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The forty-eight hours exposure we had at Cotabato Regional and Medical Center opened the door of opportunity to experience things that broadened our knowledge and enhanced our skills. We were exposed to different cases of various clients. We became accustomed with the routines in the hospital and interacting with our patients, even with their watchers. We encountered some difficulties and struggles, yet that didn’t hinder us in giving our best to do our job.

That exposure gave us an opportunity to handle different cases. With all those we’ve encountered, we chose one to be the subject of our case study.

We are presenting to you Bronchial Asthma which is the case of our patient at Medicine Ward Room C whom we will call Mr. Theodore for the purpose of confidentiality.

Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways. Bronchial asthma is the more correct name for the common form of asthma. The term 'bronchial' is used to differentiate it from 'cardiac' asthma, which is a separate condition that is caused by heart failure. Although the two types of asthma have similar symptoms, including wheezing (a whistling sound in the chest) and shortness of breath, they have quite different causes.
Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath. The cause is a sharply elevated resistance to airflow in the airways. Despite its most strenuous efforts, the respiratory musculature is unable to provide sufficient gas exchange. The result is a characteristic asthma attack, with spasms of the bronchial musculature, edematous swelling of the bronchial wall and increased mucus secretion. In the initial stage, the patient can be totally symptom-free for long periods of time in the intervals between the attacks. As the disease progresses, increased mucus is secreted between attacks as well, which in part builds up in the airways and can then lead to secondary bacterial infections.
Bronchial asthma is usually intrinsic (no cause can be demonstrated), but is occasionally caused by a specific allergy (such as allergy to mold, dander, dust). Although most individuals with asthma will have some positive allergy tests, the allergy is not necessarily the cause of the asthma symptoms.
Symptoms can occur spontaneously or can be triggered by respiratory infections, exercise, cold air, tobacco smoke or other pollutants, stress or anxiety, or by food allergies or drug allergies. The muscles of the bronchial tree become tight and the lining of the air passages become swollen, reducing airflow and producing the wheezing sound. Mucus production is increased.
Typically, the individual usually breathes relatively normally, and will have periodic attacks of wheezing. Asthma attacks can last minutes to days, and can become dangerous if the airflow becomes severely restricted. Asthma affects 1 in 20 of the overall population, but the incidence is 1 in 10 in children. Asthma can develop at any age, but some children seem to outgrow the illness. Risk factors include self or family history of eczema, allergies or family history of asthma. Bronchial asthma causes cough, shortness of breath, and wheezing. Bronchial asthma is an allergic condition, in which the airways (bronchi) are hyper-reactive and constrict abnormally when exposed to allergens, cold or exercise.

Treatment is aimed at avoiding known allergens and controlling symptoms through medication. A variety of medications for treatment of asthma are available. People with mild asthma (infrequent attacks) may use inhalers on an as-needed basis. Persons with significant asthma (symptoms occur at least every week) should be treated with anti-inflammatory medications, preferably inhaled corticosteroids, and then with bronchodilators Acute severe asthma may require hospitalization, oxygen, and intravenous medications.
Decrease or control exposure to known allergens by staying away from cigarette smoke, removing animals from bedrooms or entire houses, and avoiding foods that cause symptoms. Allergy desensitization is rarely successful in reducing symptoms.
This case study is beneficial to discover more about this case, the signs and symptoms, its occurrence and process, and the interventions we can make and apply now and tomorrow.

We have used a lot of procedures from choosing a subject to gathering of information, which helped us to accomplish this study. Applying the knowledge we gained during our level II was part of it. The physical assessment, general physical survey and health teachings helped us experience and appreciate the art of nursing profession. With the help of this case study, we now realize that indeed, people’s best educators are experiences gained out of the four walls of the classroom.

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Name: Mr. Theodore

Age: 40 years old

Sex: Male

Address: SPDA, DOS, Shariff Kabunsuan

Birthday: March 17, 1968

Birthplace: Bongo Island, Parang, Sultan Kudarat

Civil status: Married

Occupation: Not Employed

Religion: Islam

Citizenship: Filipino

ADMISSION:

Hospital: Cotabato Regional and Medical Center

Ward: Medicine ward C

Date of admission: September 8, 2008

Date discharged: September 11, 2008

Admitting physician: Red team (DR. Mamaluba, Cabico, Caragay)

Chief complaint: Difficulty of Breathing

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A. APPEARANCE AND BEHAVIOR

1. Age, Sex, Race: 40 y.o., Male, Asian

2. Body build: Athletic, with upright posture and good muscle tone.

3. Posture and gait: standing in upright position and walking straight in heel-toe gait.

4. Hygiene and Grooming: Clean and appropriate in a hospital environment.

5. Dress: Light clothing is used in upper shirt and pants.

6. Odor of body and breath: No body odor noted, no breath odor noted.

7. Signs of labor: Signs of labor is relapsing, there are moments of distress.

8. Apparent state of health: There is slightly improved wellness and cooperative.

9. Attitude: Cooperative to questions given and is coherent.

10. Affect/mood: Is not anxious and able to answer questions confidently.

11. Speech: Understandable and in moderate pace.

12. Thought process: Explaining the history of illness in a logical manner, no shifting of ideas noted and has a sense of reality.

B. Vital signs

1. Temp.: 36.9 C

2. RR: 21 BPM

3. PR: 84 bpm

4. BP: 120/80 mmhg

C. Height and weight

1. Height: 5’3”

2. Weight: 56 kgs.

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CHEST ASSESSMENT

A. INSPECTION

1. Rate, rhythm, depth and support of breathing. - 21 BPM, deep and shallow with relapsing labored breathing and has difficulty when expectorating. 2. Shape of chest, deformity of thorax, spine contour, symmetry of chest expansion. - Normal shape with no deformities of thorax, spine contour is aligned well and fixed.

3. Use of accessory muscles and retractions of intercostals muscles. - Sternocleidomastoid was used when breathing and expectorating secretions . 4. Presence of cough and sputum (color, odor, amount). - Presence of cough with greenish sputum but odorless and in minimal amount noted. 5. Position of comfort. - Comfortable position is at best when in moderate high back rest.

B. PALPATION

1. Tenderness around lesion. - No tenderness and lesions upon palpation noted.

C. AUSCULTATION

1. Presence and loudness of breathe sounds throughout the lung field (symmetry). - Wheezes upon inspiration and crackles upon expiration noted. 2. Breathe sounds. i. Bronchial- sounds heard over lung periphery. ii. Vesicular- breath sounds heard over main-stem bronchi with soft sounds. iii. Adventitious sounds- crackles and wheezes present upon auscultation.

D. Altered voice sounds

1. Bronchophony- sound was muffled after the client said ‘99’ upon auscultation.

2. Whispered pectoriloqy- muffled sound heard upon client whispering one, two, and three.

3. Egophony- muffled sound heard upon client saying “ee”.

PHYSICAL EXAMINATION: (in hospital)

General Appearance: Conscious, coherent, in respiratory distress.

Vital Signs: Temp. - 36.9 PR- 84 bpm RR- 21 bpm CR- 86 bpm BP- 120/80 mmHg

Skin: Good skin turgor; no deformities

Neck: (-) NVE

Heent: pinkish palpable conjunctiva.

Chest and lungs: SCE, (+) retraction, (+) wheezing BLT.

Cardiovascular system: AP, (-) murmur.

Extremities: grossly (N), no deformities.

Neurologic system: No neurologic deficit.

Admitting impression: Bronchial Asthma in Acute Exacerbation

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|Date |Time |Blood Pressure |Pulse rate |Cardiac rate |Respiratory rate |Temperature |
|09/09/08 |7-3 shift | | | | | |
| |8 am |110/70 | | | | |
| |12 noon |110/70 | | | | |
|09/09/08 |3-11shift | | | | | |
| |4 pm |110/80 |77 bpm |80 bpm |23 BPM |37.1 °C |
| |6 pm |110/90 |87 bpm |89 bpm |20 BPM |37.2 °C |
| |8 pm |120/80 |84 bpm |86 bpm |21 BPM |36.9 °C |
| |10 pm |110/70 |78 bpm |85 bpm |24 BPM |37.0 °C |
|09/10/08 |3-11shift | | | | | |
| |4 pm |90/70 |79 bpm |83 bpm |27 BPM |37.0 °C |
| |6 pm |100/70 |87 bpm |92 bpm |25 BPM |37.2 °C |
| |8 pm |110/70 |85 bpm |89 bpm |27 BPM |37.0 °C |
| |10 pm |110/70 |84 bpm |88 bpm |26 BPM |37.1 °C |

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|Date |Time |Oral |IVF |Total |Urine |Total |
|09/09/08 | | | | | | |
| |7am- 2pm |200cc |400 cc |600 cc |200 cc |200 cc |
| |3pm- 9pm |1000 cc |140 cc |1140 cc |800 cc |800 cc |
| | |300 cc |350 cc |550 cc |200 cc |200 cc |
|09/10/08 | | | | | | |
| |7am- 1pm |350 cc |200 cc |550 cc |100 cc |100 cc |
|9/11/08 | | | | | | |
| |7am- 2pm |430 cc |80 cc |510 cc |20 cc |20 cc |

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• 9/8/08:

➢ 10:00 pm

➢ Please admit to ward under the service of RED TEAM (Dr. Mamaluba, Cabico, Caragay).

➢ Secure consent to care.

➢ Dies As Tolerated with Aspiration Precaution.

➢ Vital signs every 2 hrs. and record.

➢ Monitor intake and output every shift and record.

➢ O2 inhalation @ 2-3 LPM via nasal cannula.

➢ Connect a pulse oximeter.

➢ Moderate High Back Rest.

➢ Increase oral fluids.

PROBLEM: Bronchial Asthma in acute exacerbation.

➢ Dx: Peak Expiratory Flow Rate BID.

(Pre & post nebulization)

➢ Chest Xray, PA view stat.

➢ CBC, BT-stat.

➢ Serum Na, K, Cl.

➢ Serum FBS, Uric acid, total cholesterol, LDL, HDL, T6

➢ Sputum OS/CS.

➢ ABG

➢ ECG 12 leads stat.

➢ Pulmonary Function Test.

Medications:

➢ Ipratoprium/Salbutamol nebulization (combivent) now x3 doses every 30mins. then every 6hrs.

➢ Cefuroxime 750 mg IVTT q 8 hrs ANST (-)

➢ Hydrocortisone 100 mg now then q 6 hrs.

➢ Aminophylline drip: D5W 500cc + 2 amps aminophylline to run @ 15 mgtts/min as SD.

➢ Refer for any signs of hypotension, severe dyspnea and tachycardia.

➢ Refer accordingly

• 9/9/08

➢ 8:00 am

➢ Increase aminophylline drip to 20 gtts/min.

➢ Follow- up official Chest X-ray Laboratory results.

➢ Continue meds.

➢ Refer.

• 9/10/08

➢ Discontinue aminophylline drip.

➢ IVF T/F: D5W 500cc @ KVO.

➢ Shift hydrocortisone IV to Prednisone 20 mg 1 tab TID.

➢ Decrease salbutamol nebulization to PRN.

➢ Fluticasone + salbutamol ( seretide ) 125/25 2 puffs BID, gargle after.

➢ Ff. up CXR C/O watcher.

➢ Shift cefuroxime IV to cefuroxime 500mg 1 tab BID.

➢ D/C O2 inhalation.

• 9/11/08

➢ MGH once cleared.

➢ Home meds:

1. Seretide fluticasone + 2 puffs, BID and gargle after.

2. Prednisone 20mg/ tab BID x7 days.

3. Ipratoprium/salbutamol (combivent) Nebulize.

4. Cefuroxime 500 mg (Roxetil) 1 tab BID x5 days.

➢ Ff. up @ OPD on September 16 ,2008.

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Medication:

▪ Seretide fluticasone, 2 puffs, twice a day and gargle after.

▪ Prednisone 20mg per tablet twice a day for 7 days.

▪ Ipratoprium/salbutamol (combivent) Nebulize once daily.

▪ Cefuroxime 500 mg (Roxetil) 1 tablet twice a day for 5 days.

Exercise:

▪ Instruct to do deep breathing exercise.

▪ Instruct to do exercise like walking in moderate pace and in a tolerable amount.

▪ Instruct to avoid strenuous activities and exercise.

Treatment:

▪ Follow the nebulization order.

Home Instructions:

▪ Continue medications as prescribed by the physician.

▪ Instruct patient to comply with the proper diet.

▪ Promote the importance of proper hygiene, diet, rest and sleep.

▪ Explain prescribed activities with restrictions and appropriate lifestyle to prepare client from the possible outcomes of his condition.

▪ Explain to avoid the possible causes that might trigger asthma attack like dust, dust mites, pets, detergents, soaps, certain foods, and pollens.

▪ Instruct to avoid the use of tobaccos in all forms and second hand smoke.

▪ Instruct to do deep breathing exercises.

Out Patient Visit:

▪ Patient will be following up his check up at OPD on September 16, 2008 five days after discharge.

Diet: ▪ Diet as Tolerated with aspiration precaution.

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Mr. Theodore complies with the treatment during her stay in the hospital. He is cooperative in any interventions implemented to promote his physical condition like having plenty of rest, doing exercise and taking prescribed medication. He is responsive, and shows willingness with his condition and gives feedback with his past condition and other diseases. He avoids all foods which is not appropriate for his diet given by her physician. Therefore, the prognosis of Mr. Theodore is good.

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Based on the findings from the study, we would like to make the following recommendation.

➢ Health teaching on the importance of stopping smoking. ➢ Health teaching on proper diet and the importance of home medication. ➢ Educate the client about his condition and provide information that promotes health condition. ➢ Regular exercise ➢ Increase fluid intake ➢ Take appropriate rest ➢ Avoidance of food and other factors that will cause complication to his condition ➢ Have a healthy lifestyle

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X-RAY RESULT
( May 1, 2008 )

➢ There are hazy infiltrates on both lung bases.

➢ Heart is not enlarged.

➢ Diaphragm and costophrenic sinuses are intact.

➢ The bony thorax is unremarkable.

IMPRESSION:

BIBASAL PNEUMONIA

|Generic Name |Brand Name |General |Mode of Action |Indication |Contraindication |Usual Dose |Actual Dose |
| | |Classification | | | | | |
|Moving |Disturbed sleeping pattern |Verbalized ”Hindi ako |Disturbed sleep pattern is an|Within the shift client will |>Recognize and assess |>Recognizing and assessing |Outcome achieved: client |
| |r/t stasis of |nakatulog ng maayos kagabi |acute periods of time |be able to report or |client’s verbalization of |client’s feeling and concern|verbalized,” ok na ang pag |
| |trachea-bronchial secretions |kasi nahihirapan akong |without sleep.The presence of|verbalize improvement in |feelings and concern. |will serve as a good basis |tulog ko mahaba- haba na |
| |2° Bronchial Asthma. |huminga”. |trachea-bronchial secretions |sleep or rest pattern. | |for appropriate nursing care |rin.” |
| | |Eye redness noted. |causes the individual to gasp| | |and to know the extent of the|>client manifested decreased |
| | |Inability to concentrate |for air.During night time | | |problem that the client is |irritability |
| | |noted. |there will be possible for | | |experiencing. | |
| | |Restlessness and |transient asthma attacks that| | | | |
| | |irritability noted. |leads to the exhaustion of | | |>Elimination of lung | |
| | | |the client. Due to the | | |secretions will promote good | |
| | | |increase in demand for | |>Eliminate lung secretions |sleep/rest pattern of client.| |
| | | |oxygen.The circadian rhythm | |through chest physiotherapy | | |
| | | |of the client is disrupted | |or suctioning when needed. |>Enhances expenditure of | |
| | | |which lead to prolonged | | |energy / release of tension | |
| | | |discomfort.During day time | | |so that client feels ready to| |
| | | |the energy level of the | | |sleep/rest. | |
| | | |client is lessened.Then the | |>Promote adequate exercise or| | |
| | | |lifestyle of the client is | |activity during daytime. |>Will prevent easy exhaustion| |
| | | |greatly affected. | | |of client. | |
| | | | | | | | |
| | | | | | | | |
| | | | | |>Provides rest periods |>Relaxation techniques | |
| | | | | |between intervals of |enhances the client to avoid | |
| | | | | |activity/exercise. |different stressors in the | |
| | | | | | |surroundings. | |
| | | | | |>Assist to do relaxation | | |
| | | | | |technique like deep |>These factors are known to | |
| | | | | |breathing, listening to music|disturb sleep patterns. | |
| | | | | |and reading magazines. |Intake of caffeine makes the | |
| | | | | | |client unable to sleep | |
| | | | | |>Instructed to limit caffeine|because caffeine is a CNS | |
| | | | | |intake and other stimulants |stimulant. | |
| | | | | |during day, afternoon and | | |
| | | | | |night time and avoid aeting |>Identifying environmental | |
| | | | | |large meals during night |stressors | |
| | | | | |time. |Will lead to the modification| |
| | | | | | |of the environment of client | |
| | | | | | |to promote good sleep/rest | |
| | | | | |>Identify environmental |pattern. | |
| | | | | |stressors that could disturb | | |
| | | | | |the client’s sleep/rest | | |
| | | | | |pattern. | | |

|HRP |Nsg. Diagnosis | AMB |Pathophysiology |Clients outcome |Intervention |Rationale |Evaluation |
|E |Ineffective Airway Clearance|Verbalized”Nahihi-rapan akong huminga”. |Theres an ineffective airway|Within the shift, client |Position client to Moderate|To facilitate lung |Outcome achieved, |
|X |r/t presence of |Rapid breathing noted. |clearance that occurs when |will be able to have |High Back Rest |expansion and breathing. |Client has an patent |
|C |tracheobronchial secretion. |RR=28bpm/cycles/minute. |the individual inhaled |patent airway and | | |airway, respiratory rate |
|H | |Productive cough with clear secretions. |different allergens like |expectorate secretions. |Provide Chest Physiotherapy|To allow expectoration of |decreases to 22 breaths |
|A | |Cracles heared on both lung fields upon |fumes, dust or smoke that | |like postural drainage, |mucous secretions by |per minute. Upon |
|N | |auscultation. |causes the immune system to | |percussion and vibration. |gravity: percussion and |re-auscultation of both |
|G | |Shortness of |produce antigens to | | |vibration done to loosen |lung fields adventitious |
|I | |breathing. |counteract the effect of | | |mucus secretions. |sounds (crackles) were |
|N | | |allergens, then due to the | | | |minimized. Client is able |
|G | | |immune response there will | | |To facilitate |to expectorate lung |
| | | |be inflammation of the lungs| |Assist in deep breathing |expectoration of |secretions freely or |
| | | |which causes the humoral | |exercise. |secretions and strengthen |without exertion. |
| | | |response to produce chemical| | |accessory musles for | |
| | | |mediators like | | |breathing. | |
| | | |prostaglandins, bradykinin, | | | | |
| | | |histamines, and | | |To help liquefy secretions| |
| | | |leukotrienes. These chemical| | |and prevent cardiac | |
| | | |mediators will cause pain , | |Increase oral fluid intake |overload. | |
| | | |increases capillary | |to at least 2000ml/day | | |
| | | |permeability or vasodilation| |within level of cardiac | | |
| | | |which leads to cellular | |tolerance. |To help liquefy secretions| |
| | | |exudation. After that there | | |and dilate airway | |
| | | |will be an edema of the | |Provide warm versus cold |passages. | |
| | | |mucous membrane in the lungs| |drinks. |To help in drawing out | |
| | | |and there will be | | |lung secretions. | |
| | | |hypersecretion of the mucus | | | | |
| | | |that goes to the trachea and| | |To ascertain client’s | |
| | | |bronchi. The hypersecretion | |Chest and back tapping |status and note of | |
| | | |of the mucus subsequently | |every after nebulization. |client’s progress. | |
| | | |lead to airway obstruction. | | | | |
| | | | | |Monitor vital signs, | | |
| | | | | |auscultate breath sounds | | |
| | | | | |assess air movements. | | |

|Type of examination |Description |Normal values |Actual values |Interpretation |Significance |
| | | | | | |
|CLINICAL CHEMISTRY |GLUCOSE |3.89-5.84 mmol/L |3.9 mmol/L |Normal |Within normal limits. |
| | | | | | |
| |URIC ACID |M: 208-416 mmol/L |260 mmol/L |Normal |Within normal limits. |
| | |F: 142-339 mmol/L | | | |
| | | | | | |
| |CREATININE |M:53-106 mmol/L |71 mmol/L |Normal |Within normal limits. |
| | |F:44-88 mmol/L | | | |
| | | | | | |
| |CHOLESTEROL |ADULT: 3.89-6.48 mmol/L |5.4 mmol/L |Normal |Within normal limits. |
| | |CHILD: 4.3-8.9 mmol/L | | | |
| | | | | | |
| | |0.4-1.86 mmol/L | | | |
| |TRIGLYCERIDES | |0.89 mmol/L |Normal |Within normal limits. |
| | | | | | |
|ELECTROLYTE TEST | |135-148 mmol/L | | | |
| |SODIUM | |140.3 mmol/L |Normal |Within normal limits. |
| | |3.5-5.3 mmol/L | | | |
| |POTASSIUM | |mmol/L |Normal |Within normal limits. |
| | |98-107 mmol/L | | | |
|MISCELLANEOUS REPORT: |CHLORIDE | |101.7 mmol/L |Normal |Within normal limits. |
| | | | | | |
|SPUTUM: Specimen submitted. | | | | | |
|FINAL REPORT: No pathogen isolated | | | | | |
|after 24 hrs. incubation. | | | | | |
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Mr. Theodore started to smoke when he was still in high school because of peer pressure.

Last 1993, he was diagnosed with Emphysema but hesitated to be admitted. He claimed that he is a chain-smoker. He can usually consume two packs of cigarette every day. By year 2000, he experienced difficulty of breathing and sought medical help then he was admitted at Notre Dame Hospital. He tried to quit smoking but he claimed that smoking is part of his life so he continued smoking. He will even wait for everyone in their house to sleep so he can smoke. Only this present year that he was diagnosed with Bronchial Asthma. According to him, his lifestyle triggered his attack.

He also claimed that both his parents have asthma.

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Four days prior to admission, Mr. Theodore complained of mild difficulty of breathing with nausea and vomiting. He also experienced headache and chest pain. To relieve him from these conditions, he took medicines for headache and has himself nebulizer. But the conditions persisted so he prompted for consultation and was admitted at Cotabato Regional and Medical Center under the service of Dr. Caragay.

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The underlying pathology in asthma is reversible and diffuse airway inflammation. The inflammation leads to obstruction due to the following factors: (1) swelling of the membranes that line the airway (mucosal edema), which reduces the airway diameter (2) contraction of the bronchial smooth muscle that encircles the airway (bronchospasm) which causes further narrowing and (3) increased mucus production, which diminishes airway size and may entirely plug the bronchi.

The bronchial muscles and mucous glands enlarged; thick tenacious sputum is produced; and the alveoli hyperventilate. Some patients have airway subbasement membrane fibrosis. This is called airway “remodeling” and occurs in response to chronic inflammation. The fibrotic changes in the airway narrowing and potentially irreversible airflow limitation, cells that play a key role in the inflammation of asthma are mast cells, neutrophils, eosinophils, and lypmhocytes. Mast cells when activated release several chemicals called mediators. These chemicals, which include histamine, bradykinin, prostaglandins and leukotrienes, perpetuate the inflammatory response, causing increased blood flow, vasoconstriction, fluid leak from vasculature, attraction of white blood cells to the area and bronchoconstriction.

In addition, alpha and beta²-adrenergic receptor of the sympathetic nervous system located in the bronchi play a role, when the alpha-adrenergic receptor are stimulated, bronchoconstriction occurs. When beta-adrenergic receptor are stimulated bronchodilation occurs. The balance between alpha and beta adrenergic receptor is controlled primarily by cyclic adenosine monophosphate (cAMP). Alpha adrenergic receptor stimulation results in a decrease in cAMP, which lead to an increase of chemical mediators released by the mast cells and bronchoconstriction. Beta- adrenergic stimulation results in increased level of cAMP, which inhibits the release of chemical mediators and causes bronchoconstriction.

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This case study aims to conduct an extensive and comprehensive research and study about Bronchial Asthma through conducting a thorough and effective data gathering methods and using appropriate communication skills in conversing to our patient through our five-day exposure at Cotabato Regional and Medical Center.

Specific Objectives:

In order to serve as our guide in finishing this case study, not just for the sake of passing it but for our own holistic growth and mental and skills enhancement, we have formulated the following goals:

• Establish a trusting relationship with our client in order to gain cooperation and gather information needed in our case study;

• Assess our patient thoroughly and holistically, to come up with an accurate physical assessment;

• Determine the personal background of our client as well as the history and present health condition;

• Define the complete diagnosis of our patient;

• Present the anatomy and physiology of the system involved in the condition;

• Trace the Pathophysiology of Bronchial Asthma.

• Interpret the diagnostic examinations and laboratory tests and their clinical significance;

• Enumerate and elaborate the drugs that are being prescribed by the doctor and to our client;

• Discuss the medical/surgical management for our clients condition;

• Formulate effective nursing care plans based on the identified nursing problems;

• Present this case study to the rest of the group and to our clinical instructor for corrections and criticism.

• Present the result of the study that will serve as one of the basis for patient’s recovery and in helping their family and significant others on what are the things to be done and not to be done.

• Provide information for the patient to broaden their knowledge, ideas, and level of awareness regarding the issue.

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• Kozier, Erb, Berman, Snyder (2004) - Fundamentals of Nursing: concept, process, and practice 7th edition.

• Smeltzers, Bare, Hinkle, Cheever (2008) – Brunner and Suddarth’s textbook of Medical-Surgical Nursing 11th edition.

• Manual of Physical Assessment.

• Doenges, Moorehouse (1991) – Nursing pocket guide: nursing diagnosis with interventions 3rd edition.

• Myers (2003) – RN notes: Nurses’ clinical pocket Guide.

• Marieb (2004) – Essentials of human anatomy and Physiology. 7th edition.

• Doenges, Moorhouse, Murr – Nursing care plans guidelines for individualizing client care across the life span.

DRUG HANDBOOKS:

• Deglin, Vallerand. (2005) – Davis’ drug guide for nurses 10th edition.

• MIMS Philippines 115th edition 2008.

• PPDs’ Nursing Drug guide 2007.