An 8-year-old male child presented with a 1-month history of cough, shortness of breath, and chest tightness. He had been previously diagnosed with asthma 2 years prior. His physical exam and tests showed signs consistent with an asthma exacerbation. He was started on medications including inhaled corticosteroids, bronchodilators, and oral steroids to treat his symptoms and prevent future attacks. Nursing care focused on teaching the family about asthma management, medication administration, and when to seek emergency help.

1. Presented by: MANOJ MANDAL
1stYEAR P.C Bsc Nsg, MIBE, GSN

2.  NAME- MASTER KRISH KHATRI
 AGE- 8YRS
 SEX- MALE
 WARD- DELUXE
 DOA- 17/10/15
 DOB- 07/09/2007
 DOCTOR INCHARGE- Dr. PARAG RANJAN
 DIAGNOSIS- ASTHMA

3.  Master Krish has a complain of cough x 1 month,
shortness of breath and tightness in the chest x 1
month.
 HISTORY OF PRESENT ILLNESS:An 8 years of
male child came in emergency with a complain
of cough x 1 month, shortness of breath and
tightness in the chest x 1 month.
 PAST HISTORY: 2 years before, master Krish was
diagnosed as Asthma and was on regular
medications.

4.  ANTENATAL: Mother attended antenatal check
up regularly, no illness during pregnancy,TT- 2
doses taken.
 INTRANATAL:Vaginal delivery conducted by
skilled person at hospital, no complication or
birth injury, cried immediately after birth,
gestation was term and baby birth was 3.7 kgs.
 POSTNATAL: No complications, baby was
normal and pink, breast feeding initiated after ½
an hour after NVD, no evidence of congenital
anomaly.

5.  Taken all immunizations according to the
immunization schedule and age group.
ANTHROPROMETRY
Head circum-50 cms
Chest circum-66 cms
Mid arm circum- 21 cms
Height-126 cms
Weight- 26.6 cms

6.  A. PHYSICAL DEVELOPMENT
1. Weight is approx 17.5-25.5kgs (26.6kgs)
2. Height approx 110-124cms (126 cms)
3. Pulse rate is 90+-15 beats/min (126/m)
4. Resp. is 21+-15 beats/min (24/m)
5. BP is 100/60+-16/10 mmHg (90/60 mmHg)

7. B. MOTOR DEVELOPMENT
GROSS:
-rides bicycles without training wheels
-runs, jumps, climbs
-constant keep moving and run all over
FINE:
-has improved hand and eye coordination
-bath self unassisted
-learn cursive writing
-continually refine previously learned skill

8. C. COGNITIVE DEVELOPMENTConcrete
Operations (7-11 yrs).
1. Children are able to take into account another
person’s point of view.
2. Children at this stage would have the ability
to pass conservation (numerical),
classification, serration, and spatial reasoning
tasks.
3. Attention spam increased.

9.  D. PSYCHOSOCIAL DEVELOPMENT
1. Industry vs. Inferiority (5-11 years of age).
2. Learn to follow the rules imposed by schools
or home.
3. Or the child can start believing they are
inferior to others.
4. Sense of industry begins
5. Has a “know it all” attitude
6. Continue to be ego centric

10.  E. PSYCHOSEXUAL DEVELOPMENT(4. LATENCY
STAGE)
1. It occurs at approximately between 6 years of age
until puberty.
2. At this stage, the child represses all interest in
sexuality and develops social and intellectual skills.
3. The pursuit of social and academic activities
channels much of the child’s energy into emotionally
safe areas and aids the child in forgetting the highly
stressful conflicts of the phallic stage.

11.  F. SPIRITUAL DEVELOPMENT(Stage 2 –
"Mythic-Literal“)
 faith (mostly in school children), stage two
persons have a strong belief in the justiceand
reciprocity of the universe, and
their deities are almost
always anthropomorphic. During this time
metaphors and symbolic language are often
misunderstood and are taken literally.

12.  G. LANGUAGE DEVELOPMENT
1. Can follow 3 series of command
2. Respond to praise and recognition
3. Can repeat sentence of 10-12 words
4. Receptive languages

13.  Nuclear family with four members.
 Family tree

14. DRUG FORM DOSE ROUTE TIME ACTIONS
CEFTRIAXONE 1g IV BD BACTERIOCIDAL
SYP. AZITHRO 200mg PO BD
BUDECORT (INHALER) 2 puffs PO BD ANTI- INFLAMMATORY
ASTHALIN (INHALER) 2 puffs PO TID BRORNCHODILATOR
NACL (0.9%) 2ml PER
NASAL
Q4H AIDS IN AIRWAY
CLEARANCE.

15. TEST RESULTS NORMAL RANGE
TOTAL IgE 470.90 KU/L <or =403 KU/L
ESR 20 mm/hr 2o mm/hr
Na+ 139mEq/L 135-145mEq/L
K+ 3.7mEq/L 3.3-5.5 mEq/L
Chest X ray Normal Normal

16. INTRODUCTION
1. Asthma is a common long-term condition
that can cause coughing, wheezing, chest
tightness and breathlessness.
2.The severity of these symptoms varies from
person to person. Asthma can be controlled
well in most people most of the time,
although some people may have more
persistent problems.

22.  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

23.  Certain medications, including beta blockers,
aspirin, ibuprofen (Advil, Motrin IB, others) and
naproxen (Aleve)
 Strong emotions and stress
 Sulfites and preservatives added to some types
of foods and beverages, including shrimp, dried
fruit, processed potatoes, beer and wine
 Gastro esophageal reflux disease (GERD), a
condition in which stomach acids back up into
your throat.

25. BOOK’S PICTURE PATIENTS’S PICTURE
Very rapid breathing Present
Coughing especially at night Present
Wheezing Moderate
Pale , sweaty face Moderate
Shortness of breath Present
Blue lips of finger nails Mild
Chest tightness Present
Trouble sleeping Present
Pain in the chest Mild pain

26.  History taking
 Laboratory test
 Serum Immunoglobin E (IgE)
 Nitric oxide test
 Pulmonary FunctionTest (PFT)
 Spirometry
 Methacholine challenge test
 Chest X ray
 Evaluation of heartburn and GERD
 CT scan of the lungs
 Sputum eosinophilias

27.  The current concept of Asthma therapy is
based on stepwise approach, depending on
disease severity.The main aims are:
a. To reduce the symptoms that results
from airway obstructions and
inflammations.
b. To prevent exacerbations
c. To maintain normal lung functions

28.  Long-term Asthma Control Medications
generally taken daily, are the
cornerstone of asthma treatment.These
medications keep asthma under control
on a day-to-day basis and make it less
likely you'll have an asthma attack.
Types of long-term control
medications includes:

29.  Inhaled corticosteroids.These anti-inflammatory
drugs include fluticasone, budesonide , flunisolide ,
beclomethasone , mometasone.
 Leukotriene modifiers.These oral medications
like montelukast help relieve asthma symptoms for
up to 24 hours.
 Long-acting beta agonists.These inhaled
medications, which include salmeterol and
formoterol open the airways.

30.  Combination inhalers.These medications —
such as fluticasone-salmeterol, budesonide-
formoterol and formoterol-mometasone , contain
a long-acting beta agonist along with a
corticosteroid.
 Theophylline.Theophylline is a daily pill that
helps keep the airways open (bronchodilator) by
relaxing the muscles around the airways. It's not
used as often now as in past years.

31.  Quick-relief (rescue) medications are used as needed for
rapid, short-term symptom relief during an asthma attack —
or before exercise if your doctor recommends it.Types of
quick-relief medications include:
 Short-acting beta agonists.These inhaled, quick-relief
bronchodilators act within minutes to rapidly ease
symptoms during an asthma attack.They include albuterol (
and levalbuterol .
 Short-acting beta agonists can be taken using a portable,
hand-held inhaler or a nebulizer — a machine that converts
asthma medications to a fine mist — so that they can be
inhaled through a face mask or a mouthpiece.

32.  Oral and intravenous corticosteroids.These
medications — which include prednisone and
methylprednisolone — relieve airway
inflammation caused by severe asthma.They
can cause serious side effects when used long
term, so they're used only on a short-term
basis to treat severe asthma symptoms.

33.  The prognosis is best in young children who wheeze with
viral respiratory infections and who have no symptoms in
between these episodes.
 It can often be difficult to differentiate these “early
wheezers” from children with true asthma. Children with
recurrent symptoms tend to have ongoing asthma later in
life.
 Boys “outgrow” asthma more often than girls, and a child
with no evidence of environmental allergies has a better
chance of “outgrowing” asthma as compared to a child with
concurrent allergic disease (hay fever).
 Even in children with ongoing asthma, prognosis is excellent
for those with preserved activity level and lung function
through the use of appropriate medications.

34. Asthma complications includes:
 Lifestyle Disruption
1. Sleep
2. Physical Activity
3. Productivity
 Airway Remodeling
1. airway wall thickening
2. increased mucous glands and mucus production
3. increased blood supply in the airways

35.  Hospitalization
 Death-Severe asthma attacks constrict the airway.
This can lead to complete respiratory failure and
death if not treated immediately.

36. NURSING DIAGNOSIS
 Ineffective air clearance related to airway spasms,
secretions retention, as evidenced by productive cough.
 Ineffective breathing pattern related to spasms of the
airway, respiratory muscles fatigue as evidenced by
dyspneoa and shortness of breath.
 Impaired gas exchange related to bronchospasm,
damaged to alveoli as evidenced by blue lips and finger
nails.

37.  Activity in tolerance related to imbalance of oxygen
supplies of the needs as evidenced by weakness and
exhaustion.
 Knowledge deficit about Asthma related to lack of
information sources as evidenced by parent’s
questions and concerns.
 Anxiety related to crisis situation, change in health
status as evidenced by parents expressions.
 Imbalanced nutrition less than body requirements
related to an increase in shortness of breath as
evidenced by child’s apprehension.

38. Health maintenance altered related to lack of
school asthma management plan as evidenced by
parent apprehensiveness

39.  Teaching was given breathing exercise and cough
expulsion
 Environmental hygiene should be maintained and
controlled all the triggers factors which may
stimulate asthmatic attack
 To take medicines regularly and come for follow up
 To plan health needs during school time
 To teach importance of play therapy
 To meet the nutritional needs of the child
 To provide warm water to the child

40.  To seek emergency medical care when the child
have:
 Wheeze, cough or shortness of breath get worse
 Breathing becomes difficult
 Trouble walking and talking
 Playing, studying or working and can’t start again
 Lips or finger nail are blue or grey

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