I.

INTRODUCTION

For the purpose of privacy and confidentiality, the real name of the patient in this Case
Study is withheld and she will referred as “Mommy Dionisia” throughout the entire document.

Mommy Dionisia is a 45 year old female and currently residing in Brgy Estrada, Capaz,
Tarlac with her husband and her four children. She was admitted at the Intensive Care Unit of
Central Luzon Doctors’ hospital on July 27,2010 with a chief complaint of difficulty of
breathing. She was then diagnosed having an acute respiratory failure secondary to asthma.

Asthma is a chronic inflammatory disease of the airways that causes airway

hyperresponsiveness, mucosal edema and mucous production. This inflammation ultimately
leads to recurrent episodes of asthma symptoms such as cough, chest tightness, wheezing and
dyspnea.

A patient with asthma may develop an exacerbation or infection that causes additional
deterioration of gas exchange which can lead to acute respiratory failure.

Acute respiratory failure(ARF) is defined as a decreased in atrial oxygen tension(PaO2)

to less than 50 mmHg (hypoxemia) and increase atrial carbon dioxide tension(PaCO2) to greater
than 50 mmHg(hypercapnia), with an atrial Ph of less than 7.35.

A patient with acute respiratory failure may manifest shortness of breath, shortness of
breath on exertion, syncope, dyspnoea, chest pain, tachycardia, tachypnoea, fatigue and
weight loss.
II. OBJECTIVES
At the end of the exposure, the student nurse will be able to:

1. Establish rapport and gain trust and cooperation of the patient and the immediate
family members.
2. Perform necessary & thorough physical assessment using the cephalocaudal approach;
collect complete medical, socio-cultural, and family history related to the client’s current health
condition.
3. Analyze and prioritize problems based from the gathered pertinent data to formulate
correct nursing diagnoses
4. Plan the appropriate nursing interventions to address client’s health problems & needs.
The interventions should provide not only the well being of the patient but also with her social,
emotional and mental welfare.
5. Implement the planned nursing interventions to meet the desired outcomes and help
improve client’s condition
6. Impart useful health teachings to the client and immediate family members to prevent
further development or recurrence of the client’s condition and other related complications
7. Acquire knowledge and responsibilities regarding Acute Respiratory failure and the
possible complication that may occur or manifest in the patient.
 II. NURSING PROCESS

A. Nursing Health History A

A. Demographic data

Patient Name: Mrs. Dionisia

Date admission: Ward: Intensive Room no: 8
July 27,2010 Care Unit (ICU)
Age: 45 Sex: Female C/S: Married Religion: Iglesia ni Cristo
Examiner: Dra. Tuquero

B. Chief Complaint

Mommy Dionisia sought consultation to the hospital due to difficulty of breathing..

C. History of Present Illness

Three days prior to admission Mommy Dionisia is experiencing difficulty of breathing

which is rapidly relieved when she nebulized at their home. By that time she can still do her
activities of daily living.

Few hours before the admission she again experienced difficulty of breathing after riding
a bicycle. She tried to nebulize but still the difficulty that she is experiencing is aggravating. That
was then her husband decided to bring her to the hospital to seek for medical management.

D. Past Medical History (prior to admission and onset of illness)

a. Paediatric illness

Mumps ______ Pertusis________ HPN _______

Measles ______ Rheumatic______ Heart Disease _______

Chicken Pox ___√___Pneumonia______ Hepatitis _______

Rubella ______ Tuberculosis_____ Others ______

b. Immunization/Tests

BCG _____ Hepa B ____ Pneumonia _____

DPT _____ Measles _____ OPV _____

FLU _____ others: Tetanus toxoid

c. Hospitalization

According to the patient she has no previous hospitalization.

d. Injuries

Mommy Dionisia had no injuries.

e. Transfusions

Mommy Dionisia has not yet undergone any blood transfusions.

f. Obstetrics

Mommy Dionisia had her first menstruation (menarche) when she was
13years old. She has a regular monthly period that lasts for 3-5 days. According to
her, she doesn’t experienced dysmenorrhea. She’s practicing natural method of
family planning (withdrawal).

Gravida: 3

TPALM: Gravida= 4

Term = 4

Para = 4

Abortion = 0

Live birth = 4

Multiple = 0

g. Medication

Before seeking help from health care professionals she nebulized first with
a medicine suggested by her neighbour (Pulmo Inhalants).
 h. Allergies

She had reported not having any allergies to either food groups or drugs.

D. Family History

Age Family Member Health Status Living or Diseases Present in

deceased the Family
80 Father Unhealthy Deceased Heart Disease
76 Mother Unhealthy Deceased Hypertenson
50 Sister Healthy Living None
45 Mommy Dionisia Unhealthy Living A.R.F.
43 Sister Healthy Living None
38 Brother Unhealthy Living None

E. Social and Personal History

Date of Birth: November 14,1965 Birthplace: Rosales, Pangasinan

Educational Attainment: High School Ethnic Background: Ilocano
(undergraduate)
Position in the Family: mother Language: Ilocano, kapampangan, tagalog

a. Residence

Mommy Dionisia and her family currently reside in Brgy. Estrada, Capaz, Tarlac.
Their house is constructed with sawali and wood and stands at the middle rice fields.
Sawali is more dominant, they do have ceiling and adequate light source. According to
her, the space is adequate enough for them. She and her family have been living in Capaz
for 21 years.

b. Occupation

Mommy Dionisia is raising animals such as pigs and chickens for four years now.
But when she was still single she worked in a factory of coffee in manila.

c. Financial
Mommy Dionisia’s family supports their daily needs through their savings from
selling animals and rice.
d. Habits

Mommy Dionisia spends her time doing household chores and attending the
needs of her animals by cleaning their pen and feeding them. She spends her free time by
watching television.

e. Diet

She eats three meals a day. She prefer to eat vegetables and fish and occasionally
she eats meat and meat products. Infact her favorite is Pinakbet and bangus.

f. Physical Activity/Exercise

Household chores and cleaning the pig pen daily were usually her form of
exercise.

g. Brief Description of Average Day

Mommy Dionisia usually wakes up as early as 4 in the morning. She then starts
doing household chores and cleaning the pigpen. She also find time to chat with her
neighbours and watch television at the afternoon. Usually she sleeps at around 7-8 in
the evening.

F. Review of Systems

Put check on significant (abnormal) findings

General Description

Weight loss Weight gain Anorexia √Fatigue

√Weakness Night sweats

Notes :Shows weakness and fatigue.

Skin

Itch Bruising Rash Bleeding

Lesions Blisters Ecchymoses
BurnsDrainage Scars

Notes: Upon performing inspection, no skin abnormality found.

Eyes

Pain Itch Vision Loss Blurring

Diplopia Excessive Tearing Eye Glasses Contact Lenses
 Notes: The above deviations from normal were not present in the patient.

Ears

Pain Discharge Tinnitus Hearing loss

Notes: The above deviations from normal were not present in the patient.

Nose

Obstruction Epistaxis Discharges

Notes: The above deviations from normal were not present in the patient.

Throat & Mouth

Sore throat Bleeding gums Tooth Ache Tooth Decay

Notes: The above deviations from normal were not present in the patient.

Chest

√Cough Hemoptysis √Wheeze √Pain on respiration

√Dysnea Sputum:___________________
Breast: Lumps Pain Bleeding Discharge

Notes: Laboured breathing was observed.

CVS

√Chest pain Palpitation √Dyspnea on Exertion Edema

PND Orthopnea Others: ___________

Notes: She declared difficulty when breathing and it was also observed by the presence of
nasal flaring .She also complain chest pain at the right side with a pain scale of 5/10.
GIT

Food Intolerance Heartburn Nausea Jaundice

Vomiting Pain: Bloating Excessive Gas
Constipation Change in BM Melena
 Notes: The above deviations from normal were not present in the patient.

GU

Dysuria Nocturia Retention Polyuria

Dribbling Hematuria Flank Pain
Menarche: 13y/o LMP: July 5,2010 Cycles: 3-5 days

Notes: The patient had her menarche when she was 13 years old with regular 3-5-day
cyclemenstruation and her last menstrual period happened last July 5,2010.

Extremities

Joint Pains Varicose Veins Claudication √Edema

Stiffness Deformities: none

Notes: There is a grade 1 edema at both legs.

NEURO

√Headaches Dizziness Memory Loss Fainting

Numbness Tingling Seizures
Paresis Paralysis
Others:_______________________

Notes:The patient complains headache 4/10.

Mental Health Status

√Anxiety (mild) Depression Insomnia Sexual Problems Fear

Notes: The patient is mildly anxious as a result of thinking to her children at home.

B. Nursing Health History

Category Before Hospitalization

I. Health Perception-Health
Management Pattern
II. Nutritional-Metabolic Pattern
According to Mommy Dionisia, a person without
an illness is considered healthy.
She does not have any known allergies to any
foods or drugs. She’s fond of eating vegetables
and fish and occasionally eat meat. She weighed

III. Elimination Pattern
IV. Activity-Exercise Pattern
V. Sleep-Rest Pattern
VI. Cognitive-Perceptual Pattern
VII. Sexuality-Reproductive Pattern
48 kg.
She voids normally, and defecates daily usually
every morning.
She considered her household chores as her daily
exercise, activities included were washing clothes,
dusting their house, washing dishes, cooking, and
cleaning the pen of her animals.
She retires at around 7-8 pm, usually wakes up at
4:00 in the morning. She’ used to sleep during the
afternoon, .
She was oriented to time, place and person. She
was able to communicate well and can
comprehend and accommodate questions.
She was sexually active and has 4 children.

VIII. Coping-Stress Tolerance Pattern
IX. Value-Belief Pattern
She was very optimistic in life. She took
medications to relieve her difficulty of breathing
and performed her usual activities as not to feel
that she’s sick.
She believes in scientifically accepted and
traditional healing, as evidenced by her consulting
a doctor. She also believe that with the help of
GOD, she will be completely cured.

C. PHYSICAL ASSESSMENT

General Survey
Overall Physical Appearance:
Mommy Dionisia is mesomorph, appeared weak, with easy fatigue ability noted, looks
tired and sleepy. Signs of physical discomfort have been noticed such as facial grimace,
irritability and mild anxiety associated with her complaints of difficulty of breathing and chest
pain.
She is oriented to time, places and persons. She is mildly anxious yet attentive and
cooperative when asked. Her speech is even and moderately paced with appropriate words in a
calm and understandable voice.
Height: 5’1.
Weight: 48 kg.
Body Make-Up: mesomorph
Communication Pattern: The patient speaks calmly in Filipino, Ilocano and
Kapampangan.
Skin Integrity
 Color: brown complexion
Turgor: normal skin turgor with instant recoil of 2-3 seconds.
Bruises: none
Rashes: none
Scars:none
Blisters: none Ecchymosis: none Burns: none

Eyes
Sclera: white
Pupils: round and equal, responsive to light
Cornea: transparent, smooth and moist.

Respiratory
Easy breathing √In Distress No Distress
Vital Signs
BP: 140/80 mmhg PR: 76bpm RR: 24bcpm TEMP: 36.6⁰C
P.S.:5/10;moderate Capillary refill: 1-2 sec
Body Position/Alignment
√Supine Fowlers Semi-Fowlers
Alignment √Appropriate Inappropriate
Others: can change position according to desire
Mental Acuity
√Oriented √Coherent √Appropriately responsive
Disoriented Incoherent Inappropriately responsive
Sensory/Motor Restrictions
Amputation Deformity: none Paresis
Fracture Gait Hearing Disorders
Speech: even and moderately paced
Emotional Status
Euphoric Distressed Apprehensive Angry/Hostile √Anxiety(mild)
Medically Imposed Restrictions
CBR w/out BRP: √ CBR w/ BRP: OOB-Chair: Restricted ambulation:
Sexual activity:
Other Health Related Patterns
√Fatigue Restlessness √Weakness √Insomnia
 √Coughing √Dyspnea Dizziness √Pain

Environment
Room temp: √Adequate Inadequate
Lighting: √Adequate Inadequate

Activities Of Daily Living

Can perform:
Feeding Brushing teeth Bathing Transfering
Dressing Combing

D. PHYSICAL EXAMINATION
Conducted last July 30, 2010; 9:00am

1. SKIN

Area/ Feature to assess Technique Key Findings

Color Inspection Brown complexion
Lesions Inspection and Absence of lesion; scars were evident in the left
Palpation posterior arm.
Moisture Palpation Moist.

Temperature Palpation Within normal temperature of 36.6 oC.

Texture Palpation Smooth and even.
Mobility and Turgor Palpation Returns immediately to its normal position when
pinched, no tenting noted, 2-3 seconds.

2. HAIR

Area/Feature to assess Technique Key findings

Color and Distribution Inspection Hair is black and well distributed.
Texture and Oiliness Palpation Fine texture and smooth to touch.
Infestation Inspection Absence of any infestation.

3. SCALP

Area/Feature to assess Technique Key findings

Scaliness and scars Inspection No scars and scaliness.
Tenderness, Lesions, Palpation Absence of lesion, tenderness and lumps; smooth
lumps, masses and intact.
 4. SKULL

Area/Feature to assess Technique Key findings

Shape and symmetry Inspection Symmetrical.
Contour, Masses, Palpation Smooth, non-tender and free from masses and
Depression and depression.
Tenderness

5. FACE

Area/Feature to assess Technique Key findings

Facial Feature Inspection Proportion to the gross body structure.
Edema and Masses Inspection No tender areas, masses, edema or deformities.
Palpation

6. EYES

Area/Feature to assess Technique Key findings

External feature Inspection With eye bags noted.
Eyebrows, pupils, iris Eyebrows are symmetrical. The pupils and iris
and sclera. are also symmetrical. There is no obvious
deformity seen in the external eye structures,
with white sclera
 for reaction to Inspection Has a normal pupillary reaction: constrict with
light light and dilate in darkness.
 for Inspection Has a normal pupillary reaction: constrict with a
accommodation near object and dilate with a distant object.
 for convergence Inspection Has a normal convergence.

7. EARS

Area/Feature to assess Technique Key findings

External and internal Inspection Symmetrical with upper attachment at eye corner
ear level, there is absence of cerumen or any
discharge.
Palpation Firm, smooth and free from lesions and pain.

Auditory acuity Inspection The numbers whispered to both ears with one ear
occluded at a time were heard clearly.
 8. NOSE AND SINUSES

Area/Feature to assess Technique Key findings

Nose Inspection and Located symmetrically, proportion to the
Palpation face.The nasal bridge is aligned, and is without
swelling, bleeding, lesion or masses.
Presence of nasal flaring .
Nasal cavities Inspection Mucosa is pink without swelling.
Nasal sinuses Palpation There is no pain or discomfort felt upon
palpating the frontal and maxillary sinuses.

9. MOUTH AND PHARYNX

Area/Feature to assess Technique Key findings

Lips Inspection Pinkish in color, quite dry but no ulcers present.
Gums Inspection Gums are pink, smooth and moist. There is
absence of swelling, inflammation, or bleeding.
Teeth Inspection Complete teeth.
Tongue Inspection Pinkish. Dorsal and ventral surface are both
smooth and mobile.
Palate Inspection Palates are concave and pink. Soft palate is
smooth and hard palate has ridges.
Tonsils Inspection Tonsils are symmetrical and there is no swelling.

10. NECK

Area/Feature to assess Technique Key findings

Symmetry and Inspection and The patient’s neck is mobile and proportion to
Masculature Palpation the gross body structure. There is absence of
neck vein engorgement, masses, or scars.
Lymph nodes Palpation The lymph nodes are normal in size and shape.
No pain felt upon palpation.

11. THORAX AND LUNGS

A. POSTERIOR THORAX

Area/Feature to assess Technique Key findings

Lesions Palpation Posterior thorax is free from tenderness and
lesion.
Breath sounds Auscultation With wheezes upon inspiration.

B. ANTERIOR THORAX

Area/Feature to assess Technique Key findings

Symmetry, Rhythm Inspection Thorax rises and falls in unison with respiratory
cycle.
Sound Auscultation With wheezes upon inspiration

12. HEART

Area/Feature to assess Technique Key findings

Heart sound Auscultation No murmur, clear.
Point of maximal Auscultation PMI was located on the 4th to 5th intercostal space
impulse(PMI) left midclavicular line or the apical area.
Heart beat Auscultation 76 cardiac cycle/min.

13. ABDOMEN

Area/Feature to assess Technique Key findings

General appearance of Inspection The 4 quadrants and 9 regions were correctly
the abdomen identified No evidence of linea nigra and
stretchmarks.
Sound Auscultation Gurgling sounds were heard over the abdomen,
with normoactive bowel sound.
Percussion The abdomen has a dull sound while the liver has
a dull sound also.
Tenderness Palpation Smooth and no tenderness noted.

14. UPPER and LOWER EXTREMITIES

Area/Feature to assess Technique Key findings

Extremities Inspection and Peripheral pulses were strong and palpable.
palpation Extremities are proportion to the gross body
structure, normal in color and mobile.But with
grade 1 edema in both legs. All body parts are
present. Peripheral IV access at right arm with no
signs of phlebitis and infiltration.
Radial pulse rate at 76 bpm.
 15. GENITAL:

Area/ feature to assess Technique Key findings

16. NAILS

Area/Feature to assess Technique Key findings

Color, shape and texture Inspection and Transparent, smooth and convex with a 160˚ nail
Palpation bed angle.
Capillary refill Palpation and 1-2 sec.
Inspection
Lesion Inspection No lesion
Anatomy and Physiology

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 funneled 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, chronic obstructive
pulmonary diseases, it makes it harder for us to get the oxygen we need and to get rid of
the waste product carbon dioxide. Common respiratory symptoms include breathlessness,
cough, and chest pain.

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

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. Traveling 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.

Blood Supply

The lungs are very vascular organs, meaning they receive a very large blood supply. This
is because the pulmonary arteries, which supply the lungs, come directly from the right side of
your heart. They carry blood which is low in oxygen and high in carbon dioxide into your lungs
so that the carbon dioxide can be blown off, and more oxygen can be absorbed into the
bloodstream. The newly oxygen-rich blood then travels back through the paired pulmonary veins
into the left side of your heart. From there, it is pumped all around your body to supply oxygen
to cells and organs
Laboratory findings

Atrial blood gas

Date: july 27, 2010 time: 3:35 pm

Test Results Normal range Impression

Ph 7.58 7.35 – 7.45 Increase
PCO2 29.9 35 – 45 mmHg Decrease
PO2 321.8 80 – 100 mmHg Increase
HCO3 27.5 22 – 26 mEq/ L Increase
B.E. 6.4 + / - 2 mEq/ L Increase
O2 sat. 99.8 95 – 100 % Normal

Significance:

Routine blood count

Date: July 27, 2010 time: 3:35 pm

Test Results Normal range Impression

WBC 10.16 3.98 – 10.04 x 10ˆ3/uL Increase
neutro% 65.8 34.0 – 71.1 Normal
lympho% 24.3 19.3- 51.7 Normal
mono% 9.8 4.7 – 12.5 Normal
eo% 0.1 0.7 – 5.8 Decrease
baso% 0.0 0.1 – 1.2 Decrease
netro 6.68 1.56 – 6.13 x 10ˆ3/uL Increase
lympho 2.47 1.18 – 3.74 x 10ˆ3/uL Normal
Mono 1.0 0.24 – 0.36 x 10ˆ3/uL Increase
Eo 0.01 0.4 – 0.54 x 10ˆ3/uL Decrease
baso 0.0 0.1 – 0.08 x 10ˆ3/uL Decrease
RBC 4.33 3.93 – 5.22 x 10ˆ3/uL Normal
Hemoglobin 12.8 11.2 – 15.7g/dL Normal
Hematocrit 37.9 34.1 – 44.9% Normal

Significance:
Blood chemistry

Date: July 27, 2010 time: 3:35pm

Test Result Normal range Impression

BUN 3.5 2.9-8.2 μ mol/L Normal
Creatinine 70.72 53-106 μ mol/L Normal

Electrolytes

Sodium 1.36 136 – 142 mmol/L Decrease

Potassium 3.53 3.8 – 5.0 mmol/L Normal
Chloride 104.5 95 – 103 mEq/ L Increase

Significance:

Chest X- Ray

Date: July 27, 2010 time: 3:00 pm

Chest Pa – basic

Radiologic findings:

The lung fields are clear, heart is not enlarged. The diaphragm and costophrenic sulci are intact.

The rest of visualized chest structures are unremarkable.

Impression: normal chest findings

Significance
Medical Management

Upon admission at the ICU of Central Luzon Doctors’ Hospital with a chief complaint of
difficulty of breathing and later accompanied by headache and chestpain.

The doctor ordered CBC , 12 lead ECG and Chest X ray, to hook plain Lactated Ringer
Solution 1L x 20 gtts/min and 5% Dextrose in Water 250 cc x 31 gtts/min, to have nebulization
every 6 hours and hook aminophyliine drip to 10 gtts/min to give omeprazole 20 mmg IV OD,
hydrocortisone 100 mg IV every 8 hours, ciphrofloxacin 400 mg. every 12 hours combivent
every 1 hour after four dose then every four hours, kalium durule 1 tab TID, meptin 50 g 1 tab
twice a day and ketorolac 30 mg 1 amp IVP PRN after negative skin test. The doctor also
ordered to feed the patient at 1800 kCal of osteorized food every four hours and delay O2
saturation after 2 hours.

Nursing management
 EVALUATION

The student-nurse were able to perform thorough physical assessment on the client and
formulated nursing diagnosis based on the gathered data, implemented the nursing interventions
and evaluated if goals were met.

From this exposure, the student nurse have acquired knowledge regarding Acute
Respiratory Failure (ARF). And the student nurse was able to impart useful health teachings to
the client to be able to perform self-care, prevent recurrence of the disease and also included her
diet and the importance of taking her medications. The patient’s condition has been improved as
evidenced by improvement of her breathing pattern and decrease chest pain from pain scale of
5/10 to 2/10.
RECOMMENDATION

With this study, the student nurse was able to gain more knowledge and wider view and
perspective of the complication of Acute Respiratory Failure. Thus, the student nurse would
like to recommend and share some pointers on how to deal with different diseases like Acute
Respiratory Failure.

To the government, primarily they should allocate sufficient budget to sustain and
provide better facilities. They must be responsible enough to create awareness program for
care and management for all the Filipino people.

To the health care team, they should righteously implementing basic and ideal procedures
regardless of the health care facilities where they belong. They must observe and always
remember to keep in line with their duties towards patient and significant others.

To the community and the family, that they must be sufficient coordinate with the
government and the health care team regarding promotion of health and prevention of
disease.
Pathology and Physiology

Causal factor: Contributing factor:

 Exposure to indoor and  Respiratory infection

outdoor allergens  Airway pollution
 Occupational sensitizers  Active/ passive smoking

Allergens/. Irritants bind to antibody molecule(IgE)

attached in mast cells and basophils

Contraction of Capillary dilation Increased mucous

bronchial production
smooth muscle
Edema of airway

Broncho constriction

Airflow limitation

Cough
Dyspnea
Decreased inhalation Wheezes Decreased exhalation of
of oxygen Chest tightness carbon dioxide

Inadequate gas
hypoxemia exchange hypercapnia

Cyanosis
Acute
Restlessness
respiratory
Confusion
failure
Headache
Tachycardia
Tachypnea
Diaphoresis