CASE STUDY:

Bronchial Asthma
Presented By:
Bulatao, Lesley Charmaine C.
Cabudoc, Maricar G.
Comilang Janielle Lyn M.
Constante, Quolette M.
Dela Cruz, Rhealyn N.
Ebuenga, Allysa O.
Espanueva, Gaylen C.
Fabon, Yvette Stephanie Nichol B.
Franco, Ma. Eliza Joy L.
Fuentes, Raquel F.
 io n
uc t
r o d
In t
 Asthma is a predisposition to
chronic inflammation of the lungs in
which the airways (bronchi) are
reversibly narrowed. During asthma
attacks (exacerbations of asthma), the
smooth muscle cells in thebronchi
constrict, and the airways become
inflamed and swollen. Breathing
becomes difficult,hat Makes a Child
More Likely to Develop Asthma.
There are many risk factors for developing
childhood asthma. These include:
 Presence of allergies
 Family history of asthma and/or allergies
 Frequent respiratory infections
 Low birth weight
 Exposure to tobacco smoke before and/or after birth
 Being male
 Being black
 Being raised in a low-income environment
How Can I Tell If My Child Has
Asthma?
Signs and symptoms to look for include:
 Frequent coughing spells, which may occur during play, at
night, or while laughing. It is important to know that cough
may be the only symptom present.
 Less energy during play
 Rapid breathing
 Complaint of chest tightness or chest "hurting“
 Whistling sound (wheezing) when breathing in or out
 See-saw motions (retractions) in the chest from labored
breathing
Shortness of breath, loss of breath
Tightened neck and chest muscles
Feelings of weakness or tiredness
Dark circles under the eyes
Frequent headaches
Loss of appetite
 Keep in mind that not all children have
the same asthma symptoms, and these
symptoms can vary from asthma episode to
the next episode in the same child. Also note
that not all wheezing or coughing is caused
by asthma.
In kids under 5 years of age, the most
common cause of asthma-like symptoms is
upper respiratory viral infections such
as the common cold.If your child has
problem breathing, take him or her to the
doctor immediately for an evaluation.
Asthma Diagnosed In Children?
Why Is Asthma is often difficult to
diagnose in infants. However, in older
children the disease can often be
diagnosed based on your child's medical
history, symptoms, and physical exam.
 Medical history and symptom description.Your
child's doctor will be interested in any history of
breathing problems you or your child may have
had, as well as a family history of asthma,
allergies, a skin condition called eczema, or
other lung disease. It is important that you
describe your child's symptoms -- cough,
wheezing, shortness of breath, chest pain or
tightness -- in detail, including when and how
often these symptoms have been occurring.
 Physical exam.During the physical examination,
the doctor will listen to your child's heart and
lungs.
 Tests.Many children will also have a chest X-ray
and pulmonary function tests. Also called lung
function tests, these tests measure the amount
of air in the lungs and how fast it can be
exhaled. The results help the doctor determine
how severe the asthma is. Generally, children
younger than 5 are unable to perform pulmonary
function tests. Thus doctors rely heavily on
history, symptoms and examination in making
the diagnosis.
Bronchial asthma triggers may include:
 Tobacco smoke
 Infections such as colds, flu, or pneumonia
 Allergens such as food, pollen, mold, dust mites, and
pet dander
 Exercise
 Air pollution and toxins
 Weather, especially extreme changes in temperature
 Drugs (such as aspirin, NSAID, and beta-blockers)
 Food additives (such as MSG)
 Emotional stress and anxiety
 Singing, laughing, or crying
 Smoking, perfumes, or sprays
 Acid reflux
 CASE
ABSTRACT
 On 24th day of September 2009, baby X, a 1
year and 2 month old boy was admitted to the
hospital under the service of Dr. M. Colasito with
a chief complaint of DOB & wheezing, this was
associated with fever. He was advice to secure
consent for management and for RR monitoring
every 2 hours.
On the same day, the child was hooked with
D5 0.3Nacl 500cc x 12°, the baby was subjected
under nebulization for every hour for the first
four hours then contrapted with O2 @ 2LPM via
NC. Then after, he received few medication;
Hydrocortisone 40mg IV q6°, Benadryl 9mg IV
stat dose, Cefuroxime 500mg IV q12° ANST as
ordered by Dr. Colasito.
 After a few hours, he was subjected under
CBC and chest X-ray AP-L. Then after, he was
encouraged to have DAT with SAP.

Sept. 25, 2009 8:45am IVF was replaced

with D5 IMB 500cc x 12° and nebulization was
adjusted q4° and he was encouraged to
continue rest. On the following day he was on
D5 IMB # 2 500cc x 12°. He is currently under
observation with no further doctors order as of
this day.
 PHYSICAL
ASSESSMENT
I. General Information
Name: Patient X
Age: 1 year old
Sex: Male
• II. Vital Signs
Temp: 36.0
Pulse: 12
Resp: 23
III. Anthropometric Measurement:
Height: 81 cm
Weight: 9 kg
Head Circumference: 48 cm
Abdominal Circumference: 49 cm
Chest Circumference: 48
cm
IV. General Appearance:
Patient shows no signs of distress,
mobile and calm
V. Skin
– Patient skin color is fair, smooth texture, dry
and warm to touch.
V. Head
– Normocepahalic, posterior and anterior
fonatanelles are closed.
– No depression upon palpation.
– Hair is fine wit even distribution.
– Scalp has no scars or lesions without nits.
– Symmetrical eyelids and eyebrows.
– Eyelashes evenly distributed.
– Smooth cornea and lens.
– Anicteric sclera.
– Pupils are responsive and reactive to light and
have an equal size.
– Conjunctivas are pink.\
VII. Ears
– Properly aligned, soft, and non tender pinna.
– Levels at the outer canthus of the eye.
– Ear canal has some cerumen.
VIII. Nose
– Appears smooth, nasolabial folds is
symmetrical.
– Septum is found in midline.
– No nasal discharge.
IX. Mouth and Pharynx
– Lips are pinkish in color, moist, symmetrical and smooth.
– Gums and buccal mucosa are pinkish in color, smooth
and moist.
– Soft and hard palate are intact.
– Uvula is found at the midline.
– Tongue moves freely.
– Tonsils are not inflamed.
X. Neck
– moves freely
– trachea is in the midline
– No palpable nodules.
– Thyroid is non palpable
XI. Chest and lungs
– Cylindrical
– Breathing is irregular with wheezing to ronchi
sound.
XII. Heart
– Precordium is flat
– Apical pulse is located at the fifth intercostals
space left midclavicular line.
XIII. Abdomen
– Appears slightly protuberant and normoactive
sounds upon palpation.
XIV. Back and extremities
– Nails and nail beds are pinkish in color.
Peripheral pulses are symmetrical.
– Peripheral pulses are symmetrical.
– Extremities symmetrical in size.
– Spine is in the midline.
ANATOMY AND PHYSIOLOGY
The upper respiratory tract consists of the nose,
sinuses, pharynx, larynx, trachea, and epiglottis.

The lower respiratory tract consists of the

bronchi, bronchioles and the lungs.

The major function of the respiratory system is to

deliver oxygen to arterial blood and remove
carbon dioxide from venous blood, a process
known as gas exchange.
Bronchi and Bronchial Tree
In the mediastinum, at the level of the
fifth thoracic vertebra, the trachea divides
into the right and left primary bronchi. The
bronchi branch into smaller and smaller
passageways until they terminate in tiny
air sacs called alveoli.
 The cartilage and mucous membrane of the
primary bronchi are similar to that in the trachea.
As the branching continues through the
bronchial tree, the amount of hyaline cartilage in
the walls decreases until it is absent in the
smallest bronchioles. As the cartilage
decreases, the amount of smooth muscle
increases. The mucous membrane also
undergoes a transition from ciliated
pseudostratified columnar epithelium to simple
cuboidal epithelium to simple squamous
epithelium.
 The alveolar ducts and alveoli consist
primarily of simple squamous epithelium,
which permits rapid diffusion of oxygen
and carbon dioxide. Exchange of gases
between the air in the lungs and the blood
in the capillaries occurs across the walls of
the alveolar ducts and alveoli.
Lungs
The two lungs, which contain all the components of the
bronchial tree beyond the primary bronchi, occupy most
of the space in the thoracic cavity. The lungs are soft and
spongy because they are mostly air spaces surrounded
by the alveolar cells and elastic connective tissue. They
are separated from each other by the mediastinum, which
contains the heart. The only point of attachment for each
lung is at the hilum, or root, on the medial side. This is
where the bronchi, blood vessels, lymphatics, and nerves
enter the lungs.
 The right lung is shorter, broader, and
has a greater volume than the left lung. It
is divided into three lobes and each lobe is
supplied by one of the secondary bronchi.
The left lung is longer and narrower than
the right lung. It has an indentation, called
the cardiac notch, on its medial surface for
the apex of the heart. The left lung has
two lobes.
 Each lung is enclosed by a double-layered
serous membrane, called the pleura. The
visceral pleura are firmly attached to the surface
of the lung. At the hilum, the visceral pleura are
continuous with the parietal pleura that line the
wall of the thorax. The small space between the
visceral and parietal pleurae is the pleural cavity.
It contains a thin film of serous fluid that is
produced by the pleura. The fluid acts as a
lubricant to reduce friction as the two layers slide
against each other, and it helps to hold the two
layers together as the lungs inflate and deflate.
The normal gas exchange depends on three
processes:
– Ventilation – is movement of gases from the
atmosphere into and out of the lungs. This is
accomplished through the mechanical acts of
inspiration and expiration.
– Diffusion – is a movement of inhaled gases in
the alveoli and across the alveolar capillary
membrane
– Perfusion– is movement of oxygenated blood
from the lungs to the tissues
The normal functions of respiration O2 and CO2 tension
and chemoreceptors are similar in children and adults.
However, children respond differently than adults to
respiratory disturbances; major areas of difference
include:
– Poor tolerance of nasal congestion, especially in infants who are
obligatory nose breathers up to 4 months of age
– Increased susceptibility to ear infection due to shorter, broader,
and more horizontally positioned eustachian tubes.
– Increased severity or respiratory symptoms due to smaller
airway diameters
– A total body response to respiratory infection, with such
symptoms as fever, vomiting and diarrhea
Control of gas exchange – involves neural and
chemical process

The neural system, composed of three parts located in the

pons, medulla and spinal cord, coordinates respiratory
rhythm and regulates the depth of respirations. The
chemical processes perform several vital functions such as:
• Regulating alveolar ventilation by maintaining normal
blood gas tension
• Guarding against hypercapnia (excessive CO2 in the
blood) as well as hypoxia (reduced tissue oxygenation
caused by decreased arterial oxygen [PaO2]. An increase
in arterial CO2 (PaCO2) stimulates ventilation; conversely,
a decrease in PaCO2 inhibitsventilation.
 G Y
LO
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O PH
T H
PA
• Asthma is an airway disease that can be
classified physiologically as a variable and
partially reversible obstruction to air flow,
and pathologically with overdeveloped
mucus glands, airway thickening due to
scarring and inflammation, and
bronchoconstriction, the narrowing of the
airways in the lungs due to the tightening
of surrounding smooth muscle. Bronchial
inflammation also causes narrowing due
to edema and swelling caused by an
immune response to allergens.
Bronchoconstriction
 Inflamed airways and bronchoconstriction in
asthma. Airways narrowed as a result of the
inflammatory response cause wheezing.
 During an asthma episode, inflamed airways
react to environmental triggers such as smoke,
dust, or pollen. The airways narrow and produce
excess mucus, making it difficult to breathe. In
essence, asthma is the result of an immune
response in the bronchial airways.
 The airways of asthma patients are
"hypersensitive" to certain triggers, also known
as stimuli (see below). (It is usually classified as
type I hypersensitivity.)
 In response to exposure to these triggers, the
bronchi (large airways) contract into spasm (an
"asthma attack"). Inflammation soon follows,
leading to a further narrowing of the airways and
excessive mucus production, which leads to
coughing and other breathing difficulties.
Bronchospasm may resolve spontaneously in 1–
2 hours, or in about 50% of subjects, may
become part of a 'late' response, where this
initial insult is followed 3–12 hours later with
further bronchoconstriction and inflammation.
• The normal caliber of the bronchus is maintained
by a balanced functioning of these systems,
which both operate reflexively. The
parasympathetic reflex loop consists of afferent
nerve endings which originate under the inner
lining of the bronchus. Whenever these afferent
nerve endings are stimulated (for example, by
dust, cold air or fumes) impulses travel to the
brain-stem vagal center, then down the vagal
efferent pathway to again reach the bronchial
small airways. Acetylcholine is released from the
efferent nerve endings. This acetylcholine
results in the excessive formation of inositol
1,4,5-trisphosphate (IP3) in bronchial smooth
muscle cells which leads to muscle shortening
and this initiates bronchoconstriction.
Bronchial inflammation
 The mechanisms behind allergic asthma—i.e.,
asthma resulting from an immune response to
inhaled allergens—are the best understood of
the causal factors. In both people with asthma
and people who are free of the disease, inhaled
allergens that find their way to the inner airways
are ingested by a type of cell known as antigen-
presenting cells, or APCs. APCs then "present"
pieces of the allergen to other immune system
cells. In most people, these other immune cells
(TH0 cells) "check" and usually ignore the
allergen molecules. In asthma patients,
however, these cells transform into a different
type of cell (TH2), for reasons that are not well
understood.
 The resultant TH2 cells activate an important
arm of the immune system, known as the
humoral immune system. The humoral immune
system produces antibodies against the inhaled
allergen. Later, when a patient inhales the same
allergen, these antibodies "recognize" it and
activate a humoral response. Inflammation
results: chemicals are produced that cause the
wall of the airway to thicken, cells which produce
scarring to proliferate and contribute to further
'airway remodeling', causes mucus producing
cells to grow larger and produce more and
thicker mucus, and the cell-mediated arm of the
immune system is activated. Inflamed airways
are more hyper-reactive, and will be more prone
to bronchospasm.
 The "hygiene hypothesis" postulates that
an imbalance in the regulation of these TH
cell types in early life leads to a long-term
domination of the cells involved in allergic
responses over those involved in fighting
infection. The suggestion is that for a child
being exposed to microbes early in life,
taking fewer antibiotics, living in a large
family, and growing up in the country
stimulate the TH1 response and reduce
the odds of developing asthma.
Stimuli
 Allergens from nature, typically inhaled,
which include waste from common
household pests, the house dust mite and
cockroach, as well as grass pollen, mold
spores, and pet epithelial cells;
 Indoor air pollution from volatile organic
compounds, including perfumes and
perfumed products. Examples include
soap, dishwashing liquid, laundry
detergent, fabric softener, paper tissues,
paper towels, toilet paper, shampoo,
hairspray, hair gel, cosmetics, facial
cream, sun cream, deodorant, cologne,
shaving cream, aftershave lotion, air
freshener and candles, and products such
as oil-based paint.
 Medications, including aspirin,β-
adrenergic antagonists (beta blockers),
and penicillin.
 Food allergies such as milk, peanuts, and
eggs. However, asthma is rarely the only
symptom, and not all people with food or
other allergies have asthma.
 Use of fossil fuel related allergenic air
pollution, such as ozone, smog, summer
smog, nitrogen dioxide, and sulfur dioxide,
which is thought to be one of the major
reasons for the high prevalence of asthma
in urban areas.
 Various industrial compounds and other
chemicals, notably sulfites; chlorinated
swimming pools generate chloramines—
monochloramine (NH2Cl), dichloramine
(NHCl2) and trichloramine (NCl3)—in the
air around them, which are known to induce
asthma.
 Exercise or intense use of respiratory
system. The effects of which differ
somewhat from those of the other triggers,
since they are brief. They are thought to be
primarily in response to the exposure of the
airway epithelium to cold, dry air.
 Early childhood infections, especially viral upper
respiratory tract infections. Children who suffer
from frequent respiratory infections prior to the
age of six are at higher risk of developing
asthma,particularly if they have a parent with the
condition. However, persons of any age can
have asthma triggered by colds and other
respiratory infections even though their normal
stimuli might be from another category (e.g.
pollen) and absent at the time of infection. In
many cases, significant asthma may not even
occur until the respiratory infection is in its
waning stage, and the person is seemingly
improving. In children, the most common triggers
are viral illnesses such as those that cause the
common cold.
 Hormonal changes in adolescent girls and adult
women associated with their menstrual cycle
can lead to a worsening of asthma. Some
women also experience a worsening of their
asthma during pregnancy whereas others find
no significant changes, and in other women their
asthma improves during their pregnancy.
 Psychological stress. There is growing evidence
that psychological stress is a trigger. It can
modulate the immune system, causing an
increased inflammatory response to allergens
and pollutants.
 Cold weather can make it harder for patients to
breathe. Whether high altitude helps or worsens
asthma is debatable and may vary from person
to person.
Pathogenesis
The fundamental problem in asthma appears to be
immunological: young children in the early stages of
asthma show signs of excessive inflammation in their
airways. Epidemiological findings give clues as to the
pathogenesis: the incidence of asthma seems to be
increasing worldwide, and asthma is now very much
more common in affluent countries.
In 1968 Andor Szentivanyi first described The Beta
Adrenergic Theory of Asthma; in which blockage of the
Beta-2 receptors of pulmonary smooth muscle cells
causes asthma. Szentivanyi's Beta Adrenergic Theory is
a citation classic using the Science Citation Index and
has been cited more times than any other article in the
history of the Journal of Allergy and Clinical Immunology.
 In 1995 Szentivanyi and colleagues
demonstrated that IgE blocks beta-2
receptors. Since overproduction of IgE is
central to all atopic diseases, this was a
watershed moment in the world of allergy.
Asthma and sleep apnea
 It is recognized with increasing frequency
that patients who have both obstructive
sleep apnea and asthma often improve
tremendously when the sleep apnea is
diagnosed and treated. CPAP is not
effective in patients with nocturnal asthma
only.
Asthma and gastro-esophageal
reflux disease
 If gastro-esophageal reflux disease (GERD) is
present, the patient may have repetitive
episodes of acid aspiration. GERD may be
common in difficult-to-control asthma, but
according to one study, treating it does not seem
to affect the asthma. When there is a clinical
suspicion for GERD as the cause of the asthma,
an Esophageal pH Monitoring is required to
confirm the diagnosis and establish the
relationship between GERD and asthma.
 R Y
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RADIOLOGY DEPARTMENT

Case No. : 09-3148

Age : 1 Yr. old and 2 Months
Examination: Chest PA/L (Radial)

ROENTGENOLOGICAL REPORT:
Point hazy opacity and present in the inner part of
both Lungs. No definite Hilar Adropathy is.
The heart is normal in size and in configuration.
The Diaphragm, CP sulci & the Thoracic cage are
intact. No other Remarks.
IMPRESSION:
Beginning bilateral Bronchopneumonia
Bronchopneumonia
 Bronchopneumonia or bronchial
pneumonia (also known as lobular
pneumonia) is a type of pneumonia
characterized by multiple foci of isolated,
acute consolidation, affecting one or more
pulmonary lobes.
 It is one of two types of bacterial
pneumonia as classified by gross
anatomic distribution of consolidation
(solidification), the other being lobar
pneumonia.
 Component & Quantity Result

Hemoglobin:
M: 12-17 g/dl 12.6 g/dl
F: 11-15 g/dl
Hematocrit:
M: 40-54% 34.5%
F: 37-47%
WBC Count:
5,000-10,000/ cu mm 17,200 / cu mm
RBC Count:
M: 4.5-6.0/ cu mm 4.28 / cu mm
F: 4.0-5.5/ cu mm

Reticulocyte Count Result

Platelet Count:
150,000-400,000 / L Adequate
Hematocrit:
 Decreased hematocrit indicates anemia, such as
that caused by iron deficiency or other
deficiencies. Other conditions that can result in a
low hematocrit include vitamin or mineral
deficiencies, recent bleeding, cirrhosis of the
liver, and malignancies. The most common
cause of increased hematocrit is dehydration,
and with adequate fluid intake, the hematocrit
returns to normal. However, it may reflect a
condition called polycythemia vera—that is,
when a person has more than the normal
number of red blood cells. This can be due to a
problem with the bone marrow or, more
commonly, as compensation for inadequate lung
function (the bone marrow manufactures more
red blood cells in order to carry enough oxygen
throughout your body).
WBC:
An elevated number of white blood cells is
called leukocytosis. This can result from
bacterial infections, inflammation, leukemia,
trauma, intense exercise, or stress.
A decreased WBC count is called leukopenia.
It can result from many different situations,
such as chemotherapy, radiation therapy, or
diseases of the immune system.
Counts that continue to rise or fall to abnormal
levels indicate that the condition is getting
worse. Counts that return to normal indicate
improvement.
Platelet Count:
 If platelet levels fall below 20,000 per microliter,
spontaneous bleeding may occur and is
considered a life-threatening risk. Patients who
have a bone marrow disease, such as leukemia
or another cancer in the bone marrow, often
experience excessive bleeding due to a
significantly decreased number of platelets
(thrombocytopenia). As the number of cancer
cells increases in the bone marrow, normal bone
marrow cells are crowded out, resulting in fewer
platelet-producing cells.
 D Y
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G S
R U
D
 Name of Classification Dosage/ Route Mechanism of Indication Nursing
the drug Frequency Action Responsibilities

Antihistamine 9 mg IV Diphenhydramine Treatment of Determine why the

Generic: q 8 hours works by blocking symptoms of medication was
Diphenhy stat the effect of allergies ordered and assess
symptoms that
dramine histamineat H1 rece
apply to the
ptor sites. individual patient
Brand By blocking the H1
name: receptor on
Benadryl peripheral
nociceptors,
diphenhydramine
decreases their
sensitization and
consequently
reduces itching that
is associated with
an allergic reaction.
 Name of Classification Dosage/ Route Mechanism of Indication Nursing
the drug Frequency Action Responsibilities

Generic Anti- 40mg IV Supresses normal Used in the Assess affected skin
name: inflammatorie q 6 hours immune response management of a prior to and daily
Hydrocortis s and inflammation wide variety of daily during therapy.
one Immunosuppr allergic / Note degree of
essants immunologic inflammation and
Brand reactions pruritus. Notify
name: physician or other
Hydrocorto health care provider
ne, Cortef if symptoms of
infection develop.
 Name of Classification Dosage/ Route Mechanism of Indication Nursing
the drug Frequency Action Responsibilities

Generic Anti-infective 500 mg IV Cefuroxime is used Treatment of Assess patient for

name: ( second q 12 to treat many kinds respiratory tract infection at the
Cefuroximegeneration of bacterial infections beginning and
cephalosporin throughout course
infections, including
Brand s) of therapy
name: severe or life- Before initiating
Ceftin, threatening forms. therapy, obtain a
Kefurox, history to determine
Zinacef previous use of and
reactions to
penicillin s or
cephalosporins.
Observe patients for
signs and symptoms
of anaphylaxis
(rash, pruritus,
laryngeal edema,
wheezing).
Discontinue the
drug and notify
physician if these
occur.
Name of the Classificatio Dosage/ Route Mechanism of Indication Nursing
drug n Frequency Action Responsibilities

Generic Salbutamo Nebule Oral The combination of Management of Take care to

name: l Sulfate q 1 hour nebuliza ipratropium and reversible ensure that the
Duavent tion albuterol is used to bronchospasms nebulizer mask
( ipratropiu prevent wheezing, associated with fits the user's
m difficulty breathing, obstructive face properly and
salbutamol) chest tightness, airway diseases, that nebulized
and coughing. bronchial asthma solution does not
Brand escape into the
name: eyes. 
DuaNeb •Evaluate
therapeutic
response.
 r e
C a
in g
urs a n
N P l
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS & EVALUATION
RATIONALE
Subjective: “ Ineffective After 8 hours of -Monitor vital -Goals
“ Ubo sya ng breathing nursing signs to serve as a partially met.
ubo at di pattern interventions, baseline data. -After 8 Hours
makahinga ng related to the patients -Avoidance of of Nursing
maayos” as painful/ineff breathing irritants; smoking interventions,
verbalized by ective pattern will be allergens, and the px
the mother cough” industrial breathing
chemicals to pattern was
prevent further improved.
irritation.
-Increased based
fluid intake to thin
mucus and make it
easier to
expectorate.
-Deep breathing
exercise to
improve air
circulation and
breathing.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS & EVALUATION
RATIONALE
-Positioning to
facilitate breathing
(Fowler’s or
Orthopneic)
-Providing
adequate nutrition
via small, frequent
meals to meet
nutritional
requirements & to
avoid suffocation.
-Avoidance of
extremes of heat
and cold to avoid
further cough.
Interdependent:
-Use of Meds:
Bronchodilators,
expectorants &
liquefying agents.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS & EVALUATION
RATIONALE
Subjective Impaired After 1 hour of •Monitor RR,depth
“Nahihirapan  gas nursing and effort including
huminga ang exchange intervention the of accessory
anak ko” related to client will muscles ,nasal
  ventilation improve flaring and
Objective perfusion ventilation abnormal
-Restlessness imbalance breathing patterns
-Irritability •Auscultate every
-Tachycardia- breath sounds
P 181 every 1-2 hours
-Cyanosis •Monitor the clients
-Diaphoresis behavior for the
-Nasal Flaring onset of
-Tachypnea restlessness
RR-41 •Observe for
-Barrel chest cyanosis of the
-Wheezing on skin especially
expiration note the color,
tongue and oral
mucus membrane
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS & EVALUATION
RATIONALE
•Position the client Goals met
in Semi fowlers The client is
with an upright improved
position at 45 ventilation
degree if possible from
 Administer  
bronchodilator as P-145
ordered by the  
doctor RR-22
Thank You
for
Listening…