ANDRES BONIFACIO COLLEGE

SCHOOL OF NURSING
College Park, Dipolog City

BRONCHIAL ASTHMA

In partial fulfillment of the requirements in NCM 314: Care of Older Person

Submitted By: Submitted To:

Ezra Cajocon Ms. Ailyn B. Manlays, RN
Lourdes Marisol O. Catubig
Bea Bianca K. Ageas

September 2023
 ANDRES BONIFACIO COLLEGE
SCHOOL OF NURSING
College Park, Dipolog City

INSTITUTIONAL VISION:
A center of excellence in instruction, research, technology, extension, athletics, and arts.

INSTITUTIONAL MISSION:

We commit to provide affordable quality education with values in industry, intelligence, integrity and undertake relevant research and socially
responsive community service using innovative technologies.

SCHOOL OF NURSING VISION

Excellent Nursing Education

SCHOOL OF NURSING MISSION

The School of Nursing shall generate, competent, safe, and compassionate professional nurses committed to:

a. Practice high standard of nursing care utilizing research and evidence-based practices that are culturally appropriate and sensitive.
b. Active involvement in local, national, and global issues affecting nursing, people’s health, and environment.
c. Ongoing holistic growth and development of the self and others.

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 TABLE OF CONTENTS

I. Introduction ……………………………………………..………………………………………… 1-8

II. Anatomy and Physiology…………………………………………………………………………. 9-14

III. Patient’s Profile……………………………………………………………………….……………15

IV. Growth and Development……………………………………………………………………….. 16

V. Physical Assessment……………………………………………………………………….……. 17-26

VI. Gordon’s Assessment………………………………………………………………………..…… 27-32

VII. Laboratory Test…………………………………………………………………………………..…33-36

VIII. Pathophysiology………………………………………………………………………………..….. 37-40

IX. Nursing Care Plan…………………………………………………………………………………. 41-46

X. Drug Study………………………………………………………………………………….………. 47-64

XI. Abstract of Related Study……………………………………………………………………….… 65-66

XII. References……………………………………………………………………………………….…. 67
General Objectives:

At the end of the case presentation, the student nurses should be able to gather critical information about the case study, demonstrate

competency, and provide appropriate knowledge and information about the provided condition in order to deliver quality nursing care to the patient. In

addition, the student nurses must show cooperation with other members of the group when doing responsibilities relevant to the case.

Specific Objectives:

At the end of the case presentation, the students will be able to:

1. Define Bronchial Asthma

2. Identify signs, symptoms, and any potential complications of the disease.

3. Recognize which organs of the body are involved and affected by the disease process, as well as which body functions have been altered by

this condition.

4. Understand the pathophysiology of Bronchial Asthma based on the sign and symptoms manifested by the patient

5. Enumerate the medication needed.

6. Apply different nursing interventions and make use of the process as a framework for the overall care for the patient

7. Provide articles and references in relation to the topic.

 INTRODUCTION

Asthma is a medical condition which causes the airway path of the lungs to swell and narrow. Due to this swelling, the air path produces
excess mucus making it hard to breathe, which results in coughing, short breath, and wheezing. The disease is chronic and interferes with daily
working. The disease is curable and inhalers help overcome asthma
attacks. Asthma can affect any age or gender and depends upon
environmental and hereditary factors at large. When ignored, disease
proves fatal claiming lives in many cases.
For some people, asthma is a minor nuisance. For others, it can be a
major problem that interferes with daily activities and may lead to a life-
threatening asthma attack.
Asthma can't be cured, but its symptoms can be controlled. Because
asthma often changes over time, it's important that you work with your
doctor to track your signs and symptoms and adjust treatment as
needed.

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
 A whistling or wheezing sound when exhaling (wheezing is a
common sign of asthma in children)

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Signs that your asthma is probably worsening include:

 Asthma signs and symptoms that are more frequent and bothersome
 Increasing difficulty breathing 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, and pet dander.

Causes
It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and genetic (inherited) factors.
Asthma triggers
Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different
from person to person and can include:

 Airborne substances, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste
 Physical activity (exercise-induced asthma)
 Air pollutants and irritants, such as smoke

Risk factors
A number of factors are thought to increase your chances of developing asthma. These include:

 Having a blood relative (such as a parent or sibling) with asthma

 Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
 Being overweight
 Being a smoker
 Exposure to exhaust fumes or other types of pollution

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Complications
Asthma complications include:

 Signs and symptoms that interfere with sleep, work or recreational activities
 Sick days from work or school during asthma flare-ups
 Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe
 Emergency room visits and hospitalizations for severe asthma attacks
 Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Prevention
While there's no way to prevent asthma, by working together, you and your doctor can design a step-by-step plan for living with your condition and
preventing asthma attacks.

 Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an
asthma attack. Then be sure to follow your plan.

Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in
control of your life in general.

 Get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-
ups.
 Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution
— can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.
 Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness
of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak
airflow with a home peak flow meter.
 Identify and treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to
control your symptoms.

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 When your peak flow measurements decrease and alert you to an oncoming attack, take your medication as instructed and immediately stop
any activity that may have triggered the attack. If your symptoms don't improve, get medical help as directed in your action plan.

 Take your medication as prescribed. Just because your asthma seems to be improving, don't change anything without first talking to your
doctor. It's a good idea to bring your medications with you to each doctor visit, so your doctor can double-check that you're using your
medications correctly and taking the right dose.
 Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma
isn't under control. See your doctor about adjusting your treatment.

Diagnosis

Physical exam
To rule out other possible conditions — such as a respiratory infection or chronic obstructive pulmonary disease (COPD) — your doctor will do a
physical exam and ask you questions about your signs and symptoms and about any other health problems.
Tests to measure lung function
You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include:

 Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how
fast you can breathe out.
 Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign
your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and
deal with low peak flow readings.

Lung function tests often are done before and after taking a medication called a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open
your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma.

How asthma is classified

To classify your asthma severity, your doctor considers your answers to questions about symptoms (such as how often you have asthma attacks and
how bad they are), along with the results of your physical exam and diagnostic tests.
Determining your asthma severity helps your doctor choose the best treatment. Asthma severity often changes over time, requiring treatment
adjustments.

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Asthma is classified into four general categories:

Asthma classification Signs and symptoms

Mild intermittent Mild symptoms up to two days a week and up to two nights a
month

Mild persistent Symptoms more than twice a week, but no more than once in a
single day

Moderate persistent Symptoms once a day and more than one night a week

Severe persistent Symptoms throughout the day on most days and frequently at
night

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Treatment
Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers,
taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of
an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol.

Medications
The right medications for you depend on a number of things — your age, symptoms, asthma triggers and what works best to keep your asthma
under control.
Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators)
quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary.
Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under
control on a day-to-day basis and make it less likely you'll have an asthma attack. Types of long-term control medications include:

 Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flonase, Flovent HFA), budesonide (Pulmicort Flexhaler,
Rhinocort), flunisolide (Aerospan HFA), ciclesonide (Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar), mometasone (Asmanex)
and fluticasone furoate (Arnuity Ellipta).

You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these
corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use.

 Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve
asthma symptoms for up to 24 hours.

In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and
suicidal thinking. Seek medical advice right away for any unusual reaction.

 Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the
airways.

Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled
corticosteroid. And because these drugs can mask asthma deterioration, don't use them for an acute asthma attack.

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  Combination inhalers. These medications — such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and
formoterol-mometasone (Dulera) — contain a long-acting beta agonist along with a corticosteroid.
 Theophylline. Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the airways open (bronchodilator) by relaxing the
muscles around the airways. It's not used as often now as in past years.

Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your
doctor recommends it. Types of quick-relief medications include:

 Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma
attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex).

Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer — a machine that converts asthma medications to
a fine mist — so that they can be inhaled through a face mask or a mouthpiece.

 Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe.
Ipratropium is mostly used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks.
 Oral and intravenous corticosteroids. These medications — which include prednisone and methylprednisolone — relieve airway
inflammation caused by severe asthma. They can cause serious side effects when used long term, so they're used only on a short-term basis
to treat severe asthma symptoms.

If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working
properly, you shouldn't need to use your quick-relief inhaler very often.
Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your
doctor. You probably need to adjust your long-term control medication.

Allergy medications may help if your asthma is triggered or worsened by allergies. These include:

 Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system reaction to specific allergens. You generally
receive shots once a week for a few months, then once a month for a period of three to five years.

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  Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe
asthma. It acts by altering the immune system.

Bronchial thermoplasty
This treatment — which isn't widely available nor right for everyone — is used for severe asthma that doesn't improve with inhaled corticosteroids or
other long-term asthma medications.
Generally, over the span of three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the
smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and possibly reducing asthma attacks.

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 ANATOMY AND PHYSIOLOGY

Anatomy and Physiology of Lungs

Lungs are pyramid-shaped, paired organs that are connected to the trachea by the right
and left bronchi; on the inferior surface, the lungs are bordered by the diaphragm.

The right lung is shorter and wider than the left lung, and the left lung occupies a smaller volume
than the right. The cardiac notch is an indentation on the surface of the left lung, and it allows
space for the heart.

Each lung is composed of smaller units called lobes. Fissures separate these lobes from
each other. The right lung consists of three lobes: the superior, middle, and inferior lobes. The
left lung consists of two lobes: the superior and inferior
lobes.

The lungs’ main role is to bring in air from the atmosphere and pass oxygen into the
bloodstream. From there, it circulates to the rest of the body. The organs require help from
surrounding structures in the body in order to breathe properly.

With each inhalation, air is pulled through the windpipe (trachea) and the branching
passageways of the lungs (the bronchi), filling thousands of tiny air sacs (alveoli) at
the ends of the bronchi. These sacs, which resemble bunches of grapes, are surrounded by small blood vessels (capillaries).

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Oxygen passes through the thin membranes of the alveoli and into the
bloodstream. The red blood cells pick up the oxygen and carry it to the
body's organs and tissues. As the blood cells release the oxygen, they pick
up carbon dioxide, a waste product of metabolism. The carbon dioxide is
then carried back to the lungs and released into the alveoli. With each
exhalation, carbon dioxide is expelled from the bronchi out through the
trachea.

Pleura

The pleura is the thin membrane that covers the lungs and lines of the
chest wall.
It protects and cushions the lungs and produces a fluid that acts like a lubricant so the lungs can move smoothly in the chest cavity.

The lungs are enclosed by the pleurae, which are attached to the mediastinum. The pleurae consist of two layers.

 Visceral pleura is the layer that is superficial to the lungs, and extends into and lines the lung fissures.
 Parietal pleura is the outer layer that connects to the thoracic wall, the mediastinum, and the diaphragm.

The pleural cavity is the space between the visceral and parietal layers. The pleurae perform two major functions: They produce pleural fluid and
create cavities that separate the major organs.

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Trachea

The wind pipe (trachea) is the tubed shaped airway in the neck and chest. It divides into two
tubes or branches called the main bronchi. One branches goes to each lung. The area
where each bronchus enters the lung is called hilum.

Your trachea is made up of 16 to 20 rings of cartilage. Cartilage is a firm yet flexible tissue. It is
your body’s main type of connective tissue.

In the trachea’s inner layer, you have small, hair-like structures called cilia. Cilia move in
rhythm to push mucus out of your trachea so that you either expel or swallow it.

Between each ring of cartilage in your trachea, you have a muscle called the trachealis. When you expel mucus through a cough, your trachealis
muscle contracts to help you expel air more forcefully.

Your trachea’s main function is to carry air in and out of your lungs. Because it’s a stiff, flexible tube, it provides a reliable pathway for oxygen to enter
your body.

Bronchi

Bronchi are made up of cartilage, smooth muscle, and mucous membranes. Together, the trachea and the
structures of the bronchi are known as the tracheobronchial tree, or simply the bronchial tree.

Right main bronchus: The right main bronchus is shorter and more vertical than the left, approximately 1
inch (2.5 cm) in length. It divides into smaller bronchi to enter the three lobes of the right lung.

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Left main bronchus: The left bronchus is smaller and longer than the right main bronchus. It is divides into two secondary lobar bronchi which enter
the two lobes of the left lung.

The bronchi function primarily as a passageway for air to travel from the mouth and trachea, down
to the alveoli, and back out of the body. In this way, the body's tissues receive oxygen, and carbon dioxide
is able to exit the body.

Because the bronchi bring in air from outside the body—potentially exposing the lungs to infectious agents
—they are lined with mucous membranes. This mucus layer provides an important "barrier" to inhaled
pathogens that can help prevent infections from taking hold.

Bronchioles

The bronchioles are lined with club cells that secrete surfactants—compounds that reduce surface
tension within airways, allowing them to expand during inhalation and preventing them from collapsing
during exhalation.

There are three types, categorized by size:

1. Lobular bronchioles (larger passages that first enter the lobes of the lungs)

2. Respiratory bronchioles (two or more branches from each terminal bronchiole that, in turn, lead to two to 10 alveolar ducts)

3. Terminal bronchioles (50 to 80 smaller passages in each lung)

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The function of the bronchioles is to deliver air to a diffuse network of around 300 million alveoli in the lungs. As you inhale, oxygenated air is pulled
into the bronchioles.

Changing Alveolar Volume

Air moves into and out of the lungs due to changes in alveolar pressure.
Alveolar pressure change is due to alveolar volume changes which can be a
result from changes in pleural pressure.

Mechanism of Breathing

The two lungs are the primary organs of the respiratory system. They sit to the
left and right of the heart, within a space called the thoracic cavity. The cavity is
protected by the rib cage. A sheet of muscle called the diaphragm serves other parts
of the respiratory system, such as the trachea, or windpipe, and bronchi,
conduct air to the lungs. While the pleural membranes, and the pleural fluid, it allows the lungs to move smoothly within the cavity.

The process of breathing, or respiration, is divided into two distinct phases. The first phase is called inspiration, or inhaling. When the lungs
inhale, the diaphragm contracts and pulls downward. At the same time, the muscles between the ribs contract and pull upward. This increases the
size of the thoracic cavity and decreases the pressure inside. As a result, air rushes in and fills the lungs. The second phase is called expiration, or
exhaling. When the lungs exhale, the diaphragm relaxes, and the volume of the thoracic cavity decreases, while the pressure within it increases. As a
result, the lungs contract and air is forced out.

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Factors that affect Gas Exchange

1. The thickness of the respiratory membrane increases during certain respiratory diseases. If the thickness of the respiratory membrane is
doubled or tripled, the rate of gas exchange is markedly decreased. Hence, oxygen exchange is affected before carbon dioxide exchange
because oxygen diffuses through the respiratory membrane about 20 times less easily than does CO2.

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 PATIENT’S PROFILE

GROWTH AND DEVELOPMENT

Name: Patient’s X
Patient’s Name: XXXXX
Sex: Female
Age: 93 yrs. old (Late Adult/ Older Adult)

Birthdate: August 10,Erikson’s

Erik 1930 Theory of Psychosocial Development

Age: 93
Developmental Stage: Ego Integrity vs. Despair
Developmental task: People in late adulthood reflect on their lives and feel either
Birthplace:
a sense ofDampalan,
satisfactionDapitan, Zamboanga
or a sense of failure.del Nortewho feel proud of their
People
accomplishments feel a sense of integrity, and they can look back on their lives with
Address: Sto. However,
few regrets. Tomas, Mutia,
peopleZamboanga delsuccessful
who are not Norte at this stage may feel as if
their life has been wasted. They focus on what “would have,” “should have,” and
Nationality:
“could have”Filipino
been. They face the end of their lives with feelings of bitterness,
depression, and despair.
Religion: Roman Catholic
Assessment:
Admission Date: May 7,
My patient is 2023
satisfied with her life. She didn’t even have any regrets. She
is happy living in the Our Lady of Lourdes Adult Care Home because she has a lot
Civil Status: Widow
of companion in the facility

Weight: 42 kgms

Height: 5’0

Medications:

After Breakfast

 Caltrate
 Centrum

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 PHYSICAL ASSESSMENT

I. GENERAL APPEARANCE FINDINGS

a. Body built  Body is proportional in size
b. Posture and gait  Patient cannot stand straight due to fracture in lumbar area
c. Hygiene and appearance  Appropriately dressed. Neat and clean
d. Obvious signs of distress  No obvious sign of distress
e. Obvious signs of illness or health  The patient’s asthma causes her to have low oxygen saturation level.

II. MMENTAL STATUS

a. Attitude  Patient is cooperative, was able to follow instructions.

b. Affect and mood  Appropriate to the situation, not too happy, not very sad either.
c. Appropriateness of the client’s response  Appropriate to situation, well- thought
d. Speech pattern  Understandable, low voice tone, well-organized

VITAL SIGNS

T-36.4oC
Date: August 26, 2023
PR- 85 bpm
RR- 23cpm
BP-90/50mmHg
O2sat-96%

T-37oC
PR- 100bpm
Date: September 02, 2023 RR-24cpm
BP-110/50mmHg
O2sat-97%

SKIN INSPECTION (INTEGUMENTARY)

a. Color and uniformity  Skin is light brown and uniform in color

b. Edema  The patient has edema on right foot.
c. Lesions  There is lesion or rashes in the butt because of the diaper.
d. Pigmentation  1 mole in the face

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e. Vascularity  Since the client is old, her veins are visible.

PALPATION

a. Edema  There is edema palpated on right foot

b. Temperature  Patient’s skin is warm.
c. Texture  It has a dry and wrinkly texture.
d. Turgor  After being pinched, patient’s skin turgor takes 4-5 seconds to recoil.

HAIR INSPECTION

a. Color  The color of her hair is white.

b. Distribution  There are no patches, and it is equally distributed
c. Quantity  The hair quantity is thin.
d. Thickness  The hair strands are thin.
e. Texture  Texture is smooth and oily.
f. Lubrication of body hair  Hair is lubricated and moisture is present.
g. Presence of lice and nits  No presence of lice and nits or parasites and dandruff seen upon inspection
h. Dandruff

NAILS INSPECTION

a. Shape  Nails is flat and oblong.

b. Angles  The angle of nail attachment is 160 degrees; no clubbing noted as schamroth test.
c. Color  She has nail polish.
d. Texture  Smooth to touch.
e. Cleanliness  Clean and well-trimmed

HEAD INSPECTION

a. Position  Head is at midline and can moved freely.

b. Size and shape of skull  Size and shape of head is appropriate for age.
c. Facial feature  The face, eyebrow and eyes are symmetrical
d. Symmetry of nasolabial folds  Nasolabial folds are symmetric.
e. Contour of the face  The contour of face is round.
f. Involuntary movements  No involuntary movements observed upon inspection.

PALPATION (HEAD)

a. Masses/nodules/depressions  No masses,nodules noted upon palpation.

b. Lumps  No lumps noted upon palpation.
c. Tenderness  No tenderness upon palpation.
d. Deformities  No deformities upon palpation.

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e. TMJ (temporomandibular joint)  Mouth opens and closes fully.

AXILLA

a. Inspection  Axilla is free of rashes and no infections

b. Color  No visible signs of rashes and infections
c. Moisture  Not moisturized
d. Lumps/masses/nodules  No lumps/masses/nodules noted

HEART

INSPECTION

a. Visible Pulsation  Apical is not visible

PALPATION

a. Apical impulse  Apical pulse is palpable

b. Abnormal pulsations  No abnormal pulsation palpated

AUSCULTATION

a. HR and rhythm  100 beats per minute with an evenly spaced beats or regular rhythm (2+grading)
b. S1  S1 or lub sound, audible
c. S2  S2 or dub sound, audible
d. Extra heart sounds  No extra heart sound
e. Murmurs  No murmur upon auscultation

NECK VESSELS

INSPECTION  Jugular pulse is visible

 There is jugular venous pressure of 6cm
a. Jugular venous pulse
b. Jugular venous pressure

PALPATION  Smooth and fair rapid upstroke, and slower downstroke. Regular rhythm 2+
grading. Its elastic, palpable pulse site change in diameter. No thrills felt.

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a. Carotid arteries

DIFFERENT PULSE SITES  Different pulse sites are palpable with a constant and regular rhythm (2+ grading)

a. Brachial
b. Apical
c. radial

PALPATION (NECK)

a. Lymph nodes

 Tederness  No tenderness and enlargement of lymph nodes.

 Enlargement

b. Trachea
 There are no deviations and it is aligned at the midline.
 Deviation
 Alignment

c. Thyroid gland
 No enlargement, masses, nodules are noted.

EYES INSPECTION

VISUAL ACUITY

a. Assess each pupil’s direct and consensual reaction to light  The patient’s pupils constrict and dilates back normally
b. Assess each pupil's reaction to accommodation to convergence  The patient’s pupil converges when an object comes close to the nose and eyes.
c. Light perception  The patient can perceive light.
d. Hand movement  The patient can see my hand movement.

VISUAL FIELD

a. Assess peripheral visual field  Peripheral vision is intact.

b. Conjunctiva and sclera  The patient conjunctiva is transparent and the sclera is white.
c. Cormea and lens  Cornea and lens are clear with no opacities.

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d. Eye alignment  No signs of inflammation.

 Extraocular movement  Patient movements is smooth both of her eyes is coordinated and aligned.
 Corneal light reflex  Eyes reacts equally.

PALPATION

a. Edema  No nodules, masses, lesions and edema noted.

b. Tenderness
c. Masses/Lesions
d. Nodules
e. Nasolacrimal duct and lacrimal sac

OPTALMIC BRANCH

 While looks upward, lightly touch the lateral sclera of the eye with  Can elicit a blink reflex
sterile gauze to elicit blink reflex  Can detect light sensation.
 To test light sensation, have client eyes close, wipe a wisp of
cotton over client’s forehead and paranasal sinuses.

EARS INSPECTION

a. Auricles

 Color  It matches the skin tone of the body and face.

 Symmetry and size  It is symmetrical and size is appropriate to the face.
 Position  Auricle aligned with outer canthus of eye.

b. External Ear Canal and Tympanic Membrane

 Cerumen  There is no cerumen that is present in both of her ears

 Skin lesion  No skin lesions
 Pus  No pus presents
 Blood  No blood presents

PALPATION

a. Auricles

 Texture  Firm texture, mobile, pinna recoils, and no tenderness as palpated.

 Elasticity
 tenderness

20
 HEARING ACUITY

a. Response to normal voice tones  The patient able to hear

NOSE AND SINUSES INSPECTION

EXTERNAL NOSE

a. Deviation in shape and symmetry  Symmetrical and there is no deviation is shape

b. Size  Appropriate to face and is well aligned.
c. Color  The color is similar to the rest of the face in color.
d. Flaring  There is sign of nasal flaring observed during inspiration.
e. Discharges  There are no drains or discharges.

NASAL CAVITY

a. Mucosa  It is pink in color

b. Hairs  A little bit presence of hairs
c. Redness  No redness
d. Swelling  No sign of swelling
e. Growths  No abnormal growths
f. Discharges  No discharges
g. Position of nasal septum  The nasal septum is intact and free of ulcers or perforations.

MOUTH INSPECTION

LIPS

a. Symmetry or contour  The patient’s lips are symmetric

b. Color  Pinkish in color
c. Texture  Texture is smooth
d. Tenderness  No tenderness noted

BUCCAL MUCOSA

a. Color  It is pinkish
b. Moisture  It is moist
c. Texture  It is smooth
d. Presence or lesions  Mo presence of lesions noted
e. Bleeding  No bleeding

TEETH

21
a. Number of teeth  No teeth noted

GUMS  Gums has a pinkish color and is moist

TONGUE

a. Position  It is symmetrical in the uvula

b. Color  It is pinkish in color
c. Texture  It is rough
d. Movement  The shape of the hard palate is convex.
e. Mouth floor  The shape of the soft palate is concave
f. Frenulum  The hard palate has ridges
g. Nodules, limps, and excoriated areas  The soft palate is smooth.

THORAX AND LUNGS

a. Configuration  Scapulae are symmetric and none protruding. Shoulders and scapulae are at
b. Size and symmetry equal horizontal positions.
c. Deformities  Spinous process appear straight and thorax is symmetric
d. Position of the Deviation  No deformities observed in the three curative areas; the cervical, thoracic, and
e. Retraction of the intercostal space lumbar
f. Use of accessory muscles  Spinal column is straight, right and left shoulders and hips are at the same height.
g. Client positioning  No retraction of intercostal spaces is observed
 The client uses accessory muscle to assist breathing.
 The client is sitting up and relaxed

 Vesicular sound is heard.

AUSCULTATION
 Crackles noted during auscultation.
 The patient’s voice transmission is soft, muffled and instinct.
a. Breath Sound
b. Adventitious Sound
c. Bronchophony

MUSCULOSKELETAL  Patient can perform small and limited movements due to her condition where she
has lumbar fracture.

GENITOURINARY SYSTEM

INSPECTION

22
a. Attachment  No catheter attached
b. Color  Light yellow urine seen on her diaper.

GORDON’S FUNCTIONAL HEALTH PATTERN

USUAL INITIAL (08-19-23) ONGOING (08-26-23)

I. NUTRITIONAL – METABOLIC PATTERN

 Patient has food allergies (shrimp & crabs)  Patient’s eats the food in the home care (rice, fish,  Patient eats the food in the home care (rice,
 The patient’s diet menu includes vegetables (i,e. vegetable soup, and banana). fish, vegetable soup, and banana)
malunggay, saluyot, okra), fish, egg and rice, she  Patient has a good appetite.  Patient has a good appetite
rarely eats meat.  Patient has no difficulty swallowing and no eating  Patient has no difficulty swallowing and no
 Patient drinks 8 glasses of water a day. discomfort. eating discomfort.
 Patient has good appetite  No changes in appetite.  Drink 5 glasses of water a day.
 Patient has no eating discomfort  Allergy to shrimp and crabs.
 Drinks 5 glasses of water a day

II. ELIMINATION PATTERN  Patient urinated 4x from morning @8am to

 Patient usually changes diaper 2x daily afternoon @4pm.
 Patient urinates at least 6-7x daily  Patient urinates at least 6-7x daily.  Urine is light yellow.
 Patient’s urine is light yellow.  Patient usually changes diaper 2x daily.  Changes diaper 2x daily
 She defecates once-twice daily.  Patient’s urine is light yellow.  Defecate once.
 Her stool is soft, yellow and intact  Patient defecate once.  Patient can defecates on her own.
 Patient no urination discomfort  Her stool is soft, black in color, foul in smelling.  Her stool is soft, yellow in color.
 No bowel discomfort  Patient no urination discomfort.  Patient no urination discomfort.
 Patient cannot defecates on her own.

23
 III. ACTIVITY & EXERCISE PATTERN
 Patient has productive cough
 Patient does not exercise or engage in any physical  Patient just lie down most of the time  Patient gets up sometimes to eat food or drink
activity due to her lumbar fracture.  Has productive cough water.
 Limited gross/fine motor skills, difficulty turning,  Patient does not exercise or engage in any physical  Has productive cough
slowed movement. activity due to her lumbar fracture.  Patient does not exercise or engage in any physical
 Level III on functional level of mobility.  She has limited gross/fine motor skills, difficulty activity due to her lumbar fracture.
turning.  She has limited gross/fine motor skills, difficulty
 At level III on functional level of mobility turning
 At level III on functional level of mobility.

IV. COGNITION AND PERCEPTION PATTERN

 She is oriented about time, place and the people
around her.  Patient is oriented about the time, place and the  Patient is oriented about the time, place and the
 Does not have any difficulty in constructing people around her people around her
 Does not have any difficulty in constructing  Does not have any difficulty in constructing
sentences and responds to questions accordingly.
sentences and responds to questions accordingly. sentences and responds to questions accordingly.
 No memory loss
 No memory loss  No memory loss

V. SLEEP AND REST PATTERN

 Patient usually sleeps at 9pm to 7am  Patient usually sleep 8pm to 7-8am  Patient usually sleep 8pm to 7-8am
 Takes afternoon nap for 1-2 hours  Takes afternoon nap for 1-2 hours
 Takes afternoon nap for 1-2 hours
 Does not use any sleeping medication  Does not use any sleeping medication
 Patient feel fresh after waking up
 No sleeping problems  No sleeping problems
 Does not use any sleeping medication
 Patient usually sleeps in the afternoon
 No sleeping problems  Patient usually sleeps in the afternoon
 Relaxation period is usually in the afternoon

24
 VI. SELF-PERCEPTION AND SELF-CONCEPT
PATTERN

 She feels good about herself

 She feels good about herself  She feels good about herself
 Satisfied with self-body image
 Satisfied with self-body image  Satisfied with self-body image
 Relinquish dependence on others (caregivers) for  Relinquish dependence on others (caregivers) for  Relinquish dependence on others (caregivers) for
grooming, bathing, sometimes feeding. grooming, bathing, sometimes feeding. grooming, bathing, sometimes feeding.
 Does not have any problems with changed body  Does not have any problems with changed body  Does not have any problems with changed body
image. image. image.

VII. ROLES AND RELATIONSHIPS PATTERN

 Her role in the family is being a mother and a house

wife
 The caregiver took care of her during admission to  The caregiver took care of her during admission to
 In her family, only her daughter is still alive, and
home care. home care.
who brought her to home care because her  Her daughter is responsible for her bills in staying at
 Her daughter is responsible for her bills in staying at
daughter has worked in another country. home care.
home care.
 The decision makers in the family are both her and
her daughter, they communicate when there’s a
problem.
 No conflict between family members
 Has a good relationship with her in-laws and
neighbors.

25
 VIII. SEXUALLY AND REPRODUCTION PATTERN

 Menarche occurred at 13 years of age

 Patient stated that she experiences dysmenorrhea
 Menarche occurred at 13 years of age  Menarche occurred at 13 years of age
during menstruation.
 Patient stated that she experiences dysmenorrhea  Patient stated that she experiences dysmenorrhea
 Patient had her first child at age 20 years old during menstruation. during menstruation.
 Para - 1, Gravida -2  Patient had her first child at age 20 years old  Patient had her first child at age 20 years old
 Menopausal starts when she is 50 years old  Para - 1, Gravida -2  Para - 1, Gravida -2
 Menopausal starts when she is 50 years old  Menopausal starts when she is 50 years old

IX. COPING AND STRESS TOLERANCE PATTERN

 Patient copes with stress by allowing herself time to

relax
 Patient’s copes stress by sleeping.  Patient’s copes stress by sleeping.
 Patient experience crisis in her life.
 Her daughter and in-law were supported her during  Her daughter and in-law were supported her during
 Her daughter is her companion in everything
this time. this time.
 Does not use any drugs or alcohol when stressed

X. VALUES AND BELIEF PATTERN

 Her religion is roman catholic
 Patient stated that she religiously goes to church  No restrictions in procedures brought by religion.  No restrictions in procedures brought by religion.
every Sunday  Medical procedures and intervention don’t interfere  Medical procedures and intervention don’t interfere
with spiritual practices with spiritual practices
 Believes in God
 Patient believes in God.  Patient believes in God.
 Always prays to God
 Patient always prays to God regarding her  Patient always prays to God regarding her
condition. condition.

26
 LABORATORY TEST
Date/Time: August 5, 2023 09:30 AM
Sample Type: Serum
Physician: Dr. Zerrudo-Ompoy

27
 Test Results Unit(Conventional) Reference Values
Creatinine 0.84 Male: 0.9 - 1.3 Within Normal Values
Female: 0.6 - 1.1 mg/dl
Albumin 3.12 3.4 - 5.5 g/dl Within Normal Values
Glocuse, Fasting 60 - 100 mg/dl
Urea Nitrogen 7.9 - 20.1 mg/dl
Uric Acid Men : 3.6 - 7.7
Women : 2.5 - 6.8 mg/dl
Sgot(AST) Up to 40 U/I
Sgpt(ALT) Male : Up to 42
Female : Up to 32 U/I
Cholesterol Total Up to 200 mg/dl
Cholesterol, HDL Male : 30 - 60
Female : 40 - 70 mg/dl
Cholesterol, LDL Less than 100
mg/dl
Less than 70 (Diabetic)
VLDL 12 - 34 mg/dl
Triglycerides Up to 150 mg/dl
Hdl Ratio Less than 4.4 ratio

Date/Time: August 25, 2023 01:00 PM

Sample Type: Serum
Physician: Dr. Zerrudo-Ompoy

Test Results Unit(Conventional) Reference Values

Creatinine H 1.36 Male: 0.9 - 1.3 Increased Creatinine
Female: 0.6 - 1.1 mg/dl

28
Urea Nitrogen 7.9 - 20.1 mg/dl
Glocuse, Fasting 60 - 100 mg/dl
Triglycerides Up to 150 mg/dl
Sgot(AST) Up to 40 U/I
Sgpt(ALT) Men : Up to 42
Women : Up to 32 U/I
Uric Acid Male : 3.6 - 7.7
Female : 2.5 - 6.8 mg/dl
Cholesterol Total Up to 200 mg/dl

COMPLETE BLOOD COUNT

Date/Time: August 25, 2023 01:20 PM

Sample Type: Whole blood
Physician: Dr. Zerrudo-Ompoy
Examinations Results Reference Value Interpretation
Haemoglobin L 9.7 Male: 13.5 - 18.0 Decreased Hgb
Female: 12.0 - 16.0 g/dL
Haematocrit L 28.9 Male: 40 - 54 Decreased Haematocrit
Female: 38 - 47 %
Total WBC H 17.80 4.5 - 11.0 x109/L Increased WBC
RBC Count L 3.32 Male: 4.6 - 6.2 Decreased RBC
Female: 4.2 - 5.4 X1012/L
Platelet Count 199 145 - 375 Within normal values
X109/L
Red Cell Indices:
MCV 87.1 80.0 - 99.0 fL Within normal values
MCH 29.1 26.5 - 33.5 pg Within normal values
MCHC 33.5 32.0 - 36.0 g/dL Within normal values

29
 Differential Count
Stab 0.03 - 0.05
Seg. Neutrophils 0.92 0.51 - 0.67 Within normal values
Lymphocytes 0.07 0.25 - 0.33 Within normal values
Monocytes 0.01 0.02 - 0.06 Within normal values
Eosinophils 7.0 0.01 - 0.04 Within normal values
Basophils 0.0 0.00 - 0.01 Within normal values
Abnormal Cells 318 Within normal values
Total: 1.00

Date/Time: August 31, 2023 09:28 AM

Organ/Region to be examined: Whole Abdomen
Physician: Dr. Zerrudo-Ompoy
SONOGRAPIC REPORT
The liver is not enlarged and exhibits a homogenous echo pattern. There are no focal parenchymal lesion noted. The right lobe of the liver
measures 9.9cm. at its longitudinal diameter at the midclavicular line. The portal vein and hepatic vessels are not dilated with anechoic lumen . The
rest of the intrahepatic ducts are not remarkable.

The gallbladder is normal in size and measures 4.4 x 2.2 x 1.7 cm. with thin wall. No intraluminal mass lesion or lithiasis is noted. The
common duct is not dilated.

The right kidney measures 7.7 x 3.9 cm. with cortical thickness of 0.9 cm. The left kidney measures 7.7 x 3.5 cm. with cortical thickness of
0.9 cm. The central and parenchymal echoes are intact. There is mild dilatation of the pelvocalyceal systems of both kidneys. Both uterus are not
dilated.

The spleen is not enlarge and it exhibits a homogenous echo pattern.

The pancreas is not enlarged and it exhibits a homogenous echo pattern.

30
 The urinary bladder is filled with urine. There are no lithiasis or mass lesions noted. The bladder wall is not thickened.

The uterus is not adequately visualized.

Incidentally, there is anechoic fluid noted above both hemidiaphragms, more on the left.

IMPRESSION

* MILD BILATERAL HYDRONESPHROSES LIKELY DUE TO ATONY SECONDARY TO INFECTION.

* NORMAL SONOGRAPHIC EVALUATION OF THE LIVER AND THE GALLBLADDER, THE URINARY BLADDER, SPLEEN AND
PANCREAS
* UTERUS NOT ADEQUATELY VISUALISED.
* BOTH ADNEXAE NEGATIVE
* NO FLUID COLLECTION AT THE POTERIOR CUL DE SAC
* INCIDENTAL FINDING OF BILATERAL PLEURAL EFFUSION

31
32
33
34
NURSING CARE PLAN
Nursing Diagnosis: Ineffective Airway Clearance related to retained secretions AEB adventitious lung sounds (wheezes).

35
 Assessment Planning Intervention Rationale Evaluation

Subjective Daa: After the end of Independent: At the end of

 “Galisod ko ug my 9.5 hours of my 9.5 hours
ginhawa.”, “lisud nursing 1. nursing
kaayo ipagawas intervention my 1. Assess respiratory Respiratory status can change intervention,
akoang plema.” patient will be status every hour during rapidly during an acute asthma goals were:
as verbalized by able to maintain a acute phase: lung sounds, attack and its treatment.
the patient patent airway as respiratory rate and depth,
manifested by: presence and severity of
Objective Data: wheezing, breathing
pattern, use of accessory
 Use of accessory muscles.
muscles noted 1. Partially
1. Effective met,
 Wheezing is -The client
expectoration
noted upon
of secretions. was also able
auscultation.
to cough out
 Nasal flaring 0. Place in High 2. These positions reduce the some
noted Fowler’s work of breathing and secretions.
increases lung expansion.
 RR=37cpm position to
facilitate
breathing and 0. Fully
0. Decreasi lung expansion.
ng signs met,
and -There is no
symptom usage of
s of 3. Increasing fluids help keep accessory
bronchos secretions thin. muscles and
pasm 0. Increase fluid nasal flaring
(use of intake to noted.
accessor 3000ml/day 4.These facilitate the
y muscle, within cardiac movement of secretions and
nasal tolerance. airway clearance.
flaring).
0. Initiate or assist 0. Parti
with chest ally
physiotherapy, met,
including -Wheezes can
0. Clearing percussion, still be
of breath coughing auscultated
exercises and 1. Budesonide works by from all lung
sounds
postural reducing the irritation and fields
(wheezes
drainage. swelling of the airways.
)
Formoterol works by relaxing
the muscles around the airways
so that they open up and you
Dependent: can breathe more easily.

1. Administer prescribed

36
 medications. (Salmeterol,
Salbutamol, Solmux)

Nursing Diagnosis: Ineffective Breathing Pattern related to bronchospasm AEB dyspnea.

Assessment Planning Intervention Rationale Evaluation

Subjective Data: After the end of my 9.5 Independent: At the end of my 9.5
 “Galisod ko ug hours of nursing 1. Changes in the hours nursing
ginhawa.”, as intervention my respiratory rate intervention, goals
verbalized by the patient will be able to and rhythm may were
patient establish effective indicate an early
1. Assess the client’s
respiratory pattern so sign of impending
vital signs as
Objective Data: as to provide respiratory
needed while in
adequate ventilation distress.
 Dyspnea as manifested by:
distress.
2. Wheezing happens
1. Fully met,
0. Assess -The client manifested
 Use of accessory as a result of
decreasing respiratory
breath
muscles bronchospasm.
sounds and rate, RR=22cpm
 Nasal flaring adventitious
Diminishing wheezing
and indistinct breath
 RR=37cpm sounds such
sounds are suggestive
1. Stabilize as wheezes 0. Partially met,
findings and indicate
respiratory rate. and stridor. -Wheezes can still be
impending respiratory
failure. auscultated from all
3. Oxygen saturation is lung fields and there is
a term referring to the still usage of accessory
0. Monitor fraction of oxygen- muscles and nasal
oxygen saturated hemoglobin flaring
saturation. relative to the total
0. Encourage hemoglobin in the
0. Slight to no client to use blood. Normal oxygen
nasal flaring pursed-lip saturation levels are
and breathing for considered 95-100%..
decreasing exhalation. 4.Pursed lip breathing
usage of Dependent: improves breathing
accessory 1. Administer prescribed patterns by moving old
muscles . medications. air out of the lungs and
(Salmeterol, allowing for new air to
Salbutamol, Solmux) enter the lungs.
1. Budesonide works
by reducing the irritation
and swelling of the
airways. Formoterol
works by relaxing the
muscles around the

37
 airways so that they
open up and you can
breathe more easily.

Nursing Diagnosis: Activity intolerance related to fatigue AEB dyspnea.

Assessment Planning Intervention Rationale Evaluation

Subjective Data: After the end of my 9.5 Independent: At the end of my 9.5
“ Kapoy kaayo akoa hours of nursing hours nursing
lawas, wala koy gana intervention my intervention, goals
mo lihok.”, as verbalized patient will: were:
by the patient.
1. Assess the 1. Provides
presence of information about
Objective Data:
weakness and energy reserves as
 Weakness Engage in normal fatigue caused by dyspnea and work
 Lethargic activities with absence airway problem. of breathing over a 1. Partially met,
period of time - the patient is able to
 Tired apperance of fatigue.
wears out these participate to some
 Dyspnea reserves activities.
 Pallor 0. Encourage
2. Avoids change in
activities such
respiratory status
as quiet play,
and energy
reading,
depletion due to
watching
excessive activity.
movies,
games during
rest.
3. Promotes
adequate rest and
decreases stimuli.
0. Schedule and
provide rest
periods in a 4. Conserves energy
calm peaceful and limits
environment. interruption in rest.

0. Disturb only
when
necessary,
perform all
care at one
time instead
of spreading
over a long

38
 period of time,
avoid doing
any care or
procedures
during an
attack.

Dependent
1. Administer prescribed
medication (Centrum)

39
 DRUG STUDY

Name of Dosage, Route, Mechanism of Indication Contraindic Adverse Nursing

Drug Frequency and Action ation Reaction Contradictions
Timing
Generic: Dosage: Attaches beta2 Salmeterol is . CNS: -instruct patient
Salmeterol COPD: receptors on indicated in the Hypersensiti Dizziness, to avoid
Brand: Adults—One bronchial cell treatment of vity to fever, excessive use
Advair, inhalation (50 membranes, asthma with an salmeterol or headache, -assess
Airduo, Airduo micrograms [mcg]) 2 stimulating the inhaled its nervousness, respiratory
Respiclick, times a day (morning intracellular corticosteroid, components, paresthesia, status
Serevent, and evening). The enzyme prevention of to treat tremor -always take
Serevent doses should be at adenylate exercise induced asthma CV: bronchodialtor
Dikus, Wixela least 12 hours apart. cyclase to bronchospasm, without use Palpitations, first
Asthma Attacks convert and the of a long- tachycardia -monitor vital
Classification Adults and children 4 adenosine maintenance of term asthma EENT: Dry signs
: years of age and triphosphate to airflow obstruction control mouth, nose,
beta-2 older—One inhalation cAMP. The and prevention of medication and throat;
adrenergic (50 micrograms resulting execrations of sinus problems
agonist [mcg]) 2 times a day increase in chronic obstructive GI: Nausea
(morning and intracellular pulmonary MS: Arthralgia
evening), at least 12 cAMP level disease. RESP: Cough,
hours apart. relaxes bronchial paradoxical
smooth-muscle bronchospasm
Route: cells, stabilizes SKIN: Contact
Oral (Inhalation) mast cells, and dermatitis,
inhibits eczema, rash,
histamine Urticaria
release. Other:
Angioedema,
generalized
aches and
pains

40
 Name Dosage, Route, Mechanism Indication Contrai Adverse Reaction Nursing
of Drug Frequency and of Action ndicatio Contradictio
Timing n ns
Name of Dosage, Mechanism of Indication Contraindic Adverse Reaction Nursing Contradictions
Drug Route, Action ation
Frequency
and Timing

Generic
Generic: Dosage:
Dosage: Acts by neutralizing Donepezil
used to prevent is Hyperse
•Hypersensiti CNS:
 Abnormal gait, agitation,
GI discomfort  -Assessfor
Screen patients
:
Calcium To19-50
treat mild to hydrochloric Reversibly
acid in or treat low blood nsitivity
used to treat vity anxiety,
hypercalcemia cognitiveand
contraindications
Donepe
Carbonate moderate
years: 1Alzheimer’s inhibits It
gastric secretions. confusion
calcium levels in to •High asthenia, depression, dizziness, potential function
drug
 hypercalciuria
zil disease
gram per acetylcholines
also inhibits the (dementia)
people who do donepez calcium dream disturbances, fatigue, fever, (memory,
interactions before
 loss of appetite
Hydroch
Brand: Adults. Initial:
day orally 5 mg at terase and
action of pepsin by related to
not get enough il, levels in the headache, attention,
initiating calcium
 constipation
loride
Tums, Alka- bedtime.
51-70 After 4 toincreasingimproves
the pH Alzheimer's
calcium from their piperidin
urine 380 dopamine hydrochlorides carbonatereasoning, therapy.
 gas
Seltzer and 6 wk, dosage
years: 1 increased acetylcholine’
and via adsorption. diets. It mayIt be e •Kidney
disease. hostility, insomnia, nervousness,
 Assess language,
patients
(flatulence)
Brand:
Rolaids to 10
grammgper
at bedtime, s
Cytoprotective does
used to not
treat derivativ
stones (renal seizures, ability to
as day
indicated.  nauseasyncope, tremor regularly perform for response to
Aricept orally Maximum:
effects mayconcentration
occur cure
conditions es,calculi)
or somnolence, calcium carbonate
10 mg daily. at cholinergic Alzheimer's their  Abnormal
CV: vomiting ECG, bradycardia,
Classifi
Classification 71 years or through increases in caused by low •Low therapy simple tasks)
➤➤ synapses. disease, but compon 
chest high calcium periodically
: cation: To treat
older: 1.2 moderate
bicarbonate ion calcium levels phosphate  Monitor vital signs
Piperidin to severe Alzheimer’s Raising it may ents levels heart failure,
pain, edema, during levels
Antacids, grams per (HCO3-) and such as bone levels  Monitor calcium
acetylcholine improve  low phosphate
hypertension,
e
Minerals and disease
day orally prostaglandins. loss •High  Evaluate therapy.
for adverse
derivativ Adults. Initial: 5 mg at level of
in the memory, levels
hypotension
electrolytes Neutralization (osteoporosis), calcium effects
e bedtime. cerebral awareness, 
EENT: milk-alkali
Pharyngitis -Monitor HR
Route:After 4 tohydrochloric acid weak bones levels
6 wk, results in cortex
Oraldosage increased the may and the
(osteomalacia/ric •Suspected ENDO:syndrome
Hyperglycemia periodically
to 10 mg at bedtime, formationimprove
of calcium ability
kets), to
decreased digoxin GI: Abdominal pain, anorexia, during
as indicated. Dosage cognition.
chloride, carbon function.
activity of the toxicity constipation, therapy. May
may be further dioxide and Donepezil
water. This
parathyroid gland diarrhea, dyspepsia, gastroenteritis, cause
increased, as needed, becomes
Approximately 90%less medication
(hypoparathyroidi fecal bradycardia.
after 3 months to 23 of calcium chlorideas
effective is is an
sm), and a incontinence, nausea, vomiting.
mg convertedAlzheimer’s
to enzyme
certain muscle GU: Cystitis, glycosuria, hematuria, -Administer in
using disease
daily at bedtime if insoluble calcium blocker(latent
disease that urinary the evening
tablet form. salts (e.g.progresses
calcium works
tetany). by frequency or incontinence, UTI just before
Maximum: 23 mg carbonate
daily andandnumber restoring the HEME: Anemia, hemorrhage going to bed.
of intact
calcium phosphate). balance of MS: Arthralgia, back pain, elevated May be taken
cholinergic natural creatine with-out
Route: neurons substances kinase level, muscle spasms regard to
Oral declines. (neurotrans RESP: Bronchitis, increased cough, food.
mitters) in pneumonia
the brain. SKIN: Ecchymosis, eczema, -Monitor vital
pruritus, rash, signs
41
ulceration
 Name of Drug Dosage, Mechanism of Indication Contraindication Adverse Nursing Contradictions
Route, Action Reaction
Frequency
and Timing
Generic: Dosage: Multivitamins used to treat  Treatm Constipation Avoid taking more than
Centrum 60 mg, 80mg have a or prevent ent of or one multivitamin product
Brand: Before therapeutic effect vitamin pernicio Diarrhea may at the same time unless
Androvite, CalciFol, meals, 2 by providing deficiency us or occur (black your doctor tells you to.
CalciFolic-D, hours after essential due to poor another stool) Taking similar vitamin
Centamin, Centrum meals vitamins and diet, certain megalo products together can
Cardio, Centrum minerals that illnesses, or blastic Upset result in a vitamin
Flavor Burst, Route: may be lacking in during anemia. stomach or overdose or serious side
Centrum oral an individual's pregnancy.  vomiting. effects.
MultiGummies, diet, helping Vitamins and Wilson's
Centrum prevent or correct iron are disease Avoid the regular use of
Performance, nutrient important . salt substitutes in your
Centrum Silver Ultra deficiencies. building  Hemoc diet if your multivitamin
Men's, blocks of the hromato contains potassium. If
body and help sis you are on a low-salt diet,
Classification: keep you in  diabete ask your doctor before
Vitamin and mineral good health. s, taking a vitamin or
combinations  alcohol mineral supplement.
depend
ence, Do not take multivitamins
 liver with milk, other dairy
disease products, calcium
. supplements, or antacids
that contain calcium.
Calcium may make it
harder for your body to
absorb certain
ingredients of the
multivitamin.

42
Name of Drug Dosage, Mechanism of Indication Contraindic Adverse Reaction Nursing
Route, Action ation Contradictions
Frequency
and Timing

Generic: Dosage: Blocks binding of Losartan is Concurrent CNS: Dizziness, • Monitor VS, may
angiotensin II to indicated to treat aliskiren fatigue, headache, cause
Losartan For diabetic receptor sites in hypertension in therapy (in hypotension,
nephropathy many tissues, patients older than patients insomnia, malaise tacycardia,
, including 6 years, reduce the angiodema,
hypertension vascular smooth risk of stroke in with CV: Hypotension hyperkalemia
Brand: and diabetes),
muscle and patients with
prevention hypersensiti EENT: Nasal • may increase
Cozaar, Hyzaar adrenal glands. hypertension and
for stroke: vity to congestion digoxin levels
Angiotensin II is left ventricular
a potent hypertrophy and to losartan or
Adults—At GI: Diarrhea, • assess blood
vasoconstrictor treat diabetic its
first, 50 indigestion, pressure and
Classification: that also nephropathy with component
milligrams nausea, heart rate
stimulates the elevated serum
Angiotensin II (mg) once a adrenal cortex to creatinine and vomiting • assess fluid
receptor antagonist, day. secrete proteinuria in
antihypertensive levels
aldosterone. The patients with type 2 HEME:
Route:
inhibiting effects diabetes and Thrombocytopenia • monitor daily
Oral of angiotensin II hypertension.3 weights with CHF
reduce blood Losartan with MS: Back pain, leg
pressure. hydrochlorothiazide pain, muscle • monitor renal
is indicated to treat spasms and liver
hypertension and to
RESP: Cough, • instruct patient
reduce the risk of
upper respiratory on how to take
stroke in patients
tract blood pressure
with hypertension
and left ventricular infection
hypertrophy.
SKIN:
Erythroderma

Other:
Angioedema,
hyperkalemia,

hyponatremia

43
 Name of Drug Dosage, Mechanism of Indication Contraindic Adverse Reaction Nursing
Route, Action ation Contradictions
Frequen
cy and
Timing
Generic: Dosage: IRON+FOLIC used for Iron Intolerance to  Stomach Asses History:
Iron + Folic Acid 1 tab ACID contains deficiency due to the drug upset and Allergy to folic
+Vitamin B-Complex daily. Iron and Folic poor absorption Iron pain acid preparations;
Brand: Severe acid (haematinics and chronic blood intolerance pernicious,
Fortifer Fa anemia: combination), loss, Gestation,
 Constipation
aplastic,
1 tab which works by Treatment of Hypersensitiv  Diarrhea normocytic
Classification: twice boosting the anemias of ity.  Nausea anemias; lactation
Vitamins & Minerals daily. production of red nutritional origin,
 Vomiting
(Pre & Post Natal) / Adult blood cells (RBC) Pregnancy, Primary Assess Physical:
Antianemics and and haemoglobin Infancy, Or hemochroma  Allergic
Skin lesions,
teenage in the body. Thus, childhood, tosis, peptic reactions
color; R,
males— the use of Treatment of ulcer,  Anorexia adventitious
150 to IRON+FOLIC megaloblastic regional
 Abdominal sounds; CBC,
400 ACID is anemias due to a enteritis, Hgb, Hct, serum
distention
microgra associated with a deficiency of folic ulcerative folate levels,
ms reduced risk of acid, Pre and post colitis.  Flatulence
serum vitamin
(mcg) iron deficiency operative  Bitter or bad B12 levels,
per day. and anaemia, treatment, Fever, Patients taste Schilling test
Route: especially in Severe burns, receiving
 Altered
Oral pregnant women. Pregnancy, parenteral
sleep Avoid I.V.
Gastrointestinal iron or blood
patterns. administration
The B-vitamins disorders and transfusions.
comprise a group other conditions.  Difficulty in because faster
of eight water Fortifer - Fa Tablet concentratin systemic
soluble vitamins may also be used g. elimination will
that perform for purposes not  Irritability reduce
essential, closely listed in this effectiveness of
 Overactivity vitamin.
inter-related roles medication guide.
in cellular  Excitement
functioning, acting  Mental Don’t give large
as co-enzymes in depression doses routinely
a vast array of  Confusion because drug is
catabolic and lost through
anabolic
 Impaired
excretion.5.
enzymatic 44 judgment Protect Vit.B 12
reactions. from light. Don’t
refrigerate or
freeze.
 Name of Drug Dosage, Mechanism of Indication Contraindica Adverse Nursing
Route, Action tion Reaction Contradictions
Frequency
and Timing
Generic: Dosage:  Do not use if
Astorvastatin 20mg once
Mechanism of
Atorvastatin is Active hepatic  diarrhe sensitive to other
daily used together disease, a antihyperlipidemi
Action Reduces
Brand: Route: with a proper diet breastfeeding,
ATORVALIQ, Oral
plasma
to lower hypersensitivit
 heartbu c agents

LIPITOR
cholesterol and
cholesterol and y to
rn  Do not use with
lipoprotein levels
triglyceride (fats) atorvastatin or  gas hepatic disease
by inhibiting or unexplained
Classification:
HMG-CoA
levels in the its  joint
elevated serum
Antihyperlipidemic, blood. This components, pain
reductase and liver enzymes
HMG-CoA reductase medicine may pregnancy,
cholesterol  forgetful  Not for use
inhibitor help prevent unexplained
synthesis in the ness or
medical persistent rise during pregnancy
liver and by memory
problems (eg, in serum or breastfeeding
increasing the loss
number of LDL
chest pain, heart transaminase  Avoid using other
attack, or stroke) level  confusi
HMGCoA
receptors on liver on
that are caused reductase
cells to enhance
by fats clogging inhibitors
LDL uptake and
the blood
breakdown.  Take caution in
vessels. It may
patients
also be used to
with hypotension,
prevent certain
uncontrolled seiz
types of heart
ures, muscle
and blood vessel
disease,
problems in
alcoholism, and
patients with risk
severe
factors for heart
metabolic,
problems.
endocrine,
or electrolyte
disorders
 Carefully use
atorvastatin with
cyclosporine,
protease
inhibitors,
45 colchicine,
niacin,
clarithromycin
 Name of Drug Dosage, Mechanism of Indication Contraindication Adverse Nursing
Route, Action Reaction Contradictions
Frequency
and Timing

Generic: Dosage: Systane Ultra hypersensitive to  itching, remove the

peg 400-propylene Instill 1-2 Ophthalmic any of the  irritatio contacts before
PEG provides
glycol drop(s) in Solution is a components in the n using the
lubrication
affected prescription formulation.  stingin medicine.
and acts as a
Brand: eye(s) prn medicine used to g
surfactant by
Systane Ultra, treat symptoms Allergies to any of sensati Keep the medicine
coating the
Systane Gel Drops, Route: of dry eyes. It the components in on at room
eye and
Systane Opthalmic lubricates the the formula  tempor temperature.
interacting
Preservative-Free eyes. This way it ary
with
provides busine
propylene Do not let the tip of
Classification: temporary relief ss
glycol and the container
Ophthalmic from burning and
other touch your eye
Lubricants discomfort
solutions that
caused by dry
help to act as
eyes. It also If you are using
surfactants on another eye
reduces redness
the eye medicine, wait at
and swelling of
mucosa 15. least 5 minutes
the eye.
This allows for before using the
long-lasting, other medicine.
soothing
effects 15. Do not let the tip of
the container
touch your eye

46
Name of Drug Dosage, Route, Mechanism Indication Contraindi Adverse Reaction Nursing
Frequency and of Action cation Contradicti
Timing ons

Generic: Dosage: Albuterol Salbutamol is Hypersensi CNS: Anxiety, dizziness, •Administer

attaches to indicated for the tivity to drowsiness, headache, pressurized
albuterol inhaler 100 beta2 symptomatic albuterol or hyperkinesia, insomnia, inhalations
micrograms (mcg) per receptors on relief and its irritability, nervousness, tremor, of albuterol
(salbutamol) dose: bronchial cell prevention of component vertigo, weakness during
membranes, bronchospasm s second half
Adults: 1-2 puffs every CV: Angina; arrhythmias,
which due to bronchial of
4 hours up to 4 times including atrial fibrillation,
Brand: stimulates the asthma, chronic inspiration,
(8 puffs) in 24 hours to extrasystoles, supraventricular
intracellular bronchitis, when
AccuNeb, relieve symptoms. tachycardia, and tachycardia;
enzyme reversible airways are
Airet, Gen- adenylate obstructive chest pain; open wider
dry powder inhaler 200
Salbutamol cyclase to airway disease, and aerosol
mcg per dose: hypertension; hypotension;
(can), Novo- convert and other chronic distribution
Salmol (can), palpitations
Adults, adolescents adenosine bronchopulmonar is more
Proair HFA, aged 12 years and triphosphate y disorders in effective.
EENT: Altered taste, dry mouth
Proventil, over and children 4 to (ATP) to cyclic which and throat, ear pain, glossitis,
Proventil 11 years of age: 1 adenosine bronchospasm is •Monitor
hoarseness, oropharyngeal
HFA,Proventil inhalation up to 4 monophosphat a complicating serum
edema, pharyngitis, rhinitis,
Repetabs, times per day to e (cAMP). This factor, and/or the potassium
taste perversion
Proventil relieve symptoms. reaction acute prophylaxis level
Syrup,Ventolin decreases against exercise- ENDO: Hyperglycemia because
HFA, Ventolin Syrup intracellular induced albuterol
Syrup, Volmax calcium levels. bronchospasm GI: Anorexia, diarrhea, may cause
Elderly (over 65 years dysphagia, heartburn, nausea, transient
It also and other stimuli
old): The usual dose is vomiting hypokalemi
increases known to induce
5 ml, up to 3 times a a.
Classification: intracellular bronchospasm.
day. GU: UTI
levels of
•Be aware
Selective tablets 2mg and 4mg cAMP, as MS: Muscle cramps that drug
beta2- shown.
tolerance
adrenergic Nebules Together, RESP: Bronchospasm, cough,
can develop
agonist, these effects dyspnea, paradoxical
The usual dose is 0.5 with
relax bronchial bronchospasm, pulmonary
sympathomime ml to 1 ml of respirator prolonged
smooth- edema
tic solution (2.5 to 5 mg use.
muscle cells
salbutamol). and inhibit SKIN: Diaphoresis, flushing,
Bronchodilator 47 pallor, pruritus, rash, urticaria
histamine
Route:
release.
Oral (inhalation)
Name of Drug Dosage, Mechanism of Action Indication Contraindica Adverse Reaction Nursing
Route, tion Contradictions
Frequency
and Timing

Generic: Dosage: The hypersecretion of Relief of This product  Stomach Assess the patient
mucus characterizes cough should not be discomfort for any history of
Solmux 500mg or serious respiratory characteriz given to s, hypersensitivity or
5ml conditions including ed by patients with  nausea, allergy to
asthma, cystic fibrosis excessive active  diarrhea, Carbocisteine.
Adults &
Brand: (CF), and chronic or sticky stomach or  headache, Special precautions:
Children
obstructive pulmonary sputum or intestinal ulcer  dizziness, GI bleeding,
above 12 yrs.
Carbocisteine disease (COPD).It phlegm to and those  dry mouth pregnancy
old: Take 1
(Solmux Forte), blocks bacterial help treat with allergy to
capsule Special precaution:
Mucodyne adherence to cells, resp tract carbocisteine
every 8 history of gastric or
preventing pulmonary disorders or to any of its
Classification: hours, or as duodenal ulcer & GI
infections. Glycoproteins eg, acute ingredients.
recommende bleeding. Pregnancy
(fucomucins, sialomucins bronchitis.
Mucolytic d by the & lactation.
and sulfomucins)
doctor.
regulate the viscoelastic
Use with caution in
Route: properties of bronchial
patients with a
mucus. Increased
history of gastric or
Oral fucomucins can be found
duodenal ulcer and
in the mucus of patients
gastrointestinal
with COPD.
bleeding since
Carbocisteine serves to
mucolytics may
restore equilibrium
disrupt the gastric
between sialomucins
mucosal barrier.
and fucomucins, likely by
intracellular stimulation
of sialyl transferase
enzyme, thus reducing
mucus viscosity.

48
 ABSTRACT OF RELATED STUDIES

Asthma in the elderly: Current understanding and future research needs—a report of a National Institute on Aging (NIA) workshop
Abstract
Asthma in the elderly is underdiagnosed and undertreated, and there is a paucity of knowledge on the subject. The National Institute on Aging
convened this workshop to identify what is known and what gaps in knowledge remain and suggest research directions needed to improve the
understanding and care of asthma in the elderly. Asthma presenting at an advanced age often has similar clinical and physiologic consequences as
seen with younger patients, but comorbid illnesses and the psychosocial effects of aging might affect the diagnosis, clinical presentation, and care of
asthma in this population. At least 2 phenotypes exist among elderly patients with asthma; those with longstanding asthma have more severe airflow
limitation and less complete reversibility than those with late-onset asthma. Many challenges exist in the recognition and treatment of asthma in the
elderly. Furthermore, the pathophysiologic mechanisms of asthma in the elderly are likely to be different from those seen in young asthmatic patients,
and these differences might influence the clinical course and outcomes of asthma in this population.

Nicola, H., King M., Braman., S (2019) Asthma in the elderly: Current understanding and future research needs—a report of a National Institute on

Aging (NIA) workshop. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164961/

Asthma in the elderly and late-onset adult asthma

Abstract

49
Elderly asthmatics are at a higher risk for morbidity and mortality from their asthma than younger patients. There are important age-related
physiologic and immunologic changes that complicate the presentation, diagnosis, and management of asthma in the aged population. Evidence
suggests that elderly asthmatics are more likely to be underdiagnosed and undertreated. Additionally, elderly patients with asthma have highest rates
of morbidity and mortality from their disease than younger patients. The underlying airway inflammation of asthma in this age group likely differs from
younger patients and is felt to be non-type 2 mediated. While elderly patients are underrepresented in clinical trials, subgroup analysis of large
clinical trials suggests they may be less likely to respond to traditional asthma therapies (ie, corticosteroids). As the armamentarium of pharmacologic
asthma therapies expands, it will be critical to include elderly asthmatics in large clinical trials so that therapy may be better tailored to this at-risk and
growing population.

Dunn, R. M., Busse, P. J., Wechsler, M. E., (2018) Asthma in the elderly and late-onset adult asthma. Allergy: European Journal of Allergy & Clinical

Immunology. https://onlinelibrary.wiley.com/doi/10.1111/all.13258

Exploring the experiences of older adults living with asthma in the United Kingdom: A co-produced qualitative study
Abstract
Older adults are the fastest growing population in the UK, but asthma is often underdiagnosed, undertreated, and poorly self-managed in this
population. It is necessary to explore the experiences of older adults with asthma to identify areas of research that could improve quality of life. This
study aimed to explore the perceptions of older adults in the UK living with asthma and how it impacts their lives.

Jackson, T., Flinn F., Rafferty L., Ehrlich E., and Fletcher M. (2022). Exploring the experiences of older adults living with asthma in the United

Kingdom: A co-produced qualitative study. Aging and Health Research. https://www.sciencedirect.com/science/article/pii/S2667032122000257

50
 REFERENCE

Book
Doenges, Moorhouse, Murr-Nurse's Pocket Guide-NANDA-15th Edition. 2019. pages 374-379 27-33, 524-528

Brunner & Suddarths (2010) Medical-Surgical Nursing 12th Edition. Asthma page 80.

Online

Yadav, M., Mittal, K. Effect of Vitamin D Supplementation on Moderate to Severe Bronchial Asthma. Indian J Pediatr 81, 650–654 (2018). Retrieved

from https://doi.org/10.1007/s12098-013-1268-4

Lizzo J.et al. (2022). Pediatric Asthma. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK551631/

51