J.H.

CERILLES STATE COLLEGE

In consortium with
Western Mindanao State University
Balangasan, Pagadian City
Zamboanga del Sur 7016

CASE STUDY
OF ASTHMA
Abas, Farha C. Amores, Wendynne

Adavan, Yzel V. Vicxy Claire

Aldaba, Niña Jean T. Quiapo, Jay Bond B.

 BIOGRAPHICAL DATA
NAME: Elisha Ramirez RELIGION: Roman Catholic

ROOM NUMBER: Pedia Ward HIGHEST EDUCATIONAL ATTAINMENT: Grade 1

AGE: 6 years old OCCUPATION: N/A

GENDER: Female DATE OF CONFINEMENT: May 20, 2021

CIVIL STATUS: Child SOURCE OF HISTORY: 40% Chart

DATE OF BIRTH: October 2, 2015 40% Significant other (mother)

BIRTHPLACE: Pagadian City ZDS 20% Attending Physician

CULTURAL GROUP: Cebuano

 BIOGRAPHICAL DATA
REASON FOR HEALTH CONTACT: The patient was experiencing reoccurring cough, wheezing, and
difficulty of breathing.

DESCRIPTION OF PATIENT:

A 6-year-old girl who lives in Purok Kapalaran, Balangasan Pagadian City ZDS. Her mother is the one who
brought her to the hospital last May 20, 2021 @1:30pm

HISTORY OF PRESENT ILLNESS: According to the mother, 5 days prior to admission, her daughter had a
cough and it was often worse at night. She self-medicated her daughter with a cough remedy such as Ascof for
kids 3 times a day. The cough was gone for a few days, but then it reoccurred. A few days later, the mother
described a strange sound she heard when she breathed as a "whistling sound," and the child was also having
difficulty breathing, which led the mother to the hospital for consultation and was advised to have the patient
admitted.
 BIOGRAPHICAL DATA

PAST HISTORY: According to the mother, her daughter was admitted with a pollen allergy when she was 3
years old. The mother recalled that her daughter took medicine like Antihistamine.

FAMILY HISTORY: According to the mother they have a family member who had food allergies. While on
the paternal side both grandparents are hypertensive and was taking their maintenance medication.

SOCIAL HISTORY: The patient Elisha is the youngest among the 2 siblings. She is in her school age. She
does not like playing outdoors so much considering she had pollen allergies.

 
 GENOGRAM
LEGEND:
Mother side Father side
MALE

FEMAL
E

PATIEN
T

ALIVE&WEL
L

ILL

FOOD
ALLERGY

HYPERTENSIVE

DECEASED
 GENOGRAM
IMMUNIZATION/EXPOSURE TO COMMUNICABLE DISEASE

He was completely immunized when he was a child. He received 3 doses of PENTA, 3 doses of Oral Polio
with 1 booster dose (injectable), 3 doses of Pneumococcal Vaccine, & 2 doses of MCV from the health
center.

ALLERGIES

The patient is allergic to pollen according to his mother.

 GORDON’S ASSESSMENT
PRESENT HEALTH (DURING
PAST HEALTH
HOSPITALIZATION)
HEALTH PERCEPTION
The client was active child and likes to play in She was upset because she can’t meet her
the classroom during break time with her playmates in school.
playmates

NUTRITIONAL METABOLIC
She eats 3x a day, loves to eat processed foods Eats rice, fruits, and vegetables. Drinks 6-8
such as hotdog, tocino, and sausage. She also glasses of water a day.
eats vegetables and drinks 6-8 glasses of water a
day.
 GORDON’S ASSESSMENT
ELIMINATION

Was able to urinate (3x a day) normally per day Urinates (3x a day) and defecate trice a day
and defecate trice a day. normally.

ACTIVITY/EXERCISE
Her daily routine were going to school, playing
with schoolmates, making assignments, and Communicate with her parents, relatives and
watching television. She also liked to talk a lot. visitors effectively

SLEEP/REST
Wakes up easily in between sleep, especially
Sleeps longer, about 8-9 hours.
when nurse’s rounds.
 GORDON’S ASSESSMENT
COGNITIVE/PERCEPTUAL

There was no problem in her senses. She can There is no problem in her senses. She is responsive
comprehend, responses to physical and verbal stimuli. and active

ROLE RELATIONSHIP
She is the youngest among the 2 siblings, one of the
She is the youngest among the 2 siblings. One of the
strength of her parents. But also stress because she is
sources of joy and strength of her parents.
sick.
COPING/STRESS TOLERANCE
She doesn’t fully identify stressors. She doesn’t fully identify stressors.
VALUES/BELIEFS
She is a Roman Catholic and goes to church every
She is a Roman Catholic and goes to church every
Sunday with her family, but since she is sick the
Sunday with her family.
family can’t attend masses for the meantime.
 LABORATORY EXAMINATION
Complete Blood Count
May 20, 2021

Examination Made Result Normal Values Clinical Significance

Hemoglobin 12.00 gms% 12-16 Normal

RBC Count 5 4.50 – 5.50 12/L Normal
Hematocrit 47.2 vol% 37-47 Increase
WBC Count 1300 5-10 thousand/cum Increase

Neutrophil 54 40-75 Normal

Lymphocyte 42 20-48 Normal
Monocyte 0.01 2.0-9.0 Decrease
Eosinophil 7.2 0.0-7.0 Increase
 LABORATORY EXAMINATION
Platelet Count Result Normal Values Clinical Significance
May 20, 2021
233,000 150-450 thousand/cum Normal
REMARKS: ERYHTROCYTES ARE NORMOCYTIC AND NORMOCHROMIC.

Urinalysis Examination Made Result Normal Values Clinical Significance

May 20, 2021 Color LT Yellow Pale Yellow Normal
Character Clear Clear Normal
Reaction/pH 6.5 4.8 – 8.0 Normal
Specific gravity 1.005 1.005 – 1.030 Normal
Protein (-) (-) Normal
Sugar (-) (-) Normal
RBC (-) (-) Normal
Pus cells 0-1/HPF (-) Normal
Epithelial cells (-) (-) Normal
Amorphous Urates Few Few Normal
 LABORATORY EXAMINATION
Chest X-ray X-RAY REPORT
May 20, 2021
• There are no evident lung parenchymal infiltrates.

• The heart is not enlarged.

• The trachea is midline.

• The hemidiaphragms and costophrenic angles are

intact.

• The chest wall structures are unremarkable.

IMPRESSION: NO RADIOGRAPHIC
ABNORMALITY
 PHYSICAL EXAMINATION
BODY PARTS NORMAL FINDINGS ACTUAL FINDINGS ANALYSIS

Uniform color, except the

Equal distribution of color, no
SKIN exposed to the sun areas, no Normal Findings
lesions, and (-) turgor.
edema present, and no lesions.

Evenly distributed hair, thick Hair is black in color, no evidence

and black, no infection, and no of alopecia, hair evenly
HAIR Normal Findings
presence of dandruff, silky and distributed, (-) pediculosis, and
resilient hair. dandruff.

Rounded, smooth skull contour,

absence of nodules and masses; There is no lumps/masses, no
HEAD/SCALP Normal Findings
has systematic facial feature, lesions, smooth skull contour.
and movements.
PHYSICAL EXAMINATION
Eyebrows and eyelashes are
evenly distributed, the eyelids
has no discoloration, pupils are
EYES black in color, round, equal in
size, normally 3-7 mm in
diameter, conjunctiva pink in
color, the sclera white in color.
Color is the same as facial skin
color, symmetrical, auricle
aligned with outer canthus of
EARS eyes about 10o from vertical, not
tender, pinna recoils after it is
folded able to hear sound in
both ears.
Eyebrows and eyelashes are
evenly distributed, eyes are dark
brown in color, sclera is white in
color, (+) light accommodation, Normal Findings
pupils are black in color and equal
in size, no lesions or discharge in
conjunctiva, and is pink in color.
Color is the same as facial skin
color, symmetrical auricle
alignment with outer canthus of
Normal Findings
the eyes, (+) ear wax, pinna
recoils after it is folded, and able
to hear sound in both ears.
 PHYSICAL EXAMINATION
Symmetric and straight, no discharge
NOSE of flaring, uniform in color, no
tenderness, and no lesions.
There is a small mucous discharge on
the nose and slight flaring of the
nostrils, symmetrical and straight,
uniform in color, no tenderness, and
no lesion
Mucous secretions may be due
to post nasal drip which triggers
an asthma attack.

Lips pink in color, soft, moist, (+)

(-) dryness, teeth are intact, no
ability to purse lips, teeth are in
LIP/MOUTH inflammation in uvula and tonsils, Normal Findings
place, tongue is in central position,
tongue is in central position.
pink in color.

Muscle equal in size, head centered;

Uniform in color, no lumps/masses
head movement is coordinated and in
NECK noted, (-) pain upon swallowing, head Normal Findings
smooth movement, no enlargement
centered
of lymph nodes.
 PHYSICAL EXAMINATION
Quiet, rhythmic respiration, normal
CHEST breathing rate, (-) wheezes or
crackles
Uniform in color, no evidence of
enlarged liver or spleen. Audible
ABDOMEN
bowel sounds, absence of arterial
bruits, no tenderness
Convex curvature, nailbeds pinkish
EXTREMITIES
in color, no tenderness or swelling
Noticeable use of accessory muscle
when breathing, symmetrical chest
movement, wheezing on auscultation
Uniform in color, skin is intact, soft,
no tenderness
Uniform in color, no fractures, and
symmetrical movement, there is no
presence of tenderness or swelling.
Greater pressure is needed to
push air through the bronchus
which results in increased use of
accessory muscle. Wheezing
confirms of airflow limitation.
Normal Findings
Normal Findings
 DISCHARGE PLAN
Medicine  Instruct the significant others (parent/guardian) to continue the prescribed home medications such as inhalers to
minimize the risk and optimize the wellbeing of the patient.

 Provide a clean environment

 Inform the patient or parent/guardian to avoid the triggers that causes asthma such as:

- Allergens like pollen, cockroaches, dust, and pet dander

Exercise - Cigarette smoke or other air pollution

- Upper respiratory infections

- Extreme physical activity

- Frequent crying, laughing, or yelling

- Cold weather
 DISCHARGE PLAN
 Instruct patient or parents to keep up with prescribed long term medications
Treatment
 Encourage the patient to drink plenty of water as it helps to keep the lining of the lungs hydrated.

 Instruct patient or parents to have at least 8 to 10 hours of sleep everyday

 Remind the patient to cover the nose and mouth when it is very cold, dusty, and dry air as it can
trigger asthma

Health Education  Teach patient/family proper used of inhaler

 Maintain normal pulmonary function by breathing exercise

 Maintain normal exercise and physical activity levels

 Maintain good hygiene by taking a daily bath

 DISCHARGE PLAN

Outpatient Dep’t
 Instruct patient to continue follow-up check up to the doctor
(follow-up check-up)
frequently especially if the condition changes over time.

Diet  Promotes healthy lifestyle by eating healthy foods such as fruits,

vegetables and meat.
 ASTHMA
What is Asthma?
Asthma is a condition in which your airways narrow and swell
and may produce extra mucus. This can make breathing
difficult and trigger coughing, a whistling sound (wheezing)
when you breathe out, 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.

 What is an Asthma Attack
An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. The attack happens in your body’s
airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like
the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and
the airways shrink. Less air gets in and out of your lungs, and mucous that your body makes clogs up the airways.

You can control your asthma by knowing the warning signs of an asthma attack, staying away from things that cause an attack,
and following your doctor’s advice. When you control your asthma:

 you won’t have symptoms such as wheezing or coughing,

 you’ll sleep better,

 you won’t miss work or school,

 you can take part in all physical activities, and

 you won’t have to go to the hospital.

 Transmission

Asthma is neither a contagious (infectious) nor a communicable (transmitted by the patient to healthy

person either by direct or by indirect contact) disease. Asthma is actually a disorder of the respiratory air-
passage.
 Characteristics

Asthma is a chronic, inflammatory lung disease involving recurrent breathing

problems. The characteristics of asthma are three airway problems:
1. Obstruction
2. Inflammation
3. Hyperresponsiveness
 Symptoms
Asthma symptoms vary from person to person. You may have infrequent asthma attacks, have symptoms only
at certain times — such as when exercising — or have symptoms all the time.

Asthma signs and symptoms include:

 Shortness of breath

 Chest tightness or pain

 Wheezing when exhaling, which is a common sign of asthma in children

 Trouble sleeping caused by shortness of breath, coughing or wheezing

 Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu
 Symptoms
Signs that your asthma is probably worsening include:

 Asthma signs and symptoms that are more frequent and bothersome
 Increasing difficulty breathing, as measured with a device used to check how well your lungs are working (peak
flow meter)
 The need to use a quick-relief inhaler more often
For some people, asthma signs and symptoms flare up in certain situations:

 Exercise-induced asthma, which may be worse when the air is cold and dry.
 Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust.
 Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste, or
particles of skin and dried saliva shed by pets.
 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.
 Risk Factors
The risk factors for developing childhood asthma are as follows:

 Allergies.

 Family history of asthma, allergies and atopy (a genetic, or inherited, likelihood to develop allergies and
asthma).

 Frequent respiratory infections.

 Low birth weight.

 Exposure to tobacco smoke before and/or after birth.

 Being male.

 Being raised in a low-income environment.

 Is Asthma contagious?
Asthma is not contagious; Its cause is still largely unknown, but researchers have determined that
asthma can be caused by both heredity and environmental factors
 Prognosis of Asthma
For the large majority of people infected with Asthma, the prognosis is most adults with asthma achieve good or very good control
of their disease and are able to lead a normal life, punctuated only by the need to take small amounts of regular medication and by
occasional exacerbations. A small subgroup of about 10% of adults with asthma have persisting symptoms and exacerbations despite
taking adequate treatment at the highest doses; the impact of this severe or ' difficult-to-control ' asthma is often significant and
many of these patients struggle at home and at work, and are prone to the adverse side-effects of treatment, particularly those
associated with oral corticosteroids at high doses. Asthmatics of particular concern are those who smoke or are exposed to passive
smoking, which can make asthma worse. The challenge of severe asthma is to find ways of controlling the frequency of
exacerbations and reversing the chronic airflow obstruction that are the most frequent hallmarks of this condition, despite the use of
optimal anti-asthma treatment. The most important long-term consequence of asthma is the development of persistent airway
narrowing, which is non- or poorly responsive to treatment; it is unclear whether this is preventable by regular treatment with
controller therapies.
 Home Remedies of Asthma

There are no home remedies for an asthma attack. Asthma is managed with medications, by avoiding
triggers, and by creating an asthma action plan with your doctor.
Keep a rescue inhaler on hand for immediate relief during an attack. Check the date on the pump
regularly to make sure it hasn't expired.
Asthma attacks are potentially life-threatening. Seek emergency medical attention if your symptoms
don't improve after using the rescue inhaler.
 Prevention
There are many ways to prevent Asthma but there are no vaccine available yet.
If you have asthma, you need to do what you can to cut your exposure to asthma triggers. That starts by
knowing what causes you to cough, wheeze and grasp for breath. While there’s no cure, there are steps you
can take to keep your asthma in control and prevent an attack.
1. Identify Asthma Triggers
Certain asthma triggers can set off a cascade of asthma symptoms.
These include:

 Air pollution  Exercise

 Allergies  Sinusitis

 Cold air  Smoke

 A cold or flu virus  Fragrances

 Prevention
2. Stay Away From Allergens 7. Consider Immunotherapy Allergy Shots

3. Avoid Smoke of Any Type 8. Take Asthma Medications as Prescribed

4. Prevent Colds 9. Follow Your Asthma Action Plan

5. Allergy-Proof Your Home 10. Use a Home Peak Flow Meter

6. Get Your Vaccinations

 Diagnosis
Diagnosing asthma in children under 5 is a little different. Children this age usually are not given a breathing
test. Instead, the doctor asks about certain signs and symptoms and prescribes a bronchodilator if they think it
might be asthma. If the bronchodilator helps reduce your child’s symptoms, that is a sign that your child may
have asthma.

To diagnose asthma, your doctor will discuss your medical history with you and perform a physical exam. You
may need a lung function test and maybe other tests, such as a chest or sinus X-ray. If you or your child are
having problems breathing on a regular basis, don’t wait! Visit a doctor immediately. Knowing what to expect
during the diagnostic process may help. 
 Assessment and
Diagnostic Findings
Laboratory criteria for the diagnosis of asthma may include 1 of the following:

Physical exam. If your doctor thinks you have asthma, they will do a physical exam. They will look at your
ears, eyes, nose, throat, skin, chest and lungs.

Lung function tests. To confirm asthma, your doctor may have you take one or more breathing tests known as
lung function tests. These tests measure your breathing. Lung function tests are often done before and after
inhaling a medicine known as a bronchodilator (brahn-ko-DIE-ah-lay-tor), which opens your airways. If your
lung function improves a lot with use of a bronchodilator, you probably have asthma. Your doctor may also
prescribe a trial with asthma medicine to see if it helps. Common lung function tests used to diagnose asthma
include:
 Assessment and
Diagnostic Findings
Spirometry 

Peak airflow

FeNO tests (exhaled nitric oxide)

Provocation tests

 Allergy tests. Allergy tests aren’t used to determine if you have asthma. But, if you have allergies, they may be
causing your asthma.
 Medical Management
Immediate intervention may be necessary, because continuing and progressive dyspnea leads to
increased anxiety, aggravating the situation.
Pharmacologic Therapy
•Short-acting beta2 –adrenergic agonists. These are the medications of choice for relief of acute
symptoms and prevention of exercise-induced asthma.
•Anticholinergics. Anticholinergics inhibit muscarinic cholinergic receptors and reduce intrinsic
vagal tone of the airway.
 Medical Management
•Corticosteroids. Corticosteroids are most effective in alleviating symptoms, improving airway
function, and decreasing peak flow variability.
•Leukotriene modifiers. Anti Leukotrienes are potent Broncho constrictors that also dilate blood
vessels and alter permeability.
•Immunomodulators. Prevent binding of IgE to the high affinity receptors of basophils and mast
cells.
•Peak Flow Monitoring
•Peak Flow Meter
 Nursing Intervention
The nurse generally performs the following interventions for Asthma include:
•Assess history. Obtain a history of allergic reactions to medications before administering medications.
•Assess respiratory status. Assess the patient’s respiratory status by monitoring the severity of symptoms,
breath sounds, peak flow, pulse oximetry, and vital signs.
•Assess medications. Identify medications that the patient is currently taking. Administer medications as
prescribed and monitor the patient’s responses to those medications; medications may include an antibiotic if
the patient has an underlying respiratory infection.
•Pharmacologic therapy. Administer medications as prescribed and monitor patient’s responses to
medications.
•Fluid therapy. Administer fluids if the patient is dehydrated.
 
Thank you!