Académique Documents
Professionnel Documents
Culture Documents
BY
Sarah alatwi
Ranay khalf
Jamela
Gaoaher
ezdehar
Outlines
Introducation
Statistic
Case presentation
DEMOGRAPHIC DETAIL
SYSTEMIC REVIEW
PRESENTING COMPLAIN
histery
PHYSICAL EXAMINATION
DISCUSSION OF ASTHMA
Mangement
Drug study
Nursing care plan
Interducation:
Asthma is a chronic
respiratory disorder in
which there is
primarily swelling
ofairways in the lungs.
The airways are
therefore narrowed
making it difficult to
breathe Normal
Inflamed (untreated)
Regular Inhaled
Steroid Partly Treated.
I.Case
presentation
DEMOGRAPHIC DETAIL
Initials : MH
Age
PRESENTING COMPLAIN
MH, a 6 years and 8 months old saoudi
SYSTEMIC REVIEW
CVS : No excessive night sweating, no
orthopnea.
CNS : No headache/dizziness, no episode
of fainting or fit
attack.
GIT : No constipation, no diarrhea, normal
bowel habit.
MSK : No muscle pain or join pain.
Urinary System: No dysuria or hematuria.
Skin : No rashes or itchiness.
ENT : No sore throat, no runny nose.
PAST MEDICAL/SURGICAL Hx
He has been diagnosed to have asthma since he
DRUGS Hx
He is not on any medication
Doctor advice him to take MDI but mother
ALLERGIES
No known allergies
BIRTH Hx
Born at King Khlid Hospital
FTSVD
Weight : 2.5kg
Antenatal, intrapartum and postpartum hx
was uneventful
Admitted to NICU for 15 days due to neonatal
jaundice diagnosed to have G6PD
FEEDING Hx
Grandmother did not recall how long he had
exclusive breastfeeding
Currently he is on family diet with balance
and adequate amount of fish, meat and rice
IMMUNISATION Hx
Up to his age
Didnt have any complications after taking
the injections
DEVELOPMENTAL Hx
Up to his chronological age. He is currently at
FAMILY Hx
2nd child out of 3 siblings
Both father and mother have asthma and
currently on medication.
Grandmother in paternal side also have
asthma.
Elder sister is 3 years old and younger
sister is 13 months old. Both of them are
well
No history of consanguinity
PHYSICAL
EXAMINATION
1. GENERAL CONDITION
MH
was
sitting
grandmother
was
on
the
sitting
bed
next
comfortably.
to
him. He
His
was
2. VITAL SIGNS
Temperature
: 38.50C
Blood pressure
and normal
Pulse rate
volume
: 110 beat per minute
Respiratory rate:
Impression:
His vital signs are normal.
3.ANTHROPOMETRIC MEASUREMENTS
Height
: 110cm.
Weight
: 17kg.
BMI
: 14.05kg/m2.
Impression:
His growth is within normal.
SYSTEMIC EXAMINATION
1.RESPIRATORY SYSTEM
2. CARDIOVASCULAR EXAMINATION
There were no abnormal findings during Inspection ,
Palpation , Auscultation.
3. ABDOMINAL EXAMINATION
No abnormal findings.
4. LYMPHATIC SYSTEM
Cervical / Supraclavicular Nodes Right submandibular
III.DISCUSSION OF ASTHMA
DEFINITION:
Chronic inflammatory
disorder of airways that
causes recurrent episodes of
wheezing, breathlessness,
chest tightness and
coughing.
RISK FACTORS
Host Factors
Genetic predisposition
Atopy
Environmental
Factors
Airway hyper-
responsiveness
Gender
Race/Ethnicity
Indoor /allergens
Socioeconomic factors
Family size
weather changes
Obesity
TRIGGERS FACTORS
Allergens
Smoke (passive smoker)
Respiratory infections
Exercise and hyperventilation
Emotional upset or excitement
Food, additives, drugs
Pathogenesis of asthma
Enviromental factors
Genetic factors
Bronchial inflamation
Bronchial hyperactivity + trigger
factors
Oedema , bronchononstriction, & increase
mucous production
Airways narrowing
Symptoms:
-cough
-wheezing
-breathlessness
-chest tightness
CLINICAL FEATURES
Cough
Chest tightness
Wheezing sound of breath
Episodic shortness of
breath
Worsen during night
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
DIAGNOSIS
Physical examination
INVESTIGATION
1)LUNG FUNCTION TEST
This can be done by using Peak Expiratory Flow
Rate(PEFR).
3)Chest X-ray.
Helpful in excluding a
pneumothorax / pneumonia.
salbutamol
If symptoms still not subside, do
endotracheal intubation and gives
mechanical ventilation.
MANAGEMENT
Give drug treatment to the patient by following the
Impact of asthma
breath.
Respiratory rate >50/min
Tachycardia >140/min
PEFR <50% from normal
LIFE-THREATENING ASTHMA
Silent chest and cyanosis.
Exhaustion,confusion or coma.
PEFR <33% of prediction.
PREVENTION
Education of the family members is a vital
role :
- teaching basic asthma facts
COMPLICATION
STATUS ASTHMATICUS
MANAGEMENT
Result
Normal
Unit
pH
7.408
7.35-7.45
HCO3
22.5
22-29
mmol/L
Base excess
-1.5
(-3)-(+3)
mmol/L
Impression: Normal
Result
Normal
10.51x103/L
4.5-13.5
4.17X106/L
4.0-5.4
Hemoglobin
11.4g/dL
11.5-14.5
Hematocrit
34.2%
37.0-45.0
MCV
82.0fL
76.0-92.0
MCH
27.3pg
24.0-30.0
Red Distribution
Width
14.5%
30.0-100.0
396x103/L
150-400
Neutrophil %
82.8%
40-75
Neutrophil #
8.71x103/L
2.9-7.9
Lymphocyte %
11.5%
20.0-50.0
Lymphocyte #
1.20x103/L
1.8- 4.0
Monocyte %
2.4%
0-8
Monocyte #
0.25x103/L
0.0- 1.6
Eosinophil %
1.9%
0-5
Eosinophil #
0.20x103/L
0.4- 2.1
Platelet
ED:
Salbutamol Nebulizer cont 1hour
Oxygen mask 2LPM
IV hydrocortisone 40mg q6h
Cefuroxime 500mg IV q12
Ipratropium bromide: 4hourly
IV fluid-maintainance
Blood investigation: FBC, VBG, electrolyte
If not, IV salbutamol or aminophyline
If the symptoms persist, intubation.
Monitoring: vital signs, SpO2, VBG
Syrup prednisolone 17mg OD 5/7
mdi fluticasone 125mcg BD
mdi salbutamol 200mg 4 hourly
At home:
Avoid allergens
syrup prednisolone
MDI Salbutamol
Drug study
Thank you