A CASE STUDY ON

BRONCHIAL ASTHMA IN ACUTE

EXACERBATION
Group 1 – BSN II - A
 INTRODUCTION
The main function of the respiratory system is to move air into the lungs
so that oxygen can enter the body and carbon dioxide can be exhaled.
Several pulmonary disorders can affect the airways. Their
pathophysiology differs but these diseases are characterized by limited
airflow. Airflow is limited when air walls are thickened, airway lumen is
obstructed by secretions, increasing resistance, and smooth muscle of the
airways is activated, causing bronchoconstriction. Limited airflow
increases the work of breathing and residual volume of the lungs as air is
trapped behind narrowed or collapsed airways.
 INTRODUCTION
Asthma is a chronic inflammatory respiratory disorder that in children,
inflammation causes recurrent episodes of wheezing, breathlessness,
chest tightness and cough, especially at night or in the early morning.
These asthma episodes are associated with airflow limitation or
obstruction that is reversible either spontaneously or with treatment.
Asthma usually begins in childhood or adolescence, but it also may first
appear during adult years. While the symptoms may be similar, certain
important aspects of asthma are different in children and adults. Children
born to families with history of allergies or asthma are more likely to
have asthma. Children who live in urban areas, where there is a higher
incidence of air pollution, or live in a home that has high levels of dust
mites or cigarette smoke, are also at a higher risk for asthma.
 INTRODUCTION
Infants born prematurely or who suffer lung damage shortly after birth
are also more likely to have asthma. Bronchial asthma is the more correct
name for the common form of asthma. The term 'bronchial' is used to
differentiate it from 'cardiac' asthma, which is a separate condition that is
caused by heart failure. Although the two types of asthma have similar
symptoms, including wheezing (a whistling sound in the chest) and
shortness of breath, they have quite different causes. Bronchial asthma is
usually intrinsic (no cause can be demonstrated), but is occasionally
caused by a specific allergy (such as allergy to mold, dander, dust).
 INTRODUCTION
This case study is thorough learning about Bronchial Asthma, which
contains a study about the normal physiology of the respiratory system,
pathological physiology of the disease, a thorough assessment of the
patient with said illness, applied nursing care plans to patients having this
kind or disease, and discharge planning to a patient to limit the
recurrence of the attack or if not proper management and care to be given
during the time of asthma attack.
 INTRODUCTION
According to the United Nation Daily Highlights, asthma kills over
180,000 people worldwide annually. In the Philippines, asthma affects
over six (6) million children. The Philippines is ranked 32nd in "self-
reported asthma," The country has a prevalence rate of about 12 %. A
nationwide study conducted by the University of Santo Tomas showed
that about 12.4% of children aged 14 to 15 years old are afflicted with
asthma. Most of these children come from low-income families or
communities. Over all, one out of 10 Filipinos has asthma, based on a
Philippine General Hospital survey.
 INTRODUCTION
In the Philippines, an estimated 21 million Filipinos are asthmatic.
Asthma deaths account for 2.37 percent of total deaths, making the
country second in asthma mortality in the world across all ages. Twenty
to 30 percent of total asthma cases account for mild asthma. Among
patients with mild asthma, there is an estimated 33 to 41 percent who
landed in the emergency room, according to a study on asthma control in
the Asia-Pacific region. The prevalence of asthma among Filipino
children has been more studied than in adults, and has been reported in at
least four previous surveys with prevalence rates ranging from 9.2% –
27.4%. Currently, there are three large international studies that could
provide data on the status of asthma in adults where local prevalence can
be compared.
 OBJECTIVES
SPECIFIC:
• To provide management care to the patient
• To educate the patient the proper maintenance of airway patency.
• To assess the patient’s respiratory status by monitoring the severity
of the symptoms.
• To identify some potential complications and how to initiate
appropriate preventive or corrective actions of the patient.
• To verbalize the patient the understanding of causes and therapeutic
management regimen.
• To demonstrate patient some behaviors to improve or maintain clear
airway.
 OBJECTIVES
GENERAL:
• To identify and provide care to patient with asthma and thereby
prevent severe morbidity and mortality.
• To provide a comfortable feeling to the patient and a comfortable
environment.
• To provide interventions to the patient and provide quality care.
ANATOMY AND PHYSIOLOGY
 ANATOMY AND PHYSIOLOGY
1. The organs of the respiratory system are the nose, pharynx, larynx,
trachea, bronchi, and lungs.
2. Respiration is the overall exchange of the gases oxygen and carbon
dioxide between the atmosphere, the blood, and the cells.
3. The cardiovascular and respiratory systems equally share the
responsibility of supplying oxygen to and eliminating carbon dioxide gas
from cells.
 ANATOMY AND PHYSIOLOGY
THE ANATOMY AND FUNCTIONS OF
THE NOSE
o The openings into the external nose are
called the nostrils or external nares.
o The internal nose connects with the throat
or pharynx via the two internal nares.
o The nose is separated into a right and left
nasal cavity by the nasal septum.
o Coarse hairs line the vestibules of the
nostrils to filter out large dust particles in
the air.
 ANATOMY AND PHYSIOLOGY
THE ANATOMY AND FUNCTIONS OF
THE NOSE
o The internal nose has three shelves formed
by the turbinate bones: the superior, middle,
and inferior meatus lined with mucous
membranes
o The olfactory receptors are found in the
superior meatus, this area is called the
olfactory region.
 ANATOMY AND PHYSIOLOGY
THE ANATOMY AND FUNCTIONS OF
THE NOSE
o The internal nose has three functions:
Air is warmed, moistened, and filtered;
olfactory stimuli are detected; and large hollow
resonating chambers are provided for speech
sounds.
 ANATOMY AND PHYSIOLOGY
THE STRUCTURE AND FUNCTION OF THE PHARYNX
• The pharynx or throat has two functions. It is a passageway for both
food and air, and it forms a resonating chamber for speech sounds.
• The pharynx is divided into the nasopharynx, the oropharynx, and the
laryngopharynx.
• The nasopharynx has four openings in its walls: the two internal nares
and the openings to the two eustachian tubes. It also houses the
pharyngeal tonsils.
• The oropharynx has one opening, the fauces or connection to the
mouth. It houses the palatine and lingual tonsils.
• The laryngopharynx connects with the esophagus posteriorly and the
larynx anteriorly.
 ANATOMY AND PHYSIOLOGY
THE LARYNX OR VOICE BOX
• The walls of the larynx are supported by
nine pieces of cartilage; three are single
and three are paired.
• The thyroid cartilage is the largest single
piece. It is also called the Adam's apple
and is usually larger in men.
• The epiglottis is a large, single leaf-
shaped piece of cartilage. It pulls down
over the glottis when we swallow to
keep food or liquids from getting into
the trachea.
 ANATOMY AND PHYSIOLOGY
THE LARYNX OR VOICE BOX
• The cricoid cartilage is a single ring of
cartilage that connects with the first
tracheal ring.
• The paired arytenoid cartilages are
ladle-shaped and are attached to the
vocal cords and laryngeal muscles.
• The paired corniculate cartilages are
cone-shaped, and the paired cuneiforms
are rod-shaped.
 ANATOMY AND PHYSIOLOGY
THE LARYNX OR VOICE BOX
• The mucous membrane of the larynx is
arranged in two pairs of folds
- The upper pair is the vestibular folds or
false vocal cords
- The lower pair is the vocal folds or true
vocal cords.
• The glottis is the opening over the true
vocal cords.
• Air coming from the lungs causes the
vocal cords to vibrate and produce
sound. The greater the volume of air, the
louder the sound.
 ANATOMY AND PHYSIOLOGY
THE LARYNX OR VOICE BOX
• Pitch is controlled by tension on the true
vocal cords. The stronger the tension,
the higher the pitch. True vocal cords
are thicker in men; they vibrate more
slowly and produce a lower pitch than
that in women.
 ANATOMY AND PHYSIOLOGY
THE TRACHEA OR WINDPIPE
• The trachea is a 4.5-inch tubular
passageway for air and is located
anterior to the esophagus
• Its epithelium is pseudostratified,
ciliated columnar cells with goblet cells
that produce mucus, and basal cells.
• Its smooth muscle and connective tissue
are encircled by incomplete rings of
hyaline cartilage shaped like a stack of
Cs
 ANATOMY AND PHYSIOLOGY
THE TRACHEA OR WINDPIPE
• The open part of the Cs faces the
esophagus and allows it to expand into
the trachea during swallowing
• The closed part of the Cs forms a solid
support to prevent collapse of the
tracheal wall.
• If a foreign object gets caught in the
trachea, a cough reflex expels it.
 ANATOMY AND PHYSIOLOGY
THE BRONCHI AND THE
BRONCHIAL TREE
• The right primary bronchus branches
from the trachea and goes to the right
lung; the left primary bronchus branches
and goes to the left lung.
• The primary bronchi branch into
secondary or lobar bronchi that go into
the lobes of the lungs. The right lung
has three lobes and the left lung has two.
 ANATOMY AND PHYSIOLOGY
THE BRONCHI AND THE
BRONCHIAL TREE
• The secondary bronchi branch into
tertiary or segmental bronchi, which
branch into the segments of the lobes of
the lungs.
• Tertiary or segmental bronchi branch
into smaller branches called bronchioles.
• Bronchioles finally branch into the
smallest branches called terminal
bronchioles.
 ANATOMY AND PHYSIOLOGY
THE BRONCHI AND THE
BRONCHIAL TREE
• Because this continuous branching of
the bronchi resembles a tree and its
branches, it is referred to as a bronchial
tree.
 ANATOMY AND PHYSIOLOGY
THE ANATOMY AND FUNCTION OF
THE LUNGS
• The pleural membrane encloses and
protects each lung. It is composed of
two layers of serous mem- branes: the
outer is the parietal pleura and the inner
is the visceral pleura.
• Between these two layers is the pleural
cavity, which contains a lubricating fluid
to prevent friction as the lungs expand
and contract during breathing.
 ANATOMY AND PHYSIOLOGY
THE ANATOMY AND FUNCTION OF
THE LUNGS
• The segment of lung tissue that each
tertiary or seg- mental bronchi supplies
is called a bronchopulmonary segment.
• Each of these segments is divided into a
number of lobules wrapped in elastic
connective tissue with a lymphatic
vessel, an arteriole, a venule, and
bronchioles from a terminal bronchiole.
 ANATOMY AND PHYSIOLOGY
THE ANATOMY AND FUNCTION OF
THE LUNGS
• Terminal bronchioles subdivide into
microscopic respiratory bronchioles,
which further divide into 2 to 11
alveolar ducts or atria.
• Around the circumference of the
alveolar ducts are alveoli and alveolar
sacs.
• Alveoli are grapelike outpouchings of
epithelium and elastic basement
membrane surrounded externally by a
capillary network.
 ANATOMY AND PHYSIOLOGY
THE ANATOMY AND FUNCTION OF
THE LUNGS
• An alveolar sac is two or more alveoli
that share a common opening
• The microscopic membrane through
which the respiratory gases move is this
alveolar-capillary (respiratory)
membrane.
 ANATOMY AND PHYSIOLOGY
THE RESPIRATION PROCESS
1. There are three basic processes of
respiration.
2. The first process is called ventilation or
breathing, which is the movement of air
between the atmosphere and the lungs.
3. The two phases of ventilation are
inhalation or inspiration, which moves air
into the lungs, and exhalation or expiration,
which moves air out of the lungs.
 ANATOMY AND PHYSIOLOGY
THE RESPIRATION PROCESS
4. The second process of respiration is
external respiration, which is the exchange
of gases between the lungs and the blood. ‘
5. The third process is internal respiration,
which is the exchange of gases between the
blood and body cells.
6. Breathing in occurs when the diaphragm
and external intercostal muscle contract,
causing decreased pressure and a vacuum in
the lungs.
 ANATOMY AND PHYSIOLOGY
THE RESPIRATION PROCESS
7. When the diaphragm and external
intercostal muscles relax, we breathe out
due to increased pressure in the lungs
forcing the air out. This is mainly a passive
activity.
8. The partial pressure of a gas is the
amount of pressure that gas contributes to
the total pressure and is directly
proportional to the concentration of that gas
in the mixture.
 ANATOMY AND PHYSIOLOGY
THE RESPIRATION PROCESS
9. The partial pressure of oxygen is PO2 =
160 mm Hg and of carbon dioxide PCO2 =
0.3 mm Hg in air.
10. Each gas diffuses between blood and its
surrounding tissues from an area of high
partial pressure to an area of low partial
pressure until equilibrium is reached.
11. The PCO, in capillary blood is 45 mm
Hg, but it is 40 mm Hg in the alveolar blood
of the lungs. Therefore, carbon dioxide
diffuses from blood into the lungs.
 ANATOMY AND PHYSIOLOGY
THE RESPIRATION PROCESS
12. The PO, in capillary blood is 40 mm Hg,
but it is 104 mm Hg in the alveolar sacs of
the lungs. Therefore, oxygen diffuses from
the lungs into the blood cells.
13. As the blood cells transport their high
levels of oxygen to tissue cells, the tissue
cells are low in oxygen but high in carbon
dioxide; therefore, carbon dioxide diffuses
into the blood cell and oxygen diffuses from
the blood cell into the tissue cell.
 ANATOMY AND PHYSIOLOGY
LUNG CAPACITY
1. Lung capacity is the lung volume that is
the sum of two or more of the four primary,
nonoverlapping lung volumes.

2. There are four lung capacities:

Functional residual capacity (FRC),
Inspiratory capacity (IC
Total lung capacity (TLC),
Vital capacity (VC).
PATHOPHYSIOLOGY
 TEXTBOOK DISCUSSION
Definition
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, short
breath, and wheezing. The disease is chronic and interferes with daily
working. The disease is curable and inhalers help overcome asthma
attacks.
 TEXTBOOK DISCUSSION
Signs and Symptoms
• Shortness of breath
• Tightness of chest
• Wheezing
• Excessive coughing or a cough that keeps you awake at night
 TEXTBOOK DISCUSSION
Causes
• Genetics.
• History of viral infections.
• Hygiene hypothesis.

Lab and Dx
• Spirometry:
• Peak Expiratory Flow (PEF):
• Chest X-ray
• Urinalysis
• CBC
 TEXTBOOK DISCUSSION
Prevention
• Minimize asthma triggers
• Take your asthma medicine
• Quit smoking
 TEXTBOOK DISCUSSION
Treatment
• Breathing exercises
• Quick-acting treatments
1. Bronchodilators
2. First aid asthma treatment
• Long-term asthma control medications
1. Anti-inflammatories.
2. Anticholinergics
3. Long-acting bronchodilators
 TEXTBOOK DISCUSSION
Management
 Eating a healthier diet. 
 Maintaining a healthy weight. 
 Quitting smoking. 
 Exercising regularly. 
 Managing stress
 TEXTBOOK DISCUSSION
Exacerbations
When your asthma symptoms get progressively worse, it’s known as an
exacerbation, or an asthma attack.
It becomes increasingly difficult to breathe because your airways are
swollen and your bronchial tubes have narrowed.
 TEXTBOOK DISCUSSION
Exacerbations
The symptoms of an exacerbation may include:
•• hyperventilation
•• cough
•• wheezing
•• shortness of breath
•• increased heart rate
•• agitation
 VITAL INFORMATION
Name: JB Jobelle Belvis
Age: 18
Civil status: Single
Educational Attainment: Grade 12
Nationality: Filipino
Religion: Roman Catholic
Doctor: Dra. Samillano
Date of Admission: April 19, 2021
Chief Complaint: Difficulty of breathing, dry cough, and chest tightness for 2 days
Admitting diagnosis: Bronchial Asthma in Acute Exacerbation
 NURSING ASSESSMENT
GENOGRAM
 NURSING ASSESSMENT
PHYSICAL EXAM
 NURSING ASSESSMENT
PHYSICAL EXAM
 NURSING ASSESSMENT
PHYSICAL EXAM
 NURSING ASSESSMENT
PHYSICAL EXAM
 NURSING ASSESSMENT
PAST MEDICAL HISTORY
At the age of 5, Pt was admitted due to indigestion due to eating 5 balots.
At the age of 7, Pt was admitted due to unhealthy lifestyle and has poor
fluid intake and was fund of eating junk food which developed into UTI,
Outpatient. Pt was consulted and given antibiotics
In 2017. Pt was operated of appendectomy because Pt was diagnosed of
acute appendicitis at St. Anthony
Complete Immunization
 NURSING ASSESSMENT
FAMILY HISTORY
In his mother side, his grandmother died because of rheumatic heart
disease. In his father side, his grandfather died because of bronchogenic
CA and his grandmother died because of COPD. His auntie died because
of complicated diabetes and his uncle died because of complicated
hyperthyroidism. One of his auntie has also history of diabetes.
SOCIAL HISTORY
He likes to go out often on Fridays and he smokes and drinks
occasionally.
 NURSING ASSESSMENT
PSYCHOLOGICAL HISTORY
He can cope up with problems and stress at home and in school.
 NURSING ASSESSMENT
HISTORY OF PRESENT ILLNESS
Patient usually jogs three times a week, and he is fond of drinking
milktea. He has allergies to dust and loves eating peanuts but no history
of food and drug allergies.
 NURSING ASSESSMENT
HISTORY OF PRESENT ILLNESS
Last April 2,2021, the patient went for an early morning jog to Baybay and he
reached Central Bank, he experiences difficulty in breathing, fatigue and
weakness, due to this, he rode in a tricycle and went home afterwards. The patient
drunk 2 Liters of water and experiences shortness of breath and patient was given
Cetirizine 1 Tab by his mother and difficulty of breathing persisted with non-
productive cough and chest tightness. By April 03, 2021 they went to St. Anthony
Hospital because he still has difficulty in breathing, chest tightness, and non-
productive cough. Patient oxygen saturation is 98%, Antigen Throat swab results
is negative. Patient is nebulizing with salbutamol 1 nebule. Afterwards, he stated
he felt relieved. That was the reason for admission at Room 302.
LABORATORY AND DIAGNOSTIC TEST
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THANK
YOU!