anp-Case-Study-on-Asthma.pdf of obg heheheheh

payalba jadeja

1. BIODATA
INTRODUCTION
My patient mrsnarbadia was admitted in the female chest 13, ward on date 07/05/15.with
complain of chest pain ,breathlessness.
Base line data:-
Name :-Mrsnarbadiya
Age &Sex :- 42 yrs. / female
Ward :- chest female ward
Bed no. :- 2
Address :- JABALPUR
Education :-illitrate
Occupation :- house wife
Religion :-hindu
Date of admission :- 07/02/13
Diagnosis :- Bronchial asthma
CHIEF COMPLAINTS:-
Mrs.narbadiya was admitted in the hospital with complaints of shortness of breath, chest pain &
cough since 1 week.
HISTORY OF PRESENT ILLNESS:-
Patient is having chest pain cough since 1 week.
HISTORY OF PAST ILLNESS:-
Patient was told about 6 month back she has a same problem .
SURGICAL HISTORY OF THE CLIENT
PAST SURGICAL HISTORY -
There is no any past surgical history.
PRESENT SURGICAL HISTORY
Not done any surgey: Nil significant

2. HISTORY OF THE CLIENT
FAMILY HISTORY–
My patient belong in nuclear family.total 4 members in her family her husband 2 son .her
husband is a farmer his monthly income is sufficient for his family.
FAMILY COMPOSITION:-
S.NOMEMBER AGE/SEX RELATIONSHIP EDUCATION HEALTH
1. Kamla 47/F self nil Sick
2. Ajay 50/m husband 10
th
Good
3. kamesh 29/f son 8
th
Good
4. manoj 25/m Grand-son 12
th
good
FAMILY TREE –
Raghu Kamla 67
Ajay 40yrs.Sarita 35yrs
Manoj 18
Male female death
Male patient Female patient Death
SOCIO ECONOMIC HISTORY

3. Family income – 6000/-
No. of earning member – 1
Per capita income – Rs 1500
Education – nil
Social support – good
Relationship with neighbours – good
Sanitation history:-
Toilet facility :- available
Environmental history:-
Type of house:-kaccha
Ventilation:- Adequate
Electricity :- Available
Water supply:-
Tape water :- not present
Well :-present
Hand pump:-present
Tube well :- present
Drainage system:-
Open drainage system:- present
Personal history :-
Health facility near byhome :- present
Sleep pattern :-ir-regular
Allergy :-not present
Health habbits:- good
Religion history :-superstitious
Exercise :- no
Nutritional history:-
Veg./ non –veg. :- both
Likes/ dislikes :-likes all food material
Dietary history :-
Veg. food:- dal ,roti, rice, green leafy vegetables, oil, ,milk ,
Curd,.
Non-veg. food:- egg, meat, fish, chicken.
Physical examination:

4. General appearance – conscious ,ill look ,debilated. Intelligence –
intelligent Mental status – little
irritable , oriented to time place and person. Expression – expressing out the
feelings.
Race – Hindu
Height – 5’2”
Weight – 54kg
Temperature – afebrile
Pulse – 78 beats/min.
Resp.– 20 breaths/min. BP – 130/70 mm of hg
Communication skill – able to speak in chattisgarhi and hindi.
General Appearance :
Behavior – good
Head – normal in shape
Hair – normal white in color
Face – cleft lip & congenital abnormality is not observed
Ear – shape , hearing activity is normal. Discharge , wax foreign body & pain not
observed.
Eyes – pupil black in color , equal in size and reactive to light, corneal reflex observed .
Nose – running nose , polyp & bleeding no observed.
Mouth/lips – breath odors not present, cleft lip is not observed.
Teeth – no discoloration observed.
Gums – texture is moist & bleeding not observed.
Tongue – normal ,moist& pink in color.
Tonsil – normal in size .
Neck – symmetrical ,veins and movement are normal carotid pulse present & palpable.
Lymphnodes – not observed
Skin – brown in color , wrinkles & dryness observed. Surgical wound observed.
Nails – normal in shape.

5. Odema – no peripheral edema observed.
Vital Signs –
Temp.- a febrile
Pulse.- 78 beats /min
Resp. – 20 breath /min.
Ribs – normal
Abdomen – abdominal reflexes are present. Distention &ascities is not observed.
Bones – deformity not observed.
Back – normal, spinabifea , kyphosis & scoliosis nit observed
Extremities – range of motion is normal
Bowel activity – regular once in a day/
Bladder activity – regular
Rectum – anatomical structure and opening is normal
Sleep pattern– regular
SYSTEMIC EXAMINATION:
Central nervous system :
Consciousness – alert , lethargy
Speech – clear
Coordination – present
Papillary reaction to light – equal size reactive to light
Reflexes –
biceps – normal flexion is found
Triceps – normal
Plantar reflex – normal flexion is seen

6. Respiratory system:
Respiratory rate – 20 breaths/min
Pattern – normal abdomino thoracic
Cyanosis – not observed
Cough – present
Flaring of nostrils –present
Presence of wheezing / stridor – not present
Cardio vascular system:
Heart rare – 80 beats /min.
Pulse –Rythum normal.
Radial – right present , pedal right present.
Blood pressure – 130/70 mm of hg
Auscultation –
Palpitation – present
Murmur – not heard
Gastro intestinal system:
Distended – not observed.
Ascities – not observed.
Visible peristalsis – not observed.
Palpable mass – not palpable
Abdominal reflex – present
Bowel sound – audible
Liver – palpable
Spleen – not palpable
Musculoskeletal system:

7. Range of motion – normal
Joint pain – not observed
Genitor urinary system:
Urine – normal
History of constipation – not present
Reproductive system:
Genitalia – normal
.
INVESTIGATION –
S.NO. PARAMETERS CLIENT
VALUE
NORMAL
VALUE
REMARK
1. HB 12-14 gm 10.6gm/dl Below normal
2. WBC 4-11u/dl 9000/u Normal
3. Lymph 20-40u/l 30u/dl Normal
4. Plt 150000-400000200000 Normal
5. Sodium 135-145meq/dl134meq/dl Normal
6 Potassium 3.5-5.5meq/dl4.5meq/dl Normal
7. Calcium 9-11 mg/dl 9mg/dl Normal
8. HIV Negative
9. Troponin Negative
10. PTT 20sec 10-14sec Normal
11. Bleeding time 2mt 2.3-9.5sec Normal
12. Clotting time 5:30mt 5-10mt Normal

8. DIAGNOSIS:-Bronchial Asthma
DEFINITION:-
Asthma is a chronic inflammatory disease of the airway that causes airway hyper
responsiveness, mucosal edema, & mucus production. This inflammation ultimately leads to
recurrent episodes of asthma symptoms: cough, chest tightness, wheezing & dyspnea.
ANATOMY & PHYSIOLOGY OF RESPIRATORY SYSTEM
The respiratory system consists of all the organs involved in breathing. These include the nose,
pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very important
things: it brings oxygen into our bodies, which we need for our cells to live and function
properly; and it helps us get rid of carbon dioxide, which is a waste product of cellular function.
The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through which the
air is funnelled down into our lungs. There, in very small air sacs called alveoli, oxygen is
brought into the bloodstream and carbon dioxide is pushed from the blood out into the air. When
something goes wrong with part of the respiratory system, such as an infection like pneumonia, it
makes it harder for us to get the oxygen we need and to get rid of the waste product carbon
dioxide.
The Upper Airway and Trachea
When you breathe in, air enters your body through your nose or mouth. From there, it travels
down your throat through the larynx (or voicebox) and into the trachea (or windpipe) before
entering your lungs. All these structures act to funnel fresh air down from the outside world into
your body. The upper airway is important because it must always stay open for you to be able to
breathe. It also helps to moisten and warm the air before it reaches your lungs.
The Lungs

9. Structure:- The lungs are paired, cone-shaped organs which take up most of the space in our
chests, along with the heart. Their role is to take oxygen into the body, which we need for our
cells to live and function properly, and to help us get rid of carbon dioxide, which is a waste
product. We each have two lungs, a left lung and a right lung. These are divided up into 'lobes',
or big sections of tissue separated by 'fissures' or dividers. The right lung has three lobes but the
left lung has only two, because the heart takes up some of the space in the left side of our chest.
The lungs can also be divided up into even smaller portions, called 'bronchopulmonary
segments'.
These are pyramidal-shaped areas which are also separated from each other by membranes.
There are about 10 of them in each lung. Each segment receives its own blood supply and air
supply.
How they work
Air enters your lungs through a system of pipes called the bronchi. These pipes start from the
bottom of the trachea as the left and right bronchi and branch many times throughout the lungs,
until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The alveoli
are where the important work of gas exchange takes place between the air and your blood.
Covering each alveolus is a whole network of little blood vessel called capillaries, which are
very small branches of the pulmonary arteries. It is important that the air in the alveoli and the
blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or
diffuse) between them. So, when you breathe in, air comes down the trachea and through the
bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will
travel across the walls of the alveoli into your bloodstream. Travelling in the opposite direction is
carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is
then breathed out. In this way, you bring in to your body the oxygen that you need to live, and
get rid of the waste product carbon dioxide.
ETIOLOGY:-
Chronic exposure to airway irritants or allergens e.g. mold, dust, roaches or animal
dander.
Exercise, stress or emotional upsets.
Sinusitis with postnasal drip.

10. Medications.
Viral respiratory tract infections.
Gastroesophageal reflux.
PATHOPHYSIOLOGY:-
Predisposing, Causal factors & Contributing factors
factors
Inflammation
Hyperesponsiveness Airflow limitation of airway
CLINICAL MANIFESTATION:-
IN BOOK IN PATIENT
Three most common symptoms of asthma are
Cough
Dyspnea
Wheezing
Asthma attack often occur at night or
early in the morning, possibly due to
circadian variations that influence
airway receptor thresholds.
Cough with or without mucus
production
Generalised chest tightness & dyspnea
occurs
Diaphoresis
Tachycardia
Widened pulse pressure may occur along
with hypoxemia & ventral cyanosis
Cough & dyspnea is present in client
since 10 days.
Has asthma attack early morning.
 Cough with mucus production is
present.
Tachycardia is present heart rate is- 102/mt
Medical management

11. IN BOOK IN PATIENT
Two general classes of asthma medications
are used they are:
1.Long acting control medications.
2.Quick relief medications.
Long acting control medications
Corticosteroids
Cromolyn sodium &nedocromil are
mild to moderate anti inflammatory
agents.
Long acting beta2 adrenergic agonists.
Methylxanthines are mild to moderate
bronchodilators.
Quick relief medications
Short acting beta adrenergic agonists
are the medication of choice for
relieving acute symptoms.
Anticholinergics e.g. ipratropium
bromide may bring added benefits in
severe exacerbations.
Long acting control medication is not
given.
Quick relief medications are
administered such as injDeriphylline
2ml IV every 8 hourly.
medications
1.TaximCefotaxim
sodium
IV 1gm Q12hAnti-
Biotic
A third
generation
cephalosp
Determine
allergy to
cefotaxime.
Use
caustiouly
Frequent
Oral
candidiasis
, mild
diarrhea,

12. orin that
binds to
bacterial
cell
memebran
es&
inhibits
cell wall
synthesis.
in patient
with renal
impairment
or GI
disease.
Reconstitut
e drug.
Administer
IV push
over 3 to 5
min.
Monitor
intake &
output.
Assess
bowel
activity.
abdominal
cramps.
Occasional
Nausea,
serum
sickness
like
reaction.
Rare
Allergic
reaction,
thromboph
lebitis.
s.n
o
Trade
name
Pharmceutical
name
Route DoseTimeAction Nursing
responsibility
Adverse
effect
2.AmikaAmikacin IV 500m
g
Q12hAntibiotic
- an
aminoglyc
osides
antibiotic
that
irreversibl
y binds to
Monitor
intake &
output to
maintain
hydration.
Monitor
peak serum
amikacin
Frequent
Pain,
induration
phlebitis.
Occasional
Hypersens
itive
reactions

13. protein on
bacterial
ribosomes
&
interferes
with
protein
synthesis
of
microorga
nism.
levels.
Alert for
ototoxic &
neurotoxic
side effects.
Inspect skin
for rashes.
Use
cautiously
in patient
with 8
th
cranial
nerve
impairment
,
myasthenia
gravis.
Rare
Neuromus
cular
blockade.
s.n
o
Trade
name
Pharmceutical
name
Route DoseTimeAction Nursing
responsibility
Adverse
effect
3.Inj.
Deriphy
lline
Theophylline
& theophylline
IV 3.2mg
/ml
Q8h Bronchodi
lators
Assess BP
& apical
pulse
before
giving
drug.
Teach
patient to
take with
food.
Frequent
Fatigue,
dizziness
Occasional
Diarrhoea,
bradycardi
a, rhinitis,
back pain.
Rare
Orthostatic

14. Urge client
to limit
alcohol &
salt intake.
Assess
clients
tolerance to
drug.
hypertensi
on, UTI,
viral
infection.
s.n
o
Trade
name
Pharmaceutic
al name
RouteDoseTimeAction Nursing
responsibility
Adverse
effect
4.AcilocRanitidine
hydrochlorid
e
IV 50mgQ12hAntiulcer
agent
It inhibits
histamine
action at h2
receptor of
gastric parietal
calls &
inhibits gastric
acid secretion
when fasting
at night or
Use
cautiously
in elderly
patient &
those with
impaired
hepatic &
renal
function.
Give regard
to meals.
Do not
Occasiona
l
Diarrhoea
Rare
Constipati
on,
headache.

15. when
stimulated by
food caffeine
or insulin.
administer
with in 1
hour of
magnesium
or
aluminium
containing
antacids.
Infuse IV
infusion
over 24 hrs
IM.
s.n
o
Trade
name
Pharmaceutical
name
RouteDoseTimeAction Nursing
responsibility
Adverse
effect
5.MetronMetronidazoleIV 500m
g
Q8h Antibacterial
It disrupts
bacterial
&protozoal
DNA
inhibiting
nucleic acid
synthsis.
Determine
hypersentivity.
Use cautionsly
in blood
dyscrasias,
CNS disorders,
hepatic failure.
Use without
regard to food.
Explain to
patient that
urine may
become reddish
brown during
Frequent
Anorexia,
nausea,
dry mouth,
cervicitis,
uterine
cramps.
Occasional
Diarrhoea,
constipatio
n,
vomiting,
dizziness
Rare

16. metronidazole
therapy.
Transient
leucopenia
,
thromboph
lebitis.
Nursing Management
According to book Done for the patient
Administers medications as
prescribed.
Fluid may be administered if
dehydrated.
If the patient requires intubation
because of respiratory failure, the
nurse assist with intubation
procedure.
Administered medications as
prescribed.
Client was well hydrated.
Nil significant.
NURSING CARE PLAN
Day 1
1.Subj. data: -client stated that she is having difficulty in breathing.
Obj. data: -client is looking restless & irritated.
Nursing diagnosis: -Ineffective airway clearance, dypnea related to inflammatory process as
manifested by observation.
Goal: -client will have effective airway clearance as evidenced by verbalization.

17. Plan of action Rationale
Assess the condition.
Provide comfort devices such as
pillows.
Provide propped up position.
Advice to take adequate rest & sleep.
Administer bronchodilator drug as
prescribed.
Assessment helps to plan the proper
care.
To reduce discomfort.
Promote lung expansion & reduce
discomfort.
Prevents fatigue & tiredness.
Relieves bronchospasm.
Evaluation: -client stated that his pain is reduced.
2.Subj. data: -client stated that she is having pain in the whole body.
Obj. data: -client is looking restless & irritated.
Nursing diagnosis: -alteration in comfort, pain related to disease condition as manifested by
observation.
Goal: -client will have adequate comfort as evidenced by verbalization.
Plan of action Rationale
Assess the condition.
Provide comfort devices such as
pillows.
Provide comfortable bed.
Provide comfortable position.
Advice to take adequate rest & sleep.
Administer analgesic drug as prescribed.
Assessment helps to plan the proper
care.
To reduce discomfort.
To promote comfort.
To reduce discomfort.
Prevents fatigue & tiredness.
Inj.Diclofenac 2ml is administered IM.
Evaluation: -client stated that his pain is reduced.
Day 2
3.Subj. data: -client stated that she is having not able to do her activities.
Obj. data: -client is not able to do activities of daily living.
Nursing diagnosis: -activity intolerance related to confinement to bed as manifested by
observation.
Goal: -client will be able to do some of her daily activity as evidenced by verbalization.
Plan of action Rationale
Assess the condition Assessment helps to plan the proper
care.

18. Assist the client in activities of daily
living.
Promote ambulation.
Change position timely
Encourage client participation in
daily activities.
To promote participation.
It promotes circulation.
Promotes circulation
Encouraged client for participation.
Evaluation: -client is able to do some of her daily activities.
Day 3
4.Subj. data: -client stated that she is not feeling to eat food.
Obj. data: -client is looking weak & tired.
Nursing diagnosis: -alteration in nutrition pattern less than body requirement related to loss
of appetite as manifested by observation.
Goal: -client will have normal nutritional pattern as evidenced by observation.
Plan of action Rationale
Asses the condition.
Provide small & frequent feed.
Provide of food items of likings.
Provide neat & clean environment for
eating.
Promote hydration.
Teach about importance of nutritious
diet.
Assessment helps to plan proper care.
Promote appetite.
Promote appetite.
Promote food intake.
Prevents dehydration.
Promote knowledge level.
Evaluation: -client started taking food orally & has normal appetite.
Day 4
5.Subj. data: -client stated that she is not aware of her disease condition.
Obj. data: -client is not knowing about her disease condition.
Nursing diagnosis: -knowledge deficit related to disease condition as manifested by
verbalization.
Goal: -client will have adequate knowledge as evidenced by verbalization.
Plan of action Rationale
Assess the condition
Explain about disease condition.
Mention about its management & its
preventive measures.
Explain about complications & its
preventions.
Clarify all doubts of client &
relatives.
Assessment helps to plan proper care.
Promote knowledge level.
Prevents further complications.
Prevents complications.
Promotes proper care.

19. Evaluation: - client & relatives understood about the disease condition & its management.
Day 5
6.Subj. data: -client stated that she is worried about her disease
Obj. data: -client is looking frightened & tensed.
Nursing diagnosis: -fear & anxiety related to disease condition as manifested by observation
& verbalization.
Goal: -client will be relieved from fear & anxiety as evidenced by verbalization.
Plan of action Rationale
Assess the condition.
Provide psychological support.
Clarify all doubts.
Explain about disease condition in
detail.
Assessment helps to plan care
properly.
To relieve fear.
To reduce fear
To promote knowledge.
Evaluation: -clients said that her fear & anxiety is reduced.
Prognosis
Day 1: -client was admitted to the hospital had mild breathing difficulty. All the basic care,
medication & psychological support are given to the client. Vital signs are monitored every
fourth hourly. Had no special complaints.Had good sleep at night. General condition of the client
looks fair.
Vital signs
Temperature: -98f
Pulse: -84/min
Respiration: -20/min
Blood pressure: -100/80mm of hg
Urine output: -1500ml
Day 2: -client had mild breathing difficulty. All the basic care, medication & psychological
support are given to the client. Vital signs are monitored every fourth hourly. Had complaints of
body pain & comfort device such as pillow is given.Had good sleep at night. General condition
of the client looks fair.
Vital signs

20. Temperature: -98.6f
Pulse: -82/min
Respiration: -20/min
Blood pressure: -110/80mm of hg
Urine output: -1700ml
Day 3: -client mild breathing difficulty. All the basic care, medication & psychological support
are given to the client. Vital signs are monitored every fourth hourly. Had no special
complaints.Had good sleep at night. General condition of the client looks fair.
Vital signs
Temperature: -98.4f
Pulse: -86/min
Respiration: -18/min
Blood pressure: -100/80mm of hg
Urine output: -1800ml
Day 4: -client had mild breathing difficulty. All the basic care & medication is given to the
client. Vital signs are monitored every fourth hourly. Had no special complaints.Had good sleep
at night. General condition of the client looks fair.
Vital signs
Temperature: -99f
Pulse: -82/min
Respiration: -20/min
Blood pressure: -100/70mm of hg
Urine output: -1600ml
Day 5: -client had mild breathing difficulty. All the basic care, medication & psychological
support are given to the client. Vital signs are monitored every fourth hourly. Had no special
complaints.Had good sleep at night. General condition of the client looks fair.

21. Vital signs
Temperature: -98.8f
Pulse: -84/min
Respiration: -18/min
Blood pressure: -110/80mm of hg
Urine output: -1800ml
COMPLICATION:-
According to book Developed in the patient.
Status asthmaticus.
Respiratory failure
Pneumonia
Atelectasis
Nil significant
HEALTH EDUCATION
Personal hygiene
Personal hygiene has an important role to prevent infection.
Patient have to take a through bath, brush teeth, cut short nails & change cloth
daily.
Diet therapy
Advice to take well balanced diet of good nutritive value.
Explain importance of balanced diet.
Rest & sleep
Advice to take adequate rest & sleep.
Ask to do active & passive exercise.
Disease condition: - Bronchial Asthma
Definition
Causes
Pathophysiology
Clinical manifestations
Diagnosis
Management
Care & prevention
Follow up

22. Advice to take medicine in time.
Do not discontinue medicine without doctors.
Advice for timely follow up checkups.
Summary
As case study on bronchial asthma was great learning experience for me. I learned about the
disease condition of the client & also how to take care of client with bronchial asthma. I thank
my patient & his relatives for their valuable cooperation & also staffs of BRAM hospital, Raipur.
Very specially I thank Mrs.Neelam Paul, M.Sc. (N), Demonstrator, Govt.college of nursing,
Raipur for her valuable guidance & support.
BIBLIOGRAPHY
SUZANNE C. SMELTZER BRENDA G. BARE, MEDICAL SURGICAL, EIGHTH
EDITION, PB-LIPPINCOTT
BRUNNER AND SUDDARTH.MEDICAL SURGICAL NURSING, 8TH EDITION,
LUCKMEN,” MEDICAL SURGICAL NURSING”PB SAUNDERS
JOYCE M. BLACK,“ MEDICAL SURGICAL NURSING”, CLINICAL
MANAGEMENT FOR POSITIVE OUTCOME,VOL.1, PB SAUNDERS, 7
TH

EDITION.
C.R.W. EDWARDS,” DAVIDSON’S PRINCIPAL AND PRACTICE OF MEDICINE”,
PB CHURCHILL LIVINGSTONE 3
RD
EDITION.
BARBARA C. LONG “MEDICAL SURGICAL NURSING” ,MOSBY, 3TH EDITION,