Case presentation on bronchial asthma, respiratory disorder, Introduction-Definition-History collection-Physical examination-lab diagnosis- nursing diagnosis of asthma, treatment of asthma

1. Asthma
Bronchial
Presented By:
Gerlin George

2. Diagnosis
BASELINE
DATA
Gender
Female Bronchial Asthma
Patient Name
Ms. Delilah Simon
Age
13 Years

3. Chief
Complaints
Coughing
since
2 weeks
Dyspnea
since
1 week
Wheezing
since
1 week
Chest tightness
since
5 days

4. History of
Present
illness
Ms. Delilah Simon was admitted in the hospital with
chief complaints of coughing since 2 weeks, dyspnea
and wheezing since 1 week and chest tightness since 5
days. After the investigation she was diagnosed with
Bronchial Asthma
Present medical history
There is no any significant history of present surgery.
Present surgical history

5. History of
Past
illness
Ms. Delilah Simon has no significant history of
past medical
Past medical history
There is no any significant history of past surgery.
Past surgical history

6. PERSONAL History
She following a mixed dietary pattern
and she is not having any allergies
towards any kind of food items.
NUTRITIONAL STATUS
She usually sleeps for 8 hours but now she
only sleeps for 4 hours she has disturbed
sleeping pattern due to dyspnea.
SLEEPING PATTERN
Ms. Delilah dependent on others to do
the daily activities
HYGIENE
She has normal and regular elimination
pattern
ELIMINATION PATTERN
06

7. FAMLIY HISTORY
Ms. Delilah belongs to a nuclear family .
There are four members in her family.
All members are healthy except herself

8. Ms. Delilah belongs to a middle-class family. She lives
in an urban area. Mineral water is the source of
drinking. The area where she is living is neat and
clean. She maintains a good relationship with the
family members and neighbors.
Socio-economic Status

9. PULSE RATE - 110bpm
vital signs
TEMPERATURE - 98.6 F
BLOOD PRESSURE - 120/90 mmHg
RESPIRATION - 32bpm

10. Inspection: The chest was barrel shape. There was no scar on
the chest wall and no dilated veins. There were suprasternal
and subcostal recession. The chest moved symmetrically with
respiration
PHYSICAL
Percussion: Resonance bilaterally.
Palpation: The trachea was centrally located. The chest
expansion was symmetrical bilaterally. The apex beat was
palpable at 5th intercostals within midclavicular line. Vocal
fremitus was equal bilaterally.
Examination
Auscultation: Normal air entry bilaterally. Vesicular breath
sound with prolong expiratory. Ronchi during expiration on the
upper zone bilaterally.
Impression: MH was having respiratory disorders evidenced by
suprasternal and subcostal recession and presence of added
breath sound, ronchi during expiration on the upper zone of her
chest.

11. CHEST X RAY
H E R E I S I N C R E A S E D D E N S I T Y A N D
E N L A R G E M E N T O F T H E R I G H T H I L U M W I T H A
M U L T I L O B U L A R C O N T O U R

12. The lungs, which is the organ for respiration is a
paired cone shaped organs lying in the thoracic
cavity separated from each other by the heart and
other structures in the mediastinum
ANATOMY &
PHYSIOLOGY OF
LUNGS
Lungs

13. ANATOMY OF
LUNGS
The lungs are a pair of spongy, air-filled organs
located on either side of the chest (thorax). The
trachea (windpipe) conducts inhaled air into the lungs
through its tubular branches, called bronchi. The
bronchi then divide into smaller and smaller branches
(bronchioles)
The function of the lungs is to oxygenate blood.
They achieve this by bringing inspired air into close
contact with oxygen-poor blood in the pulmonary
capillaries.

14. The lungs are roughly cone shaped, with an apex, base, three surfaces and three borders. The left
lung is slightly smaller than the right – this is due to the presence of the heart.
Each lung consists of:
Apex – The blunt superior end of the lung. It projects upwards, above the level of the 1st rib and
into the floor of the neck.
Base – The inferior surface of the lung, which sits on the diaphragm.
Lobes (two or three) – These are separated by fissures within the lung.
Surfaces (three) – These correspond to the area of the thorax that they face. They are named costal,
mediastinal and diaphragmatic.
Borders (three) – The edges of the lungs, named the anterior, inferior and posterior borders.

15. Air enters the body via the nose (preferably) or the mouth. The air enters the main windpipe, called the trachea,
and continues en route to each lung via either the right or left bronchus (plural=bronchi). The lungs are separated
into sections called lobes, two on the left and three on the right. The air passages continue to divide into ever
smaller tubes, which finally connect with tiny air sacs called alveoli. This gradually branching array of tubes is
referred to as the tracheobronchial "tree" because of the remarkable similarity to the branching pattern of a tree.
The other half of the respiratory system involves blood circulation. Venous blood from the body is returned to the
right side of the heart and then pumped out via the pulmonary artery. This artery splits in two for the left and
right lungs and then continues to branch much like the tracheobronchial tree. These vessels branch into a fine
network of very tiny tubes called capillaries. The capillaries are situated adjacent to the alveoli and are so small
that only one red blood cell at a time can pass through their openings. It is during this passage that gases are
exchanged between the blood and the air in the nearby alveoli. After passing the alveoli, capillaries then join
together to begin forming the pulmonary veins, which carry the blood back to the left side of the heart.
S T R U C T U R E O F L U N G S

16. The lungs are the foundational organs of the respiratory system, whose most basic
function is to facilitate gas exchange from the environment into the bloodstream.
Oxygen gets transported through the alveoli into the capillary network, where it can
enter the arterial system, ultimately to perfuse tissue.
PHYSIOLOGY OF
LUNGS
The cells in our bodies need oxygen to stay alive. Carbon dioxide is a by-product of respiration. The
lungs and respiratory system allow oxygen in the air to be taken into the body, while also letting the
body get rid of carbon dioxide in the air breathed out.

17. When you breathe in, the diaphragm moves downward toward the abdomen, and the rib
muscles pull the ribs upward and outward. See muscles of Respiration. In exhalation, the
diaphragm moves upward and the chest wall muscles relax, which causes the chest cavity
to get smaller and push air out of the respiratory system through the nose or mouth. With
each inhalation, air fills a large portion of the millions of alveoli. Oxygen diffuses from the
alveoli to the blood through the capillaries lining the alveolar walls. Once in the
bloodstream, oxygen gets picked up by the hemoglobin in red blood cells. This oxygen-rich
blood then flows back to the heart, which pumps it through the arteries to oxygen needy
tissues throughout the body.
In the capillaries of the body tissues, oxygen is freed from the hemoglobin and moves into
the cells. Carbon dioxide produced moves out of the cells into the capillaries, where most
of it dissolves in the plasma of the blood. Blood rich in carbon dioxide then returns to the
heart via the veins. From the heart, this blood is pumped to the lungs, where carbon
dioxide passes into the alveoli to be exhaled

18. F U N C T I O N O F L U N G S
It provides oxygen to the blood stream and removes carbon dioxide
It enables sound production or vocalization as expired air passes over the vocal chords.
Protection: Cilia, both in the upper airways and trachea, beat and move mucous continually
towards the mouth. Macrophage Alveolar macrophages phagocytose inhaled particulate
matter and pathogens.
It enables protective and reflexive non breathing air movements such as coughing and
sneezing, to keep the air passages clear
Thermoregulation: Heat loss from the respiratory system helps the body regulate internal
body temperature.
It assists in abdominal compression needed during micturation (urination), defecation
(passing feces) and childbirth.
The basic functions of the respiratory system are:

19. DISEASE
CONDITION -
Bronchial Asthma

20. ASTHMA
Asthma is a chronic lung disease that inflames and narrows the
airways. Asthma is a reversible, obstructive airway disease in which
trachea & bronchi respond in a hyperactive way to certain stimuli. It is
an intermittent or reversible types of obstructive lung disease in which
there is narrowing of bronchial lumen characterized by wheezing &
difficulty In breathing

21. 1.When a person has asthma, the air passages are inflamed, which means that the airways are red and
swollen. In an attack, the lining of the passages swell causing the airways to narrow and reducing
the flow of air in and out of the lungs.
2.Airway hyper-responsiveness to a wide range of stimuli. Obstruction
Inflammation of the air passages makes them over extra-sensitive to a number of different things
Clinical Symptoms that can "trigger," or bring on, asthma symptoms.
3.Muscles within the breathing passages contract (bronchospasm), causing even further narrowing
of the airways. This narrowing makes it difficult for air to be breathed out (exhaled) from the lungs.
Asthma is a condition that affects the air passages of the lungs.
It is a three-step problem:

22. Allergic Asthma (Extrinsic Asthma): The term allergic or extrinsic asthma is used when the
symptoms are induced by a hyper immune response to the inhalation of specific allergens.
Allergic asthma is triggered by allergens, such as pet dander, house dust, feathers, food
preservatives, mold, or pollen. Allergic asthma is more likely to be seasonal because it often goes
hand-in-hand with allergies that are also seasonal.
asthma
Non-Allergic Asthma (Intrinsic Asthma): This type of asthma is triggered by irritants
in the air that are not related to allergies including airway irritants (air pollution,
cold, heat, weather changes, fumes), wood or cigarette smoke, room deodorants,
household cleaning products, perfumes, respiratory tract infections, change in
temperature, stress or emotional upsets/ excitement, physical exertion or exercise,
drugs such as aspirin and other NSAIDs and food preservatives.
Types of

23. Mixed Asthma: Mixed asthma has characteristics of both allergic and non allergic
asthma. It is most common form of the asthma.
asthma
Cough-Variant Asthma (CV A): Cough-variant asthma does not have the classic symptoms
of asthma — such as wheezing and shortness of breath. Instead, CVA is characterized by
one symptom, a persistent dry cough. Cough-variant asthma can lead to full-blown asthma
that shows other asthma symptoms.
Exercise-induced Asthma (EIA): Exercise-induced asthma affects people during or
after physical activity. EIA can occur in people who are not sensitive to classic
asthma triggers such as dust, pollen, or pet dander.
Types of

24. Nocturnal Asthma: This type of asthma is characterized by asthma symptoms that worsen
at night. Those who suffer from nocturnal asthma can also experience symptoms anytime
of the day. However, certain triggers — such as heartburn, pet dander, and dust mites —
can cause those symptoms to worsen at night while sleeping.
asthma
Occupational Asthma: It is induced by triggers that exist in a person's workplace.
Irritants and allergens include dusts, dyes, gases, fumes, animal proteins, and
rubber latex that are common in a wide range of industries—including
manufacturing, textiles, farming, and woodworking.
Types of

25. CAUSES OF
Infections like sinusitis, colds, and the flu
Allergens such as pollens, mold, pet dander, and dust mites
Irritants like strong odors from perfumes or cleaning solutions
Air pollution
Tobacco smoke
Exercise
Cold air or changes in the weather
Gastroesophageal reflux disease (GERD)
Strong emotions such as anxiety, laughter, sadness,
or stress
Medications such as aspirin
Asthma

26. Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
Respiratory infections, such as the common cold
Physical activity (exercise-induced asthma) Cold air
Air pollutants and irritants, such as smoke
Certain medications, including beta blockers, aspirin and other NSAIDS drugs
Strong emotions and stress
Sulfites, preservatives added to some types of foods and beverages
Gastroesophageal reflux disease (GERD)
Menstrual cycle in some women
Allergic reactions to some foods, such as peanuts or shellfish Low birth weight
Hay fever (allergic rhinitis) and other allergies
Eczema: another type of allergy affecting the skin; and Genetic predisposition
Asthma risk factors include:
Weather, especially extreme changes in temperature
Asthma
risk factors of

27. PATHOPHYSIOLOGY
DUE TO ETIOLOGICAL FACTORS
REVERSIBLE AND DIFFUSE AIRWAY INFLAMMATION
HYPER RESPONSIVENESS OF AIRWAY
SWELLING OF THE MEMBRANE THAT LINE THE AIRWAY ( MUCOSAL EDEMA )
CONTRACTION OF BRONCHIAL SMOOTH MUSCLES ( BRONCHOSPASM )
BRONCHIAL MUSCLES AND MUCUS GLANDS ENLARGES
PRODUCTION OF THICK, TENACIOUS SPUTUM
ALVEOLI HYPERINFLATE
ASTHMA

28. manifestation
Clinical
Coughing: A persistent cough is one of the most common asthma symptoms.
Wheezing: Wheezing is a whistling noise heard during breathing.
Chest tightness: This may feel like something is squeezing or sitting on chest.
Shortness of breath: the feeling that a breath is barely finished before another is needed.
Restlessness
Irritable or A rehensive
Fever of 100 degrees or higher
Chest & abdominal pain, Vomiting
Increased respiratory rate
Dry, hacking & non-productive cough
Headache
Hypoxemia
Mental confusion
Other Clinical Manifestations

29. Patient Picture
Coughing
Wheezing
Chest tightness
Shortness of breath
Increased respiratory rate
Headache
Irritable or A rehensive

30. Mild Intermittent: This includes attacks no more than twice a week and night-time attacks no more
than twice a month. Attacks last no more than a few hours to days. Severity of attacks varies, but there
are no symptoms between attacks.
Mild Persistent: This includes attacks more than twice a week, but not every day, and night-time
symptoms more than twice a month. Attacks are sometimes severe enough to interrupt regular
activities.
Moderate Persistent: This includes daily attacks and night-time symptoms more than once a week.
More severe attacks occur at least twice a week and may last for days. Attacks require daily use of
quick-relief (rescue) medication and changes in daily activities.
Severe Persistent: This includes frequent severe attacks, continual daytime symptoms, and frequent
nighttime symptoms. Symptoms require limits on daily activities.
CURRENT GUIDELINES FOR THE CARE OF PEOPLE WITH ASTHMA INCLUDE CLASSIFYING
THE SEVERITY OF ASTHMA SYMPTOMS, AS FOLLOWS:

31. HISTORY COLLECTION
PHYSICAL EXAMINATION
SPIROMETRY
PEAK EXPIRATORY FLOW
PULSE OXIMETRY
METHACHOLINE CHALLENGE
NITRIC OXIDE TEST
CHEST X RAY
ALLERGY BLOOD TESTING
LABORATORY TESTS
BLOOD GASES
CBC
SPUTUM CULTURE
SPUTUM CYTOLOGY
DIAGNOSTIC
Evaluation

32. This device measures how much air you can exhale
and how forcefully you can breathe out.
Measures the ability to push air out of the lungs or
how fast air can be exhaled.
It is a non-invasive way to continuously monitor 02
saturation.
SPIROMETER
PEAK EXPIRATORY FLOW
PULSE OXIMETRY
METHACHOLINE CHALLENGE
NITRIC OXIDE TEST
CHEST X RAY
LABORATORY TESTS
Inhaling a known asthma trigger called methacholine
will cause mild constriction of airways.
It used to diagnose and monitor asthma. It measures
the amount of a gas called nitric oxide in breath.
It will help to find out whether a foreign object or
other disease may be causing symptoms.
Help to rule out conditions that cause symptoms
similar to asthma, to identify patient allergies.

33. Patient Picture
PULSE OXIMETRY
LABORATORY TEST
SPIROMETRY
CHEST X RAY
NITRIC OXIDE TEST
CBC

34. ASTHMA
Showing symptoms such as coughing, wheezing,
or shortness of breath.
Waking at night due to asthma symptoms.
Extremely short of breath
Unable to perform normal activities
Yellow Zone symptoms same or worse for 24 hours
Action Plan
Asthma experts, including those at the National
Institutes of Health (NIH) and the Centers for
Disease Control and Prevention (CDC),
recommend developing an asthma action plan
with your doctor to help control your asthma.
The plan will document important information
such as your daily medications (what kind and
when you should take them), how to handle
asthma attacks, and how to control your asthma
symptoms long term.
Asthma Zones
A. Green Zone - "Doing Well"
B. Yellow Zone - "Asthma is getting worse"
No asthma symptoms during the day or night
Able to perform casual activities
C. Red Zone -"Medical Alert"

35. Promote bronchodilation
Reduce inflammation (Mucosal Edema)
Remove Secretions
Prevent ongoing and bothersome symptoms
Prevent asthma attacks
Maintain normal or near-normal lung function
Have as few side effects of medication as possible
MEDICAL
MANAGEMENT -
Goals

36. PHARMACOLOGIC
THERAPY
Most people who have asthma need to take long-term control medicines daily to help prevent
symptoms. The most effective long-term medicines reduce airway inflammation. These medicines
are taken over the long term to prevent symptoms from starting. They don't give quick relief from
symptoms.
Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-
term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-
relief, or "rescue," medicines relieve asthma symptoms that may flare up.
LONG- TERM CONTROL MEDICATIONS
Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an
asthma attack — or before exercise if doctor recommends it.
QUICK- RELIEF MEDICATIONS

37. Types of long-term control medications include:
Inhaled Corticosteroids:
Leukotriene Modifiers:
Long-acting beta agonists (LABAs):
Methylxanthines:
Combination inhalers:
Cromolyn Sodium:
Omalizumab:
Inhaled corticosteroids are the preferred medicines for longterm control of asthma.
Leukotriene inhibitors are another group of controller medications.
This class of drugs is chemically related to adrenaline, a hormone produced by the adrenal glands.
Methylxanthines are another group of controller medications useful in the treatment of asthma.
Combination inhalers such as fluticasone and salmeterol and budesonide and formoterol.
Cromolyn sodium is another medication that can prevent the release of chemicals that cause asthma-related
inflammation.
Omalizumab belongs to a newer class of agents that works with the body's immune system.

38. Types of quick relief medications include:
Short-acting Beta Agonists:
Anticholinergics:
Oral and Intravenous Corticosteroids:
Short-acting beta-agonists are the most commonly used rescue medications.
Anticholinergics are another class of drugs useful as rescue medications during asthma attacks.
These medications relieve airway inflammation caused by severe asthma.
Bronchial Thermoplasty:
For severe asthma that doesn't respond to medications, bronchial thermoplasty is a treatment option.
This treatment, administered on an outpatient basis in three sessions, is used to limit how much the
airway can constrict. A small flexible tube, called a bronchoscope, is inserted into the lungs, via the
nose or mouth, where it uses heat to singe and thin the smooth muscle in the airways. During an
asthma flare-up, the thinner muscles can't narrow as much when triggered.

39. Trade Name: FLUTICASONE
Mechanism on action:
Albuterol acts on beta-2 adrenergic receptors to relax the bronchial smooth muscle. It also inhibits the release of
immediate hypersensitivity mediators from cells, especially mast cells.
Dosage :
Tablet and syrup: 2-4 mg orally every 6-8 hours; not to exceed 32 mg/day
Indication:
An indication for the treatment and prevention of bronchospasm (acute or severe) in patients with reversible obstructive
airway disease, including exercise-induced bronchospasm.
ALBUTEROL
Drug Study
Nervousness or shakiness
Headache, throat or nasal irritation
Muscle aches.
Rapid heart rate (tachycardia)
Feelings of fluttering
Side effects:
Overactive thyroid gland.
Diabetes.
Ketoacidosis.
Excess body acid.
Low amount of potassium in the blood.
Contraindications:

40. Trade Name: ASCOVENT
Mechanism on action:
Acebrophylline inhibits intracellular phosphodiesterase and facilitates bronchial muscles relaxation by increasing cAMP
levels.
Dosage :
Consider administration of 100 mg of Acebrophylline, twice daily.
Indication:
Acebrophylline is prescribed to reduce the irritation, swelling, and narrowing of the bronchial tubes in patients with
asthma, severe or chronic bronchitis, COPDand tightness of the chest.
ACEBROPHYLLINE
Drug Study
Gastrointestinal Bleeding (Major)
Breathing Difficulties (Major)
Fever with cold (Major)
Increase in the speed of heartbeats
A headache
Sleeplessness
Side effects:
Hypotension
Acute myocardial infarction
Impaired hemodynamics
Hepatic or/and renal disorders
Ambroxol allergy
GI disorders
Contraindications:

41. Oxygen therapy
Postural drainage and chest physiotherapy
Coughing and deep breathing exercises
Avoidance of known allergens
Breathing techniques
Relaxation techniques
Acupuncture
NON-PHARMACOLOGIC
INTERVENTIONS

42. Assess respirations: note quality, rate, pattern, depth, and breathing effort. Both rapid, shallow breathing patterns and
hypoventilation affect gas exchange.
Assess lung sounds, noting areas of decreased ventilation & presence of adventitious sounds.
Assess for signs and symptoms of hypoxemia: tachycardia, restlessness, diaphoresis, headache, lethargy, and confusion.
Assess for signs and symptoms of atelectasis: diminished chest excursion, limited
diaphragm excursion, bronchial or tubular breath sounds, rales, tracheal shift to affected side
Assess for signs or symptoms of pulmonary infarction: cough, hemoptysis, pleuritic pain, consolidation, pleural effusion,
bronchial breathing, pleural friction rub, and fever.
Assess changes in vital signs and temperature. Tachycardia and hypertension may be related to increased work of
breathing.
Monitor ABCs and note changes. Increasing PaC02 and decreasing Pa02 are signs of respiratory failure.
Use pulse oximetry to monitor oxygen saturation and pulse rate. Pulse oximetry is a useful tool to detect changes in
oxygenation. Oxygen saturation should be maintained at 90% or greater.
Assess patient's ability to cough effectively to clear secretions. Note quantity, color, and consistency of sputum. Retained
secretions impair gas exchange.
NURSING
MANAGEMENT

43. NURSING
Impaired gas exchange r/ t altered oxygen supply, obstruction of airways, bronchospasm and air-trapping
alveoli destruction as evidenced by dyspnea, tachypnea and tachycardia.
Ineffective airway clearance r/ t bronchospasm, obstruction from narrowed lumen, increased mucus
production and respiratory infection as evidenced by wheezing, dyspnea and cough.
Ineffective breathing pattern related to presence of secretions & bronchospasm as evidenced by productive
cough and dyspnea.
Imbalanced Nutrition: Less than Body Requirements related to dyspnea, sputum production, anorexia, nausea
or vomiting as evidenced by weight loss.
Fatigue related to physical exertion to maintain adequate ventilation and use of accessory muscles to
breathe.
Fear and anxiety may be related to perceived threat of death, possibly evidenced by apprehension, fearful
expression, and extraneous movements.
Activity Intolerance may be related to imbalance between 02 supply and demand, possibly evidenced by fatigue
and exertional dyspnea.
Diagnosis

44. Improving gas exchange
Assess the patient for presence of cyanosis, quality of inspiration breath sounds & cerebral function
Monitor vital signs and skin &mucous membrane color.
Monitor &graph serial ABGs and pulse oximetry.
Encourage adequate rest and limit activities to within client tolerance.
Encourage deep breathing, coughing exercise, using incentive spirometer as indicated.
Change patient's position every 2 hours. Assist the client into high Fowler's position.
Demonstrate diaphragmatic and pursed lip breathing for patient with chronic disease.
Administer bronchodilator medications as indicated.
Desired Outcome:
Interventions:
Impaired gas exchange r/ t altered oxygen supply, obstruction of airways, bronchospasm and
air-trapping alveoli destruction as evidenced by dyspnea, tachypnea and tachycardia.

45. Improving gas exchange Achieving Airway Clearance
Evaluate respiratory rate/ depth and breath sounds.
Assist client to maintain a comfortable position
Keep environmental free from sources of allergen such as dust, smoke, and feather pillows to a
minimum according to individual situation.
Encourage/instruct in deep breathing and directed coughing exercises
Perform postural drainage and chest physiotherapy with percussion and vibration.
Encourage practice of pursed-lip & diaphragmatic breathing exercises.
Encourage oral intake of fluids within the limits of cardiac reserve.
Desired Outcome:
Interventions:
Ineffective airway clearance r/ t bronchospasm, obstruction from narrowed lumen, increased
mucus production and respiratory infection as evidenced by wheezing, dyspnea and cough.

46. Maintain patient airway
Assess respiratory rate rhythm and patient review/monitor respiratory frequency record the ratio off
expiration /inspiration.
Teach patient diaphragmatic, pursed lip and deep breathing
Encourage to use a humidifier at night
Encourage patient to use controlled coughing to clear a secretions that might have in the lungs
during sleep
Administer low concentrations of oxygen as ordered. perform blood gas analysis
Evaluate the appropriateness of inspiratory muscle training
Desired Outcome:
Interventions:
Ineffective breathing pattern related to presence of secretions & bronchospasm as evidenced
by productive cough and dyspnea.

47. To increase the weight of the patient.
Assess the general health status of patient for baseline data.
Provide nutritional diet to the patient.
Insert the NG tube if pt is unable to take food by mouth.
Check the weight daily.
Find likes and dislikes.
Instruct for mobilization.
Encourage a rest period of 1 hr before and after meals. Provide frequent small feedings.
Administer I/N fluids with vitamins supplements.
Desired Outcome:
Interventions:
Imbalanced Nutrition: Less than Body Requirements related to dyspnea, sputum production,
anorexia, nausea or vomiting as evidenced by weight loss.

48. SELF-CARE AT HOME
Avoid trigger-Taking steps to reduce exposure to things that trigger asthma symptoms is a key part of asthma
control.
Use air conditioner-Air conditioning reduces the amount of airborne pollen from trees, grasses and weeds that
find its way indoors.
Reduce pet dander-If you're allergic to dander, avoid pets with fur or feathers. Having
Clean regularly- Clean home at least once a week. If you're likely to stir up dust, wear a mask or have someone
else do the cleaning.
Get regular exercise- Treatment can prevent asthma attacks and control symptoms during activity. Regular
exercise can strengthen heart and lungs, which helps relieve asthma symptoms.
Maintain a healthy weight. Being overweight can worsen asthma symptoms, and it puts you at higher risk of
other health problems.
Eat fruits and vegetables- Eating plenty of fruits and vegetables may increase lung function and reduce asthma
symptoms. These foods are rich in protective nutrients (antioxidants) that boost the immune system.
pets regularly bathed or groomed also may reduce the amount of dander in your surroundings.

49. Summary
Ms. Delilah Simon was admitted with the chief
complaints of coughing, wheezing, dyspnea, chest
tightness. after investigation she was diagnosed with
BRONCHIAL ASTHMA and undergone the medication
i.e Tab Albuterol, Tab Acebrophylline. Her general
condition was much improved through out the treatment
procedure being hospitalized

50. SURESH K, SHARMA, Brunner & Suddarth’s Textbook of Medical Surgical Nursing,
2nd Edition, WOLTERS KLUWER Publishers, Page No: 777-786
BT BASAVANTHAPPA, Medical Surgical Nursing, 2nd Edition, JAYPEE Publishers,
Page No: 457-463
MRINALINI MANI, Lewis’s Medical-Surgical Nursing, 3rd Edition, ELSEVIER
Publishers, Page No:577-585
Bibliography
https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653
https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma

51. Thank you