PNNA DHAI MAA SUBHARTI

NURSING COLLEGE

CASE STUDY
ON
ASTHMA

SUBMITTED TO: SUMITTED BY ;

DEMOGRAPHIC DATA :-

Name : Sahil
Age : 11 year
Gender : Male
IP No. : 18910588
Father’s Name : Mr. rahul
Mother’s Name : Mrs.Soni
Religion : Hindu
Admission unit : PICU
Address : Meerut, UP
Date of admission : 15/01/2018,
Chief complain : Difficulty in breathing
Provisional diagnosis : Asthma
Date of surgery, if any : NIL
Date of care started : 17/01/18
Date of care end : 21/01/18

PRESENTING COMPLAINTS:
 Breathing difficulty
 Shortness of breath
 Wheezes throughout the lungs

HISTORY OF PRESENT ILLNESS:

 Sahil was symptomatic few days before, suddenly he develop rhinitis and cough in that
he do not take proper care which further lead to breathlessness, chest tightness and cough.
Child looks irritable.

HISTORY OF PAST ILLNESS:

Significant Medical History: no past history related to asthma.

SURGICAL HISTORY:Not Significant

FAMILY HISTORY:
Type of Family: Nuclear
No. of Members in the family: 5
No history of any congenital abnormality.

PEDIGREE TREE:

shail
Family Composition:

S Name Age Sex Relationship Marital Educatio Occupatio Health

No with the Status n n Status
. child

1. Ramsuma 40 yrs. Male Father Married 12th shopkeeper Healthy

n
2. Rekha 38yrs. Female Mother Married Illiterate Housewife Healthy

3. Sumit 18 yrs. male brother - 12th - Healthy

4. Ekta 15 yrs. Female Sister - 10th - Healthy

5. Shail 11 yr male Self - 8th - Unhealthy

HEREDITARY ILLNESS:
Not Significant

SOCIO- ECONOMIC HISTORY:

a. Housing : Pucca House
b. Rooms : 2 room
c. Occupancy : Own house
d. Ventilation : adequate
e. Light : Electricity
f. Water Supply : Hand pump, municipality water

PERSONAL HISTORY:
 Birth History
 Antenatal History
Normal : Yes
Nutrition of the mother : Mall nourished
Regular Antenatal Checkup : Yes
Consumption of Folic Acid : No
Deviation from Normal : No
Any Exposure to teratogens : No
 Drugs : No
 Infection : No
 Irradiations : No
Any Complications : Nil.
 Natal History
 Normal Delivery : yes
Cry : Cried immediately after birth.
Apgar score : Not known
Place of Delivery : Hospital
Mode of Delivery : Normal Vaginal Delivery
Conducted by : Obstetrician
Weight of the baby : 2.6kg
Condition of Neonate : Term baby
Deviation from normal : Nil
Any congenital deformity : NIL

 Postnatal History:
Condition of mother : Normal, No Postpartum hemorrhage, puerperal
Sepsis

Condition of Neonate : Meconium passed after 24 hours of birth, Urine

passed

 Personal Hygiene of the child: Hygiene well maintained by mother and family
members.

 DIETARY PATTERN:
Patient is vegetarian.
Eat healthy food according the need.

 Response of parents to child’s illness: Parents are anxious. They don’t have
adequate knowledge about disease condition. Parents are worried because is not fast
breathing and not taking proper feeds. Parents are not aware of the treatment.

 IMMUNIZATION

AGE IMMUNIZATION RECEIVED NOT RECEIVED

Birth BCG, OPV0, HepB1 
6 weeks PANTA 1, 
OPV1,Hib1,HepB2
10 weeks PANTA2, OPV2, 
 Hib2
14 weeks PANTA 3, OPV3, 
Hib3, Hep3
9 months Measles 
15-18 months PANTA B1, OPV4, 
Hib B1, MMR1
2 years Typhoid 
5 years PANTA B2, OPV5, 
MMR2
10 years Tetanus 

 VITAL ASSESSMENT
S No. Vital Signs Patient’s Value Normal Value Remarks
1. Blood Pressure 120/74 mmhg 120/80 Normal
2. Temperature 100° F 98.2°-98.8° F Increased
3. Pulse 70 beats/min 80 beats/min Normal
4. Respiration 24 breaths/min 18-24 Normal
breaths/min

PHYSICAL EXAMINATION (OBSERVATION & ASSESSMENT)

 General assessment:
Appearance : ill
Body built : slim
Sensorium : conscious
Emotional state : stable
Posture : mild flexion

 Skin condition:
Skin color : whitish,
Skin lesions : no
Temperature : 100˚F
 Texture : smooth
Turgor & elasticity : poor skin turgor
Edema/ puffiness : Absent

 Hair:
Color : black
Distribution : scanty

 Nails:
Hygiene : clean
Condition : smooth
Angle of nail beds : no clubbing
Nail bed color : pale

 Head & face

Shape : normal
Facial appearance : dull
Cyanosis : no
Tenderness : no
Fontanel : palpable

 Eyes:
Eye brows : equally distributed
Eye lashes : present
Eye lids : normal
Eye Shape, appearance : normal, symmetrical
Sclera : white
Cornea : clear
Pupils : reacting to light
Vision : normal

 Ears:
Position : normal
Shape & size : symmetrical
Tympanic membrane : normal
Hearing : normal
Hearing aid : absent

 Nose:
External nose
Size : Normal
 Shape : Normal
Internal nasal mucosa : Normal, secretions present

 Mouth:
Lips
Color : pink
Shape : symmetrical
Condition : dry
Teeth : not
Gums : pink
Tongue : whitish
Oropharynx : pink
Tonsils : normal
Uvula : normal
Palate : normal

 Glands
Parotid : normal
Submandibular : normal
Sublingual : normal

 Neck
Range of motion : Diminished
Thyroid : no enlargement
Lymph node : no enlargement

 Thorax & lungs:

Respiratory rate : 24/min
Rhythm : Regular
Shape : normal
Chest wall movement : normal
Lung auscultation : Wheezing sound present
Crept : present

 Chest & axilla

Lymph node : normal

 Heart
Heart rate : 80/min
Heart sound : S1 S2 Normal & no murmur
soundpresent

 Abdomen:
 (i) Inspection:
Scar : no
Lesions : no
Size : normal
Umbilicus : normal

(ii) Palpation:
Liver : not palpable
Spleen : not palpable

(iii) Percussion:
Ascites : no

(iv) Auscultation: peristaltic movement: normal

 Genitalia:
Rectum : normal

 Back:
Vertebral column : straight
Joints : normal

 Extremities:
(i) Upper extremities : symmetrical
Range of motion : diminished
Syndactyl : no
Polydactyl : no
Webbing of fingers : no
Clubbing of fingers : no

(ii) Lower extremities : symmetrical

Range of motion : diminished

INVESTIGATIONS DONE:
 S Investigations Patient’s value Normal Value Remarks
No.
1. Hb 10 mg/dl 10.7-17.1 mg/dl slightly lower
3
2. TLC 22300 5000-19500 mm Increased
3. DLC N52%,L45%,M2%.E1% N25%,L57%,M5.9%.E2.7% -
4. Platelet 248x103 84-478 x103/mm3 Normal
5. RBC 245x102 31-530 x103/mm3 Normal
6. HCT 45 % 33-55% Normal
7. Potassium 5.3 3.5-5.0mEq/L Increased
8. Sodium 130 135-146mEq/L Decreased
9. RBS 75 mg/dl 65-99 mg/dl Normal
10. CRP 1:8 (Positive)

Chest X-ray: Done

TREATMENT GIVEN:

S Name of Action Route Indications Side-effects Contra- Nursing

no drug indications Responsibilitie
. s
1. InjMono The I.V Severe Diarrhea, Hypersensi -monitor for
cef bactericid infections. headaches, tivity to Hyper
al activity vomiting, any sensitivity
of nausea, penicillin, reaction
Ceftriaxon Hyper colitis, - Ensure safety
e results sensitivity pregnancy of the patient.
from reaction
inhibition
of cell
wall
synthesis.
2 Inj. It works I.V. Sepsis, skin rash, Renal -monitor for
Amikaci by causing systemic drug fever, impairment ototoxicity,
n the infection headache, , vertigo neurotoxicity or
bacterium nausea, hypersensitivity
unable to vomiting, and -monitor for
synthesize hypotension renal function.
proteins
vital to its
 growth.

3. Neb It directly Nebulizat Obstructive Headache, Hypersensi - monitor for

Asthalin relaxes ion airway paradoxical tivity to hypersensitivity
airway disease, bronchospas salbutamol reaction.
smooth Acute m,
muscles bronchospa Tremor,
and -
sm anxiety
produces
bronchodil
ation.
4. Syp. It exhibits Oral Fever Nausea, Renal or - Monitor the
PCM analgesic allergic hepatic temperature of
action by reactions, impairment patient before
peripheral skin rashes, ; alcohol- administration.
blockage acute renal dependent
of pain tubular patients;
impulse necrosis G6PD
generation deficiency
It
produces
antipyretic
by
inhibiting
the
hypothala
mic heat-
regulating
center.
 ASTHMA

DEFINITION: Asthma is a chronic lung-disease that inflames and narrows the airways (tubes
that bring air into and out of an individual’s lungs).

Asthma is the most common chronic disease among children.

CLASSIFICATION OF ASTHMA

Asthma is classified into 4 categories based on the symptoms

1. Mild intermittent asthma

2. Mild persistent asthma
3. Moderate persistent asthma
4. Severe persistent asthma
CAUSES OF ASTHMA

 Allergens
 Changes in weather or temperature
 Environmental changes
 Cold and infections
 Animals
 Certain medications

PATHOPHYSIOLOGY

Always inflammation

Bronchospasm

Inflammation and edema of the mucus memdranes

Accumulation of tenancies secretions from mucus gland

Spasm of the smooth muscle muscle of the bronchi and bronchioles which decreases the caliber
of the bronchioles

Bronchial constriction

Narrowing and shortening of the airways

Increase resistance of airflow

Respiratory difficulty

Increase resistance on the airflow

Air tripping in the lungs

Airway close

Severe breathing difficulty

 Asthma

SYMPTOMS

Common symptoms of asthma include:

 Coughing

 Wheezing

 Tightness in the chest

 Shortness of breath

DIAGNOSIS

 Medical history

 Physical examination

 Lab Test results

 Chest X-ray & CT scan

 Pulmonary function test

MANAGEMENT

Successful treatment of asthma involves three components:

1. Controlling and avoiding asthma triggers

2. Regularly monitoring asthma symptoms and lung function
3. Understanding hoe and when to use the medication to treat asthma
 Medications
Long term: there anti-inflammatory drugs includes:

=fluticasone
 =montelukast

=salmeterol

Quick relief

=ipratropium bromide

Bronchial thermoplasty: this treatment is not widely available is not right for everyone, it is
used for severe asthma that does not improve with the inhaled corticosteroids or other long-
acting medication.

Bronchial thermoplasty heats the inside of the airways in the lungs with an electrodes, reducing
the smooth muscles breathing easier and possibly reducing asthma attacks.

COMPLICATIONS

 Status asthmaticus
 Severe respiratory failure
 Death

NURSING MANAGEMENTS

 Maintain patent airway

 Assist with measures to facilitate gas exchange
 Enhance nutritional intake.
 Prevent complication and slow progression of conditions.
 Provide information about disease process, prognosis and treatment.
 LIST OF NURSING DIAGNOSIS

1. Impaired Gas Exchange related to reduced oxygen supply disruptions as

evidenced by airway secretion obstruction.

2. Ineffective Airway Clearance related to ineffective coughing and increased

sputum production as evidenced by breathing difficulty.

3. Ineffective Breathing Pattern related to disease process as evidenced by

shortness of breath & cough

4. Impaired nutrition status less than body requirement related to inappropriate

feeding as manifested by regurgitation of feeds.

5. Infection related to impaired body defenses as evidenced by raised body

temperature.

6. Disturbed sleeping pattern related to hospitalization as evidenced by discomfort

and irritable behavior.

7. Risk of Impaired parent child attachment related to child’s physical illness and
hospitalization.
  Nursing Care Plan

S Assessment Nursing Goal Plan of Interventio Rational Evaluation

N Diagnosis Action ns e
o

1. Objective Impaired To - assess To detect - provided

data Gas provide the the level of assessed adequate
Exchange adequat breathing severity the oxygenatio
Taking deep
related to e pattern breathing n
breath, To reduce
reduced oxygen pattern
weakness - provide dyspnea
oxygen ation
semi -
supply
fowlers provided
disruption
position semi
s as
fowlers
evidenced - check
position
by airway oxygen
secretion saturation - checked
obstructio oxygen
n saturation

2. Objective Ineffectiv To - assess - To check - reduced

data e Airway reduce the the airway assessed cough and
Clearance cough airway clearance the clear the
related to and airway airway
Restlessness - provide - to maintain
ineffective clear
, cough semi airway -
coughing the
fowlers provided
as airway To reduce
position semi
evidenced cough
fowlers
by - provide
position
breathing medicatio
difficulty n -
provided
-
medicatio
collaborat
 e with n
doctor
collabora
ted with
doctor

3. Subjective Ineffectiv To - assess -to check - reduced

data e reduce the the assessed breathing
Breathing breathi breathing breathing the difficulty
Breathing
Pattern ng pattern pattern breathing
difficulty,
related to difficul pattern
Crying - provide - to maintain
disease ty
O2 by breathing -
process as
hood provided
evidenced
O2
by
shortness
of breath.

4. Objective Adequate
Data: nutritional
Impaired Maintai Child -small but -To
nutritional n the will not frequent prevent level was
Child is maintained.
looking very status less adequat have breast feeds. from
than body e malnutriti
weak, -Intravenous malnutriti Child
malnourishe requireme nutritio on.
fluids were on general
d and skin nt related nal administere - To condition is
turgor is to level. d. maintain improving
poor. inappropri the after
ate adequate admition.
feeding as nutritiona
manifeste l level.
d by
refusal of
feeds.
5. Subjective Disturbed to gain .=Provide To reduce =Provide gained
data sleeping normal home stress d home normal
pattern sleepin environm environm sleeping
insomnia To relax
related to g ent. ent. pattern
mind
hospitaliz pattern.
=Allow =Allowe
ation as
parents to d parents
evidenced
spent to spent
by
time with time with
discomfor
the child the child
t and
irritation.

6. Objective Fluid Child - -the Child

Data: volume Mainte will be Intravenous requirem shows no
Child not deficit nance able to fluids were ent of the signs of
accepting related to of fluid maintain given to the body was fluid and
the breast disease and the fluid child. fulfilled electrolyte
feeding well condition electrol and by
characteri yte in electrolyt - Educating intraveno
zed by dry the e balance mother us fluids.
oral body in the about proper
mucosa body. breast -for
and skin feeding adequate
turgor is technique breastfee
low. ding of
child.

 Day to Day Prognosis:

15/01/2018: General condition is poor.

Child is febrile HR-98/ min. RR-68/Min

16/01/2018: General condition is improving, Child is febrile. No coughing.

HR-150/ min.

RR-42/Min

17/01/2018- No cough and No fever. Accepting normal diet.

HR-72 b/ min. RR-20 b/Min
APPLICATION OF OREM’S SELF CARE DEFECIT THEORY:

This theory was given byDorothea Orem

ACCORDING TO THIS CASE:

My patient is suffering from asthma with rapid breathing and cough. As he is a
dependent to his family for self care and totally dependant on other for all his
activities. So this is the most suitable theory for the client.

OBJECTIVES

 To assess the patient condition by the various methods explained by the nursing
theory
 To identify the needs of the patient
 To demonstrate an effective communication and interaction with the patient.or
 To select a theory for the application according to the need of the patient
 To apply the theory to solve the identified problems of the patient
 To evaluate the extent to which the process was fruitful.

OREM’S THEORY OF SELF CARE DEFICIT

 The self care deficit theory proposed by Orem is a combination of three theories,
i.e. theory of self care, theory of self care deficit and the theory of nursing
systems.
 In the theory of self care, she explains self care as the activities carried out by the
individual to maintain their own health.
 The self care agency is the acquired ability to perform the self care and this will be
affected by the basic conditioning factors such as age, gender, health care system,
family system etc.
 Therapeutic self-care demand is the totality of the self care measures required.
 The self care is carried out to fulfill the self-care requisites.
 There are mainly 3 types of self care requisites such as universal, developmental
and health deviation self care requisites.
 Whenever there is an inadequacy of any of these self care requisite, the person will
be in need of self care or will have a deficit in self care.
 The deficit is identified by the nurse through the thorough assessment of the
patient.
 Once the need is identified, the nurse has to select required nursing systems to
provide care: wholly compensatory, partly compensatory or supportive and
educative system.
 The care will be provided according to the degree of deficit the patient is
presenting with.
  Once the care is provided, the nursing activities and the use of the nursing systems
are to be evaluated to get an idea about whether the mutually planned goals are
met or not.
 Thus the theory could be successfully applied into the nursing practice.

For newborn baby

 He admitted in PEDIA ward with rapid breathing and coughing. He has these
complaints since 5 week and has taken treatment from local hospital.
 As he is a preschooler ,unable to do anything.
 His parents were knowledge deficit and were not aware about the condition.

OREM’S THEORY OF SELF CARE DEFICIT

UNIVERSAL SELF-CARE REQUISITES

Breaths without difficulty, no

Air pallor cyanosis
Water Fluid intake is sufficient. Edema
absent.
Turgor normal for the age
Food Hb – 9.6gm%, .Food intake is
not adequate or the diet is not
nutritious.
Elimination Voids and eliminates bowel
without difficulty.
Activity/ rest Frequent rest is required due to
pain.
Pain not completely relieved,
Activity level has come down.
Deformity of the joint secondary
to the disease process and use of
the joints.
Social interaction Communicates well with
neighbors and calls the daughter
by phone Need for medical care
is communicated to the
daughter.
Prevention of hazards Need instruction on care of
joints and prevention of falls.
Need instruction on
improvement of nutritional
 status. Prefer to walk bare foot.
Promotion of normalcy Has good relation with daughter

DEVELOPMENTAL SELF-CARE REQUISITES

Maintenance of Able to feed self , Difficult to

developmental perform the dressing, toileting
environment etc
Prevention/ Feels that the problems are due
management of to her own behaviours and
the conditions discusses the problems with
threatening the husband and daughter.
normal
development

HEALTH DEVIATION SELF CARE REQUISITES

Adherence to Reports the problems to the

medical regimen physician when in the hospital.
Cooperates with the
medication, Not much aware
about the use and side effects of
medicines
Awareness of Not aware about the actual
potential problem disease process.
associated with Not compliant with the diet and
the regimen prevention of hazards. Not
aware about the side effects of
the medications
Modification of Has adapted to limitation in
self image to mobility.
incorporates
changes in health The adoption of new ways for
status activities leads to deformities
and progression of the disease.
Adjustment of Adjusted with the deformities.
lifestyle to Pain tolerance not achieved
accommodate
changes in the
health status and
 medical regimen.

MEDICAL PROBLEM AND PLAN

Physician’s perspective of the condition: Diagnosed with asthma.

Medical Treatment: Medication.

AREAS AND PRIORITY ACCORDING TO OREM’S THEORY OF SELF-CARE

DEFICIT: IMPORTANT FOR PRIORITIZING THE NURSING DIAGNOSIS.

 Air
 Water
 Food
 Elimination
 Activity/ Rest
 Solitude/ Interaction
 Prevention of hazards
 Promotion of normalcy
 Maintain a developmental environment.
 Prevent or manage the developmental threats
 Maintenance of health status
 Awareness and management of the disease process.
 Adherence to the medical regimen
 Awareness of potential problem.
 modify self image
 Adjust life style to accommodate health status changes and MR