Concordia College

College of Nursing

Case
Study
On
Bronchial
Asthma

Prepared By:
De Castro, Richelle Sandriel C.
BSN III-D

Submitted To:
Ms. Susie May Jardio RN, RM, MSN
I. INTRODUCTION
 The main function of the respiratory system is to move air into the lungs so that
oxygen can enter the body and carbon dioxide can be exhaled. Several pulmonary
disorders can affect the airways. Their pathophysiology differs but these diseases
are characterized by limited airflow. Airflow is limited when air walls are thickened,
airway lumen is obstructed by secretions, increasing resistance, and smooth muscle
of the airways is activated, causing bronchoconstriction. Limited airflow increases
the work of breathing and residual volume of the lungs as air is trapped behind
narrowed or collapsed airways.

Asthma is a chronic inflammatory respiratory disorder that in children,

inflammation causes recurrent episodes of wheezing, breathlessness, chest
tightness and cough, especially at night or in the early morning. These asthma
episodes are associated with airflow limitation or obstruction that is reversible
either spontaneously or with treatment. (Hockenberry, 2005) Asthma usually begins
in childhood or adolescence, but it also may first appear during adult years. While
the symptoms may be similar, certain important aspects of asthma are different in
children and adults. Children born to families with history of allergies or asthma are
more likely to have asthma. Children who live in urban areas, where there is a
higher incidence of air pollution, or live in a home that has high levels of dust mites
or cigarette smoke, are also at a higher risk for asthma. Infants born prematurely or
who suffer lung damage shortly after birth are also more likely to have asthma.
(Lemone, 2004)

Bronchial asthma is the more correct name for the common form of asthma. The
term 'bronchial' is used to differentiate it from 'cardiac' asthma, which is a separate
condition that is caused by heart failure. Although the two types of asthma have
similar symptoms, including wheezing (a whistling sound in the chest) and
shortness of breath, they have quite different causes (http://respiratory-lung.health-
cares.net/asthma-prevention.php).
Bronchial asthma is usually intrinsic (no cause can be demonstrated), but is
occasionally caused by a specific allergy (such as allergy to mold, dander, dust).
This case study is a thorough learning about Bronchial Asthma, which contains a
study about the normal physiology of the respiratory system, pathological
physiology of the disease, a thorough assessment of the patient with said illness,
applied nursing care plans to patients having this kind or disease, and discharge
planning to a patient to limit the recurrence of the attack or if not proper
management and care to be given during the time of asthma attack.

Significance of the study

Lower airway problems directly affect gas exchange and have serious
consequences. Many of these problems are chronic and progressive, requiring major
changes in person’s lifestyles. Such airway problem includes Bronchial Asthma
which is a serious problem and could probably lead to death if proper precautions
are not observed. This study is made so that every reader or listener of the case
study and research will gain enough knowledge and understand Bronchial asthma,
its cause, manifestations, treatment, and preventions. This study points and focuses
on the significance of reaching out to the awareness of every individual who may
have this kind of disease and to the member of the health care team and share to
them the proper ways on how to effectively care to patients suffering from this
problem.

II. OBJECTIVES OF THE STUDY

At the end of the case study, the student will be able to:
• Know what Bronchial Asthma is all about.
• Apply the knowledge that they have learned in the ward.
III. PATIENT’S PROFILE

Name: T.M
Address: Western Bicutan, Taguig
Age: 25 years old
Date of Birth: November 16, 1984
Sex: Female
Nationality: Filipino
Religion: Roman Catholic
Date & Time of Admission: May 17, 2010 (03:25 pm)
Mode of Arrival: Wheelchair
Chief Complaint: Pruritic Rashes
Source of Information: Patient, Chart

IV. PERSONAL DATA

HISTORY OF PRESENT ILLNESS

The patient was diagnosed with bronchial asthma since 2008 given Salbutamol
nebulization as necessary.
2 days prior to admission, the patient experienced non productive cough, watery
nasal discharge, and (-) fever, and decreases in appetite.
1 day prior to admission, the patient experienced difficulty of breathing, excessively
vomit once. Few hours prior to admission, they went to San Juan de Dios Hospital
for consultation, the patient experienced persistence of difficulty of breathing.

FAMILY HISTORY

She has a history of Bronchial Asthma (Maternal Grandmother). She also has a
history of Diabetes Mellitus from her paternal grandmother.

PERSONAL/SOCIAL HISTORY

She is a human resource clerk, non-smoker, non-alcoholic beverage drinker.

MARITAL HISTORY
She has a live-in partner of 1 year, a 28-year old monitoring specialist.
 V. PATHOPHYSIOLOGY

Asthma is an airway disease that can be classif

Causal Factors
Predisposing Factor Contributing Factors
-Exposure to indoor
-Atopy -Respriratory infections
and outdoor
-Female gender -Air pollution
allergens
-Occupational -Others: diet, small size at birth
sensitizers

Hyperresponsiveness Inflammation
of airways

Airflow limitation

-Risk Factors for Symptoms

Exacerbations -Wheezing
-Allergens -Cough
-Respiratory infections -Dyspnea
-Exercise and hyperventilation -Chest tightness
-Weather changes
-Exposure to sulfur dioxide
-Exposure to food, additives,
medications

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.

IX. DISCHARGE SUMMARY

 MEDICATIONS:
- .Salbutamol
- Prednisone
- Hydrocortisone
- Amikacin

 ECONOMIC STATUS:
T.M, an employed woman, can afford for to pay for her medications, and other
necessities by using the money she is earning.

 TREATMENT:
The client should be encouraged to learn and use of relaxation techniques
including guided imagery and music therapy are used to shift the focus of the brain
away from the pain, decrease muscle tension, and reduce stress. Tension and stress
can also be reduced through biofeedback. Being massaged or applying backrub is
very relaxing and helps reduce stress.

 HEALTH TEACHINGS:
- Encourage to take a well - balanced diet.
- Encourage a healthy lifestyle.
- Educate patient in pain management.

 OPD VISITS:
Teach patient that if asthma occurs, she should notify it to the physician. She
may report to the physician after 7 to 10 days to know the indictor of disease or
response progression.

 DIET:
The client should be instructed to avoid alcohol, spicy foods, any caffeine-
containing foods, heavy meals, high fatty foods.

 SPIRITUAL CARE:
Encourage client to pray in accordance with their beliefs. Ask for help to God for
complete recovery.