Written Report: (Bronchial Asthma)

Angeles University Foundation
Angeles City
College of Nursing
Written Report
(Bronchial Asthma)
Submitted by:
Sanchez, Hannah Joy G
BSN II - F
Submitted to:
Myron L. Roque, RN,MN
Bronchial Asthma
Introduction
Asthma is a common lung problem that effects about five percent of the
population, occurs at all ages, and has had major changes in understanding and
treatment in the last decade. The major change in understanding is realization
that asthma is a bronchial inflammatory disease. It appears that inflammation is
the cause of symptoms of wheezing, shortness of breath, and mucous
production which have been known since the classical Greek period 3,000 years
ago. The importance of inflammation has led to the changes in treatment
discussed below.
Synthesis of the Disease

Bronchial asthma is a lung disease in which the bronchial tubes are
hypersensitive to many different irritants including viral infections, air pollution,
exercise, allergens and various fumes. The reaction to these irritants has long
been recognized as narrowing of these small airways and increased mucous
secretions. This gives characteristic variability of lung function with obstruction
on exhaling that is easily measurable in the medical office and at the patient's
home.
Anatomy and Mechanism of Asthma

The air-conducting tubes in the lungs carry the air from the upper airway and
trachea (major windpipe in the neck) through approximately 10 branches before
reaching the air sacs (alveoli) that bring the air in intimate close contact with tiny
blood vessels where exchange of oxygen and carbon dioxide can occur between
air and blood. The circulation then transfers oxygen rich blood to the tissues
where it diffuses by simple concentration gradients into the tissues. In the
meantime, waste carbon dioxide diffuses back into the blood in these tiny blood
vessels (capillaries) to be returned for removal by the lungs. These small air
tubes called bronchi and bronchioles are the location of problems in the asthma
sufferer. Because of irritated membranes in these little tubes, reflexes make
smooth muscle surrounding the air tubes contract, narrowing the airways. Other
reflexes stimulate normal glands in the bronchi to secrete extra mucous thus
narrowing the openings further. Of particular concern is the likelihood that
continual inflammation of the bronchi may result in permanent scarring of the
little tubes so they are permanently narrowed and thus not able to ever transport
air to the alveoli normally.
Pathophysiology
The underlying pathophysiology in asthma is reversible and diffuse airway
inflammation that leads to airway narrowing.
 Activation. When the mast cells are activated, it releases several chemicals
called mediators.
 Perpetuation.These chemicals perpetuate the inflammatory response,
causing increased blood flow, vasoconstriction,, fluid leak from the
vasculature, attraction of white blood cells to the area, and
bronchoconstriction.
 Bronchoconstriction. Acute bronchoconstriction due to allergens results
from a release of mediators from mast cells that directly contract the airway.
Progression. As asthma becomes more persistent, the inflammation progresses
and other factors may be involved in the airflow limitation.
Causes
 Allergy. Allergy is the strongest predisposing factor for asthma.
 Chronic exposure to airway irritants. Irritants can be seasonal (grass,
tree, and weed pollens) or perennial (mold, dust, roaches, animal dander).
 Exercise. Too much exercise can also cause asthma.
 Stress/ Emotional upset. This can trigger constriction of the airway leading
to asthma.
 Medications. Certain medications can trigger asthma.
Symptoms
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
 Trouble sleeping caused by shortness of breath, coughing or wheezing
 A whistling or wheezing sound when exhaling (wheezing is a common sign
of asthma in children)
 Coughing or wheezing attacks that are worsened by a respiratory virus, such
as a cold or the flu
Signs that your asthma is probably worsening include:

 Asthma signs and symptoms that are more frequent and bothersome
 Increasing difficulty breathing (measurable with a peak flow meter, a device
used to check how well your lungs are working)
 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)
Risks
The main risk factors include:
 Family history (parent or sibling) of bronchial asthma.
 Susceptive to an allergic reaction such as atopic dermatitis or hay fever.
 Habits which make you overweight.
 Smoking, or passive smoking.
 Exposure to chemical fumes or pollution, and irritants from hair sprays or
perfumes.
Nursing Management
The immediate care of patients with asthma depend on the severity of the
symptoms.
Nursing Assessment
Assessment of a patient with asthma includes the following:
 Assess the patient’s respiratory status by monitoring the severity of the
symptoms.
 Assess for breath sounds.
 Assess the patient’s peak flow.
 Assess the level of oxygen saturation through the pulse oximeter.
 Monitor the patient’s vital signs.
Nursing Interventions
The nurse generally performs the following interventions:
 Assess history. Obtain a history of allergic reactions to medications before
administering medications.
 Assess respiratory status. Assess the patient’s respiratory status by
monitoring the severity of symptoms, breath sounds, peak ﬂow, pulse
oximetry, and vital signs.
 Assess medications. Identify medications that the patient is currently
taking. Administer medications as prescribed and monitor the patient’s
responses to those medications; medications may include an antibiotic if the
patient has an underlying respiratory infection.
 Pharmacologic therapy. Administer medications as prescribed and monitor
patient’s responses to medications.
 Fluid therapy. Administer fluids if the patient is dehydrated.
Medical management:
Immediate intervention may be necessary, because continuing and progressive
dyspnea leads to increased anxiety, aggravating the situation.
Pharmacologic Therapy
 Short-acting beta2 –adrenergic agonists. These are the medications of
choice for relief of acute symptoms and prevention of exercise-induced
asthma.
 Anticholinergics. Anticholinergics inhibit muscarinic cholinergic
receptors and reduce intrinsic vagal tone of the airway.
 Corticosteroids. Corticosteroids are most effective in alleviating
symptoms, improving airway function, and decreasing peak flow
variability.
 Leukotriene modifiers. Anti Leukotrienes are potent bronchoconstrictors
that also dilate blood vessels and alter permeability.
 Immunomodulators. Prevent binding of IgE to the high affinity receptors
of basophils and mast cells.
References:
https://www.medanta.org/bronchial-asthma/
https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/
syc-20369653
https://nurseslabs.com/asthma/#Nursing-Management

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Angeles University Foundation

Synthesis of the Disease

Anatomy and Mechanism of Asthma

Asthma signs and symptoms include:

Signs that your asthma is probably worsening include:

 Exercise-induced asthma, which may be worse when the air is cold and

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