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GENERAL DATA

This is a case of xx 47 year old female single roman catholic,residing at SEVILLA NORTE SAN FERNANDO LA UINON
ADMITTED AT LORMA
CHIEF COMPLAINT
Coughing
HISTORY OF PRESENT ILLNESS
2 DAYS PTA, patient had onset of cough productive of whitish sputum associated with colds and dyspnea. NO noted fever
persistence of condition now with noted wheezing prompted consult in this hence admission.
PAST MEDICAL HISTORY
Hypertension (-)Diabetes (-)Asthma (+)Heart disease (-)
Cerebrovascular accident (-)History of trauma (-)Previous operation (-)Allergies to foods and drugs (-)

FAMILY HISTORY
Diabetes (-) Asthma (+)Heart disease (-)Cerebrovascular accident (-History of trauma (-)Previous operation (-)Allergies to
foods and drugs (-)
PERSONAL AND SOCIAL HISTORY
Patient is a non-smoker and a non-alcoholic beverage drinker
REVIEW OF SYSTEMS

SKIN (-)
HEAD (-)
EYES (-)
EARS (-)
NOSE (-)
ALLERGIES (-)
MOUTH (-)
NECK (-)
BREAST (-)
RESPIRATION/CARDIAC WHEEZING(+) CHEST PAIN (+) PRODUCTION OF PHLEGM(+) SOB(+)
WEIGHT (-)
URINARY (-)
PERIPHERAL VASCULAR (-)
MASCULAR NEUROLOGIC (-)
HEMATOLOGIC (-)
ENDOCRINE (-)
PYSCHIATRIC (-)

PHYSICAL EXAMINATION
GENEARAL SURVEY
VITAL SIGNS: respiratory rate usually >30 breaths/min , heart rate >120 beats/min; wheezing throughout both the
inspiration and the expiration; use of accessory respiratory muscles
SKIN: NO JAUNDICE NO PALLOR SKIN WARM TO TOUCH
RECTAL: murmur
GENITALIA: DIRECT TENDERNESS AT THE LUMBAR AREA
DIFFERENTIAL DIAGNOSIS
ADMITTING DIAGNOSIS
Bronchial Asthma in Acute Exacerbation
MANAGEMENT:
Please admit to roc
Secure consent and mngt
TPR q shift and records
NPO X 2hrs THEN Low salt Low fat
DX
CBC with PC
Serum NA,K
CXR PA
ECG
IVF PNSS1L X KVO
TX
Hydrocortisone 250mg IVP now then 100MG q6hrs
Neb with Duavent 1 neb now then Q8hrs
Azithromycin 500mg/tab,1tab OD
Monitor vs q4 and records
Moderate high back rest
Notify amd
Refer accordingly
Orders:
> Use Lupivent for the nebulization
> Use Gozimax for the Azithromycin
> Start Flutiform 250/10, 2 puffs now then BID
> Biozone 1.5 grams IV every 8 hours ANST(-)
> Dextein 600mg 1 tablet in 50cc of water daily at bedtime
> Stelix 1 tablet now then daily

DISEASE DISCUSSION
S O A P
#cough and colds x 2days Chest and Lungs SCE (+) Pls admit to ROT
DOB BLF Secure consent at MNGT
Autosat 98% TPR
Patient is known Asthmatic TPR Q shift AND record
– hpn with meds Npo x 2 hours then low salt,
BP I30/70 low fat
BX
CBC With PC
Serum NA K
CXR
PA
ECG
IVF PNSS1L X KVO
Hydrocortisone 250 mg IVP
now then qq8hrs
Azithromycin 500mg/tab, 1
tab OD
Monitor vs q4 and records
Moderate high back rest
Notify Nmd

Bp 200/120 Continue medication


Chest pain  Clonidine
Paint at axillary line 75mg/tab/1tab SL
radiating to the back now q15 minutes x
3 doses oif
bp>150/90mmhg
 Metocloromide
1amp IV prior to
tramadol
 Tramadol 50mg IV
now, then q8 PRn x
Pain
 Trimetizine 35MG
Tab BID
Bronchial Asthma in Acute Exacerbation

DEFINITION

A condition of the lungs characterized by widespread narrowing of the airways due to spasm of the smooth muscle, edema
of the mucosa, and the presence of mucus in the lumen of the bronchi and bronchioles. Bronchial asthma is a chronic
relapsing inflammatory disorder with increased responsivenessof tracheobroncheal tree to various stimuli, resulting in
paroxysmal contraction of bronchial airwayswhich changes in severity over short periods of time, either spontaneously or
under treatment. Ever hear the term "bronchial asthma" and wonder what it means? When people talk about bronchial asthma,
they are really talking about asthma, a chronic inflammatory disease of the airways that causes periodic "attacks"
of coughing, wheezing, shortness of breath, and chest tightness.

ETIOLOGIES
A role for atypical bacterial infection in exacerbations is also increasingly recognized. Exacerbations are
characterized by airway inflammation, which can differ in type depending on whether it is primarily infective or allergic in origin.

CLASSIFICATION
DIAGNOSIS
An asthma exacerbation is an acute or subacute episode of progressive worseningof 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. Because asthma symptoms don't
always happen during your doctor's appointment, it's important for you to describe your, or your child's, asthma signs and symptoms
to your health care provider. You might also notice when the symptoms occur such as during exercise, with a cold, or after smelling
smoke.
DIAGNOSTIC

 Spirometry: A lung function test to measure breathing capacity and how well you breathe. You will breathe into a device
called a spirometer.
 Peak Expiratory Flow (PEF): Using a device called a peak flow meter, you forcefully exhale into the tube to measure
the force of air you can expend out of your lungs. Peak flow monitoring can allow you to monitor how well your asthma is
doing at home.
 Chest X-ray: Your doctor may do a chest X-ray to rule out any other diseases that may be causing similar symptoms.

TREATING BRONCHIAL ASTHMA


Once diagnosed, your health care provider will recommend asthma medication (which can include asthma inhalers and pills) and
lifestyle changes to treat and prevent asthma attacks. For example, long-acting anti-inflammatory asthma inhalers are often
necessary to treat the inflammation associated with asthma. These inhalers deliver low doses of steroids to the lungs with minimal
side effects if used properly. The fast-acting or "rescue" bronchodilator inhaler works immediately on opening airways during an
asthma attack.
If you have bronchial asthma, make sure your health care provider shows you how to use the inhalers properly. Be sure to keep
your rescue inhaler with you in case of an asthma attack or asthma emergency. While there is no asthma cure yet, there are
excellent asthma medications that can help with preventing asthma symptoms. Asthma support groups are also available to help
you better cope with your asthma.

MANAGEMENT:
ASTHMA

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult
and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance. For others, it can
be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Asthma can't be
cured, but its symptoms can be controlled. Because asthma often changes over time, it's important that you work with your
doctor to track your signs and symptoms and adjust treatment as needed.

The National Asthma Education and Prevention Program has classified asthma as:
 Intermittent.
 Mild persistent.
 Moderate persistent.
 Severe persistent.
These classifications are based on severity, which is determined by symptoms and lung function tests. You should be
assigned to the most severe category in which any feature occurs.
 Classification is based on symptoms before treatment.
 Classification may change over time.
 A person in any category can have severe asthma attacks.
 Asthma in children younger than age 4 can be hard to diagnose. And its symptoms may be different from asthma in
older children or adults.
Intermittent asthma
Asthma is considered intermittent if without treatment any of the following are true:
 Symptoms (difficulty breathing, wheezing, chest tightness, and coughing):
 Occur on fewer than 2 days a week.
 Do not interfere with normal activities.
 Nighttime symptoms occur on fewer than 2 days a month.
 Lung function tests (spirometry and peak expiratory flow [PEF]) are normal when the person is not having an asthma
attack. The results of these tests are 80% or more of the expected value and vary little (PEF varies less than 20%)
from morning to afternoon.

Mild persistent asthma


Asthma is considered mild persistent if without treatment any of the following are true:
 Symptoms occur on more than 2 days a week but do not occur every day.
 Attacks interfere with daily activities.
 Night time symptoms occur 3 to 4 times a month.
 Lung function tests are normal when the person is not having an asthma attack. The results of these tests are 80% or
more of the expected value and may vary a small amount (PEF varies 20% to 30%) from morning to afternoon.
Moderate persistent asthma
Asthma is considered moderate persistent if without treatment any of the following are true:
 Symptoms occur daily. Inhaled short-acting asthma medication is used every day.
 Symptoms interfere with daily activities.
 Night time symptoms occur more than 1 time a week, but do not happen every day.
 Lung function tests are abnormal (more than 60% to less than 80% of the expected value), and PEF varies more than
30% from morning to afternoon.
Severe persistent asthma
Asthma is considered severe persistent if without treatment any of the following are true:
 Symptoms:
 Occur throughout each day.
 Severely limit daily physical activities.
 Nighttime symptoms occur often, sometimes every night.
 Lung function tests are abnormal (60% or less of expected value), and PEF varies more than 30% from morning to
afternoon.

PATHOPHYSIOLOGY
 Chronic Inflammation of Lower airways
 Mucosal infiltration of activated eiosinophils and T lymphocytes
 Thickening of basement Membrane
 Goblet cell metaplasia
 Smooth muscle hyperthropy and thickening
 Shedding of epithelium
 Occlusion of airway by mucosal plug

Clinical Signs and Symptoms

 Mild wheezing and coughing initially, which may progress to severe dysnea if the attack is not reserved.

 The cough is initially nonproductive, progressing to a productive cough by the end of the episode.

 Secretions contain high level of Eosinophils.

 Intercostal and supraclavicular retractions.

 Use of accessory muscle to breathe.

 Tachycardia & tachypnea

 Cyanosis

Characteristics of CXR Films

 Hyperinflation ( Hyperlucency of the Lung fields)

 Atelectasis

 Infiltrates

Treatment (During an Attack)

 Rescue SABAs such as Albuterol or Xopenex

 O2 Therapy

 IV Corticosteroids
BRONCHIAL ASTHMA IN ACUTE
EXACERBATION
BRONCHIAL ASTHMA IN ACUTE
EXACERBATION

SUBMITTED BY:

TAMBOGON, REINDELL KYLE G.

SUBMITTED BY:

CARILLO, ACE LOUIS M.

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