Asthma (Case Study 6)
Asthma (Case Study 6)
Asthma (Case Study 6)
MEMBERS:
CASIPIT, SABINA
CAPUA, ROSS DHECEL
DE VERA, JAYA MAE
MENDOZA, MYLENE
MURILLO, GENERRA ANNE
March 18, 2020
CASE STUDY NO 6
ASTHMA
A. Abbreviations
CC – Chief Complaint
HPI – History of Present Illness
PMH – Past Medical History
Meds – Medicines / Medications
PE – Physical Examination
Gen – General
VS – Vital Signs
BP – Blood Pressure
RR – Respiratory Rate
HR – Heart Rate
SABA – Short-Acting Beta-2- agonist
ED – Emergency Department
Sore throat - pain, scratchiness or irritation of the throat that often worsens
when you swallow. The most common cause of a sore throat (pharyngitis) is a
viral infection, such as a cold or the flu. A sore throat caused by a virus resolves
on its own
Rhinorrhea - condition where the nasal cavity is filled with a significant amount
of mucus fluid. The condition, commonly known as a runny nose, occurs
relatively frequently. Rhinorrhea is a common symptom of allergies (hay fever) or
certain viral infections, such as the common cold
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Heart Rate - also known as pulse, is the number of times a person's heart beats
per minute
Hyper Inflated Chest - occur when air gets trapped in the lungs and causes
them to overinflate. Hyperinflated lungs can be caused by blockages in the air
passages or by air sacs that are less elastic, which interferes with the expulsion
of air from the lungs
Suprasternal Retraction - when the skin in the middle of your neck sucks in.
It's also called a tracheal tug
Intercostal Retraction - occur when the muscles between the ribs pull inward.
The movement is most often a sign that the person has a breathing problem.
Intercostal retractions are a medical emergency.
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Auscultation - the action of listening to sounds from the heart, lungs, or other
organs, typically with a stethoscope, as a part of medical diagnosis.
Pulse Oximetry - test used to measure the oxygen level (oxygen saturation) of
the blood. It is an easy, painless measure of how well oxygen is being sent to
parts of your body furthest from your heart, such as the arms and legs.
Blood Pressure - the pressure of the blood in the circulatory system, often
measured for diagnosis since it is closely related to the force and rate of the
heartbeat and the diameter and elasticity of the arterial walls. wheezing often
accompanies expiratory wheezing when heard over the lungs, specifically in
acute asthma.
allergic reactions. They are often used as part of the treatment for a number of
different diseases, such as severe allergies or skin problems, asthma, or arthritis.
C. Medication
albuterol ( salbutamol )
Indication:
Mechanism of action:
Drug Interaction:
Tricyclic anti depressants and MAOIs mono amine oxydase inhibitors should
not be combined with albutarol sulfate because of their additive effects on the
vascular system (increase blood pressure heart rate)
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Beta-blockers, for example, propranolol (Inderal, Inderal LA), block the effect
of albuterol sulphate and may induce bronchospasm in asthmatics.
PE
Gen
Anxious appearing young girl in moderate respiratory distress with audible expiratory
wheezes
Asthma is an obstructive lung disease; therefore, the primary limitation to airflow
occurs during expiration. This outflow obstruction leads to the classic findings of
dyspnea, expiratory wheezes, and a prolonged expiratory phase during the
ventilatory cycle. Wheezing is a whistling sound produced by turbulent airflow
through a constricted opening and usually is more prominent on expiration.
VS
BP 110/83mmHg; RR 30 breaths/min; HR 130 beats/min; temperature 37.8 degree
Celsius; pulsus paradoxus 18mmHg
Classification of blood pressure JNC VII
Systolic BP (mmHg) Diastolic BP (mmHg)
Normal <120 mmHg <80 mmHg
Prehypertention 120-139 mmHg 80-89 mmHg
Stage 1 hypertention 140-159 mmHg 90-99 mmHg
Stage 2 hypertention >160 mmHg >100 mmHg
Interpretation: the blood pressure of the patient is normal.
Respiratory rate
Normal 12-20 breaths/min
Tachypnea Faster respiratory rate >20 breaths/min
Bradypnea Slow respiratory rate <12 breaths/ min
Interpretation: the respiratory rate of the patient is tachypnea.
Heart rate
Normal 60-100 beats/min
Bradycardia <60 beats/min
Tachycardia >100 beats/min
Interpretation: the heart rate of the patient is tachycardia.
Temperature
Normal body temperature: 37 degree Celsius
Generally accepted fever to be oral body temperature of 38 degree Celsius
Oral body temperature is 1 degree Celsius lower than rectal body temperature
Axillary body temperature is 2 degree Celsius lower than rectal body temperature
The increased pulse, RR, and anxiety experienced by the patient can be
attributed both to hypoxemia and the feeling of suffocation. The hypoxemia in
acute asthma is due principally to an imbalance between alveolar ventilation and
pulmonary capillary blood flow,known as ventilation-perfusion mismatching.
When ventilation is decreased to an area of the lung, the alveoli in ithat area
become hypoxic, and the pulmonary artery to that region constricts as a normal
physiologic response. As a result, blood flow is shunted to the well-ventilated
portions of the lung because of the need to preserve adequate oxygenation of
the blood.
Chest
Hyperinflated chest and suprasternal , supraclavicular and intercostal retractions
The small airways become completely occluded during expiration, and air can be
trapped behind the occlusion; therefore, the patient has to breathe at higher
than normal lung volumes. Consequently, the thoracic cavity becomes
hyperexpanded, and the diaphragm is lowered. As a result, the patient must use
the accessory muscles of respiration to expand the chest wall. Hyperinflated
chest and her use of suprasternal, supraclavicular, and intercostal muscles to
assist in breathing also are compatible with obstructive airway diseases.
Other findings:
Upon auscultation, the doctor heard a bilateral inspiratory and expiratory wheezes with
decreased breath sound on the left side heard on auscultation.
The audible expiratory wheezing in patient is compatible with bronchial
obstruction. Patient’s obstruction is so severe that even inspiratory wheezes and
decreased air movement were detected on auscultation. The classic symptom of
wheezing requires turbulent airflow; therefore, effective therapy of acute asthma
may result in increased of wheezing initially 9as airflow increases throughout the
lung. As a result, patient’s increased wheezing on auscultation is compatible with
her clinical improvement following the albuterol nebulizer treatments.
Questions:
Other Questions:
Airborne substances, such as pollen, dust mites, mold spores, pet dander or
particles of cockroach waste
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• For acute severe asthma, treatment goals are to (1) correct significant hypoxemia,
(2) rapidly reverse airway obstruction (within minutes), (3) reduce likelihood of
recurrence of severe airflow obstruction, and (4) develop a written action plan in
case of future exacerbation.
• All patients on inhaled drugs should have their inhalation technique evaluated
monthly initially and then every 3 to 6 months.
• After initiation of anti-inflammatory therapy or increase in dosage, most
patients should experience decreased symptoms within 1 to 2 weeks and
achieve maximum improvement within 4 to 8 weeks. Improvement in
baseline FEV1 or PEF should follow a similar time course, but decrease in BHR
as measured by morning PEF, PEF variability, and exercise tolerance may
take longer and improve over 1 to 3 months.
References: