 Presents as an acute or subacute episode of

progressive worsening of symptoms, such as

shortness of breath, wheezing, cough, and
chest tightness.

 Pulse rate, respiratory rate, subjective

assessment of respiratory distress, accessory
muscle use, and auscultation of the lung
fields are key factors to assess during
physical examination.

 An increased airway obstruction that can be

quantified objectively by peak flow
measurement or FEV1 is typical in an acute
exacerbation.
 Early administration of bronchodilators and
corticosteroids relieves airflow obstruction
and helps to prevent future relapses. Severe
exacerbations often require additional therapy
including oxygen, magnesium, and, in some
circumstances, mechanical ventilation.

 Pneumonia,pneumothorax, pneumomediastinum,
and respiratory failure are complications.
An asthma exacerbation is an acute or subacute
episode of progressive worsening of symptoms of
asthma, including shortness of breath, wheezing,
cough, and chest tightness.

Exacerbations are marked by decreases from

baseline in objective measures of pulmonary
function, such as peak expiratory flow rate and
FEV1.
 DATE AND TIME OF ADMISSION

July 13, 2019 7:20 pm

Room Type: Royal Suite Room no. RS2
PatientNo. :1900023377
Name: Santican,AlveedSodayemBalindong T- 36.5 BP- 90/60 WT- 20.5 KG
Address: JAS,MalabangLanao delSur
Age: 6 Years Religion: Islam Status:Child
DOB: 11/06/2012 Natinality:Filipino Sex: Male
Chief Complaint: Cough
Father’sName: JohairT. Santican
Mother’sName: JonaiifahT. Santican Admitting Diagnosis: Bronchial Asthma in Acute
ContactNo. 09755005165 Exacerbation, Rule in Pediatric Community Acquired
Service:Pediatrics Pneumonia
AttendingPhysician:Manginsay,Judy
 History of Present Illness
• 3 nights Prior to admission, client is having cough with a yellow green
discharges (Phlegm). Night prior to admission client was given
Cefuroxime.
Gordon’s 11 Functional Before hospitalization During Hospitalization
pattern
3 nights Prior to admission client is During Hospitalization client has been
Health perception having cough with a yellow green given IVF D5LR.
discharges (Phlegm). Nebulize- Salbutamol
Night prior to admission client was given
Metronidazole.

Patient’s verbalized that she use to eat Diet as tolerated.

Nutritional- junk foods. And his favorite dish for meal Clients is encourage to eat vegetables
is fried chicken, the clients S/O also said and fruits.
Metabolic that the client’s hardly eat vegetables.
 The clients defecate 2 to 3x a day Clients doesn’t have any problem with
and urinates at least 7 to 10x a day. bowel movement.
Elimination No difficulty of defecating and
urinating

Before the cough occur clients verbalize As the cough occur clients stopped
that he use to play outside with his playing , and not able to strenuous
Activity Exercise playmates that serve as their exercise,
like running. (Dakpanay).
activity.

The clients can speak, hear , see, smell Client’s 5 senses are functioning well.
and feel. and can absolutely remember
Cognitive Perceptual what happens from yesterday.
 Prior to admission clients S/O
verbalize that clients having
Sleep rest difficulty of sleeping due to
excessive coughing.
After given medication for cough
clients S/O verbalize that clients can
now at least sleep w/ slight
disturbance of his cough.

Client is having difficulty of eating The client feels a bit relief after
properly due to excessive coughing given a medication for cough.
Self perception or Self that makes the clients upset about his
Concept cough.

The patients feel the support of his The clients has good relationship wit
family specially his parent were his family specially his parents.
Role Relationship always there for him, who
immediately bring him to hospital.
 Clients is male Clients has no identity confusion

Sexuality reproductive

Clients is well supported by parents Clients doesn’t have problem with

coping stress.
Coping stress tolerance

Clients came from a devoted Islam

Values and beliefs

Anatomy and Physiology of the Respiratory
System
 Basic functions of the respiratory system are:
1. provides oxygen to the blood stream and
removes carbon dioxide
2. enables sound production or vocalization as
expired air passes over the vocal chords
3. enables protective and reflexive non-
breathing air movements such as coughing
and sneezing, to keep the air passages clear
4. control of Acid-Base balance
5. control of blood pH
 The parts of the respiratory system

• The respiratory system is divided into two parts:

1. Upper respiratory tract:

• This includes the nose, mouth, and the beginning of the trachea (the
section that takes air in and lets it out).

2. Lower respiratory tract:

• This includes the trachea, the bronchi, broncheoli and the lungs (the
act of breathing takes place in this part of the system)
 Upper Respiratory System
Nose
- Serves as passageway for air to pass to and from the
lungs. It is responsible for olfaction or smell because the
olfactory receptors are located in the nasal mucosa.
Paranasal sinuses
- A prominent function of the sinuses is to as a resonating
chamber in speech. The sinuses are a common site of infection.
Turbinate bones or conchae
- This bones increases the mucous membrane surface of
the nasal passages and slightly obstruct the air flowing through
them.
Pharynx
The pharynx or throat is a tube like structure that connects
the nasal and oral cavities to the larynx. It is divided into 3
regions
1. Nasopharynx
Located posterior to the nose and above the soft palate
2. Oropharynx
Houses the faucial or palatine tonsils
3. Laryngopharynx
Extends from the hyoid bone to the cricoid cartilage
Larynx
The voice organ is a cartilaginous epithelium line structures
that connects the pharynx and the trachea. The larynx consist;
1. Epiglottis – a valve flap of cartilage that covers the
opening to the larynx during swallowing
2. Glottis – Opening between the vocal cords in the larynx
 3. Thyroid cartilage – The largest of the cartilage
structures; part of it forms the adam’s apple
4 Cricoid cartilage – The only complete
cartilaginous ring in the larynx (located below the
thyroid cartilage)
5. Arytenoid cartilage – Use in vocal cord
movement with the thyroid cartilage.
6. Vocal cords – Ligaments controlled by
muscular movements that produce sounds; Located
in the lumen of the larynx.
• Trachea
– Windpipe composed of smooth muscle with c-shaped rings of
cartilages at regular intervals
 Lower Respiratory System
1. Lungs
Are paired elastic structures enclosed in the thoracic cage which is an airtight
chamber with distensible walls.
2. Bronchi and bronchioles
The trachea divides into two bronchi (tubes). One leads to the left lung, the
other to the right lung. Inside the lungs each of the bronchi divides into smaller
bronchi.
The bronchi become smaller the closer they get to the lung tissue and are then
considered bronchioles.
 The act of breathing
Two stages – inhalation and exhalation
• Inhalation – the intake of air into the lungs through expansion
of chest volume.
• Exhalation – the expulsion of air from the lungs through
contraction of chest volume.
 Diffusion
• Diffusion is the movement of a substance from an area of high
concentration to an area of low concentration.
• Diffusion happens in liquids and gases because their particles
move randomly from place to place.
 Pulmonary Perfusion
• The actual blood flow through the pulmonary circulation. The
blood is pump into the lungs by the right ventricle through the
pulmonary artery.
PREDISPOSING FACTORS PRECIPITATING FACTORS
• Age • Environmental factors
• Gender • Allergens
• Genetics -foods
- pollen
- strong odors
- pets
• Exhaustion

Airway Inflammation
 Airway Inflammation

Hypersecretion of Airway muscle Swelling of the

mucus constriction bronchial membranes

Narrow Breathing Passages

Narrow Breathing Passages

Signs and Symptoms:

• Wheezing
• Crackles
• Cough
• Yellowish-green
sputum
 CHEST X-RAY
A chest X-ray can help determine if
you have pneumonia or another
condition that may explain your
cough. This is especially important if
you ever were or currently are a
smoker.
 CT scan
It is a specialised X-ray test. It
can give quite clear pictures of
the inside of your body. In
particular, it can give good
pictures of soft tissues of the
body which do not show on
ordinary X-ray pictures.
 SPUTUM TESTS
Sputum is the mucus that you
cough up from your lungs. It can
be tested to see if you have
illnesses that could be helped by
antibiotics. Sputum can also be
tested for signs of allergies.
 PULMONARY FUNCTION
TEST
During a pulmonary function test,
you blow into a device called a
spirometer, which measures how
much air your lungs can hold and
how quickly you can get air out of
your lungs. This test checks for
signs of asthma or emphysema.
DIAGNOSIS
• Ineffective airway clearance
related to bronchospasm as
evidenced by presence of
secretion, wheezing,
respiratory rate of ,
dyspnea, inability to remove
airway secretions
PLANNING
• After days of rendering
holistic care, the patient will
maintain clear, open airways
as evidence by normal
breath sounds, normal
respiratory rate and ability
to effectively cough up
secretions after treatments
and deep breaths.
INTERVENTION
1. Establish rapport
2. Monitor patient’s vital sign
3. Provide optimal positioning
(sitting position) for patient.
RATIONALE
• Alleviate the patient’s
anxiety.
• To determine if there’s any
alteration in the
temperature, pulse rate,
and respiratory rate.
• The proper sitting position
and splinting of the
abdomen promote effective
coughing by increasing
abdominal pressure and
upward diaphragmatic
movement.
INTERVENTION
4. Instruct patient the proper
ways of coughing and
breathing.
5. Position the patient upright
if tolerated. Regularly check
the patient’s position to
prevent sliding down in bed.
6. Perform nasotracheal
suctioning as necessary,
especially if cough is
ineffective.
RATIONALE
• The most convenient way to
remove most secretions is
coughing. So it is necessary to
assist the patient during this
activity. Deep breathing, on the
other hand, promotes oxygenation
before controlled coughing.
• Upright position limits abdominal
contents from pushing upward and
inhibiting lung expansion. This
position promotes better lung
expansion and improved air
exchange.
• Suctioning is needed when
patients are unable to cough out
secretions properly due to
weakness, thick mucus plugs, or
excessive or tenacious mucus
production.
 INTERVENTION RATIONALE
7. Encourage patient to increase • Fluids help minimize mucosal
fluid intake to 3 liters per day. drying and maximize cilliary
action to move secretions.
• A variety of medications are
8. Give medications as prepared to manage specific
prescribed, such as problems. Most promote
antibiotics, mucolytic agents, clearance of airway secretions
bronchodilators, expectorant, and may reduce airway
noting effectiveness and side resistance.
effects.
9. Pace activities especially for • Fatigue is a contributing factor to
patients with reduced energy. ineffective coughing. Effective
Maintain planned rest coughing requires enough energy
periods. Promote energy- and may consume an extra effort
conservation methods. to the patient.
10. Explain further the effects of • Chemical irritants and allergens
smoking, including can increase mucus production and
secondhand smoke. bronchospasm.
EVALUATION
• After days of rendering holistic care, the
patient reported a maintain clear and open
airways as evidenced by normal breath
sounds, normal respiratory rate of .. and
ability to effectively cough up secretions after
the treatments and deep breaths method.
Cefuroxime

 Dosage: 500 mg IVTT via solu-set

 Indication
Susceptible mild to moderate infections including pharyngitis/tonsillitis,
acute maxillary sinusitis, chronic bronchitis.
 Action/Mechanisms of action
Axetil is a bactericidal agent that acts by inhibition of bacterial cell wall
synthesis. The presence of penicillinases and cephalosporinases.
 Side Effects
• Diarrhea Drowsiness
• Dizziness Rash
• Headache Nausea and vomiting
 Nursing Precautions
• Tell the patient to eat first before drinking the medicine
Salbutamol

 Dosage nebulize q 4hrs

 Indication
Used as a bronchodilator in the management of reversible airway obstruction
cause by asthma or COPD
 Mechanism of Action
Binds to beta-adrenergic receptors in airway smooth muscle. Relaxation of
airway smooth muscle with subsequent bronchodilation.
 Side Effects
• Nausea and Vomiting
• Chest pain
• Headache
• Insomnia
 Nursing Precautions
Tell the mother not to expose the child in a smoking area.
Advise the mother to rinse the child’s mouth with water
after each inhalation
Budesonide

 Dosage q 8hrs
 Indication
Is indicated for the maintenance treatment of asthma and as prophylactic
therapy in children 12 months to 8 years of age.
 Mechanism of Action
Is an anti-inflammatory corticosteroid that exhibits potent glucocorticoiod
activity and weak mineralocorticoid activity
 Side Effects
• Headache
• Feeling tired
• Nausea
• Bloating
Ped-Zinc

 Dosage 1tsp OD
 Indication
Treatment for the common cold and for enhanced wound healing. Zinc also
has applications in pneumonia, diarrhea.
 Mechanisms of Action
Zinc in acute diarrhea derives from a regulation of intestinal fluid transport,
mucosal intergrity, immunity, gene expression and oxidative stress.
 Side Effects
• Constipation
• Diarrhea
• Upset stomach