ASTHMA

Patient Profile

Name: Zed

Room Number: 305

Age: 5 years old

Gender: Male

Civil Status: Single

Date of Birth: November 10, 2016

Birthplace: Poblacion Tabina, Zamboanga del Sur

Cultural Group: Cebuano

Religion: Roman Catholic

Date of confinement: November 19, 2021

A. Description of Patient
A 5 years old boy who lives in Poblacion, Tabina, Zamboanga del Sur. Her mother is the
one who brought her to the hospital last November 19, 2021 @8am.

B. Reasons for seeking Health Care

He was experiencing difficulty of breathing and chest pain while playing during the
birthday party of his brother, he couldn’t talk and lips turned blue, and it didn't get better even
after he used the rescue inhaler so the parents decided to take him to the hospital right away.

C. History of Present Illness

According to the parents, their son was experiencing coughing and wheezing 3 days
before the birthday party, at the said party he was playing with his cousins, but after an hour of
playing, the mother noticed that his son was having trouble breathing and his lips were turning
blue. His mother quickly grabbed the rescue inhaler from her bag but no improvement and
decided to take him to the hospital.

D. Past Health History (PHH)

Patient was diagnosed with asthma since he was 3 years old and the pattern of attack is
once/twice a month.

Diagnosis: Activity intolerance related to disease condition as evidence by easily fatigue and
weakness

Reason for Admission: Difficulty of breathing

Test/Examination:

Vital signs: BP: 80/60 mmHg

HR: 70bpm

R: 17 breaths per minute

TEMP: 38°C

SpO2: 90%

Measurement: Height: 39 inches; weight: 14.6kg

General appearance: well nourishment, thin, dull and unhealthy

E. Family History:
According to her mother, both of the patient's grandfathers are hypertensive, and were
taking his maintenance medicine. There's no any family disease on the mother's side. On the
paternal side, two of his father's siblings deal from asthma.
 GENOGRAM

F. Social History
Patient is the second child. He is currently a preschooler and very active loves to play outdoor
games and also likes to play mobile games.

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 and month of October he received his anti titanus vaccine at the Rural
Health Unit.

H. Allergies
According to his mother, the patient has no any allergy.

I. Home Medication/Alternative Medicine

According to the mother when asthma attacks on her son, she usually prepares a turmeric tea
with honey extract.
Gordon’s Assessment
BEFORE DURING
HOSPITALIZATION HOSPITALIZATION
Health perception Client is active in school and Client can’t play and go to
loves to play games school because he is ill
Nutritional Metabolic Client eats 3x a day. Drinking Client eats vegetables and
milk 2x a day. Loves to eat fruits to bring back his health
vegetables and soap meals.
Elimination Client urinates 6-7 times a Client is able to urinate 6-7
day and defecate once a day times a day and defecate once
a day normally everyday
Activity/Exercise Client goes to school every Client plays with his gadgets
day and after school he plays
with his brothers
Sleep and rest Client sleeps 8-9 hours in Client has a hard time
night and 2-4 hours during sleeping due to his condition
afternoom
Cognitive/Perceptual There is no problem in his Client is very responsive
senses. He can comprehend, when asked some questions
and physically and verbally
responsive.
Role-Relationship He and his brother are the His parents are stressed out
source of strength of his due to his condition
parents
Sexuality-Reproductive Client has not yet undergone Same
puberty and has less
knowledge on topics related
to sexuality
Coping/Stress Tolerance Client does not recognize Same
stressors
Values/Beliefs Client is a Roman Catholic Client is sad because he is
and participates actively on unable to go to church
church activities 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 distributed, 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 moves upward
plate. Torus palatinus symmetrically as the
may be present. 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
Date: Nov. 20, 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. 21, 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, % 90-93 95 Normal
ctCO2, mmol/L 24-32 18.8 Decreases
lgE, IU/mL <100 516.3 Normal
DISCHARGE PLAN
Medicine Advise the significant others
(parent/guardian) to continue the prescribed
home medications to make sure the optimum
recovery of the patient.
Exercise Instruct the patient parent to have an exercise
or yoga
Treatment Inhalers should be accessible to the clients.
Take medicines as prescribed.
Use of nebulizer to help get medicine into the
lungs
Health Education  Environmental hygiene should be
maintained
 Control all the triggers factors that
may stimulate asthmatic attack
 Take medicines regularly and come
for follow up checkup
 Meet the nutritional needs of the child
 Provide warm water to the child

Outpatient Dep’t Encourage parents to take their children to

(Follow-up Check-Up) follow-up appointments as directed by their
doctor.
Diet The client should be instructed to maintain a
healthy weight, eat fruits and vegetables,
avoid allergic foods that can trigger asthma
Spirituality Encourage clients to pray in accordance with
their beliefs. Ask for help from God for
complete recovery.

ASTHMA
What is Asthma?

Asthma is a chronic (long-term) lung disease. It affects

your airways, the tubes that carry air in and out

of your lungs. When you have asthma, your airways can

become inflamed and narrowed. This can cause

wheezing, coughing, and tightness in your chest.

When these symptoms get worse than usual, it is called an asthma attack or flare-up.

However, there are several different types of asthma, and each has its own set of triggers,
namely: exercise-induced bronchospasm (EIB), allergic asthma, cough-variant asthma,
occupational asthma, and nocturnal or nighttime asthma.

Anatomy

Pathophysiology
Environmental factors + genetic
predisposition

Symptoms
In childhood asthma, the lungs and airways become easily inflamed when exposed to certain
triggers, such as inhaling pollen or catching a cold or other respiratory infection.

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.

Common childhood asthma symptoms include:

 Frequent coughing that worsens when your child has a viral infection, occurs while your
child is asleep or is triggered by exercise or cold air
 A whistling or wheezing sound when breathing out
 Shortness of breath
 Chest congestion or tightness

Symptom severity varies from person to person. There’s no cure for asthma, but treatment can
help. It’s important to treat the condition early to prevent health complications from developing.

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.

Asthma can cause a number of complications, including:

 Severe asthma attacks that require emergency treatment or hospital care

 Permanent decline in lung function
 Missed school days or getting behind in school
 Poor sleep or fatigue
 Symptoms that interfere with play, sports or other activities

Causes
The exact cause of asthma is unknown, and the causes may vary from person to person. It’s not
clear why one person reacts to exposure while others do not. Genes seem to play a role in
making some people more susceptible to asthma. Normally, the body’s immune system helps to
fight infections. Sometimes a person’s immune system responds to a substance in the
environment called an allergen. When someone breathes in an allergen, such as ragweed, the
immune system in the airways may react strongly. Other people exposed to the same substance
may not react at all.

The immune system reacts to an allergen by creating inflammation. Inflammation makes your
airways swell and narrow and possibly produce more mucus. This can make it harder to breathe.
The muscles around the airways may also tighten, which is called a bronchospasm. This can
make it even harder to breathe. Over time, the airway walls can become thicker.

Your asthma may have been caused partly by a viral infection or allergens in the air when you
were a baby or young child. During this stage of life, your immune system is still developing.

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?

Asthma symptoms may start suddenly or up to several hours after you or your child has been
exposed to triggers, such as tobacco smoke or animal dander. In some cases (such as with asthma
that happens during your job), symptoms may not occur until 4 to 12 hours after contact. There is
no latency period. The symptoms develop soon after the exposure, usually within 24 hours, and
may reappear after months or years, when the person is re-exposed to the irritants.
Prognosis of Asthma

Although asthma is considered a chronic disease, the large majority of patients have good control
of the disease if prevention measures are applied and the inhaled treatment is done correctly.
Only a small percentage of patients have asthma refractory to conventional treatment.

Asthma is a disorder that affects individuals of essentially any age group. While it is particularly
common in children, it may persist for decades. In general, once an asthmatic, long-term an
asthmatic. That doesn't mean that asthma will always be as severe as it might be initially. And it
is also true that asthma, while it waxes and wanes, may be more severe at certain times of the
year or in certain years than others. There are certain things that exacerbate asthma such as viral
infections and those may also predispose to a more severe asthma episode.

The prognosis of asthma is generally quite good. The therapies that are available are excellent
and control of asthma is generally quite easily achieved. It may take more work for some than
others and it does take perseverance in using the treatments that are prescribed. But in general,
asthma is not associated with long-term severe respiratory consequences.

Home Remedies for Asthma

Alongside medication and a proper treatment plan, home remedies can help in keeping asthma
symptoms under control. Several home remedies and lifestyle changes can help people manage
the condition when practiced alongside their prescribed treatment plan. 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.

Prevention

Careful planning and avoiding asthma triggers are the best ways to prevent asthma attacks.

o Limit exposure to asthma triggers. Help your child avoid the allergens and irritants that
trigger asthma symptoms.
 o Don't allow smoking around your child. Exposure to tobacco smoke during infancy is a
strong risk factor for childhood asthma, as well as a common trigger of asthma attacks.
o Encourage your child to be active. As long as your child's asthma is well-controlled,
regular physical activity can help the lungs to work more efficiently.
o See the doctor when necessary. Check-in regularly. Don't ignore signs that your child's
asthma might not be under control, such as needing to use a quick-relief inhaler too often.
o Asthma changes over time. Consulting your child's doctor can help you make needed
treatment adjustments to keep symptoms under control.
o Help your child maintain a healthy weight. Being overweight can worsen asthma
symptoms, and it puts your child at risk of other health problems.
o Keep heartburn under control. Acid reflux or severe heartburn (gastroesophageal reflux
disease, or GERD) might worsen your child's asthma symptoms. He or she might need
over-the-counter or prescription medications to control acid reflux

Diagnosis

Asthma can be hard to diagnose. Your child’s doctor will consider the symptoms and their
frequency and your child’s medical history. Your child might need tests to rule out other
conditions and identify the most likely cause of the symptoms.

To diagnose asthma, your doctor will ask you your medical history, including your family
history, especially if anyone in your family has asthma. The doctor might also perform a general
physical check-up and prescribe you to go for a lung function test, along with a sinus x-ray and
chest x-ray.

The lung function tests include:

 Spirometry- A spirometer is a device used to check lung function. It can be done in

young children, including infants.
 Peak Airflow- A peak flow meter is used to measure the amount of air a child can blow
out of the lungs. This measurement is very important in checking how well your child’s
asthma is being controlled.
 Trigger Tests
Assessment and Diagnostic Findings

To determine the diagnosis of asthma, the clinician must determine that episodic symptoms of
airway obstruction are present

Positive family history. Asthma is a hereditary disease and can be possibly acquired by any
member of the family who has asthma within their clan.

Environmental factors. Seasonal changes, high pollen counts, mold, pet dander, climate changes,
and air pollution are primarily associated with asthma.

Comorbid conditions. Comorbid conditions that may accompany asthma may include
gastroesophageal reflux, drug-induced asthma, and allergic bronchopulmonary aspergillosis.

Medical management

The following medical managements are available for asthma:

 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.

 Pharmacotherapy:
o Quick relievers. When needed to relieve bronchospasm during an acute attack.
(Salbutamol, Terbutaline, Adrenaline, and Aminophylline)
o 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)
o Long-acting pain relievers. Used to relieve bronchospasm for longer periods of time.
(Salmeterol, Formoterol, Bambuterol)
 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.
 Magnesium sulfate. In children with severe asthma who are being treated with
bronchodilators and corticosteroids, IV magnesium sulfate may be beneficial.
 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 Intervention

The nurse generally performs the following interventions:

 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.
References:

Marainne, Belleza (2021) Asthma Nursing Care Management

https://nurseslabs.com/asthma/#prevention

Danielle Dresdan (2021) Asthma in Children, Also called: Childhood asthma, Pediatric asthma

https://www.medicalnewstoday.com/articles/home-remedies-for-asthma?
fbclid=IwAR2rTbfQvGn_Ojjk_fd2TeUOyTCiPg7M8kyw_Fb1QwDX9iuzTeg4q50I2So