L.F GONZALES COLLEGES OF SCIENCE AND TECHNOLOGY INC.

MAHARLIKA HIGHWAY, SAN LEONARDO NUEVA ECIJA

Presented by: Keith Randolf Cruz

Introduction Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm .Its diagnosis is usually made based on the pattern of symptoms and/or response to therapy over time As of 2010, 300 million people were affected worldwide. In 2009 asthma caused 250,000 deaths globally.(Wikipedia)

Objectives General objective: This case presentation aims to give information about asthma.

Specific objectives: After this case presentation the students will be able to: 1. Describe the pathophysiology of asthma 2. Describe the physical assessments associated with mild persistent asthma 3. Identify the risk factors for asthma 4. Describe the diagnostic tests used to evaluate the patient with asthma 5. Discuss therapy and management of the adult patient with asthma

Disease background

Definition Asthma- is a chronic lung disease that inflames and narrows the airways. Mild persistent asthma-is one of the four types of asthma. People who suffer from mild persistent asthma generally have asthma symptoms more than twice a week, but not more than once a day. Their night-time symptoms occur more than twice a month. Asthma attacks may affect the activities of people with mild persistent asthma Causes The exact cause of asthma is not known. What all people with asthma have in common is chronic airway inflammation and excessive airway sensitivity to various triggers Signs and symptoms When the breathing passages become irritated or infected, an attack is triggered. The attack may come on suddenly or develop slowly over several days or hours. The main symptoms that signal an attack are as follows:

wheezing, Shortness of breath, chest tightness, coughing, and difficulty speaking. Symptoms may occur during the day or at night. If they happen at night, they may disturb your sleep. Wheezing is the most common symptom of an asthma attack.

Wheezing is a musical, whistling, or hissing sound with breathing. Wheezes are most often heard during exhalation, but they can occur during breathing in (inhaling). Not all asthmatics wheeze, and not all people who wheeze are asthmatics. Current guidelines for the care of people with asthma include classifying the severity of asthma symptoms, as follows:

Mild intermittent: This includes attacks no more than twice a week and nighttime attacks no more than twice a month. Attacks last no more than a few hours to days. Severity of attacks varies, but there are no symptoms between attacks.

Mild persistent: This includes attacks more than twice a week, but not every day, and nighttime symptoms more than twice a month. Attacks are sometimes severe enough to interrupt regular activities.

Moderate persistent: This includes daily attacks and nighttime symptoms more than once a week. More severe attacks occur at least twice a week and may last for days. Attacks require daily use of quick-relief (rescue) medication and changes in daily activities.

Severe persistent: This includes frequent severe attacks, continual daytime symptoms, and frequent nighttime symptoms. Symptoms require limits on daily activities.

Risk factors Gender Family history Lifestyle Environmental factors Obesity

Patients profile Name: Mrs. M Gender: female Address: Bantug norte, Cabanatuan city Age: 65 y.o. Religion: Roman Catholic Weight: 68 kg Height: 55 Date of admission: October 7, 2011 Initial diagnosis: Bronchial asthma Final diagnosis: bronchial asthma Source of information: patient, husband, medical team

History of present illness The night before the attack, the patients husband had a card game with friends at their home, the players were smoking cigarettes. It was tiring for the patient because she had to do the cooking and entertained the house guests. By 3 am on the following day the patient

woke up and thought that she just had a bad night because she was coughing persistently and had difficulty sleeping. At around 5 am, she cleaned the house and did some dusting. By 7:30 am, she had a bad attack, severe coughing and wheezing and she also experienced shortness of breath. Her metered dose inhaler did not help too much so that is when her husband decided to take her to ELJ to undergo medical check up. Past history Patient was diagnosed with bronchial asthma six months ago She was prescribed with Ventolin MDI on her precious check up.

Developmental task Stage Ego integrity vs. despair (maturity) virtue wisdom task accepting responsibility for ones self and life

Activities of daily living Before hospitalization Do house chores Worked as a librarian(retired) Owned a cat during hospitalization complete bed rest after hospitalization limit activities and exposure to allergens

Physical assessment Body part Skin Assessment Pale in appearance, no lesions, bleeding, rashes, itching, irritation or sores No lesions, bleeding or sores, no discharges noted No involuntary eye movement, can see clearly, no abnormal sensitivity to light Remarks Pale color due to decreased oxygen supply caused by present medical condition Normal Normal

Head Eyes

Ears Lungs

No hearing loss, presence of cerumen noted With productive cough, dyspnea, wheezing, uses accessory muscles No chest pain, palpitations noted

Normal Patient is suffering from dob because of narrowed airway due to present medical condition Palpitations may have occured because of overexertion of the patient and as a side effect of the drug albuterol Normal Normal

Chest

Abdomen Limbs Course in the ward

Bowel sounds noted, no distention No pain or swelling noted

Patient came to the ER with a chief complaint of persistent coughing, wheezing, pressure like discomfort in anterior chest that does not radiate and shortness of breath. Her initial vital signs were: t-37, PR-120, RR-36, BP-140/100 while sitting. Patient was ordered by the doctor to be admitted after being nebulized with a stat dose of airomir .5 ml + 2.5 cc nss. An ivf of D5 water 1 liter was inserted via left metacarpal vein and regulated at KVO rate. She was given a stat dose af solu medrol 125 mg via IV.O2 was administered @ 3-5 LPM. She was ordered to have complete bed rest without bathroom privilages.her medications are airomir and beclomethasone. She was scheduled for PFT. Arterial blood gas was monitored. On the second day her respiratory status improved. Her RR is now 20 bpm, no coughing, no dyspnea was noted. On the third day she the doctor ordered that she may go home. Home meds were prescribed and instructed (airomir and becotide).she was discharged from the hospital and was ordered for follow up check up after one week. Anatomy and physiology UPPER AIRWAY The human airway has two openings: the nose and the mouth. Remember: the floor of the nose is the roof of the mouth. The nose leads to the NASOPHARYNX and the mouth leads to the OROPHARYNX. Separated anteriorly by the PALATE, these two passages join posteriorly in the PHARYNX. At the base of the tongue, the EPIGLOTTIS separates the OROPHARYNX and theLARYNGOPHARYNX/HYPOPHARYNX. The LARYNX extends from the lower part of the pharynx to the TRACHEA. LOWER AIRWAY THE CONDUCTING ZONE At the CARINA, the trachea bifurcates into the RIGHT AND LEFT MAIN BRONCHI. The right and left main bronchi further branch into lobar/secondary bronchi (one to each lobe of the lung thus, two on the left and three on the right), then divide again into segmental/tertiary bronchi and finally terminal bronchioles, which are the smallest airways

without alveoli. The segmental/tertiary bronchi are of particular importance because they supply each BRONCHOPULMONARY SEGMENT. These structures make up the conducting airways and serve to lead inspired air to the gasexchanging regions downstream. The conducting airways contain NO ALVEOLI and, thus, do not take part in gas exchange. The conducting zone of the airway constitutes the anatomical dead space (150ml). THE RESPIRATORY ZONE The terminal bronchioles divide into respiratory bronchioles which continue downstream as alveolar ducts. While respiratory bronchioles have occasional alveoli budding from their walls, alveolar ducts are completely lined with alveoli/alveolar sacs. There are over 300 million alveoli in the human lung and each alveoli is covered in an extensive network of capillaries. The Acinus refers to the anatomical unit formed by the portion of lung distal to a terminal bronchiole. The respiratory zone makes up most of the lung (2.5-3L). .

Laboratory Spirometry revealed mild persistent asthma Chest x ray was done during previous check up ABG revealed respiratory acidosis

Result Ph7.3

normal values 7.35-7.45 45

remarks decreased increased

PaCO2- 52 PaO2- 60 SaO290

96-100

decreased

HCO3- 24

Medical management Eliminate or reduce contributory factors Medication regimen

Discharge planning M- advise patient to follow medication regimen E- encourage ambulation but limit or prevent overexertion T- encourage adequate rest H- proper use of MDIs and DPIs Avoid environmental hazards Advise husband to minimize or if possible refrain from smoking especially at home Advise patient to have a diary to monitor her status O- Remind the patient of her follow up check up D- diet as tolerated, if possible, patient must maintain ideal weight.