CASE # 4 DIFFICULTY OF BREATHING

This is the case of P.F a 15-year-old, female, who came in to your local health center
with a chief complaint of difficulty of breathing.

3 days PTC, patient claimed to have a non-productive cough, worse in the morning
and at night. No other associated symptoms noted.

On the day of consult, patient noted difficulty of breathing after cleaning their
backyard, which is not relieved by rest, hence consult.

On physical examination, vital signs are within normal limits except for RR: 28 CPM.
The rest of the physical examination is unremarkable except for bilateral wheezing.

PAST MEDICAL HISTORY:

(+) allergic dust and seafood; no known drug allergies
(+) complete vaccination until 15 months old, no other vaccination thereafter
(-) asthma

FAMILY HISTORY:
(+) asthma, both sides
(+) allergic rhinitis
(+) hypertension, paternal side
(-) PTB, heart and kidney diseases

SOCIAL HISTORY:
- Lives in a small bungalow house located at a roadside
- Sometimes uses firewood to cook
- Exposed to cigarette smoking at home
- Patient is non-smoker

1. What is Asthma?
Asthma is a disease that affects your lungs. It is one of the most common long-term
diseases of children, but adults can have asthma, too. Asthma causes wheezing,
breathlessness, chest tightness, and coughing at night or early in the morning. If you have
asthma, you have it all the time, but you will have asthma attacks only when something bothers
your lungs.

2. What are the signs and symptoms of Asthma?

Asthma symptoms vary from person to person. You may have infrequent asthma
attacks, have symptoms only at certain times — such as when exercising — or have symptoms
all the time.

Asthma signs and symptoms include:

● Shortness of breath
● Chest tightness or pain
● Wheezing when exhaling, which is a common sign of asthma in children
● Trouble sleeping caused by shortness of breath, coughing or wheezing
● Coughing or wheezing attacks that are worsened by a respiratory virus, such as a
cold or the flu
● Difficulty talking

Signs that your asthma is probably worsening include:

● Asthma signs and symptoms that are more frequent and bothersome
● Increasing difficulty breathing, as measured with a device used to check how well
your lungs are working (peak flow meter)
● The need to use a quick-relief inhaler more often

For some people, asthma signs and symptoms flare up in certain situations:
● Exercise-induced asthma, which may be worse when the air is cold and dry
 ● Occupational asthma, triggered by workplace irritants such as chemical fumes,
gases or dust
● Allergy-induced asthma, triggered by airborne substances, such as pollen, mold
spores, cockroach waste, or particles of skin and dried saliva shed by pets (pet
dander)

3. According to what you have learned in your health assessment, what other
subjective data should you further investigate?

- how often do you clean outside

- When does the smoker in the house often smoke
- Is the road that the patient live in busy and what time does it get busy
- Do you have any pets
- Are exposed to chemical fumes, dust, or other airborne irritants

4. What other objective data should you perform?

- Perform bronchoprovocation challenge with methacholine, mannitol, or exercise.

- Administer allergy test
- Examine your skin for signs of allergic conditions such as eczema and hives.

5. Give at least 3 possible nursing care plans to P.F.

Assessment Nsg Dx Plan Intervention Evaluation

Subjective: Ineffective breathing After 2 hours of 1. Establish Goal Met.

Non-productive cough pattern related to nursing intervention, rapport
asthma the patient will be
Objective: able to verbalize
-bilateral wheezing. understanding and 2. Record
-RR: 28 CPM. demonstrate proper and
deep breathing monitor
techniques to VS
facilitate proper
oxygenation. 3. Auscultat
e breath
After 1 day of sounds
nursing intervention, and
Patient will maintain assess
an optimal breathing airway
pattern, as patterns
evidenced by
relaxed breathing,
normal respiratory
rate or pattern, and 4. Elevate
absence of head of
dyspnea. bed

5. Administ
er
medicati
ons as
ordered

6. Demonst
rate
diaphrag
matic
and
pursed
lip
breathing
Assessment Nsg Dx Plan Intervention Evaluation

Subjective: Ineffective airway After 2 hours of 1. Place Goal Met.

-difficulty of breathing clearance related nursing intervention, patient
to asthma as Patient’s respiratory with
evidenced by rate returns remain proper
Objective: difficulty of within established body
-non-productive breathing limits. alignmen
cough t for
-RR: 28 CPM. maximu
m
-bilateral wheezing.
After 1 day of nursing breathing
intervention, The pattern
patient maintains an
effective breathing
pattern, as
evidenced by relaxed 2. Auscultat
breathing at normal e breath
rate and depth and sounds.
absence of dyspnea. Note
adventiti
ous
breath
sounds
like
wheezes
,
crackles,
and
rhonchi

3. Keep
environm
ental
pollution
to a
minimum

4. Monitor
arterial
blood
gasses
(ABGs).

5. Provide
warm
liquids
and
recomme
nded
intake of
fluids
between
meals
instead
of during
it..

Assessment Nsg Dx Plan Intervention Evaluation

Subjective: Deficient After 2 hours of 1. Explain Goal Met.

-House located at a Knowledge of nursing intervention, the
roadside asthma related to the patient will be disease
- Sometimes uses lack of information aware of what are to the
that triggers the the possible triggers client and
firewood to cook
disease of her illness around significan
- Exposed to cigarette her surroundings. t others.
smoking at home
- Patient is After 1 day of
nursing intervention,
non-smoker
patients and 2. Instruct
significant others will the client
Objective: verbalize knowledge how to
(+) allergic to dust of the disease and avoid
(+) asthma, both its management asthma
sides triggers:
(+) allergic rhinitis -Smoke.
-Exercise
-Air pollution.
-Allergens.

3. Educate
the client
about the
warning
signs and
symptom
s of an
asthma
attack
and the
importan
ce of
early
treatment
of an
impendin
g attack.
Provide a
written
copy of
daily
exacerba
tion
manage
ment.

4. Reinforce
the need
for taking
controller
medicatio
ns as
indicated.

6. Make a drug study on salbutamol + another anti-asthma drugs

Drug Dosage Mechanism Indication Side Effects Nursing
of Action and and Adverse Responsibility
Contraindic Reactions
ations

Generic The usual Acts on Indication: -Tremor, -Check and verify

Name: dosage for beta-2 For -nervousness, with doctor’s order
Salbutamol adults and adrenergic treatment of -headache,
children 4 receptors to acute -dizziness, -Observe rights in
Brand years of relax the episodes of -excitement, medication
Name: age and bronchial bronchospa -insomnia, administration
Proventil older is two smooth sm or -weakness, such as giving the
hfa inhalations muscle. It prevention -tachycardia, right drug to the
 repeated also inhibits of asthmatic -epistaxis, right patient using
Classificati every 4 to 6 the release of symptoms -hypokalemia, the right route and
on: hours, 1 inh immediate -local irritation, at the right time.
Bronchodila every 4hrs hypersensitivi Contraindic -paradoxical
tor, may suffice. ty mediators ations: -bronchospasm -Administer
Beta 2 from cells, -Hypersensi -immediate accurately
agonist Exercise-in especially tivity to hypersensitivity because adverse
duced mast cells. salbutamol reactions (eg, reactions and
bronchospa rash, urticaria, tolerance might
sm: 2 -Tachyarrhyt angioedema); occur.
inh15–30 hmias and -metabolic
minutes tachycardia acidosis. -Raise side rails up
before because client
exercise. -Cardiac might be restless
disease and drowsy
because of this
-Hypertensi drug.
on
-Keep room well-lit
-Hyperthyroi and see to it that
dism client has a person
with him closely in
-Glaucoma case of vertigo.

-Geriatric -Assess lung

patients sounds, PR and
BP before drug
-Pregnant administration and
especially during peak of
near term medication.

-Lactation -Assess pulse for

rhythm. Provide
-Children oral care or let
less than 2 patient gurgle after
years of inhalation to get rid
age. of the unpleasant
aftertaste of the
inhalation.

-Auscultate lungs
for presence of
adventitious breath
sounds that may
signal pulmonary
edema, airway
resistance or
bronchospasm.

-Inspect client’s
nail bed and oral
mucosa for pallor.

-Place client in
position of comfort
to facilitate
optimum rest and
sleep.

Drug Dosage Mechanism Indication Side Effects Nursing

of Action and and Adverse Responsibility
Contraindi Reactions
cations
 Generic Ipratropium Inhibits Indication: The most -Protect solution
Name: is via interaction of Persistent common side for inhalation from
Ipratropium inhalation, acetylcholine bronchospa effects are: light. Store unused
either orally at receptors sm, -Dry mouth, vials in a foil
Brand or sites of COPD -Cough, pouch.
Name: intranasally bronchial exacerbatio -Headache,
Atrovent smooth n -Nausea, -Ensure adequate
muscle -Dizziness, and hydration, control
Classificati 13 years Contraindi -Difficulty environmental
on: old or cations: breathing. temperature to
Bronchodilat above. -Hypersensi prevent
or, NEB tivity to Most common hyperpyrexia.
Anticholiner (0.02%): ipratropium, adverse
gic 0.5 MG atropine, reactions: -Have patient void
every 20 alkaloids, -Headache before taking
mins as peanuts. -Nervousness, medication to
needed up -Anaphylaxi -Fatigue avoid urinary
to 3 hours s -Bronchitis retention.
for -Nausea
moderate -Mouth dryness -Teach patient
to severe -Skin flushing proper use of
asthma -Dyspnea inhaler.
exacerbatio -Symptoms of a
n. -common cold -Advise patients
-Dizziness not to exceed the
-Sinusitis prescribed dose.
-Dyspepsia
-Back pain -Advise to rinse
-UTI mouth after each
-Tachycardia use of the inhaler.
-Arrhythmias
-Severe -Advise frequent
adverse drinks and the use
reactions of sugar-free gum
-Hypersensitivit can help with dry
y reaction mouth.
-Paradoxical
bronchospasms -Be cautious not to
-Anaphylaxis confuse Atrovent
-Closed-angle with Alupent.
glaucoma
-Evaluate
therapeutic
response.

7. What will be your health education to P.F?

- Avoiding triggers. Steer clear of chemicals, smells, or products that have caused
breathing problems in the past.
- Stay away from the street as much as possible
- Refrain from said backyard cleaning for a while
- Have the smoker in the house stop smoking or stay away from the smoker when he
does smoke.
- Do not overwork yourself
- When feeling a serious difficulty of breathing, take the short acting inhaler.
- When taking the short acting inhaler, wait 2 hours before taking the long acting one.
- When taking inhaled corticosteroids, wash mouth after inhaling drug and clean the tip of
the inhaler.