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Bronchialasthma.pptx“Care of A Client With bronchial asthma Secondary To allergens”
Presented by:
201017134
| المملكة العربية السعودية وزارة التعليم جامـعـة حـائل كلية التمريض | KINGDOM OF SAUDI ARABIA Ministry of Education University of Ha’il College of Nursing |
Client’s Health Profile
History of Past & Present Illness / Chief Complaint / Ongoing Medical Treatment:
The client was admitted in FMW via wheelchair due to shortness of breath and productive cough secondary to weather , genetic factor.
In the initial assessment, the client has a dyspneic ,not cyanotic ,with occasional wheeze.
According to past medical history , the client was diseases with genetic component, Atopic diseases such as eczema .
Medical File No.:25**3
Date & Time of Admission:13/7/36@16:55H.
Age:15Yrs.
Gender: female.
Nationality : Saudi.
Level of Education: school.
Occupation: student.
Client’s Health Profile (cont.)
Chief Complaint / History of Past & Present Illness / Ongoing Medical Treatment:
The client was treated/managed with ventoline nebulization/6h,1ml+3NS, atrovent nebulization/6h,250mug+4NS,hydrocortisone/6h,200mg,IV, RL 500cc /12h,ampicillin 1gm IV TID, CXR, normal diet,
The client was transferred to/admitted in FMW on the wheelchair th day at 13/7/36@16:55H . The goal of care is to improve respiration which included the following interventions: place in high fowler position ,give oxygen and nebulization as order, provide bronchial clapping.
The client’s condition has improved spo2 and RR wither normal limits.
Disease Process
Definition of Medical Terms, Causes, Signs/Symptoms:
Bronchial asthma:
Is a chronic, inflammatory disease of the respiratory tract, Which is characterized by bronchial hyperactivity and Respiratory obstruction.
Causes:
1-genetic factor.
2-weather.
Signs/symptoms:
1-coughing.
2-wheezing.
3-dyspnea.
Anatomy of the bronchial asthma System and Presentation of Affected Organ(s)
Causes / Risk Factors of bronchial asthma:
Nonmodifiable factors:
1.Genetic factors.
Modifiable factors:
1.smoking.
2.dust.
3.obesity.
4.stress.
5.Cold air.
Algorithm/Treatment Protocol for bronchial
asthma:
Pathophysiology Diagram of bronchial asthma:
Source:
Actual Physical Examination
Affected Organ :
Lung
Significant on Inspection:
>chest movement.
X-ray.
Increased respiratory rate .
Significant on Auscultation:
>wheezing
Significant on Percussion/Palpation:
>tactile fremitus : decreased ,hyperresonant.
Date & Time Examined:13-7-36@16:55H
Diagnostic Tests and Procedures
Lab Test / Imaging #1:
WBC
Result & Reference Value:
11.3L(3.5-10)
Interpretation:
infecation
Lab Test / Imaging #2:
RBC
Result & Reference Value:
5.39L(4.5-5.0)
Interpretation:
Normal .
Lab Test / Imaging #3:
HP
Result & Reference Value:
15.9g/dl(12-16)
Interpretation:
Normal.
Date & Time Reported:13/7/36@16:55H
Date & Time Reported:13/7/36@16:55H
Date & Time Reported:13/7/36@16:55H
Diagnostic Tests and Procedures (cont.)
Lab Test / Imaging #4:
urea
Result & Reference Value:
16.8mg/dl(0.0-50.5)
Interpretation:
Normal .
Lab Test / Imaging #5:
Glucose
Result & Reference Value:
84.9mg/dl(70-115)
Interpretation:
Normal .
Lab Test / Imaging #6:
CREA jaffe gen2 comp
Result & Reference Value:
0.8mg/dl(0.5-1.2)
Interpretation:
Normal .
Date & Time Reported:13/7/36@16:55H
Date & Time Reported:13/7/36@16:55H
Date & Time Reported:13/7/36@16:55H
Drug Study #1
Adverse Reactions & Nursing Responsibilities:
1.Palpitation .
2.Cough .
3.Shaking .
4.Nervousness .
5.nausea/vomiting .
Classification: Short action beta2 agonists
Indication for Patient: Relief of action symptoms preventive treatment for exercise induced bronchospasm prior to exercise.
Generic Name: albutero
Trade Name: ventolin
Prescribed dose, route & frequency:
1ml+3NS,inhalation,6h
Drug Study #2
Classification:
Systemic corticosteroids
Indication for Patient: For moderate or sever exacerbations to prevent progression of exacerbation ,reverse inflammation , speed recovery and reduce rate of relapse .
Generic Name: Prednisone
Trade Name: deltasone
Prescribed dose, route & frequency:
10g,P/o , TID
Adverse Reactions & Nursing Responsibilities:
1.Insomnia .
2.Irritability .
3.Disorientation .
4.Headache .
5.Dizziness .
14
Drug Study #3
Classification: anticholinergic
Indication for Patient: Acute bronchospasm reverses only cholinergically mediated bronchospasm dose not modify reaction to antigen,dose not block exercise induced bronchospasm .
Generic Name: ipratropium
Trade Name: Atrovent
Prescribed dose, route & frequency:
250mug+4ml,inhalation,6h
Adverse Reactions & Nursing Responsibilities:
1.Burning eyes .
2.Back pain .
3.Dryness of the mouth .
4.Diarrhea .
5.Heartburn.
Drug Study #4
Classification: aminopenicillin
Indication for Patient: infections of the respiratory tract :non penicillinase-producing H.influenzae and staphylococci and streptococcin including streptococcus pneumoniae .
Generic Name: ampicillin
Trade Name: omnipen
Prescribed dose, route & frequency:
1mg,IV,TID
Adverse Reactions & Nursing Responsibilities:
1. Diarrhea .
2.Vomiting.
3.Rash .
4.urticaria .
5.Oral candidiasis .
Drug Study #5
Classification:short to medium acting glucocoticoids .
Indication for Patient:hydrocortisone is a corticosteroid it works by decreasing or preventing tissues from responding to inflammation it also modifies the bodys response to certain immune stimulation .
Generic Name:hydrocortisone .
Trade Name: enzone ,cortef .
Prescribed dose, route & frequency:
200mg,IV,6h
Adverse Reactions & Nursing Responsibilities:
1. Nausea .
2. Heartburn .
3.Dizziness .
4.Increase sweating .
5.Headache.
Nursing Care Plan - Actual Problem #1
Subjective Cues
>patient says l have difficulty breathing .
Objective Cues
Inspection:
>chest movement is irregulars .
Auscultation:
>decreased chest expansion unilaterally .
Percussion / Palpation:
>hyper resonance .
Lab Tests / Diagnostics:
>chest X-ray,routine blood examination .
Nursing Diagnosis:
inefective breathing pattern
Related to:
bronchospasm
As evidenced by:
Dyspnea
Nursing Care Plan - Actual Problem #1 (cont.)
Short-term goal
The client will be free respiratory disease and can breath easily .
Independent Intervention:
>peoform chest physiotherapy
Rationale: to reduce the breathing difficulty .
Dependent Intervention:
>admnistor oxygen
Rationale:
To improve breathing pattern .
Collaborative Intervention:
>the lap results
Rationale:to assess the improvement .
Nursing Care Plan - Actual Problem #1 (cont.)
Outcome Evaluation
The client’s condition has improved as evidenced by effective breathing pattern .
Nursing Care Plan - Actual Problem #2
Subjective Cues
>patient says l have cough .
Objective Cues
Inspection:
>the PT is asking so many questions .
Auscultation:
>absent or diminished lung sounds
Percussion / Palpation:
> hyper resonance .
Lab Tests / Diagnostics:
>chest X-ray, sputum culture .
Nursing Diagnosis:
Anxiety
Related to:
Difficulty in breathing
As evidenced by:
Cough
Nursing Care Plan - Actual Problem #2 (cont.)
Short-term goal
To improve breathing pattern
Independent Intervention:
>provide psychological support
>stay with the patient
Rationale: to reduce anxiety
Dependent Intervention:
>administer medication as prescribed
>administer oxygen as prescribed
Rationale:
To reduce cough
To reduce breathing difficulty
Collaborative Intervention:
>cheek lab tests
Rationale:to assess the improvement of treatment
Nursing Care Plan - Actual Problem #2 (cont.)
Outcome Evaluation
The client’s condition has improved as evidenced by decreed cough.
Nursing Care Plan - Potential Problem #1
Risk Factors:
>malnutration,immune dysfunction
Nursing Diagnosis:
Risk for infection
Related to:
Increase WBC count
Nursing Care Plan - Potential Problem #1 (cont.)
Short-term goal
To reduce the risk of infection
Independent Intervention:
>perform universal precaution before and after touch the patient
Rationale:to reduce cross infection
Dependent Intervention:
> administer medication as prescribed
Rationale:
To reduce the infection
Collaborative Intervention:
>repeat the blood examination
>encourage nutrition meals
Rationale:to assess the level of infection
Nursing Care Plan - Potential Problem #1 (cont.)
Outcome Evaluation
The client’s condition has improved as evidenced by normal blood results .
Patient Education
M-medication:
Many inhaled asthma medications are meant to be used daily to keep your airways healthy, even if you are not experiencing symptoms.
E-exercise:
Avoid exercising near chemicals or irritants in the air, such as places with heavy automobile traffic, deep breathing exercise and passive ROM.
T-treatment:
Avoid exposure to allergens such as pollen and dust.
H-health education:
Keep yourself away from smoking, Keep the air-conditioner filters free of dust.
O-OPD follow up:
appointment after one week .
D-diet:
Avoid eating foods to which you are allergic, Drink plenty of water.
S-spirituality :
Meditation is an experience of relaxing the body, quieting the mind, and awakening the spirit. Meditation encourages a deepening of consciousness or awareness, and also facilitates a deeper understanding of self and others.
Nursing Research Journal
“Evidence-based Nursing Practice”
Title of Nursing Research:
Intervention Review Breathing exercises for adults with asthma
Author & Year Published:
Diana A Freitas1, Elizabeth A Holloway2, Selma S Bruno1, Gabriela SS Chaves1,
Guilherme AF Fregonezi3, Karla MPP Mendonça3.
Editorial Group: Cochrane Airways Group
Published Online: 1 OCT 2013
Source:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001277.pub3/abstract
ABSTRACT:
Background Breathing exercises have been widely used worldwide as a complementary therapy to the pharmacological treatment of people with asthma.
Objectives To evaluate the evidence for the efficacy of breathing exercises in the management of patients with asthma.
Search methods The search for trials led review authors to review the literature available in The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and AMED and to perform hand searching of respiratory journals and meeting abstracts. Trial registers and reference lists of included articles were also consulted. The literature search has been updated to January 2013.
Thank You!
