BRONCHIAL ASTHMA IN ACUTE EXACERBATION

I. Overview of the Disease

Acute exacerbation of bronchial asthma (AEBA) defined as an episode of quickly

dynamic increment in shortness of breath, cough, wheezing, or chest snugness, or a few
combinations of these side effects requiring a non-scheduled visit, and related to a diminish of
respiratory wind stream measured by estimations of top expiratory stream (PEF) or FEV1. Acute
asthma exacerbations are episodes of worsening asthma symptoms and lung function; they can
be the presenting manifestation of asthma or occur in patients with a known asthma diagnosis in
response to a “trigger” such as viral upper respiratory infection, allergen or irritant exposure, lack
of adherence to controller medication, or an unknown stimulus
Epidemiology
Acute exacerbations of bronchial asthma (AEBA) are most commonly triggered by viral
respiratory infections, particularly with human rhinovirus. Given the importance of these events
to asthma morbidity and health care costs, we will review common inciting factors for asthma
exacerbations and approaches to prevent and treat these events.
Asthma is a highly prevalent chronic respiratory disease affecting 300 million people
world‐wide. A substantial percentage of the costs and morbidity associated with asthma is due to
acute asthma exacerbations. Each year in the United States, there are around 15 million
outpatient visits, 2 million emergency department visits, and 500 000 hospitalizations for acute
asthma management. The majority of exacerbations in children and adults are caused by
common respiratory viruses, particularly rhinoviruses.
According to the latest NIH National Asthma Education and Prevention Guidelines,
asthma exacerbations are acute or subacute episodes of progressively worsening shortness of
breath, cough, wheezing, and chest tightness, or some combination of these symptoms,
characterized by decreases in expiratory airflow and objective measures of lung function
(spirometry and peak flow). These episodes are distressing to patients and result in considerable
utilization of health care resources and loss of work productivity and school attendance.
Prognosis
Asthma exacerbations are more common in females than in males, and females are twice
as likely as males to be hospitalized for asthma. However, asthma prevalence is higher in post‐
pubertal females than post‐pubertal males and this fact is a large part of the explanation for the
higher numbers of adult females seeking care for acute asthma. The higher prevalence of asthma
in adult females contrasts with the higher prevalence of asthma in male children. This difference
in gender predisposition for asthma in adulthood vs. childhood likely reflects the complicated
effects of sex hormones in asthma pathogenesis. Evidence for a role of estrogen in asthma comes
from observations of increased asthma exacerbations during menses, a higher incidence of adult‐
onset asthma in women taking hormone replacement therapy, and from animal models. Race and
ethnicity also play an important role in risk of asthma exacerbation.
Asthma exacerbations can be classified as mild, moderate, severe, or life threatening.
Criteria for exacerbation severity are based on symptoms and physical examination parameters,
as well as lung function and oxygen saturation.
Causes/Risk Factor

 Exposure to an allergen, such as tree, grass or weed pollen, dust mites, cockroaches or
animal dander.
 Exposure to irritants in the air, such as smoke or chemical fumes, and strong odors, such
as perfume.
  Exposure to irritants such as cigarette smoke exposure and diesel exhaust fumes
 Drugs known to worsen asthma
 Weather, especially extreme changes in temperature
 Exercise
 Respiratory infections such as colds, flu, or pneumonia

Other bacteria that can cause bronchial asthma acute exacerbation:

 Haemophilus influenza
 Streptococcus pneumoniae
 Moraxella catarrhalis
 Mycoplasma pneumoniae
 Chlamydia pneumoniae

Asthma risk factor

 Using more than two rescue inhalers per month

 Having asthma exacerbations, or attacks, that come on suddenly
 Having other chronic health problems
 Smoker
 Not using asthma medication as directed
 Having a cold, flu, or another respiratory infection

Clinical Manifestation

 Most common symptoms of asthma are cough (with or without mucus generation),
dyspnea, and wheezing (first on expiration, at that point conceivably amid inspiration as
well)
 Cough. There are occasions that hack is the as it were symptom
 Dyspnea. Common snugness may happen which leads to dyspnea
 Wheezing. There may be wheezing, to begin with on close, and after that conceivably
amid motivation as well
 Asthma assaults frequently occur at night or within the early morning
 An asthma worsening is habitually gone before by expanding indications over days, but it
may start abruptly
 Expiration requires exertion and gets to be prolonged. As compounding advances, central
cyanosis auxiliary to extreme hypoxia may occur
 Additional side effects, such as diaphoresis, tachycardia, and an extended beat weight,
may happen
 Exercise-induced asthma: maximal indications amid work out, nonattendance of
nighttime side effects, and some of the time as it were a depiction of a “choking”
sensation amid exercise
  An extreme, persistent response, status asthmaticus, may happen. It is life-threatening
 Eczema, rashes, and brief edema are unfavorably susceptible responses which will be
famous with asthma
 Severe shortness of breath
 Chest tightness or pain

Diagnostic/Laboratory Procedure
 Spirometry is a simple breathing test that measures how much and how fast you can
blow air out of your lungs. It is often used to determine the amount of airway obstruction
you have. 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 that 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.
 Exhaled nitric oxide, nitric oxide is a gas that is produced in the lungs and has been
found to be an indicator of inflammation. Used to evaluate airflow, which is determined
by ratio of force expiratory volume (FEV) to force vital capacity (FVC).
 Challenge tests, these tests might be performed if your symptoms and screening
spirometry do not clearly or convincingly establish a diagnosis of asthma.
 Methacholine and Mannitol. These agents when inhaled, can cause the airways to
spasm and narrow if asthma is present.
 Methacholine is a known asthma trigger. When inhaled, it will cause your airways
to narrow slightly. If you react to the methacholine, you likely have asthma. This
test may be used even if your initial lung function test is normal.
 Chest X-ray. An X-ray helps doctor look for signs of inflammation in the chest. It can
help identify any structural abnormalities or diseases (such as infection) that can cause or
aggravate breathing problems. If inflammation is present, the X-ray can also inform the
doctor about its location and extent.
Treatment
Asthma exacerbations may usually be treated at home or with a visit to your doctor. Your
asthma action plan, which you created with your doctor, can help you manage your symptoms
and acute attacks. However, acute exacerbations often result in a trip to the emergency room.
Emergency treatment may include:
 Administration of oxygen. Administer supplemental oxygen (by nasal cannulae or
mask, whichever is best tolerated) to maintain an SaO2 >90 percent (>95 percent in
pregnant women and in patients who have coexistent heart disease).
  Inhaled beta-2 agonists, such as albuterol (ProAir HFA, Ventolin HFA). Short
Acting Beta Antagonist or SABA treatment is recommended for all patients. The
repetitive or continuous administration of SABA is the most effective means of reversing
airflow obstruction. the frequency of administration varies according to the improvement
in airflow obstruction and associated symptoms and the occurrence of side effects.
 Corticosteroids, such as fluticasone (Flovent Diskus, Flovent HFA). To prevent
difficulty breathing, chest tightness, wheezing, and coughing caused by asthma in adults
and children. It is in a class of medications called corticosteroids. Fluticasone works by
decreasing swelling and irritation in the airways to allow for easier breathing.
An acute exacerbation requires close monitoring. Your doctor may repeat diagnostic tests
several times. You won’t be discharged until your lungs are functioning adequately. If your
breathing continues to be labored, you may have to be admitted for a few days until you recover.
You may need to take corticosteroids for several days following the exacerbation. Your
doctor may also recommend follow-up care.
Medical Management
 Inhaled bronchodilators (beta-2 agonists and anticholinergics) are the pillar of asthma
treatment within the crisis office. In grown-ups and more seasoned children, albuterol
given by a metered-dose inhaler (MDI) and spacer is as viable as that given by nebulizer.
 Nebulized ipratropium can be co-administered with nebulized albuterol for patients
who don't react ideally to albuterol alone
 Systemic corticosteroids (prednisone, prednisolone, and methylprednisolone) ought to
be given for all but the mildest intense worsening; they are unnecessary for patients
whose PEF normalizes after 1 or 2 bronchodilator dosages.
 Antibiotics are indicated only when history, examination, or chest x-ray proposes
underlying bacterial disease; most diseases fundamental asthma exacerbations are likely
viral in beginning.
Pharmacology Management
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 medications include fluticasone propionate (Flovent
HFA, Flovent Diskus, Xhance), budesonide (Pulmicort Flexhaler, Pulmicort Respules,
Rhinocort), ciclesonide (Alvesco), beclomethasone (Qvar Redihaler), mometasone
(Asmanex HFA, Asmanex Twisthaler) 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, inhaled corticosteroids have a relatively
low risk of serious side effects.
  Leukotriene modifiers. These oral medications — including montelukast (Singulair),
zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms.
Montelukast has been linked to psychological reactions, such as agitation, aggression,
hallucinations, depression and suicidal thinking. Seek medical advice right away if you
experience any of these reactions.
 Combination inhalers. These medications — such as fluticasone-salmeterol (Advair
HFA, Airduo Digihaler, others), budesonide-formoterol (Symbicort), formoterol-
mometasone (Dulera) and fluticasone furoate-vilanterol (Breo Ellipta) — contain a long-
acting beta agonist along with a corticosteroid.
 Theophylline. Theophylline (Theo-24, Elixophyllin, Theochron) is a daily pill that helps
keep the airways open by relaxing the muscles around the airways. It's not used as often
as other asthma medications and requires regular blood tests.
Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during
an asthma attack. They may also be used 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, Xopenex HFA). 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. They're inhaled through a face
mask or mouthpiece.
 Anticholinergic agents. Like other bronchodilators, ipratropium (Atrovent HFA) and
tiotropium (Spiriva, Spiriva Respimat) act quickly to immediately relax your airways,
making it easier to breathe. They're mostly used for emphysema and chronic bronchitis,
but can be used to treat asthma.
 Oral and intravenous corticosteroids. These medications — which include prednisone
(Prednisone Intensol, Rayos) and methylprednisolone (Medrol, Depo-Medrol, Solu-
Medrol) — relieve airway inflammation caused by severe asthma. They can cause serious
side effects when used long term, so these drugs are used only on a short-term basis to
treat severe asthma symptoms.
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.
 Biologics. These medications — which include omalizumab (Xolair), mepolizumab
(Nucala), dupilumab (Dupixent), reslizumab (Cinqair) and benralizumab (Fasenra) — are
specifically for people who have severe asthma.
Nursing management
 Assess history. Get a history of unfavorably susceptible responses to solutions some time
recently regulating medications.
 Assess respiratory status. Evaluate the patient’s respiratory status by observing the
seriousness of side effects, breath sounds, top flow, beat oximetry, and imperative signs.
 Assess medication. Recognize medicines that the understanding is as of now taking.
Regulate solutions as endorsed and screen the patient’s reactions to those drugs; drugs
may incorporate an anti-microbial in the event that the understanding has a basic
respiratory infection.
 Pharmacologic treatment. Regulate solutions as prescribed and screen patient’s reactions
to medications.
 Fluid treatment. Regulate liquids in case the patient is dehydrated.
 II. Demographic Data
On the 26th day of July year 2018 around 10:00 in the morning, a 38-year-old female
client was rushed to hospital. The patient was born on October 15, 1983 in Cauayan, Isabela, she
is a Filipino citizen from City of Ilagan, Isabela. Patient Mrs. MC is a devoted member of
Methodist since she was young. The patient was brought by her husband with chief complaint of
Dyspnea and low-grade fever the final diagnosis is Bronchial Asthma in Acute Exacerbation.

III. Nursing History

According to the patient she had cough accompanied by fever for 3 days, body weakness and
not relieved by analgesic. She also has a hoarness of voice, difficulty of breathing, easily get
tired, no known allergy and no history of smoking. Her husband said before they went to the
hospital, her wife is having a productive cough with phlegm. And he also mentioned that his wife
was diagnosed with asthma 2 years before her current hospitalization
Upon admission, the patient is conscious, her vital signs indicate as follow: blood pressure of
120/80mmHg, heart rate of 110 beats per minute, respiratory rate of 24 breaths per minute,
temperature of 36.3 ̊c and oxygen saturation of 97%. Her HEAD-EENT shows pink, palpable
conjunctiva, and anicteric sclerae. She is positive in dyspnea, and has wheezes, when the patient
laid in bed, the intercostal retraction is so obvious because her abdomen is flat but there’s no
signs of cyanosis and vomiting. Her extremities, genitalia, Musculo-skeletal and neurologic
function are unremarkable.
Dr. Spencer then ordered the following laboratories: Complete Blood Count, Urinalysis and
Chest x-ray. As for medication he ordered: Nebulize with 1 combivent q8, Paracetamol 500 mg
1-tab q4 PRN for fever, Cefuroxime 750 mg IV q8 ANST (-), Fluimucil 200 mg TID (dissolve
the granules into 1 glass of water), and Hydrocortisone 100 mg IV q12. Administration of IVF:
D5LR 1L x 8 hours, DAT, and secure consent.
He then admitted Mrs. Pedro to ROD under the service of Dr. Ferrer on July 26, 2018 at
10:28 in the morning with the final diagnosis of Bronchial Asthma in Acute Exacerbation.
 IV. Anatomy and Physiology

Asthma is a chronic lung disease. It causes inflammation and narrowing of your airways.
This can affect your airflow. The symptoms of asthma come and go. When symptoms flare up
and get progressively worse, it can be called an exacerbation, an attack, an episode, a flare-up.
Your airways become swollen during an acute exacerbation. Your muscles contract and your
bronchial tubes narrow. Breathing normally becomes more and more difficult.
In asthma, the dominant physiological event leading to clinical symptoms is airway
narrowing and a subsequent interference with airflow. In acute exacerbations of asthma,
bronchial smooth muscle contraction (bronchoconstriction) occurs quickly to narrow the airways
in response to exposure to a variety of stimuli including allergens or irritants. Allergen-induced
acute bronchoconstriction results from an IgE-dependent release of mediators from mast cells
that includes histamine, tryptase, leukotrienes, and prostaglandins that directly contract airway
smooth muscle (Busse and Lemanske 2001). Aspirin and other nonsteroidal anti-inflammatory
drugs (see section 3, component 3) can also cause acute airflow obstruction in some patients, and
evidence indicates that this non-IgE-dependent response also involves mediator release from
airway cells (Stevenson and Szczeklik 2006). In addition, other stimuli (including exercise, cold
air, and irritants) can cause acute airflow obstruction. The mechanisms regulating the airway
response to these factors are less well defined, but the intensity of the response appears related to
underlying airway inflammation. Stress may also play a role in precipitating asthma
exacerbations. The mechanisms involved have yet to be established and may include enhanced
generation of pro-inflammatory cytokines.
 Asthma is characterized by episodic symptoms and variable airflow obstruction that
occur either spontaneously or in response to environmental exposures. Current therapeutic
approaches are based on an understanding of allergen induced airway responses and, when
optimally applied, minimize the day‐to‐day variability of asthma and lead to significant
improvements in quality of life. Despite this, however, people with asthma continue to
experience exacerbations of their disease. These exacerbations are frequently triggered by viral
respiratory infection and current treatment approaches are of limited value during these
exacerbations. This indicates that asthma exacerbations have a different immunopathogenesis,
and emphasizes the need to identify the pathways involved in order to improve their treatment.
Asthma exacerbations are an exaggerated lower airway response to an environmental
exposure. Respiratory virus infection is the most common environmental exposure to cause a
severe asthma exacerbation. Airway inflammation is a key part of the lower airway response in
asthma exacerbation, and occurs together with airflow obstruction and increased airway
responsiveness. The patterns of airway inflammation differ according to the trigger factor
responsible for the exacerbation. The reasons for the exaggerated response of asthmatic airways
are not completely understood, but recent studies have identified a deficient epithelial type 1
interferon response as an important susceptibility mechanism for viral infection.
The symptoms of asthma vary. You may not have any symptoms between exacerbations.
The symptoms can range from mild to severe. They may include wheezing, coughing, chest
tightness, shortness of breath. An exacerbation can pass quickly with or without medication. It
can also last for many hours. The longer it goes on, the more likely it is to affect your ability to
breathe.
The signs and symptoms of an acute exacerbation or attack of asthma includes agitation,
hyperventilation, increased heart rate, decreased lung function, difficulty speaking or breathing.
Moreover, an accute exacerbations can be triggered by a variety of things. Some of the more
common triggers are upper respiratory infections, colds, allergens (such as pollen, mold, and dust
mites), cats and dogs, tobacco smoke, cold, dry air, exercise, gastroesophageal reflux disease. It
may be a combination of factors that set off the chain reaction. Since there are so many potential
triggers, it’s not always possible to identify the exact cause.
Trachea
The trachea, often known as the windpipe, is the lungs' principal airway. At the fifth
thoracic vertebra, it splits into right and left bronchi, directing air to the right or left lung. It is
lined with goblet cells that produce mucus and pseudostratified ciliated columnar epithelial cells.
The trachea is a component of the conducting zone that allows air to enter and exit the lungs.
To protect and preserve the airway, there are around 15 to 20 C-shaped cartilaginous
rings that reinforce the anterior and lateral sides of the trachea, leaving a membranous wall (pars
membranes) dorsally without cartilage where the C-shape is open. The C-shaped cartilaginous
rings allow the trachea to gently collapse at the aperture, allowing food to flow down the
esophagus. During coughing, the trachealis muscle joins the ends of the open part of the C-
shaped rings and contracts, lowering the size of the trachea lumen and increasing air flow rate.
The esophagus is located behind the trachea. The mucocilliary escalator is a device that helps
keep infections out of the lungs. The conducting zone includes the trachea, which adds to
anatomical dead space.
Lungs
The lungs are the respiratory system's foundational organs, and their primary role is to
promote gas exchange from the environment into the bloodstream. Made up of hundreds of tubes
known as bronchi that terminate in small sacs known as alveoli, where gases are exchanged. The
tubes, which are very small, are surrounded by muscle that can constrict or relax. These tubes
also are lined with tissue that if irritated can swell and produce mucus. If constriction of the tubes
takes place, and mucus accumulates, an asthmatic attack will result. Usually, an allergic reaction
causes tubes to react. The alveoli deliver oxygen into the capillary network, from which it can
enter the arterial system and ultimately perfuse tissue.
 The two lungs aren't the same, they are not identical. The right lung has three lobes, while
the left lung has two. They are further subdivided into segments, which are then further
subdivided into lobules. The smallest subdivision visible to the naked eye is lobules, which are
hexagonal divisions of the lungs. The oblique fissure, which divides the inferior lobe from the
middle and superior lobes, and the horizontal fissure, which divides the superior from the middle
lobe, divide the right lung. The oblique fissure separates the top and lower lobes of the human is
the left lung. It has a cardiac notch, which is a concave indentation formed to fit the heart's
shape. The lingula is the left lung's equivalent of the right lung's middle lobe, however it is not
strictly a lobe. The hilium is the root of the lung and contains the pulmonary nerves and lymph
arteries, as well as the tissues involved in pulmonary circulation.

Bronchus
A bronchus is a respiratory tract airway that transports air to the lungs and separates into
terminal bronchioles. A bronchus (plural bronchi, adjective bronchial) is a passage of airway that
conducts air to the lungs. Bronchioles are tiny tubes that branch off from the bronchus. The
bronchi and bronchioles, like the trachea and upper respiratory tract, are considered anatomical
dead space since no gas exchange occurs within this zone.
At the anatomical point known as the carina, the human trachea (windpipe) separates into
two main bronchi (also known as mainstem bronchi). The right major bronchus is both wider and
shorter than the left. The left major bronchus separates into two and the right main bronchus
divides into three lobar bronchi.
Each of the bronchopulmonary segments is supplied by the tertiary bronchi, also called as
segmentalinic bronchi. The segmental bronchi are divided into multiple primary bronchioles,
which divide into terminal bronchioles, each of which gives rise to several respiratory
bronchioles, which subsequently divide into and terminate in tiny air sacs known as alveoli. The
mucous membrane of the principal bronchi is lined by 8ciliated pseudostratified columnar
epithelium at first, but it soon transforms to simple cuboidal epithelium, then plain squamous
epithelium. Part of the conducting zone, the bronchi contribute to anatomical dead space.
The function of alveoli in the respiratory system is to exchange oxygen and carbon
dioxide molecules into and out of the bloodstream. These tiny, balloon-shaped air sacs are
organized in clusters throughout the lungs and are found at the extreme end of the respiratory
tree.
The alveoli are hollow cavities in the lungs that exchange gas with the blood. An
anatomical structure in the shape of a hollow cavity is known as an alveolus. Its plural is alveoli,
which comes from the Latin word alveolus, which means "small cavity." The pulmonary alveoli
are the terminal terminals of the respiratory tree that protrude from either alveolar sacs or
alveolar ducts, both of which are sites of gas exchange with blood, and are found in the lung
parenchyma. The gas-exchange surface is the alveolar membrane. Carbon dioxide-rich blood is
pumped from the rest of the body into the alveolar blood vessels, where it is released and oxygen
is absorbed through passive diffusion. An epithelial layer and an extracellular matrix surround
capillaries in the alveoli. The pores of Kohn are found between alveoli in some alveolar walls.
To keep the lungs elastic, great alveolar cells release pulmonary surfactant, which lowers the
surface tension of water.
Diaphragm
The thoracic (chest) and abdominal chambers are separated by the diaphragm, a dome-
shaped muscular and membrane structure. It is the primary respiratory muscle. The diaphragm
muscles are linked to a central membrane tendon that originates from the lower half of the
sternum (breastbone), the lower six ribs, and the lumbar (loin) vertebrae of the spine. When the
diaphragm contracts, it raises the internal height of the thoracic cavity, lowering the internal
pressure and allowing air to enter. Expiration is caused by the diaphragm relaxing and the natural
flexibility of lung tissue and the thoracic cage. Coughing, sneezing, vomiting, sobbing, and
releasing feces, urine, and, in parturition, the fetus are all actions that require the diaphragm.
 V. Pathophysiology

BRONCHIAL ASTHMA IN ACUTE EXACERBATION

Exercise, cold, exposure to an allergen, ingestion of aspirin, pulmonary

infection, inhaled irritants, stress

IgE Production

Re-exposure to allergen

Release pre-formed medicators that open tight junction between

Antigen enter the mucosa

Activation of mucosal mast cell

Medicators: histamine, SRS-A, prostaglandin, bradykinins, leukotines

Airway hyperresponsiveness

↓ Vascular Bronchospasm Further release ↓No. of mucus Basement

permeability membrane
of leukocytes by goblet cells
(Neutrophils, in mucosa and underlying the
eosinophils, hypertrophy of mucosal
Edema epithelium is
basophils, submandibular
thickened and
lymphocytes) glands
there is
hypertrophy

Chest Wheezes

Peak flow Shortness of

variability breathing

Intense
Productive
inflammation of
Cough
bronchial walls
 VI. Lab/dx result and Interpretation
DIAGNOSTICS: JULY 25,2018

COMPLETE BLOOD COUNT:

WBC 5.92 4.0000-10,0000 RBC:4.96 3.5000-5.0000
Neu% 0.645 0.5000-0.7000 HGB:151 110.0000-150.0000
Lym% 0.220% 0.2000-0.4000 HCT; 0.468 0.3700-0.4700
Mon% 0.123% 0.0300-0.1200 MCV:94.0 80.0000-100.0000
Eos% 0.010% 0.0050-0.500 MCH:30.3 27.0000-34.0000
Bas% 0.002% 0.0000-0.0100 MCHC:323 320.0000-360.0000
PLT:246 100.0000-300.0000

INTERPRETATION
The following components of Patient XY's complete blood count are normal: white blood cells,
red blood cells, neutrophils, lymphocytes, hemoglobin, hematocrit, eosinophils, MVC, MCH,
MCHC, basophils, and platelet count. However, the patient XY Monocyte values are extremely
high that is related to cardiovascular disease, and that early detection of increased monocytes.
URINALYSIS: JULY 25,2018

MACROSCOPIC ANALYSIS
Color: Dark yellow RBC: 0-2/hpf
Transparency: Turbid WBC: 1-2/hpf
Epithelial cells: Many
Result : Amorphous Materials: Rare
Glucose: Negative Mucus Threads: Few
Protein: Negative Bacteria: Many
pH: 6.0
Specific Gravity: 1.030

INTERPRETATION:
Patient XY urinalysis shows that the urine is highly concentrated because it has a darker yellow
appearance. Normally, fresh urine is clear to very slightly cloudy, but patient XY's turbid urine
transparency indicates dehydration, or infections. Patient XY urine shows presence of bacteria,
epithelial cells and a few mucus threads. And also, glucose, protein, pH and specific gravity in
the patient's urine is normal.
CHEST PA: JULY 25,2018

Radiological Findings:

There are no parenchymal infiltrates in both lung fields.

The heart is not enlarged
Aorta is unremarkable
Chest wall, hemidiaphragms,costophrenic sulci and visualized bones are intact.

Impression:
Unremarkable chest XRAY.

INTERPRETATION:
Patient XY radiologic test shows a normal size and shape of the chest wall and the main
structures of the chest. It generally means that the test did not find anything abnormal. It means
there was nothing critically wrong with the patient. The chest X-ray of the patient is normal.
 VII. Course in the ward (Treatment Modalities)

COURSE IN THE WARD

Patient XY, 38 years old, female. Diagnose with Bronchial Asthma in Acute Exacerbation.
Date& Time of Admission: 07/26/2018 10:28 AM
Date & Time of Discharged: 07/29/2018 11:34 AM

DATE ASSESSMENT DOCTOR'S RATIONALE NURSING

ORDER RESPONSIBILITY
Day of Chief Flutizal 250/25 These  Assess
Admission Complaint: mcg MDI 2 medications is patient's
(07/26/2018) Dyspnea and puffs OD used in the history.
low-grade fever Dilatair 200 mg treatment of
Obtain a
tab BID obstructive
Zykast 10 mg airway history of
tab OD HS diseases. It is allergic
T/F PNSS 1L x indicated for reactions to
KVO the treatment of medications
Continue other bronchial before
medications asthma, administering
↑ nebulization pulmonary
medications.
to q8 hrs x 3 disease with
doses then q6 spastic  Assess
hrs bronchial respiratory
component and status.
Chronic  Administer
Obstructive medications
Pulmonary
Disease as prescribed
(COPD). It and monitor
helps prevent the patient’s
wheezing, responses to
difficulty in those
breathing, chest medications.
tightness, and
 Assess for
coughing
caused by breath
asthma in sounds.
adults.  Monitor the
patient’s vital
signs.

Second Day no DOB, ↓↓ Continue Continuing  Assess

(07/27/2018) wheezes, no medication medications respiratory
fever T/F PNSS 1L x helps in aiding status.
KVO the symptoms  Administer
of bronchial
medications
asthma in
adults. as prescribed
and monitor
the patient’s
responses to
those
medications.
 Assess for
breath
sounds.
 Monitor the
patient’s vital
signs.

Third Day ↓wheezes, no ↓Hydocortisone Nebulizers can  Assess

(7/28/2018) DOB to q12 hrs be used to respiratory
↓neb to q8 hrs administer status.
IVF to consume medication
directly and  Administer
quickly to the medications
lungs. as prescribed
and monitor
the patient’s
responses to
those
medications.
 Assess for
breath
sounds.
 Monitor the
patient’s vital
signs.

Fourth Day no DOB, no May Go Home Continuing  Health

(Discharged) wheezes (MGH) medications at teaching on
(7/29/2018) Take home home aid in the the disease,
Medication recovery of the
food intake
Duavent neb q8 patient.
hrs and exercise.
Cefuroxime  Health
(Zegen) 500 mg teaching
tab BID x 5 about
days medication
Meprasone 16
that will be
mg tab 1 tab
OD taken at
Flutizal MDI 2 home as
puffs OD prescribed by
Dilatair 200 mg the doctor.
tab BID
Zykast 10 mg
tab OD HS
Follow-up on
Saturday 1 pm
 VIII. Nursing Care Plan (Focus Assessment)

NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective Data Ineffective Airway Short Term Independent Independent Short Term
“Ilang raw na po Clearance related Objective  Establish rapport.  To gain patient’s and Objective
kasi inuubo yung to tracheobronchial After 2 hours of relatives’ trust. Goal was fully met
wife ko, tapos po
secretions as quality nursing care after 2 hours of
kaninang umaga
bigla po siyang evidenced by: intervention the  Monitor vital signs  To check if there is a quality nursing care
nahirapan sa patient will be able including pulse rate, change or any intervention as the
 Dyspnea to demonstrate patient
paghinga kaya nag respiratory rate, and improvements.
worry po kami” as  (+) DOB reduction of temperature. demonstrates
verbalized by the  Productive congestion as reduction of
husband cough evidenced by:  Monitor and observe  Because these are congestion as
 Normal and clear respirations and breath indicative of evidenced by:
Objective Data
 Vital signs: breath sounds. sounds, noting rate respiratory distress  Normal and clear
 Lessen sounds (e.g., and/or accumulation of breath sounds.
 BP: 120/80 secretions. tachypnea, stridor, secretions.  Lessens
 HR: 110bpm crackles, wheezes). secretions.
 RR: 24cpm Long Term
 T: 36.3°C Objective  Position head  To open or maintain Long Term
 O2 Sat: 97% After 8 hours of open airway of the Objective
appropriate for age and
quality nursing care Goal was fully met
 Dyspnea condition. Elevate patient.
intervention the after 8 hours of
head of bed and
patient will be able quality nursing care
change position every
to maintain airway intervention as the
2 hours and prn.
patency as patient maintains
evidenced by:  Encourage deep- airway patency as
 Maintain normal breathing and courage  To maximize effort. evidenced by:
and clear breath exercises.  Maintain normal
sounds. and clear breath
 Clear secretions  Maintain an adequate sounds.
fluid intake at least  Clear secretions
readily.  To determine ability to
1000 mL/day. readily.
protect own airway.
 Evaluate patient’s   (-) DOB
Hydration can help
cough/gag reflex and liquify viscous
swallowing ability. secretions and
improve secretion
clearance.
Dependent Dependent
 Give expectorants  To promote
and bronchodilators pharmacologic
as ordered.
regimen.
 Administer oxygen
support via nasal  To maintain open
canula as ordered. airway.
 Suction
naso/tracheal/oral prn  To clear airway when
excessive or viscous
secretions are blocking
airway or client is
unable to swallow or
Collaborative cough effectively.
 Assist with procedures
(e.g., bronchoscopy, Collaborative
tracheostomy) as  To clear and maintain
ordered. open airway.
 Assist with appropriate  To identify
testing. causative/precipitatin
g factors.
 Refer to chest x-rays
department, ABG’s as  To provide further
ordered. information and
examination.
 Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective Data Ineffective Short Term Independent Independent Short Term
"I have a cough Breathing Objective  Establish rapport.  To gain patient’s trust Objective
that accompanied Pattern related to After 2 hours of Goal was fully met
by fever for 3  Monitor and record 
tracheobronchial nursing care To obtain baseline data after 2 hours of
days and vital signs
hoarseness of secretions as intervention the nursing care
voice" as evidenced by: patient will lessen intervention as the
 Assess and monitor  To check if there is an
verbalized by the the secretion and patient lessen the
 Dyspnea breath sounds, improvement or
patient. coping to maintain a respiratory rate, depth secretion and able
 DOB indicative of
normal breathing and rhythm. respiratory distress to maintain a
Objective Data  Productive pattern as evidenced normal breathing
 Vital signs: cough by:  Assess client’s  pattern as
Affects ability to
 BP: 120/80 awareness and manage own airway evidenced by:
 Normal cognition and cooperate to
 HR: 110bpm
breathing intervention  Normal
 RR: 24cpm
sounds and breathing
 T: 36.3°C  Note presence and  Cough that is persistent
pattern sounds and
 O2 Sat: 97% character of cough and constant can
 Lessen pattern
interfere with breathing
 Dyspnea secretion  Lessen
 (+) DOB  Breathing secretion
effort  Encourage  To improve respiratory  Breathing
decrease ambulation/exercise muscle strength effort
decrease

Long Term Long Term

Objective Dependent Dependent Objective
After 8 hours of Goal was fully met
nursing care
intervention the  Medicate with  To promote deeper after 6 hours of
patient will lessen analgesics as ordered respiration and cough nursing care
the secretion and intervention as the
able to maintain  Administer  For the patient lessen the
normal breathing prescribed pharmacological secretion and able
pattern as evidenced medication as ordered management of the to maintain normal
by: patients breathing pattern as
evidenced by:
 Maintain normal
breathing sounds Collaborative Collaborative  Maintain
and pattern normal
 Clear secretions  Assist with  To promote breathing
readily bronchoscopy or physiological and sounds and
 Effortless chest tube insertion psychological ease of pattern
breathing as ordered maximal inspiration  Clear secretions
readily
 Effortless
 Refer for general  To maximize the
breathing
exercise program client’s level of
functioning

 Provide/encourage  To facilitate deeper

use of adjuncts such respiratory effort
as incentive
spirometer
 Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Impaired Gas After 8 hours of Independent: Independent: Goal – met when
“nahihirapan po Exchange related nursing intervention 1. Monitor skin and 1.-Duskiness and central patient was able to
ako huminga as to altered oxygen patient will be able mucous membrane color cyanosis indicate advanced demonstrate
verbalized by the supply to: hypoxemia. improved
patient” (obstruction of 1. Demonstrate ventilation and
airways by improved ventilation 2. Elevate head of the 2.Oxygen delivery may be adequate
Objective: secretion) and adequate bed, assist patient to improved by upright oxygenation of
RR: 24  As evidenced oxygenation of assume position to ease suctioning. tissues by HBGs
cycles/min by wheezing tissues by HBGs work of breathing. within clients
PR:110 beats/min upon within client’s normal limits
HR: 12/80 normal limits. 3. Suction when needed. 3.Suctioning is required
auscultation
 -present when cough is ineffective
Wheezing 2. Participate in for expectoration of
sound during treatment regimen secretions.
(e.g., breathing
auscultation.
exercises, effective 4. Auscultate breath 4.Presence of wheezes may
coughing, use of sounds, noting areas of indicate
oxygen) within level decreased air-flow or bronchospasm/retained
of ability/situation. presence of adventitious secretions.
sound.
 3. Verbalize
understanding of 5.Palpate for fremitus 5.Decrease of vibratory
causative factors tremors suggest fluid
and appropriate collection or air tapping.
intervention
Dependent: Dependent:
1. administer 1. facilitates mobilization
bronchodilators of secretion from bronchial
medication as prescribed tree, improves distribution
by the physician. of ventilation.
Collaborative: Collaborative:
 Assisted with  to improve respiratory
procedures as function/oxygen-
individually indicated carrying capacity.
(e.g., transfusion,
phlebotomy,
bronchoscopy
 Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective Data Activity Short term Independent Independent Short Term
“Nanghihina po ako Intolerance After 3 hours of  Establish rapport  To gain trust. Goal was met after 3
at hirap po sa related to nursing care hours of nursing
paghinga. Hindi ko imbalance  Steam inhalation and  Loosen secretions and intervention as the
intervention the
na po magawa mga between oxygen cool environment maintain breathing patient decreased in
trabaho ko po sa supply and patient will be physiological signs of
patency
aming tahanan.” demand as able to intolerance as
manifested by: demonstrate  Have the patient sit  Helps in performing evidenced by:
Objective Data decrease in comfortably with efficient breathing by  Improved
 Vital signs:  Body physiological knees bent and maximizing the breathing
weakness signs of shoulders, head, expansion of the  Can perform ADL
 BP: 120/80  DOB neck relaxed. lungs. without assistance
intolerance as
 HR: 110bpm
manifested by:
 RR: 24cpm  Encourage  This method relaxes Long Term
 T: 36.3°C  Improve diaphragmatic muscles and increases Goal was met after 24
 O2 Sat: 97% breathing breathing for the patient’s oxygen hours of nursing
 Able to perform patients with chronic level. intervention as the
 Dyspnea ADL with disease. patient demonstrates
 (+) DOB minimal  Extra activity can and reports
 Encourage frequent worsen shortness of measurable increased
 Weak in assistance
rest periods and breath. Ensure the in activity tolerance as
appearance teach patient to pace patient rests between evidenced by:
Long term activity. strenuous activities.
Within 8 hours of  (-) DOB
nursing care  To motivate the  (-) dyspnea
intervention, the  Encourage patient and lessen  Able to
patient will report participation in anxiety. accomplish ADL’s
measurable recreation, social and usual activity
activities, and without difficulty
increase in
hobbies appropriate  Patients have to go and assistance.
activity tolerance
as evidenced by: for situation. through difficult times
 Able to do  Provide with their illnesses
ADL’s and opportunities for the and experience a lot
patient to express of change. It is
usual activity
positive and negative beneficial for the
without any feelings. patient to vent and
difficulty and talk about their
assistance emotions.
 Maintain
normal  Symptoms may be a
breathing  Note clients report result of or contribute
weakness, fatigue, to intolerance of
pattern
pain, difficulty activity.
accomplishing tasks,
and/or insomnia.  To enhance ability to
participate in
 Promote comfort activities.
measures and
provide relief of
pain. Dependent
 Beta-adrenergic
Dependent agonist medications
 Provide respiratory relax airway smooth
medications and muscles and cause
oxygen, per bronchodilation to
doctor’s orders. open air passages.

Collaborative
 To have further
Collaborative information on the case
 Refer to x-ray as of the patient
ordered
 Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective Data Deficient Short term Independent Independent Short Term
“Hindi ko naman po Knowledge After 3 hours of  Establish rapport  To gain trust. Goal was met after 3
alam na aabot ng related to nursing care hours of nursing
ganto kalala. Akala insufficient  Steam inhalation and  Loosen secretions and intervention as the
intervention the
po kasi naming information cool environment maintain breathing patient is able to
simpleng ubo at sources as patient will be demonstrate and
patency
lagnat lang po gawa manifested by: able to identify interferences
nga po ng panahon demonstrate and  Encourage  This method relaxes to learning and
at akala po naming  Ineffective identify diaphragmatic muscles and increases specific actions to
kaya na po ng self-care interferences to breathing for the patient’s oxygen deal with them as
paracetamol lang learning and patients with chronic level. manifested by:
yung fever ko po”
specific actions to disease.  Identify
 To motivate the relationship of
Objective Data deal with them as
 Provide patient and lessen signs/symptoms to
 Vital signs: manifested by: the disease
opportunities for the anxiety because
 Identify patient to express patients have to go process
 BP: 120/80 relationship of positive and negative through difficult times
 HR: 110bpm signs/symptoms feelings. with their illnesses Long Term
 RR: 24cpm to the disease and experience a lot Goal was met after 24
 T: 36.3°C of change. It is hours of nursing
process.
 O2 Sat: 97% beneficial for the intervention as the
patient to vent and patient is able to
 Inaccurate Long term talk about verbalize
their
follow-through Within 8 hours of emotions. understanding of
of instruction or
nursing care condition, disease
performance on
intervention, the  Determine the  Because the process, and treatment
a test or
procedure patient will be client’s ability, individual may not be as manifested by:
readiness, and physically,  Perform necessary
 DOB able to verbalize
barriers to learning. emotionally, or procedures
understanding of mentally capable at correctly and
condition, disease this time. explain reasons
process, and  Note personal for the action.
treatment as factors (age and  This may affect  Initiate necessary
developmental level, ability and desire to lifestyle changes
manifested by:
gender, social and learn and assimilate and participates in
 Perform cultural influences, new information. treatment regimen
necessary religion, and  (-) DOB
procedures emotional stability.)
correctly and
explain reasons  Begin with  This can arouse
for the action. information that interest and limit
client already knows sense of being
 Initiate and move to client overwhelmed.
necessary does not know,
lifestyle progressing from
changes and simple to complex.
participates in
treatment  Involve the  To provide a role
client/SO in model and sharing of
regimen
explaining. information.

 Provide information  Reducing the amount

relevant only to the of information at
situation and identify anyone given time
information that helps to keep the
needs to be client focused and
remembered. prevents client from
feeling overwhelmed.

 Differentiate  To identify
“critical” content information that can
 from “desirable” be addressed at a later
content. time.
 Provide written  This reinforces the
information or learning process and
guidelines and self- allows the client to
learning modules for proceed at his or her
clients to refer as own pace.
necessary.

 Provide positive  To encourage

reinforcement. continuation of efforts
of the client

Collaborative
 Refer to support Collaborative
groups, as ordered  Asthma support groups
offer an environment in
which the client can
learn new ways of
dealing with the illness
and appropriate health
behaviour changes such
as smoking cessation.
 IX. Drug Study Discharge Plan
NURSING
DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS
RESPONSIBILITY
GENERIC NAME Paracetamol To relieve mild to Hypersensitivity to  Hematologic:  Monitor vital signs
Paracetamol exhibits analgesic moderate pain acetaminophen or Hemolytic anemia,  Assess patients’ fever
BRAND NAME action by due to things such phenacetin; use with leukopenia, or pain: type of pain,
Biogesic peripheral as headache, alcohol. neutropenia, location of pain,
CLASSIFICATIO blockage of pain muscle and joint thrombocytopenia, intensity, duration,
impulse pain, backache pancytopenia temperature, and
N
generation. It and period pains.  Hepatic: Liver diaphoresis.
Pharmacologic produces It is also used to damage, jaundice  Assess allergic
class: Synthetic antipyresis by bring down a high  Metabolic: reaction: rash,
non-opioid inhibiting the temperature. Hypoglycemia uiticaria: if these
paminophenol hypothalamic heat-  Skin: rash, occur, drug may have
regulating centre. urticuria. to be discontinued.
Therapeutic class: Its weak anti-  Teach patient to
inflammatory recognize signs of
Analgesic,
activity is related chronic overdose:
antipyretic to inhibition of bleeding, bruising,
ACTUAL DRUG prostaglandin malaise, fever, sore
ORDER synthesis in the throat.
500mg – 1 tab CNS.  Tell patient to notify
prescriber for pain/
FREQUENCY fever lasting for more
q4 PRN than 3 days.
 NURSING
DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS
RESPONSIBILITY
GENERIC NAME Ipratropium To prevent and Patient with cardiac  CNS: dizziness,  Monitor vital signs
Ipratropium/ appears to inhibit relieve tachyarrhythmias, excitement,  Monitor respiratory
Albuterol vagally mediated bronchospasm hypertrophic headache, status, auscultate
BRAND NAME reflexes by in patients with obstructive hyperactivity, lungs before and after
antagonizing the reversible cardiomyopathy and insomnia nebulization.
Combivent
action of obstructive patient with history of  CV: hypertension,  Stay alert for
CLASSIFICATIO
acetylcholine. airway disease hypersensitivity palpitations, hypersensitivity
N Anticholinergics tachycardia, chest reactions and
Pharmacologic prevent the pain paradoxical
class: increases in  EENT: bronchospasm. Stop
Anticholinergic intracellular conjunctivitis, dry drug immediately if
concentration of and irritated throat, these occur.
Therapeutic class: cyclic guanosine pharyngitis  Teach patient signs
monophosphate  GI: nausea, and symptoms of
Bronchodilator
(cyclic GMP) that vomiting, anorexia, hypersensitivity
ACTUAL DRUG result from the
heart-burn, GI reaction and
ORDER interaction of distress, dry mouth paradoxical
Nebulize 1 acetylcholine with  Metabolic: bronchospasm. Tell
combivent the muscarinic hypokalemia him to stop taking
receptor on  Musculoskeletal: drug immediately and
FREQUENCY bronchial smooth muscle cramps contact prescriber if
muscle. these occur.
q8  Respiratory:
cough, dyspnea,  Instruct patient to
wheezing, notify prescriber
paradoxical immediately if
bronchospasm prescribed dosage
 Skin: pallor, fails to provide usual
urticaria, rash, relief, because this
angioedema, may indicate
flushing, sweating seriously worsening
 asthma.
 Advise patient to
limit intake of
caffeine-containing
foods and beverages
and to avoid herbs
unless prescriber
approves.

NURSING
DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS
RESPONSIBILITY
GENERIC NAME Interferes with Moderate to  Hypersensitivity to  CNS: headache,  Monitor vital signs
Cefuroxime bacterial cell- severe infections, cephalosporins or hyperactivity,  Monitor patient for
BRAND NAME wall synthesis including those of penicillins hypertonia, seizures life-threatening
Zinacef and division by skin, bone, joints,  Carnitine deficiency  GI: nausea, adverse effects,
CLASSIFICATIO binding to cell urinary or vomiting, diarrhea, including
wall, causing respiratory tract, abdominal pain, anaphylaxis, Stevens-
N
cell to die. gynecologic dyspepsia, Johnson syndrome,
Pharmacologic Active against infections pseudomembranous and
class: Second gram-negative colitis pseudomembranous
generation and gram-  GU: hematuria, colitis.
cephalosporin positive vaginal candidiasis,  Monitor neurologic
bacteria, with renal dysfunction, status, particularly for
Therapeutic class: expanded acute renal failure signs of impending
activity  Hematologic: seizures.
Anti-infective
against gram- hemolytic anemia,  Monitor CBC with
ACTUAL DRUG negative aplastic anemia, differential and
ORDER bacteria. hemorrhage prothrombin time;
750 mg IV Exhibits  Hepatic: hepatic watch for signs and
minimal dysfunction symptoms of blood
FREQUENCY immunosuppres  Metabolic: dyscrasias.
ant activity.
q8 hyperglycemia  Monitor temperature;
 Skin: toxic watch for signs and
epidermal symptoms of
necrolysis, superinfection.
erythema
multiforme,
Stevens-Johnson
syndrome

NURSING
DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS
RESPONSIBILITY
GENERIC NAME Decreases Treatment of  Hypersensitivity  CNS: dizziness,  Monitor respirations,
Acetylcysteine viscosity of respiratory to drug (except drowsiness, cough, and character
BRAND NAME secretions, infections with antidotal use) headache of secretions.
Fluimucil promoting characterized by  Status asthmaticus  CV: hypotension,  Instruct patient to
CLASSIFICATIO secretion removal thick and viscous (except with hypertension, report worsening
through hypersecretions: antidotal use) tachycardia cough and other
N
coughing, acute bronchitis,  EENT: severe respiratory
Pharmacologic postural drainage, and its rhinorrhea symptoms.
class: N-acetyl and exacerbations: 
 GI: nausea, Advise patient to mix
derivative of mechanical pulmonary vomiting, oral form with juice
naturally occurring means. In emphysema, stomatitis, or cola to mask bad
amino acid (L- acetaminophen mucoviscidosis constipation, taste and odor.
cysteine) overdose, and anorexia  Monitor effectiveness
maintains and bronchiectasis  Hepatic: of therapy and advent
Therapeutic class:
restores hepatic hepatotoxicity of adverse/allergic
Mucolytic, glutathione,  Respiratory: effects
acetaminophen needed to hemoptysis, tracheal
antidote inactivate toxic and bronchial
metabolites. irritation, increased
secretions,
 ACTUAL DRUG wheezing, chest
ORDER tightness,
200mg – dissolve bronchospasm
the granule into 1  Skin: urticaria,
rash, clamminess,
glass of water
angioedema

FREQUENCY
TID

CONTRAINDICATI NURSING
DRUG NAME ACTION INDICATION ADVERSE EFFECTS
ON RESPONSIBILITY
GENERIC NAME Suppresses Replacement  Hypersensitivit  CNS: headache,  Monitor vital signs
Hydrocortisone inflammatory and therapy in y to drug, nervousness,  In high-dose therapy
BRAND NAME immune adrenocortical alcohol, euphoria, psychoses, (which should not
Colocort, Cortef, responses, mainly insufficiency; bisulfites, or vertigo, paresthesia, exceed 48 hours),
by inhibiting hypercalcemia tartrazine (with insomnia, conus watch closely for signs
Cortenema
migration of due to cancer; some products) medullaris syndrome, and symptoms of
CLASSIFICATIO
leukocytes and arthritis; collagen  Systemic meningitis, seizures depression or
N hydrocortisone diseases; fungal  CV: hypotension, psychotic episodes.
Pharmacologic phagocytes and dermatologic infections hypertension, heart  Monitor vital signs.
class: N Short- decreasing diseases;  Concurrent use failure, shock, fat Monitor blood
acting inflammatory autoimmune and of other embolism, pressure, weight, and
Corticosteroid mediators hematologic immunosuppres arrhythmias electrolyte levels
disorders; sant  EENT: cataracts, regularly.
trichinosis; corticosteroids glaucoma, nasal  Assess blood glucose
Therapeutic class:
ulcerative colitis; congestion, levels in diabetic
Anti-inflammatory multiple sclerosis;  Concurrent hoarseness. patients. Expect to
(steroidal) proctitis; administration  GI: vomiting, increase insulin or oral
ACTUAL DRUG nephrotic of live virus nausea, esophageal hypoglycemic dosage.
ORDER syndrome; vaccines candidiasis or ulcer,  Urge patient to
aspiration
100mg IV pneumonia abdominal distention, immediately report
peptic ulceration, unusual weight gain,
FREQUENCY pancreatitis. face or leg swelling,
q12  GU: menstrual epigastric burning,
irregularities vomiting of blood,
 Hematologic: black tarry stools,
purpura irregular menstrual
 Metabolic: cycles, fever,
hypokalemia, prolonged sore throat,
hyperglycemia, cold or other infection,
diabetes mellitus. or worsening of
 Musculoskeletal: symptoms.
osteoporosis, aseptic  Caution patient not to
joint necrosis, muscle stop taking drug
pain or weakness, abruptly. In long-term
spontaneous fractures use, instruct patient to
 Respiratory: cough, have regular eye
wheezing, rebound exams.
congestion,  Monitor signs of
bronchospasm thrombophlebitis
 Skin: rash, pruritus, (lower extremity
urticaria, skin swelling, warmth,
fragility and thinness, erythema, tenderness)
angioedema, delayed and thromboembolism
wound healing (shortness of breath,
chest pain, cough,
bloody sputum). Notify
physician or nursing
staff immediately

NURSING
DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS
RESPONSIBILITY
 GENERIC NAME Has potent Treatment of  Hypersensitivity  CNS: light  Monitor vital signs
Fluticasone vasoconstrictive asthma for to drug or its headedness,  Monitor patient for
propionate – and anti- patients not components dizziness, giddiness. withdrawal
inflammatory adequately  Primary treatment  EENT: glaucoma, symptoms after
salmeterol
properties controlled on a of status epistaxis, nasal Flovent is
BRAND NAME
long-term asthma asthmaticus or burning or irritation, discontinued. Stay
Flutizal control other acute asthma nasal congestion, alert for systemic
CLASSIFICATIO medication such episodes nasal septum, corticosteroid effects.
N as inhaled necessitating perforation, nasal  Advise patient to
Pharmacologic corticosteroid intensive measures sinus pain, sinusitis, immediately report
class: (ICS) or whose  Severe allergy to allergic rhinitis. signs of allergic
Corticosteroid - disease warrants milk proteins.  GI: nausea, reaction. Instruct
long-acting beta2- initiation of vomiting, diarrhea, patient to report
treatment with abdominal pain, burning, irritation, or
adrenergic agonist
both ICS and  oral candidiasis persistent or
long-acting beta2  GU: dysmenorrhea worsened condition.
Therapeutic class: adrenergic agonist  Caution patient to
 Metabolic:
Antiasthmatics; (LABA). hyperglycemia, avoid exposure to
Anti-inflammatory glucosuria people with
drug  Musculoskeletal: chickenpox or
ACTUAL DRUG aches and pains; measles.
ORDER joint pain, limb  Advise patient that
100/25 mcg MDI 2 pain, sprain, strain, proper application
aches and pains, includes washing area
puffs
back pain before application
 Respiratory: and applying agent
FREQUENCY sparingly and rubbing
asthma symptoms,
OD cough, bronchitis, it in lightly.
wheezing,  Tell patient to avoid
bronchitis, chest prolonged use,
congestion, contact with eyes, or
bronchospasm. use around genital
  Skin: pruritus, skin, area, rectal area, on
dryness, skin face, and in skin
burning, creases.
erythematous rash,  Urge patient to rinse
dusky erythema, mouth well after
eczema corticosteroid
exacerbation, skin inhalation.
irritation, urticaria;
hypertrichosis,
increased erythema.

DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING

RESPONSIBILITY
GENERIC NAME Blocks action of Asthma, seasonal  Contraindicated in  CNS: fatigue,  Monitor vital signs
Montelukast leukotrienes, allergic rhinitis, patients headache, dizziness,  Assess eosinophil
BRAND NAME decreasing parental allergic hypersensitive to asthenia, agitation, count.
Zykast smooth muscle rhinitis drug or its aggressive behavior  Monitor temperature.
CLASSIFICATIO contractions and ingredients. or hostility, Watch for fever and
edema in  Avoid use with anxiousness, other signs and
N
bronchial aspirin and other depression, symptoms of
Pharmacologic airways and hallucinations,
NSAIDs in patients infection.
class: Leukotriene preventing with known aspirin insomnia,  Monitor patient for
receptor antagonist inflammation sensitivity because irritability, change in mood or
and drug hasn't been restlessness, behavior, including
Therapeutic class: bronchospasm shown to affect the suicidal thinking suicidal ideation.
Antiasthmatic bronchoconstrictor and behavior  Instruct patient or
ACTUAL DRUG response to aspirin  EENT: nasal caregiver to notify
and other NSAIDs congestion, otitis prescriber if mood or
ORDER
in aspirin-sensitive and sinusitis (in behavior changes.
10 mg tab asthmatic patients. children)  Caution patient to
 GI: abdominal pain; avoid driving and
 FREQUENCY  Patients with nausea and diarrhea other hazardous
OD HS asthma may present (in children); activities, because
with systemic dyspepsia; drug causes dizziness
eosinophilia that infectious
may manifest as gastroenteritis
clinical features of  Respiratory: cough
vasculitis consistent  Skin: rash
with Churg-Strauss
syndrome.

DRUG NAME ACTION INDICATION CONTRAINDICATI ADVERSE NURSING

ON EFFECTS RESPONSIBILITY
GENERIC NAME The main Indicated for the  Individuals who  CNS: headache,  In high-dose therapy
Doxofylline mechanism of treatment of have shown cephalagia, (which should not
BRAND NAME action of chronic hypersensitivity to irritably, insomnia exceed 48 hours),
Dilatair doxofylline is obstructive its components. It is  CV: heart disease, watch closely for signs
CLASSIFICATIO unclear. One of pulmonary also contraindicated tachycardia, and symptoms of
the mechanisms disease (COPD), in patients with extrasystole, depression or
N
of action of is bronchial asthma acute myocardial tachypnea. psychotic episodes.
Pharmacologic thought to arise and pulmonary infarction,  GI: vomiting,  Monitor vital signs.
class: Xanthines from the disease with gipotensia arterial nausea, epigastric Monitor blood
Therapeutic class: inhibition of spastic bronchial (hypotension), pain pressure, weight, and
Antiasthmatic phosphodiestera component. arrhythmia, electrolyte levels
ACTUAL DRUG se activity thus duodenal ulcer, regularly.
ORDER increasing the epilepsy, convulsion  Assess blood glucose
levels of cAMP and in lactating/ levels in diabetic
200 mg tab
and promoting pregnant women. patients. Expect to
smooth muscle increase insulin or oral
FREQUENCY relaxation. hypoglycemic dosage.
BID  Urge patient to
immediately report
 unusual weight gain,
face or leg swelling,
epigastric burning,
vomiting of blood,
black tarry stools,
irregular menstrual
cycles, fever,
prolonged sore throat,
cold or other infection,
or worsening of
symptoms.
 Caution patient not to
stop taking drug
abruptly. In long-term
use, instruct patient to
have regular eye
exams.
 Monitor signs of
thrombophlebitis
(lower extremity
swelling, warmth,
erythema, tenderness)
and thromboembolism
(shortness of breath,
chest pain, cough,
bloody sputum). Notify
physician or nursing
staff immediately