Presentation on asthma

ASTHMA CASE PRESENTATIONS

1. A CASE STUDY PRESENTATION ON ASTHMA Presented by: MANOJ MANDAL 1 st YEAR P.C Bsc Nsg, MIBE, GSN

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

3. CHIEF COMPLAINS 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. BIRTH HISTORY 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. IMMUNIZATIONS HISTORY 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. DEVELOPMENTAL HISTORY A. PHYSICAL DEVELOPMENT Weight is approx 17.5-25.5kgs (26.6kgs) Height approx 110-124cms (126 cms ) Pulse rate is 90+-15 beats/min (126/m) Resp. is 21+-15 beats/min (24/m) 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 DEVELOPMENT Concrete 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 Industry vs. Inferiority (5-11 years of age). Learn to follow the rules imposed by schools or home. Or the child can start believing they are inferior to others. Sense of industry begins Has a “know it all” attitude Continue to be ego centric

10. E. PSYCHOSEXUAL DEVELOPMENT(4. LATENCY STAGE) It occurs at approximately between 6 years of age until puberty. At this stage, the child represses all interest in sexuality and develops social and intellectual skills. 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  justice and 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 Can follow 3 series of command Respond to praise and recognition Can repeat sentence of 10-12 words Receptive languages

13. FAMILY HISTORY Nuclear family with four members. Family tree

14. MEDICATIONS 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. INVESTIGATIONS 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. ASTHMA INTRODUCTION 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.

17. INCIDENCE

18. ANATOMY OF LUNGS

19. CAUSES 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

20. 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.

21. PATHOPHYSIOLOGY

22. CLINICAL FEATURES 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

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

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

25. 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:

26. 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.

27. 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.

28. 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.

29. 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.

30. GENERAL PROGNOSIS 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.

31. COMPLICATIONS Asthma complications includes: Lifestyle Disruption Sleep Physical Activity Productivity Airway Remodeling airway wall thickening increased mucous glands and mucus production increased blood supply in the airways

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

33. NURSING MANAGEMENT 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.

34. 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.

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

36. HEALTH EDUCATION 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

37. 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

38. SUMMARY 3D VIDEO AVAILABLE HERE!