Asthma

NAME: RAPRAP
ROOM NUMBER: Pedia Ward
AGE: 9 years old
GENDER: Male
CIVIL STATUS: Child
DATE OF BIRTH: June 12,2012
BIRTHPLACE: Pagadian City, Zamboanga del Sur
CULTURAL GROUP: Cebuano
RELIGION: Roman Catholic
HIGHEST EDUCATIONAL ATTAINMENT: Grade 3
OCCUPATION: N/A
DATE OF CONFINEMENT: November 5, 2021

A. Description of Patient
A 9 year old boy who lives at Tuburan District Pagadian City,Zamboanga del sur. His parents
brought him to the hospital last November 5, 2021
B. Reasons for seeking Health Care
He was experiencing severe breathlessness or wheezing while having family dinner outside, he
couldn't talk, and it didn't get better even after he used the rescue inhaler, so her parents decided
to take her to the hospital right away.
C. History of Present Illness
According to the parents, their son was fine before going out for family dinner, but after 5
minutes of eating masi dessert, they noticed that their son was having trouble breathing and that
his lips were turning blue. His mother quickly grabbed the rescue inhaler from his son’s bag
when she realized what had happened. They inquired of one of the crew about the contents of the
dessert, and when they discovered that it contained nuts, they rushed their son to the hospital for
admission.
D. Past Health History (PHH)
Patient was diagnosed with asthma since he was 3 years old and the pattern of attack is once a
month.
E. Family History:
According to the mother, they have family members who are asthmatic (mother side). On the
other hand in the paternal side, grandmother is diabetic and has a maintenance medicine

Family Genogram

Mother’s Side Father’s Side

Legend:

Female Alive and well Ill

Male Deceased Asthma

Patient Diabetes

F. Social History
Patient is the second child. He is currently a grade 3 student and loves to play outdoor games like
soccer, basketball and badminton

G. Immunization Exposure to Communication Disease

The patient had completed his immunization when he was a child. He received Hepatitis B
vaccine right after birth. He received MMR vaccine received flu vaccine, DPT, OPV and
pneumonococcal vaccine at the Rural Health Unit.

H. Allergies
According to his mother, the patient is allergy on nuts, shrimps, crabs and other crustaceans

I. Home Medication/Alternative Medicine

 According to the mother when asthma attacks on her son, she usually prepare a turmeric tea with
honey extract.
Gordon’s Assessment
Health perception
Nutritional Metabolic
Elimination
Activity/Exercise
Sleep and rest
Cognitive/Perceptual
Role-Relationship
Sexuality-Reproductive
Coping/Stress Tolerance
Values/Beliefs
BEFORE
HOSPITALIZATION
Client is active in school and
loves to play games
Client eats 3x a day. His diet
includes eating canned goods
and processed foods and
doesn’t want to eat vegetables
Client urinates 6-7 times a
day and defecate once a day
Client goes to school
everyday and after school he
plays with his friends
Client sleeps 8-9 hours
There is no problem in his
senses. He can comprehend,
and physically and verbally
responsive.
He and his brother are the
source of strength of his
parents
Client has not yet undergone
puberty and has less
knowledge on topics related
to sexuality
Client does not recognize
stressors
Client is a Roman Catholic
and participates actively on
church activities
DURING
HOSPITALIZATION
Client can’t play and go to
school because he is ill
Client eats vegetables and
fruits to bring back his health
Client is able to urinate 6-7
times a day and defecate once
a day normally everyday
Client reads books and plays
with his gadgets
Client has a hard time
sleeping due to his condition
Client is very responsive
when asked some questions
His brother and parents are
stressed out due to his
condition
Same
Same
Client is sad because he is
unable to go to church
because of his condition
Physical Assessment

BODY PARTS NORMAL ACTUAL ANALYSIS

FINDINGS FINDINGS
Skin Uniform color, Skin color is equally Normal Findings
except the exposed to distributes, no lesions
the sun areas, no or edema present.
edema present and no
lesions.
Hair Evenly distributed Hair is evenly Normal Findings
hair, thick and black, distributed, hair is
no infection, and no black, with no
presence of dandruff, evidence of alopecia,
silky and resilient no presence of
hair dandruff
Head/Scalp Rounded, smooth The color of the scalp Normal findings
skull contour, is fine and there are
absence of nodules no lumps/masses, no
and masses; has lesions. Smooth skull
systematic facial contour
features and
movements
Eyes Eyebrows and Eyebrows and Normal findings
Eyelashes are evenly Eyelashes are evenly
distributed, the distributed, there
eyelids has no were no presence of
discharge and no discharge on eyelids
discoloration; pupils and no discoloration,
are black in color; eyes are dark brown
round, equal in size in color, sclera is
normally 3-7 mm in white in color, pupils
diameter, conjunctiva are black in color and
pink in color, the equal in size
sclera white in color
EARS Color is the same as Color is the same as Normal findings
facial skin color, facial skin color, Ears
symmetrical, auricle are equal in size
aligned with outer bilaterally
canthus of eyes about The auricle aligns
10o from vertical, not with the corner of
tender, pinna recoils each eye, Earlobes
after it is folded able are attached to the
 to hear sound in both skin.The earlobes are
ears. bean-shaped, parallel,
and symmetrical, The
pinna recoils when
folded
NOSE Symmetric and symmetric, smooth, Normal Findings
straight, no discharge uniform in color, no
of flaring, uniform in signs of discharge or
color, no tenderness flaring, no lesions are
and no lesions present
LIP/MOUTH Lips pink in color, Lips are bluish in It indicates a lack of
soft, moist, (+) ability color blood flow or a lack
to purse lips, teeth are of oxygen circulating
in place, tongue is in in the blood due to
central position, pink his condition
in color
Throat Uvula is midline Uvula is midline,the Normal Findings
absence of edema, thyroid cartilage,
normal mucosa is cricoid cartilage
oink with ridged hard move
plate. Torus palatinus upward
may be present. symmetrically as the
client swallows
NECK Muscle equal in size, Muscle equal in size, Normal Findings
head centered; head head centered,
movement is Uniform in color, no
coordinated and in lumps/masses, no
smooth movement, pain when
no enlargement of swallowing, head
lymph nodes/ centered
CHEST Quiet, rhythmic Breathing faster, Breathing problem,
respiration, normal shortness of breath, coughing and
breathing rate, (-) there is presence of wheezing due to the
wheezes or crackles coughing and muscles surrounding
wheezing the walls of the
airways tighten as
well.
ABDOMEN Uniform in color, no Uniform in color, Normal findings
evidence of enlarged skin is intact, soft and
liver or spleen. no tenderness.
Audible bowel
sounds, absence of
arterial bruits, no
tenderness
EXTREMITIES Convex curvature, Convex curvature, Normal findings
nailbeds pinkish in Nails are pinkish in
 color, (+) capillary color and there are no
refill return to usual signs of markings and
color (2-3 sec) the capillary refill
return to usual color

LABORATORY EXAMINATION

Date: Nov. 5, 2021

Examination Normal Values Actual Findings Significance

Hemoglobin, mg/dL 11.3 - 16.0 15.4 Normal
RBC, 104/μL 370-550 529 Normal
WBC, /μL 4000-11,000 6250 Normal
Lymphocyte % 0.38 - 0.54 0.42 Normal
Segment % 0.40 - 0.60 0.53 Normal
Monocyte % 0.02 - 0.05 0.02 Normal
Eosinophil % 0.0 - 0.01 0.03 Abnormal
Platelet, 104/μL 12.0 - 40.0 24.6 Normal
BUN, mg/dL 8 - 20 11.0 Normal
Creatinine, mg/dL 0.6 - 1.5 0.8 Normal
eGFR, mL/min/1.73 >60 87.80 Normal
m2

Date: Nov. 6, 2021

pH 7.35 - 7.45 7.585 Increases

PO2, mmHg 80-100 112.5 Increases
PCO2, mmHg 35-45 19.6 Decreases
HCO3, mmHg 12.5 12.8 Increases
HCO3 act, mmol/L 24-29 18.2 Decreases
BE (B), mmol/L - 2.4 - 2.4 -1.2 Normal
O2sat, % 95 - 98 98 Normal
ctCO2, mmol/L 24-32 18.8 Decreases
lgE, IU/mL <100 516.3 Normal
Discharge Plan

Medicine Advise the parent or guardian to continue the

prescribed home medications unless the
pediatrician says it’s finished to ensure
complete recovery of the patient.
Exercise Instruct the patient to exercise on a regular
basis
Treatment Inhalers should be easy access to the clients
Take the prescribed medications
Use of nebulizers when needed.
Health Education Advice guardian or parents to use dust-proof
covers on mattress and pillows. Wash the
sheets and blankets on bed once a week in
very hot water.
Teach the client to monitor early signs and
symptoms of asthma
Remind the client to always have quick
inhaler or teach the patient using paper bag to
regulate hyperventilation.
Advice parents to do follow up check-up as a
Outpatient Dep’t physician’s order.
(Follow-up Check Up)
Diet Maintain a healthy weight, eat fruits and
vegetables, avoid allergic foods that can
trigger asthma
Spirituality Encourage the parents to pray and ask for
God’s Continues healing of their child
ASTHMA

What is Asthma?

Asthma is a long-term disease of the lungs. It causes airways to get inflamed and narrow, and it
makes it hard to breathe. During an asthma attack, the airways will swell, the muscles around
them will tighten, and it becomes difficult for air to move in and out of the lungs. Asthma can't
be cured, but its symptoms can be controlled.
The five most common types of asthma are: exercise-induced bronchospasm (EIB), allergic
asthma, cough-variant asthma, occupational asthma, and nocturnal or nighttime asthma. EIB
occurs after physical exertion. It’s not always easy to determine which type of asthma you have.
Proper diagnosis and regular communication with your doctor can help you to determine the best
course of action.

Anatomy
Pathophysiology
Symptoms
Asthma is marked by inflammation of the bronchial tubes, with extra sticky secretions inside the
tubes. People with asthma have symptoms when the airways tighten, inflame, or fill with mucus.
There are three major signs of asthma:
 Airway blockage. When you breathe as usual, the bands of muscle around your airways
are relaxed, and air moves freely. But when you have asthma, the muscles tighten. It’s
harder for air to pass through.
 Inflammation. Asthma causes red, swollen bronchial tubes in your lungs. This
inflammation can damage your lungs. Treating this is key to managing asthma in the long
run.
 Airway irritability. People with asthma have sensitive airways that tend to overreact and
narrow when they come into contact with even slight triggers.

These problems may cause symptoms such as:

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

Complications
For most people with asthma, using medications and making certain lifestyle changes will allow
them to manage their symptoms and avoid most short and long-term complications.
But poorly managed or poorly treated asthma can result in additional problems. In the short-term
those problems can include severe asthma attacks, disruption to normal activities, and increased
risk of pneumonia and other lung infections. Farther down the line, problems can include
permanent airway damage, mental health problems, weight gain, and increased risk of other
chronic illnesses.

Causes
It isn't clear why some people get asthma and others don't, but it's probably due to a combination
of environmental and inherited (genetic) factors.
Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and
symptoms of asthma. Asthma triggers are different from person to person and can include:
• Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of
cockroach waste
• Respiratory infections, such as the common cold
• Physical activity
• Cold air
• Air pollutants and irritants, such as smoke
• Strong emotions and stress
• Sulfites and preservatives added to some types of foods and beverages, including shrimp,
dried fruit, processed potatoes, beer and wine
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up
into your throat

Risk Factors
A number of factors are thought to increase your chances of developing asthma. They include:
• Having a blood relative with asthma, such as a parent or sibling
• Having another allergic condition, such as atopic dermatitis — which causes red, itchy
skin — or hay fever — which causes a runny nose, congestion and itchy eyes
• Being overweight
• Being a smoker
• Exposure to secondhand smoke
• Exposure to exhaust fumes or other types of pollution
• Exposure to occupational triggers, such as chemicals used in farming, hairdressing and
manufacturing

How Long Is The Incubation Period for Asthma, and How Long Does Asthma Last?

There is no fixed period of time in which asthma can develop. Symptoms can appear shortly
after exposure and can last anywhere from a few weeks to many years after the initial exposure.
Based on the respiratory responses of sensitized workers, three basic patterns of asthmatic
attacks have been identified: immediate, develops within minutes of exposure and peaks after
approximately 20 minutes; recovery takes about 2 hours; Late, they come in different forms. It
usually begins several hours after exposure and peaks between 4 and 8 hours, with full recovery
occurring within 24 hours. It may begin at night in some cases, with a tendency to recur at the
same time for a few nights after a single exposure; Dual or Combined asthma occurs when both
immediate and late types of asthma occur at the same time.

Prognosis of Asthma
Asthma is a condition that many children outgrow. Children with asthma, on the other hand,
appear to have less severe symptoms as they enter adolescence, but 50% of these children
continue to have asthma. Asymptomatic children with mild asthma have a better chance of
improving and becoming symptom-free later in life. Children with severe asthma, on the other
hand, are more likely to develop asthma as adults. Although asthma is responsible for a
significant number of deaths each year, the majority of these can be avoided with proper
treatment. As a result, children who have access to treatment and are able to adhere to their
treatment plan have a good prognosis.

Home Remedies for Asthma

Asthma is treated with medications, avoiding triggers, and working with your physician to
develop an asthma action plan. However, in addition to the prescribed medications, the following
natural home remedies for asthmatic children should be tried.
• Taking a sauna bath can help open up nasal and chest congestion.
• Garlic's anti-inflammatory properties can help asthmatics breathe easier.
• Ginger can help with chest congestion and tightness.
• Turmeric has anti-allergic properties and has been found to be safe for asthmatic children.
• Honey helps to soothe throat irritation. Asthmatic children can get relief from honey and
a warm mixture.
• For immediate relief during an attack, keep a rescue inhaler on hand.
However, before using these remedies, you should consult first your doctor for safety.

Prevention
There are many things that can be done to help children with asthma prevent symptoms or
attacks. Children with allergies who are prone to asthma attacks should keep the following items
out of their bedrooms:
• Pillows made of feathers
• Rugs and carpets
• Drapes
• Upholstered pieces of furniture
• Stuffed toys
• Pets
• Other possible dust mite and allergen sources
There are also other ways to reduce allergens, such as
• Pillows made of synthetic fibers and mattress covers that are impermeable
• Using hot water to wash bed sheets, pillowcases, and blankets
• Cockroach extermination and cleaning of the house to prevent cockroach exposure
• Smoking cessation in the home
If a particular allergen cannot be avoided, doctors may recommend allergy shots
(immunotheraphy) to children.

Diagnosis
Although asthma is difficult to diagnose in infants, it can be diagnosed in older children based on
their medical history, symptoms, physical examination, and certain tests. The doctor will most
likely inquire about your child's medical history and symptom description. Make sure to include
in detail your child's medical history and symptom description, as well as when and how
frequently these symptoms have occurred. Other tests, such as allergy skin testing and blood
tests, may be ordered by the doctor to help identify specific asthma triggers.

Assessment and Diagnostic Findings

Your doctor may examine your nose, throat, and upper airways during the physical examination;
wheezing, which is characterized by high-pitched whistling sounds when you exhale, is one of
the most common symptoms of asthma. Your doctor will also look for signs of an allergic
reaction like eczema or hives on your skin. Will also listen to your breathing using a stethoscope.
The following are some of the tests:
ü Spirometry. It will assist you in determining how well your lungs are performing
(pulmonary function)
ü Challenge test. To see how “reactive” or “responsive” your lungs are
ü Nitric oxide test. To check for elevated nitric oxide levels, which are indicative of
narrowed airways

Medical Management
 The following medical managements are available for asthma:

ü Oxygen. All children with asthma who are cyanosed or whose difficulty breathing
interferes with talking, eating, or breastfeeding should be given oxygen to
maintain an oxygen saturation of >95 percent.

ü Pharmacotheraphy:

 Quick relievers. When needed to relieve bronchospasm during an acute attack.

(Salbutamol, Terbutaline, Adrenaline, and Aminophylline)
 Preventers. Long-term use is recommended to control inflammation and prevent further
attacks. (Prednisolone, Theophylline, and other oral and inhaled steroids) (Steroids (oral
and inhaled) like prednisolone, Theophylline)
 Long-acting pain relievers. Used to relieve bronchospasm for longer periods of time.
(Salmeterol, Formoterol, Bambuterol)
ü If no other options for delivering salbutamol are available, inject 0.01 ml/kg of a 1:1000
solution of adrenaline subcutaneously (up to a max of 0.3 ml). If no improvement is seen
after 15 minutes, repeat the dose once more.
ü Magnesium sulfate. In children with severe asthma who are being treated with
bronchodilators and corticosteroids, IV magnesium sulfate may be beneficial.
ü Oral bronchodilators. When inhaled salbutamol is not available for a child who has
improved enough to be discharged home, this medication is used instead.

Nursing Interventions
In general, the nurse will perform the following interventions:

• Assess history. Before administering medications, get a history of allergic reactions to

medications.
• Assess respiratory status. Monitor the severity of symptoms, breath sounds, peak flow, pulse
oximetry, and vital signs to determine the patient's respiratory status.
• Assess medications. Determine which medications the patient is currently using. Administer
medications as directed and keep track of the patient's reactions to them.
• Pharmacologic therapy. Administer medications as directed and keep track of the patient's
reaction to them.
• Fluid therapy. If the patient is dehydrated, give them fluids.