CASE STUDY ON

BRONCHIAL ASTHMA

BASE LINE DATA:-

 Name :- Mrs Narbadiya

 Age & Sex :- 42 yrs. / female
 Ward :- female ward
 Bed no. :- 2
 Address :- Rajiv Gandhi ward ghamapur jabalpur
 Education :- illitrate
 Occupation :- house wife
 Religion :- hindu
 Date of admission :- 12-10-2019
 Diagnosis :- Bronchial asthma

CHIEF COMPLAINTS:-

Mrs.narbadiya was admitted in the hospital with complaints of shortness of breath, chest pain & cough
since 1 week.

HISTORY OF PRESENT ILLNESS:-

Patient is having chest pain cough since 1 week.

HISTORY OF PAST ILLNESS:-

Patient was told about 6 month back she has a same problem .

SURGICAL HISTORY OF THE CLIENT

PAST SURGICAL HISTORY -

There is no any past surgical history.

PRESENT SURGICAL HISTORY

Not done any surgey: Nil significant

FAMILY HISTORY –

My patient belong in nuclear family.total 4 members in her family her husband 2 son . her husband is a
farmer his monthly income is sufficient for his family.

FAMILY COMPOSITION:-

S.NO MEMBER AGE/SEX RELATIONSHIP EDUCATION HEALTH

1. Kamla 47/F self Nil Sick
2. Ajay 50/m husband 10th Good
3. kamesh 29/f son 8th Good
4. manoj 25/m Grand-son 12th Good
SOCIO ECONOMIC HISTORY

 Family income – 6000/-

 No. of earning member – 1
 Per capita income – Rs 1500
 Education – nil
 Social support – good
 Relationship with neighbours – good
Sanitation history:-
 Toilet facility :- available
Environmental history:-
 Type of house:- kaccha
 Ventilation:- Adequate
 Electricity :- Available
Water supply:-
 Tape water :- not present
 Well :- present
 Hand pump:- present
 Tube well :- present
Drainage system:-
 Open drainage system:- present
Personal history :-
 Health facility nearby home :- present
 Sleep pattern :-irregular
 Allergy :- not present
 Health habbits:-good
 Religion history :- superstitious
 Exercise :- no
Nutritional history:-
 Veg./ non –veg. :- both
 Likes/ dislikes :- likes all food material
Dietary history :-
 Veg. food: - dal, roti, rice, green leafy vegetables, oil, ,milk , Curd,.
 Non-veg. food:- egg, meat, fish, chicken.

Physical examination:

 General appearance – conscious , ill look ,debilated.

 Intelligence – intelligent
 Mental status – little irritable , oriented to time place and person.
 Expression – expressing out the feelings.
 Race – Hindu
 Height – 5’2”
 Weight – 54kg \
 Temperature – afebrile
 Pulse – 78 beats/min.
  Resp. – 20 breaths/min.
 BP – 130/70 mm of hg
 Communication skill – able to speak in chattisgarhi and hindi.

General Appearance :

Behavior – good

Head – normal in shape

Hair – normal white in color

Face – cleft lip & congenital abnormality is not observed

Ear – shape, hearing activity is normal. Discharge, wax foreign body & pain not observed.

Eyes – pupil black in color, equal in size and reactive to light, corneal reflex observed.

Nose – running nose, polyp & bleeding no observed.

Mouth/lips – breath odors not present, cleft lip is not observed.

Teeth – no discoloration observed.

Gums – texture is moist & bleeding not observed.

Tongue – normal, moist & pink in color.

Tonsil – normal in size .

Neck – symmetrical, veins and movement are normal carotid pulse present & palpable.

Lymphnodes – not observed

Skin – brown in color , wrinkles & dryness observed. Surgical wound observed.

Nails – normal in shape.

Odema – no peripheral edema observed.

Vital Signs –

Temp.- a febrile
Pulse.- 78 beats /min
Resp. – 20 breath /min.

Ribs – normal

Abdomen – abdominal reflexes are present. Distention & ascities is not observed.

Bones – deformity not observed.

Back – normal, spina bifea , kyphosis & scoliosis nit observed

Extremities – range of motion is normal

Bowel activity – regular once in a day/

Bladder activity – regular

Rectum – anatomical structure and opening is normal

Sleep pattern– regular

SYSTEMIC EXAMINATION:

Central nervous system:

 Consciousness – alert, lethargy

 Speech – clear
 Coordination – present
 Papillary reaction to light – equal size reactive to light

Reflexes –

Biceps – normal flexion is found

Triceps – normal
Plantar reflex – normal flexion is seen

Respiratory system:

 Respiratory rate – 20 breaths/min

 Pattern – normal abdomino thoracic
 Cyanosis – not observed
 Cough – present
 Flaring of nostrils –present
 Presence of wheezing / stridor – not present

Cardio vascular system:

 Heart rare – 80 beats /min.

 Pulse – Rythum normal.
 Radial – right present , pedal right present.
 Blood pressure – 130/70 mm of hg

Auscultation –

Palpitation – present

Murmur – not heard

Gastro intestinal system:

Distended – not observed.

Ascities – not observed.

Visible peristalsis – not observed.

Palpable mass – not palpable

Abdominal reflex – present

Bowel sound – audible

Liver – palpable

Spleen – not palpable

Musculoskeletal system:

Range of motion – normal

Joint pain – not observed

Genitor urinary system:

Urine – normal

History of constipation – not present

Reproductive system:

Genitalia – normal

INVESTIGATION –

S.NO. PARAMETERS CLIENT VALUE NORMAL REMARK

VALUE
1. HB 12-14 gm 10.6gm/dl Below normal

2. WBC 4-11u/dl 9000/u Normal

3. Lymph 20-40u/l 30u/dl Normal

4. Plt 150000-400000 200000 Normal

5. Sodium 135-145meq/dl 134meq/dl Normal

6 Potassium 3.5-5.5meq/dl 4.5meq/dl Normal

7. Calcium 9-11 mg/dl 9mg/dl Normal

8. HIV Negative

9. Troponin Negative

10. PTT 20sec 10-14sec Normal

11. Bleeding time 2mt 2.3-9.5sec Normal

12. Clotting time 5:30mt 5-10mt Normal

 BRONCHIAL ASTHMA

INTRODUCTION:-

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make
breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a
minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a
life-threatening asthma attack. Asthma can't be cured, but its symptoms can be controlled. Because asthma
often changes over time, it's important that you work with your doctor to track your signs and symptoms and
adjust treatment as needed.

DEFINITION:-

Asthma is a chronic inflammatory disease of the airway that causes airway hyper
responsiveness, mucosal edema, & mucus production. This inflammation ultimately leads to recurrent
episodes of asthma symptoms: cough, chest tightness, wheezing & dyspnea.

ANATOMY & PHYSIOLOGY OF RESPIRATORY SYSTEM

The respiratory system consists of all the organs involved in breathing. These include the nose, pharynx,
larynx, trachea, bronchi and lungs. The respiratory system does two very important things: it brings oxygen
into our bodies, which we need for our cells to live and function properly; and it helps us get rid of carbon
dioxide, which is a waste product of cellular function. The nose, pharynx, larynx, trachea and bronchi all
work like a system of pipes through which the air is funnelled down into our lungs. There, in very small air
sacs called alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed from the blood out
into the air. When something goes wrong with part of the respiratory system, such as an infection like
pneumonia, it makes it harder for us to get the oxygen we need and to get rid of the waste product carbon
dioxide.
The Upper Airway and Trachea

When you breathe in, air enters your body through your nose or mouth. From there, it travels down your
throat through the larynx (or voicebox) and into the trachea (or windpipe) before entering your lungs. All
these structures act to funnel fresh air down from the outside world into your body. The upper airway is
important because it must always stay open for you to be able to breathe. It also helps to moisten and warm
the air before it reaches your lungs.

The Lungs

Structure:- The lungs are paired, cone-shaped organs which take up most of the space in our chests, along
with the heart. Their role is to take oxygen into the body, which we need for our cells to live and function
properly, and to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a left
lung and a right lung. These are divided up into 'lobes', or big sections of tissue separated by 'fissures' or
dividers. The right lung has three lobes but the left lung has only two, because the heart takes up some of the
space in the left side of our chest. The lungs can also be divided up into even smaller portions, called
'bronchopulmonary segments'.

These are pyramidal-shaped areas which are also separated from each other by membranes. There are about
10 of them in each lung. Each segment receives its own blood supply and air supply.

FUNCTION:-

Air enters your lungs through a system of pipes called the bronchi. These pipes start from the bottom of the
trachea as the left and right bronchi and branch many times throughout the lungs, until they eventually form
little thin-walled air sacs or bubbles, known as the alveoli. The alveoli are where the important work of gas
exchange takes place between the air and your blood. Covering each alveolus is a whole network of little
blood vessel called capillaries, which are very small branches of the pulmonary arteries. It is important that
the air in the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon
dioxide can move (or diffuse) between them. So, when you breathe in, air comes down the trachea and
through the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will
travel across the walls of the alveoli into your bloodstream. Travelling in the opposite direction is carbon
dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is then breathed out. In
this way, you bring in to your body the oxygen that you need to live, and get rid of the waste product carbon
dioxide.

ETIOLOGY:-

• Airborne substances, such as pollen, dust mites, mold spores, pet dander or particles of cockroach
waste
 • Respiratory infections, such as the common cold

• Physical activity (exercise-induced asthma)

• Cold air

• Air pollutants and irritants, such as smoke

• Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and
naproxen (Aleve)

• 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

PATHOPHYSIOLOGY:-

Predisposing, Causal factors & Contributing factors

Inflammation

Hype responsiveness Airflow limitation of airway

CLINICAL MANIFESTATION:-

IN BOOK IN PATIENT
Three most common symptoms of asthma are • Cough & dyspnea is present in client
• Cough since 10 days.
• Dyspnea
• Wheezing • Has asthma attack early morning.
• Asthma attack often occur at night or
early in the morning, possibly due to
circadian variations that influence airway
receptor thresholds.
• Cough with or without mucus production • Cough with mucus production is present.
• Generalized chest tightness & dyspnea
 occurs
• Diaphoresis
• Tachycardia
• Widened pulse pressure may occur along Tachycardia is present heart rate is- 102/mt
with hypoxemia & ventral cyanosis

MEDICAL MANAGEMENT

IN BOOK IN PATIENT
Two general classes of asthma medications are • Long acting control medication is not
used they are: given.
• Long acting control medications.
• Quick relief medications.
Long acting control medications
• Corticosteroids
• Cromolyn sodium & nedocromil are
mild to moderate anti inflammatory • Quick relief medications are
agents. administered such as inj Deriphylline
• Long acting beta2 adrenergic agonists. 2ml IV every 8 hourly.
• Methylxanthines are mild to moderate
bronchodilators.
Quick relief medications
• Short acting beta adrenergic agonists are
the medication of choice for relieving
acute symptoms.
• Anticholinergics e.g. ipratropium
bromide may bring added benefits in
severe exacerbations.

COMPLICATIONS:-

Asthma complications include:

 Signs and symptoms that interfere with sleep, work or recreational activities
  Sick days from work or school during asthma flare-ups

 Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can
breathe

 Emergency room visits and hospitalizations for severe asthma attacks

 Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused
by asthma.

PREVENTION:-

 Follow your asthma action plan. With your doctor and health care team, write a detailed plan for
taking medications and managing an asthma attack. Then be sure to follow plan.

Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of
treatment can make feel more in control of life in general.

 Get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu
and pneumonia from triggering asthma flare-ups.

 Identify and avoid asthma triggers. A number of outdoor allergens and irritants ranging from
pollen and mold to cold air and air pollution can trigger asthma attacks. Find out what causes or
worsens your asthma, and take steps to avoid those triggers.

 Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as
slight coughing, wheezing or shortness of breath. But because your lung function may decrease
before notice any signs or symptoms, regularly measure and record peak airflow with a home peak
flow meter.

 Identify and treat attacks early. If you act quickly, less likely to have a severe attack. Also won't
need as much medication to control your symptoms.

When peak flow measurements decrease and alert you to an oncoming attack, take medication as
instructed and immediately stop any activity that may have triggered the attack. If your symptoms
don't improve, get medical help as directed in action plan.

 Take your medication as prescribed. Just because your asthma seems to be improving, don't
change anything without first talking to doctor. It's a good idea to bring your medications with you to
 each doctor visit, so doctor can double-check that you're using medications correctly and taking the
right dose.

 Pay attention to increasing quick-relief inhaler use. If you find yourself relying on quick-relief
inhaler, such as albuterol, asthma isn't under control. See doctor about adjusting your treatment

NURSING CARE PLAN

Day 1

• Subj. data: -client stated that she is having difficulty in breathing.

Obj. data: -client is looking restless & irritated.

Nursing diagnosis: -Ineffective airway clearance, dypnea related to inflammatory process as manifested
by observation.

Goal: -client will have effective airway clearance as evidenced by verbalization.

Plan of action Rationale

• Assess the condition. • Assessment helps to plan the proper care.
• To reduce discomfort.
• Provide comfort devices such as pillows.
• Provide propped up position. • Promote lung expansion & reduce
discomfort.
• Advice to take adequate rest & sleep. • Prevents fatigue & tiredness.
• Administer bronchodilator drug as
prescribed. • Relieves bronchospasm.

Evaluation: -client stated that his pain is reduced.

• Subj. data: -client stated that she is having pain in the whole body.

Obj. data: -client is looking restless & irritated.

Nursing diagnosis: -alteration in comfort, pain related to disease condition as manifested by observation.

Goal: -client will have adequate comfort as evidenced by verbalization.

 Plan of action Rationale
• Assess the condition. • Assessment helps to plan the proper care.
• To reduce discomfort.
• Provide comfort devices such as pillows.
• Provide comfortable bed. • To promote comfort.
• Provide comfortable position. • To reduce discomfort.
• Advice to take adequate rest & sleep. • Prevents fatigue & tiredness.
• Administer analgesic drug as prescribed.
• Inj.Diclofenac 2ml is administered IM.

Evaluation: -client stated that his pain is reduced.

Day 2

• Subj. data: -client stated that she is having not able to do her activities.

Obj. data: -client is not able to do activities of daily living.

Nursing diagnosis: -activity intolerance related to confinement to bed as manifested by observation.

Goal: -client will be able to do some of her daily activity as evidenced by verbalization.

Plan of action Rationale

• Assess the condition • Assessment helps to plan the proper
care.
• Assist the client in activities of daily • To promote participation.
living.
• Promote ambulation. • It promotes circulation.

• Change position timely • Promotes circulation

• Encourage client participation in • Encouraged client for participation.
daily activities.
Evaluation: -client is able to do some of her daily activities.

Day 3

• Subj. data: -client stated that she is not feeling to eat food.

Obj. data: -client is looking weak & tired.

 Nursing diagnosis: -alteration in nutrition pattern less than body requirement related to loss of appetite as
manifested by observation.

Goal: -client will have normal nutritional pattern as evidenced by observation.

Plan of action Rationale

• Asses the condition. • Assessment helps to plan proper care.
• Promote appetite.
• Provide small & frequent feed.
• Provide of food items of likings. • Promote appetite.
• Provide neat & clean environment for
eating. • Promote food intake.
• Promote hydration.
• Teach about importance of nutritious • Prevents dehydration.
diet. • Promote knowledge level.
Evaluation: -client started taking food orally & has normal appetite.

Day 4

• Subj. data: -client stated that she is not aware of her disease condition.

Obj. data: -client is not knowing about her disease condition.

Nursing diagnosis: -knowledge deficit related to disease condition as manifested by verbalization.

Goal: -client will have adequate knowledge as evidenced by verbalization.

Plan of action Rationale

• Assess the condition • Assessment helps to plan proper care.
• Promote knowledge level.
• Explain about disease condition. • Prevents further complications.
• Mention about its management & its
preventive measures. • Prevents complications.
• Explain about complications & its
preventions. • Promotes proper care.
• Clarify all doubts of client &
relatives.
Evaluation: - client & relatives understood about the disease condition & its management.
Day 5

• Subj. data: -client stated that she is worried about her disease

Obj. data: -client is looking frightened & tensed.

Nursing diagnosis: -fear & anxiety related to disease condition as manifested by observation &
verbalization.

Goal: -client will be relieved from fear & anxiety as evidenced by verbalization.

Plan of action Rationale

• Assess the condition. • Assessment helps to plan care properly.
• To relieve fear.
• Provide psychological support.
• Clarify all doubts. • To reduce fear
• Explain about disease condition in • To promote knowledge.
detail.
Evaluation: -clients said that her fear & anxiety is reduced.

HEALTH EDUCATION

• Personal hygiene

• Personal hygiene has an important role to prevent infection.

• Patient have to take a through bath, brush teeth, cut short nails & change cloth daily.

• Diet therapy

• Advice to take well balanced diet of good nutritive value.

• Explain importance of balanced diet.

• Rest & sleep

• Advice to take adequate rest & sleep.

• Ask to do active & passive exercise.

• Disease condition: - Bronchial Asthma

• Definition

• Causes

• Pathophysiology
 • Clinical manifestations

• Diagnosis

• Management

• Care & prevention

• Follow up

• Advice to take medicine in time.

• Do not discontinue medicine without doctors.

• Advice for timely follow up checkups.

Summary

As case study on bronchial asthma was great learning experience for me. I learned about the disease
condition of the client & also how to take care of client with bronchial asthma. I thank my patient & his
relatives for their valuable cooperation & also staffs of BRAM hospital, Raipur. Very specially I thank
Mrs.Neelam Paul, M.Sc. (N), Demonstrator, Govt.college of nursing, Raipur for her valuable guidance &
support.
 BIBLIOGRAPHY

• SUZANNE C. SMELTZER BRENDA G. BARE, MEDICAL SURGICAL, EIGHTH EDITION,

PB-LIPPINCOTT
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POSITIVE OUTCOME,VOL.1, PB SAUNDERS, 7TH EDITION.
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CHURCHILL LIVINGSTONE 3RD EDITION.
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