I. Personal Profile Name: Mr.

Hicks Sex: Male Address: Banggot, Bambang, Nueva Vizcaya Age: 2 yrs & 6mo old Nationality: Filipino Religion: Iglesia in Cristo Dialect: Tagalog/Ilocano Date of Admission: November 20, 2005 Chief Complaint: Cough and Vomiting Ward: Male ward Admitting Diagnosis: Bronchial Asthma Final Diagnosis: Bronchial Asthma II. History of Present Illness One day prior to admission patient experienced cough and vomited 3x, no medications are given but mother immediately brought the patient to the hospital. III. History of Past Illness According to mother patient sometimes experienced cough but treated with over the counter medicines like Bisolvon & Loviscol. The mother had normal delivery with the patient. The patient has also received complete immunization BCG when he was 2 days old, 3 doses of OPV, DPT and Hepa B for 3 consecutive months, his first doses was administered when he was 1 month and 2 weeks old. He also received Measles vaccine when he was 9 months old. The mother brings him to Bunuan clinic in Bambang, Nueva Vizcaya for consultation whenever the patient does not feel good and the usual diagnosis is fever with cough and colds. IV. History of family Illness Grandmother had asthma but was cured before she reached adulthood; mother also had asthma but was able to overcome/outgrow it before she reached 18. No other family illness is known. V. Brief Description of the Disease Asthma is an inflammatory disorder of the airways characterized by periodic attacks of wheezing, shortness of breath, chest tightness and coughing. Causes - allergens a. Animal dander ( hair or feathers) b. Dust c. Cockroaches d. Pollen - irritants a. Cigarette smoking b. Air pollution c. Sudden changes in weather d. Scented products e. Strong emotional expression and stress Signs and Symptoms - auscultation during episodes reveals wheezing but lung sounds are usually normal between episodes - wheezing, cough, chest pain - anxiety due to shortness of breath, nasal flaring - intercostals retractions - rapid pulse, sweating, severe drowsiness

Prevention Asthma can be reduced by avoiding allergens and respiratory irritants. Exposure to dust mites can be reduced by encasing mattresses & pillows in allergen impermeable covers, dust mites & molds can be reduced by lowering indoor humidity. Animals should be kept out of patients bedroom. Exposure to cigarette smoke, air pollution, industrial dust and irritating fumes should also be avoided. Long term management of Asthma 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Diagnosis: Lung Function Assess severity Explain and assess socio economically Plan treatment Give significant doses to maintain best lung function Investigate trigger factor Treat aggravating conditions Write crisis plan See the patient regularly Minimize therapy

VII. Pathophysiology Bronchial Asthma Hereditary Risk Factor Allergens Respiratory infections Inhalation of irritants (dust, fumes, gasses) Air pollution & humidity Sudden change in weather Emotional factors Increase in IgE

Primary mediators are released & mast cells & Basophil degranulate Vasodilation of mucosal surface for penetration of antigen to mast cells & basophil Increased mucus secretion

Secondary mediators are released

Bronchoconstriction occurs

Late phase Additional recruitment of leukocytes (neutrophils, eosinophils, basophils)

Inflammation, Cell damage

Coughing

Dyspnea

Wheezing

Cyanosis

Body malaise

Blurred vision

Release of sputum
VIII. Laboratory Diagnosis

Blood cells Hemoglobin Hematocrit Platelet Count WBC Granulocytes Lymphocyte / Monocyte Granulocyte % Lymphocyte / Monocyte %

Hematology November 20, 2005 Result Normal ranges 11.4 g/dl M 14-18 g/dl F 12-16 g/dl 37.3 M 40.0-54.0 F 37.0-47.0 372 g/L 140-440 x 10 g/L 18.4g/L 4.3-10.0 x 10 g/L 15.1 2.0-8.6 3.3 1.2-5.3 82 18

Interpretation Anemia Anemia Infection Infection, Asthma

Blood cells Hemoglobin Hematocrit Platelet Count WBC Granulocytes Lymphocyte / Monocyte Granulocyte % Lymphocyte / Monocyte %

Hematology November 25, 2005 Result Normal Ranges 10.9 g/dl M 14-18 g/dl F 12-16 g/dl 35.2 M 40.0-54.0 F 37.0-47.0 212 g/L 140-440 x 10 g/L 8.6 g/L 4.3-10.0 x 10 g/L 3.6 2.0-8.6 5.0 1.2-5.3 42 58

Interpretation Anemia Anemia

IX. Physical Assessment 4

Psychosocial: The patients significant others are his mother and father Coping mechanisms are coughing and crying Religion is Iglesia ni Cristo Primary language are tagalog and ilocanno Primary source of health care is Bunuan Clinic at Bambang, Nueva Vizcaya Financial resources are Philhealth and SSS of patients father Patient is active despite his illness When one makes funny faces patient reacts by smiling When the patients grandmother visited he immediately recognizes her Memory of the patient cannot be assessed due to patients age Patient has normal speech for his age Elimination: Abdomen has generalized distention with umbilicus inverted No masses was palpated on the abdominal area Bowel sounds are at 6 gurgles/min/quadrant With stool pattern of one time a day, soft in consistency and brown in color Voiding pattern of 3 or 4 x a day depending on fluid intake, with clear amber color Rest & Activity: Patient is able to play, eat, and sleep Patient sleeps for 6hrs at night and able to sleep for 2hrs in the afternoon Patient has mesomorph body frame Muscle tone is normotonic and muscle strength is rated at 5 each at both legs and arms because he was able to lift with force Has fine motor function because he is able to scribble shapes and has gross motor function because he is able to stand and walk The range of motion for both legs and arms are rated at 5 each because patient is able to abduct & adduct legs and arms w/o pain while playing Medications are given to avoid asthma attacks and patients mother back taps patient regularly Safe Environment: No known allergies to medication and food but is allergic to dust and smoke With equal and active corneal response Has no scars and surgical wounds With moist and intact mucous membrane (-) fever temperature is 36.5o C Oxygen: Nose is filled with mucus Has undergone oxygen inhalation but only nebulization is given afterwards Respiration is irregular, sometimes deep breaths sometimes shallow with 45 cycles/min Has rales Has fair skin clean nails and pinkish lips Normal capillary refill 3 sec Has bounding pulses with irregularity and right pulse rate is higher than left one (R=105 bpm L=100 bpm) Nutrition: With D5IMB 500 ml inserted in the right arm Fluid intake of 4 220 ml bottles of milk & 2-3 glasses of water/day 5

Has normal tissue turgor Height: 2 3 Weight: 12.1 kg Has the ability to chew, swallow, tolerate food, feed self Gag reflex is intact and there is no vomiting

X. Course in the Ward On November 20 2005 a male patient 2 yrs old and 6 months is admitted at 12:58pm due to cough since yesterday and has already vomited several times. The patient is weighed at 12.1 kg and the temperature is 36.5o C. He was examined by the residence on duty with orders made and carried out. The nurse inserted D5IMB 500ml on the patient and regulated it then laboratory request for hematology is forwarded. After the procedure the patient is carried by the mother and is placed comfortably on the bed then oxygen inhalation is administered, Hydrocortisone 60mg IV is given nebulized and medication is started. At 4-12 o clock IMB is still around 450 cc or more and the patient is feverish with a temperature of 37.6o C with cough. On November 21, 2005 from 12-8 o clock nurse received D5IMB 500ml but still around 250 cc or more, there were no vomiting noticed and the patient is no longer feverish but has dyspnea, medication is given. At 8-4 o clock nurse received D5IMB 500ml but still around 50 cc level more. Patient has no signs of fever no dyspnea but with cough, an increase in fluid intake is emphasized. Medication is given and also nebulization is administered.

XI. Drug Study Salbutamol Expectorant Brand name: Ventolin Expactorant Classification: Bronchodilator Indication: Treatment and prevention of Bronchial Asthma, Adverse Reaction: Fine tremor of skeletal muscle, fillings of tension, peripheral vasodilation, acompensatory small increase in heart rate, headache, hypersensitivity reactions, hyperactivity in children, tachycardia Dose: 1 tsp TID Nebule: with salbutamol every 6o Manufacturer: Glaxo Smith Kline Nursing Considerations: Do not exceed the recommended dose If the dose of drug used previously does not provide relief, contact the provider immediately When given by nebulization, either a face mask or mouthpiece may be used. Compressed air or oxygen with a gas flow of 6-10 L/min should be used, with a single treatment lasting from 5-15 min Cefuruxime Brand name: Zegen Classification: Cephalosporin Indication: Treatment for Bronchitis and other lower respiratory tract infection Adverse Reaction: Diarrhea, nausea, decrease in hemoglobin, decrease in hematocrit, transient increase in liver enzymes, possibly seizures Dose: 250 mg IV every 8o ANST Manufacturer: United American Pharmaceuticals (UAP) Nursing Considerations: Check expiration date on container Check for recommended method of storage for the drug and store accordingly Parenteral solutions infused too rapidly may cause pain and irritation; infuse over 30 min unless otherwise indicated and assess site frequently Therapy should be continued for at least 2-3 days after symptoms of infection have disappeared If seizures occur, discontinue the drug immediately and give anticonvulsant drugs Hydrocortizone Brand name: Solucortef Classification: Adrenocorticosteroid Indication: For Respiratory neoplastic diseases, severe allergies Adverse Reaction: Fluid and electrolyte disturbances, musculoskeletal, GI, Dermatologic, Neurological, Metabolic complications Dose: 60 mg IV now then 30 mg every 12o Manufacturer: Pfizer Nursing Considerations: Check label of parenteral hydrocortisone to verify route that can be used for a particular preparation, because IM and IV routes are not necessarily interchangeable When treating clients with conditions such as asthma, corticosteroids given every other day may maintain therapeutic effects while reducing or eliminating undesirable side effects. When ordered every other day, administer in the morning to coincide with the normal body secretion of cortisol