved during his third
of the patient day. There were negative signs of
wheezing and retractions and health
has greatly improved on the fourth
day thus the patient was permitted
to go home with home medications
given by the physician.
C. Performance of / The patient was able perform daily

daily living of the activities like bathing, eating, change
of clothing and using the restroom
patient during the
with the assistance of the parents.
confinement
D. Compliance of the / Patient was cooperative with the

patient to the drug regimens and was able to take
all medications with the help of the
medication and
nurse. The Patient’s parents were
therapy fully aware of the different
medications, route, and dosage and
fully agreed to the medications
given.
E. Adequacy of rest / Throughout his admission, the

and sleep of the patient was able to maintain
adequate amounts of rest, but sleep
patient receives
was disrupted by the taking of vital
signs and administration of
medications.
F. Consumption of / Patient was cooperative as he was

the medication able to consume all the medications
that were prescribed to him during
and therapeutic
his admission.
regimen of the
patient
77
Excellent (3) 1x5=5
Very Good (2) 3 x 4 = 12
Good (2) 2x1=2
Fair (0) 0x2=0
Poor (0) 0x1=0
TOTAL 19
Formula:
(The total score / The Highest possible Score) x 100 = Percentage Score (%)
(19 / 30) x 100 = 63.33%
Rating Scale:
81% - 100% - Excellent
61% - 80.99% - Very Good
41% - 60.99% - Good
21% - 40.99% - Fair
20.99% below - Poor
The Prognosis and Rating of the patient: 63.33% - Very Good Prognosis
The patient was admitted to the hospital on December 1, 2020. Upon admission, the
patient had a cough and experienced tachypnea and retractions. The first day, the patient
had tachypnea and it was lessened hours after admission due to the medications that were
taken. On the second day, tachypnea and retractions were still present. The patient
experienced occasional wheezing and food appetite is improving. On the third day, the
patient still had wheezing, rales bilateral, retractions but food appetite was even better. On
his last day, the patient showed no signs of wheezing, rales bilateral, retractions. The patient
was afebrile throughout his admission and vitals were checked from time to time and it was
78
stable and thus permitting the patient to discharge on the fourth day, however, home
medications were still prescribed.
This would indicate that the medications and procedures given to the patient were
effective and these include: Phenylpropanolamine and Brompheniramine maleate drops 1
mL TID, Ceftriaxone 600 mg IV drip x 1hour q12h ANST, Hydrocortisone 45mg IVTT Q6,
Salbutamol nebula q4H, Co-amoxiclav 750mg/62.5mg/5ml 2.5 ml, TB PO, O2 2LPM/Canal.
The overall progress of the patient was very good, with the percentage of 63.33%.
Appropriate nursing care was provided as a result that the patient showed improvements
with the help of the medications and procedures given by the physician. The patient’s
parents interacted with the physician and health care team and as shown by the prognosis
chart, the patient improved well, however, home medications are still needed to be taken.
79
XIV. CONCLUSION
A 1-year-old male child with a final diagnosis of Bronchial Asthma in Acute
Exacerbation was admitted to the Emergency Room with a chief complaint of cough and
colds.
All necessary information was gathered through thorough studying of the patient’s
chart: admission date (12/01/20 – 11:27PM) until discharge date (12/09/20 – 6:00PM). Client
showed an impression of having PCAP-C (Pediatric Community Acquired Pneumonia) with
asthma and was therefore given nebulization and treatment with medications of Ceftriaxone
(Viatrex), Salbutamol, Phenylpropanolamine HCl + Brompheniramine Maleate (Nasatapp)
Drops, and Paracetamol drops as noted by physician and advised to follow medication
compliance regarding the take-home medications given with no surgical procedures needed.
The client’s condition falls under very good prognosis. Appropriate nursing care
interventions were provided. Client's condition improved as a result of the medications and
procedures prescribed by the doctor.
Upon admission, it was evident that the client had persistence of symptoms
(non-productive cough with clear nasal discharge), associated fast breathing, decreased
appetite, decreased milk formula intake (6 oz from usual intake of 18 oz), positive vomiting
(post tussive), (+) SC/IC (subcostal/intercostal) retractions, and tachypneic. Following
admission, there was evident improvement through decreased tachypnea, decreased
retractions, and afebrile temperature until there are clear breath sounds, no wheezing, no
retractions, good activity, afebrile temperature, and alert state. Health teachings were given
with emphasis on proper nutrition, safety precautions, adequate rest and hydration including
verbalization of any concern, infection control, comfort measures, and precautions regarding
medications (medication compliance).
80
The proposed nursing actions focused on how to improve the condition affecting the
recovery of the client during their hospitalization. This can be achieved through interactive
discussions and reinforcement of teaching to the parents of the 1-year-old. Furthermore, the
student nurses were able to achieve their objectives. They have gained new knowledge that
raises awareness of personal and professional accountability. With this new knowledge, their
skills will improve to provide the appropriate nursing care to their future clients.
81
VX. RECOMMENDATION
Based on the mentioned conclusions, the student nurses have established the
following recommendations. The following points aim to guide and suggest for improvement
to the following individuals and groups:
Patients with Bronchial Asthma. The patient must know what triggers their signs
and symptoms of asthma. By knowing what activates it, they will be aware of what they
should stay away from as far as possible. They should reduce their contact with pets and
refrain from smoking cigarettes. The best way to prevent an asthma episode, or attack, is to
follow the physician’s treatment plan and to take their medications regularly. On top of
everything else, if the patient experiences adverse effects from the medications, they should
immediately contact the nearest healthcare provider.
Level two, three and four nursing students. For the optimal well-being of the
patient, nursing students should address every sign and symptom by continual monitoring
and ensuring the improvement of the patient’s condition. Pursuing this further, medications
are crucial for the patient’s health and thus, should be checked if the patient is complying
correctly with the doctor’s orders. Also, health teachings should be carefully instructed by
making sure the patient understood the needed information. With this, nursing students
should aspire to improve their knowledge, skills, & character and provide appropriate nursing
interventions. If there is a need to perform a study on a similar case, nursing students must
investigate further into every detail and expand their knowledge on the concept of Bronchial
Asthma.
Physicians, registered nurses, and other members of the healthcare team. As
frontline workers, they need to ensure that quality patient care is observed throughout the
procedure, like measuring effectiveness and tracking improvement. Having an open and
welcoming approach would be appreciated in initiating with the patient. In recognition of the
82
diagnostic process, healthcare professionals must have the appropriate knowledge, skills,
resources, and support to engage in teamwork. They must also collaborate with patients and
their families as healthcare team members and facilitate patient and family engagement
during the whole process.
Future nursing students. The presented data of this study would serve as
information for future purposes such as research studies. Furthermore, case presentations
like this serve not only as a prerequisite for passing the course but also as a learning
opportunity to better understand the conditions of the patients. These are beneficial to future
nurses in understanding the necessary precautions, actions, priorities, and most importantly,
to be free from medical errors.
83
XVI. BIBLIOGRAPHY
a. Books
Doenges, M., Moorhouse, M. F., & Murr, A. (n.d.). Nursing Care Plan (8th Edition).
DavisPLus.
Doupnik, S. K., Hill, D., Palakshappa, D., Worsley, D., Bae, H., Shaik, A., Qiu, M. K., Marsac,
M., & Feudtner, C. (2017). Parent Coping Support Interventions During Acute
Pediatric Hospitalizations: A Meta-Analysis. Pediatrics, 140(3), e20164171.
https://doi.org/10.1542/peds.2016-4171
Jones & Bartlett Learning. (2015). 2015 Nurse’s Drug Handbook (14th ed.). Jones & Bartlett
Learning.
Kizior, R. J., & Hodgson, K. (2018). Saunders Nursing Drug Handbook 2019 (1st ed.).
Saunders.
Padula, C. A., Yeaw, E., & Mistry, S. (2009). A home-based nurse-coached inspiratory
muscle training intervention in heart failure. Applied nursing research : ANR, 22(1),
18–25. https://doi.org/10.1016/j.apnr.2007.02.002
Vallerand, A. H.,; Deglin, J. H. (2009). Davis's Drug Guide for Nurses (11th ed.).
Philadelphia, Pennsylvania: F.A. Davis.
b. Online References
Bellou, P., & Gerogianni, K. (2014). The Contribution of Family in the Care of Patient in the
Hospital, 3-4. Retrieved April 14, 2021, from
https://www.hsj.gr/medicine/the-contribution-of-family-in-the-care-of-patient-in-the-ho
spital.php?aid=3681
Carrera, A. (2012) Healthy at home: preventing aspiration in children. Retrieved from
http://www.shieldhealthcare.com/community/nutrition/2012/08/10/healthy-at-home-pr
eventing-aspiration-in-children/
84
Fidel, J. B. (2012). NCP Ineffective Breathing Pattern Tala. Retrieved April 13, 2021, from
https://www.scribd.com/doc/79860275/NCP-Ineffective-Breathing-Pattern-Tala
Grimm, L. J. (2021, April 03). Asthma imaging and Diagnosis: Practice Essentials,
RADIOGRAPHY, computed tomography. Retrieved April 16, 2021, from
https://emedicine.medscape.com/article/353436-overview
Impaired Gas Exchange Nursing Diagnosis & Care Plan. (n.d.). Retrieved April 13, 2021
from https://rnlessons.com/impaired-gas-exchange/
Institute of Medicine (US) Committee on Health and Behavior: Research, Practice, and
Policy. (2001). Health and Behavior: The Interplay of Biological, Behavioral, and
Societal Influences. National Academies Press (US), 5. Washington (DC). Retrieved
from https://www.ncbi.nlm.nih.gov/books/NBK43749/
LaMorte, W. W. (2017). Asthma. Respiratory Health. Boston University School of Public
Health. Retrieved April 16, 2021, from
https://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/RespiratoryHealth/RespiratoryHe
alth6.html
Lab Tests Online (2016). Asthma. Retrieved April 16, 2021, from
https://labtestsonline.org/conditions/asthma
Martin, P.(2020, January 09). Nursing diagnosis FOR Asthma: 8 nursing care plans.
Retrieved April 13, 2021, from https://nurseslabs.com/asthma-nursing-care-plans/
Mayo Clinic. (2020). Asthma - Symptoms and causes. Retrieved April 16, 2021, from
https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369
653
MIMS Philippines. (n.d.). Ceftriaxone: Indication, Dosage, Side Effect, Precaution. MIMS.
Retrieved April 13, 2021, from
https://www.mims.com/philippines/drug/info/ceftriaxone
MIMS Philippines. (n.d.). Hydrocortisone: Indication, Dosage, Side Effect, Precaution. MIMS.
https://www.mims.com/philippines/drug/info/hydrocortisone
85
MIMS Philippines. (n.d.). Ipratropium bromide Salbutamol: Indication, Dosage, Side Effect,
Precaution. MIMS. Retrieved April 12, 2021, from
https://www.mims.com/philippines/drug/info/ipratropium%20bromide%20+%2salbuta
mol
MIMS Philippines. (n.d.). Nasatapp Dosage & Drug Information. MIMS. Retrieved April 13,
2021, from https://www.mims.com/philippines/drug/info/nasatapp
MIMS Philippines. (n.d.). Prednisone: Indication, Dosage, Side Effect, Precaution. MIMS.
https://www.mims.com/philippines/drug/info/prednisone
Morris, M. J. (2021, April 03). Asthma. Retrieved April 16, 2021, from
https://emedicine.medscape.com/article/296301-overview#a4
Nursing care plan for aspiration (n.d.) Retrieved from
https://nursing.com/lesson/nursing-care-plan-for-aspiration/
Perlas, R. (2010). Ineffective Breathing Pattern. Retrieved April 13, 2021, from
https://www.scribd.com/doc/44674914/Ineffective-Breathing-Pattern
Selected Normal Pediatric Values. (n.d.). Retrieved April 13, 2021 from
https://wps.prenhall.com/wps/media/objects/354/362846/London%20App.%20B.pdf
Sinyor B., & Concepcion Perez L. (2020). Pathophysiology Of Asthma. In StatPearls.
Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved April 16, 2021,
from: https://www.ncbi.nlm.nih.gov/books/NBK551579/
Spader, C. (2020, November 15). Chest physiotherapy. Retrieved April 14, 2021, from
https://www.healthgrades.com/right-care/lungs-breathing-and-respiration/chest-physi
otherapy
Ukena, D., Fishman, L., & Niebling, W. (2008, May). Bronchial asthma: Diagnosis and
long-term treatment in adults. Retrieved April 16, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696883/
Vera, M. (2020). 11 Pneumonia Nursing Care Plans. Retrieved April 13, 2021 from
https://nurseslabs.com/pneumonia-nursing-care-plans/2/
86
Wayne, G. B. (2019, March 20). Ineffective Airway Clearance Nursing Care Plan.
Nurseslabs. https://nurseslabs.com/ineffective-airway-clearance/
Wayne, G. (2017) Risk for Aspiration Nursing Care Plan. Retrieved from
https://nurseslabs.com/risk-for-aspiration/
WebMD (n.d.). Asthma diagnosis & tests: How doctors diagnose asthma. Retrieved April 16,
2021, from https://www.webmd.com/asthma/diagnosing-asthma-tests#1
WebMD (n.d.). Bronchial asthma treatments, symptoms, causes, and more. Retrieved April
16, 2021, from https://www.webmd.com/asthma/guide/bronchial-asthma
WebMD (n.d.). Risk factors for asthma: Gender, genetics, allergies, and more. Retrieved
April 16, 2021, from https://www.webmd.com/asthma/asthma-risk-factors
WHO (2010, December 07). Asthma: Definition. Retrieved April 16, 2021, from
https://www.who.int/respiratory/asthma/definition/en/
87
XVII. APPENDICES
A. Doctor’s Orders
PHYSICIANS NOTES (SOAP) ORDERS
12/1/20 ● Please admit

5PM ● TPR q4H
● DA
● D50.3 in NaCl 500cc @ 65cc/HR
● IVF TF D5LR 1L @ 60cc/Hr
● CXR APL view
● CBC
● U/A
● Salbutamol 1 nebule now then ā4H,
use face mask firmly attached to
patients face.
● Phenylpropanolamine HCI +
○ Brompheniramine maleate
(Nasatapp)drops 1mL TID
P.O.
● Ceftriaxone (Viatrex) 600 mg IV drip x
1 hour q 12h; after negative skin test
(ANST)
● Paracetamol drops (Tempra) 1.2 mL q
4h PRN for temperature ≥ 37.8 C
● Oxygen at 2 L per minute (LPM) via
cannula
● Refer for SPO2 < 95%, cyanosis,
severe respiratory distress
● Inform me once admitted
● Checked informed consent form for
admission
● Give salbutamol 1 nebule now x2 doses

12/1/2020 ● Start hydrocortisone 45 mg IVTT now
5.25 pm then q 6 hrs
● O2 at 2LPM
12/1/2020
Assessment: RR 60, positive SL/IC
retractions
8: 25 PM
● Nebulize salbutamol every 3 hrs
● Please do chest tapping post
nebulizing
● Increase O2 to 3 LPM
● NPO temporarily
88
12/1/2021
Assessment: less tachypnea, afebrile
8:40 PM (absence of fever)
12/1/2020 ● Alternate nebulization using salbutamol 1

nebule and salbutamol + ipratropium 1
10:40 PM nebule q3 hrs
● Start antibiotics now
12/2/2020 Vital signs q 2hrs with strict O2 saturation

1:44 AM ● Refer saturation <95%
12/2/2020 Assessments:
6:30 AM decreased tachypnea,decreased retractions
(chest inwards), RR 50 -52 cpm, O2 sat
at 97% at 2 liters per minute, HR: 150s +
rales(crackles), better at eating
● Decrease O2 to 2 LMP
● Continue meds
●May have diet for age with strict aspiration
precaution
● Follow-up official CXR (chest x-ray) result
12/3/2020 Assessments: afebrile, good appetite, HR

9:40 AM 110s, RR 20s, SPO2 98% - room air
(RA), tolerated well
❏ Positive Rales bilateral o
positive Wheeze
❏ Negative Retraction
❏ Ceftriaxone D1 + 1
● Discontinue O2
● Refer if with desaturation (<95% sat)
● Decrease IVF to 45 cc/hr
● IVF to follow D5IMB @ 50 cc/hr
● Decrease nebulization interval to q4
12/3/2020 ● Assessment: no wheezes, no

11 AM retractions, afebrile, 97% sat at RA
● To consume ceftriaxone 600 mg
● Available stacks then shift to
Co-amoxiclav (Natravox) 250 mg/62.5
mg every 5 mL, 2.5 mL TID PO
● May not reinsert IV line once dislodged
and inform me
● Decrease IVF rate to 30 cc/hr
● Discontinue salbutamol + ipratropium
● Increase salbutamol to 1 nebule q 4h
89
● Continue hydrocortisone
● Assessment: 2 HD (hospital day), +

12/3/2020 wheeze (occasional), no retractions,
4:00 PM BP: 90/60, 114 BPM, 30 CPM, 99%
SPO2 at room air
12/4/2020 Assessment: - wheeze, no retraction,

9:00 AM +BM; VS: 90/60, 114 bpm, 28-38
CPM 98% sat
● Advise to do chest tapping every after
nebulization
● Increase oral fluid intake (OFI)
● Refer accordingly
12/4/2020 ● May go home

11:30 AM ● Take home medications
❏ Salbutamol 1 nebule q6h
(3-9-3-9) for 5 days
❏ Co-amoxiclav 250 mg/62.5 mg
(Amoxicillin/clavulanic acid)
❏ Prednisone (Pred 20) 20
mg/5mL (20 mg per 5 mL)
❏ Phenylpropanolamine HCL +
Brompheniramine maleate
(nasatapp) drops 1 mL OD
hour of sleep (HS)
❏ Follow up check up on
12/14/20 at MRXUH clinic
12NN
90
B. Nurse’s Notes
Date & Focus Data/Action/Response

Time
12/01/20 Pt entered emergency room due to cough and

colds; Ushered safely to bed, side rails raised,
3:30 PM ROD informed, admission facilitated, doctor’s
orders carry out
12-2-2020 Admission D: Received patient from emergency room A:

Health teaching given with emphasis on proper
8:00AM nutrition and safety precaution. Emphasized
proper nebulization technique towards watchers.
VS taken and recorded
R: Endorsed to nurse on duty
12-2-2020 Safety D: Pediatric Patient A: Placed on ____ side rails

Precaution raised,______, vital signs taken and
9AM recorded______
R: Safety maintained
12-2-2020 Adequate Rest A: encouraged & reinforced_____ pt’s rest &

& Hydration safety, encouraged verbalization of______
3PM concern, V.S. taken and recorded, needs
attended, kept rested & monitored for any
abnormalities
R : Positive understanding
12-3-2020 Safety A: placed patient safely at the center of the bed,

Precaution side rails raised, instructed mother not to leave
9AM patients unattended due to medication given,
V.S. taken & recorded,_____ keep watched for
any unusualities/abnormalities
R: Safety Maintained
12-3-2020 Infection Control ________
3PM
12-4-2020 Comfort A: _____

measures R: + well rested
8AM
91
C. Consent
92

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A GRAND CASE PRESENTATION OF A 1-YEAR-OLD CHILD

DIAGNOSED WITH BRONCHIAL ASTHMA IN ACUTE EXACERBATION

Presented to the Faculty of the College of Nursing

Xavier University-Ateneo de Cagayan

In Partial Fulfillment of the Requirements of

Nursing Care Management 109:

Related Learning Experience

Jennifer O. Asio, RN, MN

Roviech John M. Echeveria, RN, MAN

Ivy Royo Go, RN, MAN, DScN

April 16, 2021

Ali, Sittie Jobaisah T.

Banaag, Ma. Venus Caress T.

Bantol, John Louise T.

Banza, Khrisna Nymph P.

Carlos, Jude Mariano Jr. A.

Danseco, Danna Francesca S.

Del Rosario, Carylle M.

Famacion, Kyra Bianca R.

Go, Clarke Nathaniel Sean E.

Laid, Althia Crizza J.

Mah, Chloe Gwyneth R.

Maribao, Dylan Sean Ezekiel

Miñoza, Ana Rose Anthony E.

Nagac, Ailene Grace C.

Ragpala, Fide Lynn C.

Ravacio, Earl Christoffer C.

Romorosa, Christine Marie Pauline C.

Samoya, Abigail Kim T.

Sio, Zoe Nicole C.

Torion, Zenn Pauline M.

Torre, Carlos Joseton Paolo S.

Vallecer, Matthew Orlando IV V.

Waga, Mikayla Martina C.

Yongco, Sheila Adrianne S.

expanded their capabilities as a student nurse.

competent in all aspects and to be the true example of a dedicated nurse.

better version of themselves.

were essential for the completion of this paper.

effort spent from Block F was very much appreciated.

II. Specific Objectives ……………………………………………………………………….2

III. Significance of the Study…………………………………………………………………4

IV. Scope and Limitations…………………………………………………………………….6

VIII. Laboratory Results………………………………………………………………………...22

XI. Nursing Care Management……………………………………………………………….57

a. Nursing Care Plan 1………………………………………………………….57

b. Nursing Care Plan 2………………………………………………………….61

c. Nursing Care Plan 3………………………………………………………….65

d. Nursing Care Plan 4………………………………………………………….68

e. Nursing Care Plan 5………………………………………………………….71

XII. Discharge Plan…………………………………………………………..………………...73

XVI. BIBLIOGRAPHY…………………………………………………………. ………………84

patient-centered healthcare professionals in the future. Furthermore, effective

the greater glory of God.

● Thoroughly discuss the pathophysiology of the condition of the patient to fully

understand the etiology, methods of prevention, pathologic processes, signs

and symptoms, and the appropriate treatment and nursing interventions;

based on the assessment findings of the patient;

● Explain the relevance and rationale of the nursing interventions presented

with regards to alleviating the condition of the patient;

● Discuss the importance and indications of the medications prescribed by the

physician through the presentation of the drug study;