Asthma

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA-

Dr. Jose G. Tamayo Medical University

Sto. Nio, Bian, Laguna

C O L L E G E OF N U R S I N G

CASE PRESENTATION OF

BRONCHIAL ASTHMA

IN PARTIAL FULFILLMENT FOR OUR REQUIREMENTS IN COMPETENCY APPRAISAL 1

BACHELOR OF SCIENCE IN NURSING 4th YEAR A

GROUP 3

PREPARED BY:

GODINEZ, Leo Patrick V M. LUNAS, Anna Carmela L. MONGCAL, Joe Marie R.

PALMA, Charmaine J.

REYES, Ericka Jane P.

RITUALO, Philip Gerard A.

UNIDA, Rezelle C.

VALDEZ, Merry-Lhou F.

VERGARA, Bernadeth U.

VIRAY, Jessica May C.

August 03, 2012

INTRODUCTION

Asthma is a chronic inflammatory disease of the airways that causes airway

hyper-responsiveness mucosal edema, and mucus production. This inflammation

ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness,

wheezing and dyspnea.

In 1995 the international study of asthma and allergies in children conducted

phase 1 of a worldwide study to describe the prevalence and severity of asthma, rhinitis

and eczema among school children. One hundred fifty five centers in 56 countries

participated, including the Philippines. More than 450,000 children were interviewed

using a one-page written questionnaire or a video asthma questionnaire. The study

showed that the prevalence of asthma symptoms in children varied greatly in different

populations with differences ranging between 20 and 60 fold. The highest prevalence

was found from centers in the United Kingdom, Australia and New Zealand. Three

thousand two hundred and seven children in metro manila aged 13-14 years

participated in the ISAAC. Participants accomplished a 12 month prevalence of self-

reported asthma symptoms from written questionnaires and from video questionnaires.

The results showed that approximately 12% and 8% prevalence based on responses to

the written questionnaires and to the video questionnaires respectively. In a subsequent

study, 12.3% of the same population reported wheezing.

Asthma differs from the other obstructive lung disease is that it is largely

reversible, either spontaneously or with treatment. Patients with asthma may experience

symptom-free periods alternating with acute exacerbations, which last from minutes to

hours or days. Asthma can occur at any age and is the most common chronic disease

in the childhood. Despite increased knowledge regarding the pathology of asthma and

the development of better medications and management plans, the death rate from

asthma continues to increase. For most patients it is a disruptive disease, affecting

school and work attendance, occupational choices, physical activity, and general quality

of life.

Allergy is the strongest predisposing factor for asthma. Chronic exposure to

airway irritants or allergens also increases the risk for developing asthma. Common

allergens can be seasonal (e.g. grass, tree and wood pollens) or perennial (e.g. mold,

dust, roaches, or animal dander). Common triggers for asthma symptoms and

exacerbations in patients with asthma include airway irritants (e.g. air pollutants, cold,

heat, weather changes, strong odors or perfumes, smoke), exercise, stress or emotional

upsets, sinusitis with postnasal drip, medications, viral respiratory tract infections and

gastroesophageal reflux. Most people who have asthma are sensitive to a variety of

triggers. A patients asthma condition will change depending upon the environment,

activities, management practice, and other factors.

On a pregnant woman with asthma, they will have difficulty pulling in air; on

exhalation, she has too much difficulty in releasing air that she makes a high pitched

whistling sound from air being pushed past the bronchial narrowing. Asthma has the

potential of reducing the oxygen supply to a fetus leading to preterm birth or fetal growth

restriction if a major attack should occur during pregnancy, although this is not likely

with well-managed asthma. Many women find that their asthma improves during

pregnancy because of the high circulating levels of corticosteroids that are present. A

woman should check with her physician or nurse-midwife about the safety of the

medication she routinely takes for this disorder before pregnancy to be certain it will be

safe to continue using them during pregnancy and breast feeding.

PATIENTS PROFILE NAME : C. D. R. ADDRESS : City of Sta. Rosa Laguna GENDER : Female AGE : 21 years old BIRTHDAY : December 19, 1990 CIVIL STATUS : Single NATIONALITY : Filipino RELIGION : Roman Catholic FATHERS NAME : R. C. MOTHERS NAME : F. R. ADDRESS : City of Sta. Rosa Laguna ADMISSION DATE : July 02, 2012 ADMISSION TIME : 10:10 PM HOSPITAL NAME : UPH-DJGTMC ADMITTING DOCTOR: Dr. P ATTENDING PHYSICIAN: Dra. R DIAGNOSIS : PU 27-28 weeks AOG with Bronchial Asthma in Mild Respiratory Distress

PATIENTS HISTORY

HISTORY ADMISSION

History of Present Illness

>Upon admission, the patient complained difficulty of breathing and is febrile.

Past Medical History No Past Medical History

Family History

>Mother is 46; Father is 49. >Her mother has asthma.

Past Social History

>A Housewife. >Shes taking cigarette. >She does not exercise. >Sleeps almost 8 hours a day. >Taking medications but doesnt remember the specific name.

Obstetric History

>LMP: December 15, 2011 >AOG: 27- 28 Weeks >EDC: Sept, 19, 2012 >G=1 P=0 (T=0 P=0 A=0 L=0) >Cephalic presentation of fetus >FHT located at RLQ

Past Health History

>Difficulty of breathing especially at night since childhood. >Immunizations taken during childhood years. >No problems at birth. >No surgeries.

PHYSICAL ASSESSMENT

GENERAL SURVEY >Patient is slightly cooperative and actively speaking. >Patient appears weak and restless.

SKIN, HAIR AND NAIL

>Brown colored skin with no signs of dehydration >Skin is smooth, soft and warm >Good skin turgor. No presence of edema. >Scalp is symmetrical, smooth and firm with no signs of lesion >Hair is black, adequate amount and equally distributed. >Nails are long, clean; black pigmented, pale, presence of clubbing (>180

O angle), round, hard,

and immobile, smooth, firm.

HEAD AND NECK >Neck is smooth and has controlled movement. >No presence of enlargement of lymph nodes.

EYE

>Eyelids and lashes is symmetrical and evenly spaced. >Blinking is symmetrical. >Iris and pupil is round and equal. >Lens is clear >Conjuctiva and sclera has inconsistent color (slightly red) >Cornea is transparent and moist >Pupils converge and constrict >No abnormal movement of eyes >Both eyes move with coordination. >Presence of reflection of light on the eyes.

EAR >Nontender auricle and tragus >No presence of tenderness of mastoid process. >No presence of discharge.

MOUTH, NOSE, SINUS

>Lips and surrounding tissue relatively symmetrical with no lesions >buccal mucosa is pink, smooth and without lesions. >Gums are pink. >Tongue is pink, no lesions. >Nose is smooth, firm and symmetrical. >Sinuses are nontender.

THORAX AND LUNGS

>Color of thorax is pallor >Intercostals spaces are retracting. >Chest symmetry is equal >Rib slope is less than 90

O downward

>Respiration pattern is uneven and labored, > 20cpm >Chest expansion is less than 3 inches. >Vibration decreases over lung with consolidation >Wheezing present during auscultation

ABDOMINAL >Presence of striae gravidarum and linea nigra >No presence of lesions >Enlargement of abdomen due to pregnancy

ANATOMY & PHYSIOLOGY

RESPIRATORY SYSTEM

Breathing is necessary because all living cells of the body require oxygen and produce carbon dioxide. The respiratory system allows the exchange of these gases between the air and the blood. And the cardiovascular system transports them between the lungs and the cells of the body. The capacity to carry out normal activity is reduced without healthy respiratory and cardiovascular systems. Function:

1. Gas Exchange. The respiratory system allows oxygen from the air to enter the blood and carbon dioxide to leave the blood and enter the air. The cardiovascular system transports oxygen from the lungs to the cells of the body and carbon dioxide from the cells of the body to the lungs. Thus, the respiratory and cardiovascular systems work together to supply oxygen to all cells and to remove carbon dioxide.

2. Regulation of blood pH. The respiratory system can alter blood pH by changing blood carbon dioxide levels.

3. Voice Production. Air movement past the vocal folds makes sound and speech possible.

4. Olfaction. The sensation of smell occurs when airborne molecules are drawn into the nasal cavity.

5. Protection. The respiratory system provides protection against some microorganisms by preventing their entry into the body and by removing them from the respiratory surfaces.

Nose

A protuberance in vertebrates that houses the nostrils, or nares, which admit and expel air for respiration in conjunction with the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind thenasal cavity, air next passes through the pharynx, shared with the digestive system, and then into the rest of the respiratory system.

Nasal Cavity

Cavity between external nares and the pharynx. It is divided into two chambers by the nasal septum and is bounded inferiorly by the hard and soft palate.

N

asal Cavity

Cavity between

external

nares

and the

pharynx.

It is divid

ed into two cha

mbers by

the nasa

l septum

and is

bounded

inferiorly by

the hard and soft

palate.

The

nasal cavity conditions the air to be received by the other areas of the respiratory tract. Owing to the large surface area provided by the conchae, the air passing through the nasal cavity is warmed or cooled to within 1 degree of body temperature. In addition, the air is humidified, and dust and other particulate matter is removed by vibrissae, short, thick hairs, present in the vestibule. The cilia of therespiratory epithelium move the particulate matter towards the pharynx where it passes into the esophagus and is digested in the stomach.

Oral Cavity

The mouth; consists of the space surrounded by the lips, cheeks, teeth, and palate; limited posteriorly by the fauces.

Pharynx The common passageway of both the digestive and respiratory systems. It

receives air from the nasal cavity and receives air, food, and drink from the oral cavity. Inferiorly, the pharynx is connected to the respiratory system at the larynx and to the digestive system at the esophagus. The pharynx is divided into three regions:

o Nasopharynx - located posterior to the choanae and superior to the soft

palate, which is an incomplete muscle and connective tissue partition separating the nasopharynxfrom the oropharynx.

- Air passes through them to equalize air pressure between the atmosphere and the middle ear.

o Oropharynx - extends from the soft palate to the epiglottis, and the oral cavity opens into the oropharynx. Thus, air, food, and drink all pass through the oropharynx.

o Laryngopharynx - extends from the tip of the epiglottis to the esophagus and passes posterior to the larynx.

- Foods and drink pass through the laryngopharynx to the esophagus. A small amount of air is usually swallowed with the food and drink.

Epiglottis A flap of elastic cartilage tissue covered with a mucus membrane,

attached to the root of the tongue. It projects obliquely upwards behind the tongue and the hyoid bone, pointing dorsally.

The epiglottis guards the entrance of the glottis, the opening between

the vocal folds. It is normally pointed upward during breathing with its underside functioning as part of the pharynx, but during swallowing, elevation of the hyoid bone draws the larynx upward; as a result, the epiglottis folds down to a more horizontal position, with its superior side functioning as part of the pharynx. In this manner it prevents food from going into the trachea and instead directs it to the esophagus, which is posterior.

Larynx Is located in the anterior part of the throat and extends from the base of

the tongue to the trachea. It is a passageway for air between the pharynx and the trachea.

Fine manipulation of the larynx is used to generate a source sound with a

particular fundamental frequency, or pitch. This source sound is altered as it travels through the vocal tract, configured differently based on the position of the tongue, lips, mouth, and pharynx. The process of altering a source sound as it passes through the filter of the vocal tract creates the many different vowel and consonant sounds of the world's languages as well as tone, certain realizations of stress and other types of linguistic prosody. The larynx also has a similar function as the lungs in creating pressure differences required for sound production; a constricted larynx can be raised or lowered affecting the volume of the oral cavity as necessary in glottalic consonants.

Trachea

Is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells, which produce mucus. This mucus lines the cells of the trachea to trap inhaled foreign particles, which the cilia then waft upwards towards the larynx and then the pharynx where it can either be swallowed into the stomach or expelled as phlegm.

Lungs

The Lungs are paired organs in the chest that perform respiration. Each human has two lungs. Each lung is between 10 and 12 inches long. The two lungs are separated by a structure called the mediastinum. The mediastinum contains the heart, trachea, esophagus, and blood vessels. A protective membrane called the pulmonary pleura covers the lungs.

The lungs oxygenate the body because air is breathed in via the nose or

mouth. When a person breathes in, the lungs expand and need assistance from other muscles in order to function properly. When a person breathes out, or exhales, the lungs do not need assistance.

Gas Exchange

Oxygen and Carbon Dioxide in partial pressure diffusion gradients between the

alveoli and the pulmonary capillaries and between the tissues and the tissue capillaries are responsible for gas exchange.

Diffusion of Gases in the Lungs and in the Tissues

1. Oxygen diffuses into the arterial ends of pulmonary capillaries and CO2 diffuses into the alveoli because of the differences in partial pressure.

2. As a result of diffusion at the venous ends of pulmonary capillaries, the PO2 in the blood is equal to the PO2 in the alveoli and the PCO2 in the blood is equal to the PCO2 in the alveoli.

3. The PO2 of the blood in the pulmonary veins is less than the pulmonary capillaries because of mixing with deoxygenated blood from veins draining the bronchi and bronchioles.

4. Oxygen diffuses out of the arterial ends of tissue capillaries and CO2 diffuses out of the tissue because of the differences in partial pressures.

5. As a result of diffusion at the venous ends of tissue capillaries, the PO2 in the blood is equal to the PO2 in the tissue and the PCO2 in the blood is equal to the PCO2 in the tissue.

Major Regulatory Mechanisms of Ventilation The major regulatory mechanisms that affect the rate and depth of ventilation are shown. A plus indicates an increase in ventilation and minus sign indicates a decrease in ventilation.

a. Higher centers of the brain (speech, emotions, voluntary control of breathing and action potential in motor pathways).

b. Medullarychemoreceptors pH, CO2 c. Carotid and aortic body chemreceptors O2. d. Hering-Breuer reflex (stretch receptors in lungs). e. Proprioceptors in muscles and joints. f. Receptors for touch, temperature and pain stimuli.

PATHOPHYSIOLOGY

Non-modifiable Factors:

Age Gender Immunity Hereditary

Modifiable Factors:

Environmental Factors Pollution Smoking Cliamte Alleregens

Occupation Lifestyle

Exercise SleepingPattern ADL Diet

Stimuli enters the

nasopharynx straight to

the trachea then travels

to the bronchial tree.

Allergens enters the

tissue.

Allergens invades the

tissues.

Prostaglandins are

released.

Increased blood flow of

the bronchiole.

Increased vascular

permeability of the

bronchioles.

Narrowing of bronchioles

(vasoconstriction).

Wheezing sound Secretions Increase Respiratory

Rate

Dyspnea

MEDICAL MANAGEMENT

During pregnancy

Independent

Ensure optimal asthma control throughout pregnancy Manage and control asthma triggers aggressively Avoid delay in diagnosis and treatment Assess medication needs and response to therapy frequently Ensure adequate patient education and acquisition of self-management skills Encourage smoking cessation Monitor fetal movements daily after 28 weeks. Treat rhinitis, gastric reflux, and other comorbidities adequately Do not give flu vaccination until after 12 weeks of pregnancy Be aware of the risk of pre-eclampsia and intrauterine growth retardation Educate pregnant patients to develop a partnership in asthma management.

Dependent

Monitor mother's pulmonary function through a spirometry or a peak flow meter(to measure your lung function) at least monthly

Ultrasound examination to check the babys growth and activity, and also the amount of amniotic fluid around the baby. Collaborative

Refer patient to an asthma specialist and an obstetrical provider.

During Labor and Delivery

Independent

Closely monitor the woman and assess fetal wellbeing continuously Maintain oxygen saturation >95% The patient's PEFR may be taken upon admission to labor and delivery and,

subsequently every 12 hours, if indicated.

Place woman in a left lateral position The patient's regularly scheduled asthma medications should be continued

during labor and delivery. Provide ample hydration with intravenous fluid (isotonic saline 125 ml/h) if

drinking is impossible

Avoid hypotension with adequate position, hydration, and treatment

Use adrenaline (epinephrine) only in the context of an anaphylactic reaction

Consider intubation earlier than usual and call an expert if intubation is required as it can be more difficult in pregnant women owing to the edema of the oropharyngeal mucosa

Continue medications and give short acting 2 agonists or corticosteroids, or both, if asthma is not well controlled (Pre-Term Labor)

Provide ample hydration with intravenous fluid

Evaluate pulmonary status and oxygen saturation on admission, and later as needed

Favor lumbar epidural analgesia to provide adequate pain relief (which decreases bronchospasm) and to reduce oxygen consumption and minute ventilation(Pain Control)

Avoid bronchoconstrictor agents for management of abortion or labour (such as prostaglandin F2 ) or for postpartum haemorrhage (such as ergonovine, methylergonovine (neither is licensed in the UK), and carboprost)

Postpartum Period

Education

Review asthma regularly after delivery. Encourage breastfeeding. Remind parents that passive smoking increases the risk of childhood asthma and

other respiratory conditions in their child. Keep home as allergen-free Keep baby's weight within a healthy range Live in a place where air quality is good, such as limited car exhaust fumes and

smog Manage stress, since maternal distress can increase asthma risk in children

DIAGNOSTIC EXAMINATIONS

URINALYSIS -Is an array of tests performed on urine and one of the most common methods of medical diagnosis. Using urine dipsticks, in which the results can be read as color changes, can perform a part of a urinalysis. Date:

TEST PATIENTS

RESULT NORMAL VALUE

INTERPRETATION SIGNIFICANCE

a. Color Light Yellow Straw to Dark

Yellow Normal Normal

b. Transparency/

Turbidity

Clear Clear to Slightly Hazy

Normal Normal

c. Reaction

Acidic 4.6- 6.5 Acidic May be caused by excessive

dietary intake of purines

d. Specific Gravity

1.010 1.016- 1.022 Normal ---

e. Protein Negative Normal Normal

f. Glucose 14 --- ---

g. Pus Cells 0-2 --- ---

h. RBC 0-1 --- ---

i. Epithelial Cells

few Small amounts of

Hyaline, coarse fine granular,

RBC, WBC, waxy casts

Normal Normal

DIAGNOSTIC HEMATOLOGY

- to check for blood diseases and disorders, infections in blood, oxygen levels in blood, diabetes, kidney, and liver disease and a host of ailments.

Department of Pathology and Laboratory Hematology July 02, 2012 HbsAg: ( - )

COMPONENTS GENDER NORMAL VALUE

PATIENTS RESULT

SIGNIFICANCE

Hemoglobin M F

120- 150 gm/L 110- 140 gm/L

120 gm/L Normal

Hematocrit M F

0.40- 0.54 0.37- 0.47

0.36 Normal

Red Blood Cells

M F

4.5-6 x10 4.5-5 x10

4.1 Normal

Erythrocyte Sed Rate

M F

0- 10 mm/hr 0-20 mm/hr

--- ---

White Blood Cells

5.0- 10 x 10 8.4 Normal

Platelets 150- 400 x10 204 Normal

SCHILLING DIFFERENTIAL BLOOD COUNT

- A method of counting blood cells in which the polymorphonuclear neutrophils are separated into four groups according to the number and the arrangement of the nuclear masses in each cell.

COMPONENTS NORMAL VALUE PATIENTS RESULT SIGNIFICANCE

Basophils 0- 0.01 0 Normal

Eosinophils 0- 0.04 0.01 Normal

Stabs 0- 0.04 0 Normal

Segmenters 0.50- 0.70 0.84 May due to

inflammatory diseases

Lymphocytes 0.20- 0.40 0.15 Normal

Monocytes 0- 0.05 0 Normal

ARTERIAL BLOOD GAS ANALYSIS

Objective:

To recognize the different acid base parameters.

Be able to define simple and mixed acid base abnormalities.

Be able to interpret ABG results.

Arterial blood sample analysis provides precise measurement of acid base

balance of the lungs ability to oxygenate the blood and remove excess carbon

dioxide.

Arterial blood sample obtained by inserting a needle into a major artery.

1. pH (Hydrogen Ion Concentration) a measurement of the hydrogen ion (H+)

concentration in the plasma. Normal value is 7. 35 7.45.

2. PaCO2 (Partial Pressure of Arterial CO2) reflection of the respiratory component

of acid base status. Normal value is 35 45 mmHg.

3. HCO3- (Arterial Blood Bicarbonate) reflection of the metabolic component of

acid base balance and is regulated by renal system. Normal value is 22 26

mEq/L.

4. PaO2 (Partial Pressure of O2 in Arterial blood) measurement of the pressure or

tension of oxygen in the plasma of the arterial blood. Normal value is 80 100

mmHg.

5. SaO2 (Oxygen Saturation) index of the actual amount of oxygen in hemoglobin

expressed as percentage of total capacity. Normal value is >95%.

ACID BASE DISORDERS

1. Simple Disorders

a. Respiratory Acidosis

- An abnormal condition in which there is a primary reduction in alveolar ventilation

relative to the rate of CO2 production.

- PaCO2 is elevated or when it is higher than the expected level of compensation.

- One of the common causes of respiratory acidosis is COPD.

b. Respiratory Alkalosis

- An abnormal condition in which there is a primary increase in alveolar ventilation

relative to the rate of CO2 production.

- PaCO2 is below the expected level and indicates that the ventilation is exceeding

the normal level.

- One of the common causes of Respiratory Alkalosis is Pulmonary Fibrosis.

c. Metabolic Acidosis

- Identified when the plasma HCO3- or base excess falls below normal.

- Can occur when buffers are not produced in sufficient quantities or when they are

lost excessively.

- One of the common causes of Metabolic Acidosis is Ketoacidosis.

d. Metabolic Alkalosis

- Identified by an elevation of the plasma HCO3- above normal.

- Occurs whenever HCO3- ions in the blood or when an abnormal number of H+ ions

are lost from the plasma.

- One of the common causes of Metabolic Alkalosis is Loss of gastric fluid (e.g.

Vomiting).

2. Mixed Acid Base Disorders

a. Respiratory and Metabolic Acidosis

- Can be identified by an elevated PaCO2 and a reduction in plasma HCO3-.

b. Respiratory and Metabolic Alkalosis

- Can be recognized by identifying an elevated plasma HCO3- and a PaCO2 below

normal.

c. Respiratory Alkalosis and Metabolic Acidosis

- Metabolic acidosis usually occurs as a primary disorder and is compensated for by

a predictable degree of hypocapnea.

d. Respiratory Acidosis and Metabolic Alkalosis

- Can be identified by having an elevated plasma HCO3- concentration together with

an elevated PaCO2.

ABG RESULT

PATIENTS RESULT

NORMAL VALUE INTERPRETATION

pH 7.27 7.35 7.45 Acidemia / Acidosis

PaCO2 78 mmHg 35 45 mmHg Respiratory Acidosis

HCO3- 26 mEq/L 22 26 mEq/L Normal

PaO2 71 mmHg 80 100 mmHg Mild Hypoxemia

SaO2 87% >95% ---

Final Interpretation: Uncompensated respiratory acidosis with mild hypoxemia

DRUG STUDY

DRUG NAME

BRAND NAME INDICATION ACTION NURSING CONSIDERATION

Solucortef

Solucortef

Generic Name

hydrocortisone Na succinate

Frequency

q 6 hrs. 3 days

Route

IV

Dosage

100mg

Endocrine, hematologic, rheumatic and collagen disorders; dermatologic,ophth GI, resp and neoplastic diseases. Allergies. Acute exacerbations of TB meningitis with subarachnoid block, trichinosis. Multiple scelorosis.

Glucocorticoid with anti-inflammatory effect because of its ability to inhibit prostaglandin synthesis, inhibit migration of macrophages, leucocytes and fibroblasts at sites of inflammation, phagocytosis and lysosomal enzyme release. It can also cause the reversal of increased capillary permeability.

Do not confuse hydrocortisone with

hydrocodone (a narcotic agent). Check label of parenteral

hydrocortisone because IM and IV preparations are not necessarily interchangeable.

Give reconstituted direct IV solution at a rate of 100mg / 30 sec. Doses larger than 500mg shoud be infused over 10 mins.

Report worsening of condition, any fever, sore throat, muscle aches, slow healing, sudden weight gain, or swelling of extremities.

DRUG NAME

BRAND NAME INDICATIONS ACTION NURSING CONSIDERATIONS

Tums

Tums

Generic Name

Ca carbonate

Frequency

OD

Route

Oral

Dosage

2 Tab

Relief of acid ingestion; heartburn, sour stomach and upset stomach associated with these symptoms; Ca supplement.

Decreases total acid load of GI tract. Increases esophageal sphincter tone, strengthens gastric mucosal barrier and reduce pepsis activity by elevating gastric pH.

Take as directed. Increase fluid

intake and bulk; prevents constipation.

As a supplement take: 1 1 hr after meals; as an antacid take 1 hr after meals and bedtime.

DRUG NAME


Bricanyl

Bricanyl

Generic name:

terbutaline sulfate

Frequency:

OD (given at ER)

q 6 hours (given at OB ward)

Route:

SC (ER)

Nebulization (OB)

Dosage:

0.25mg (SC)

Brochospasm in bronchial asthma, chronic bronchitis, emphysema, other lung diseases where bronchoconstriction is a complicating factor.

Specific beta 2 receptor stimulant, resulting to bronchodilation and relaxation of peripheral vasculature. Minimum beta 1 activity. Action resembles that of isoproterenol.

Take oral medication with meals to minimize GI tract.

Do not confuse terbutaline with terbinafine (antifungal) or tolbutamine (an oral hypoglycemic).

Discard unused portion after single client use.

Do not use if discoloured. Review and demonstrate appropriate

method for administration. Review use of spacer to administer therapy and peak flow meter to assess response to therapy.

DRUG NAME BRAND NAME INDICATIONS ACTION NURSING CONSIDERATION

Aminophylline

drip

Atlantic

Aminophylline Generic Name

aminophylline

Frequency

--

Route

IV

Dosage

2 ampules D5W gtts/min

Symptomatic treatment of bronchial asthma, bronchitis, bronchospasm and status asthmaticus. Relieve periodic apnea. Adjunct in treatment of pulmonary edema and paroxysmal nocturnal dyspnea caused by left heart failure.

Competitive nonselective phosphodiesterase inhibitor which raises intracellular cAMP, activates PKA, inhibits TNF-alpha and leukotriene synthesis, and reduces inflammation and innate immunity and nonselective adenosine receptor antagonist. Less potent and shorter-acting than theophylline. Its most common use is in the treatment of bronchial asthma.

Monitor for S&S of toxicity (generally related to theophylline serum levels over 20 mg/mL). Observe patients receiving parenteral drug closely for signs of hypotension, arrhythmias, and convulsions until serum theophylline stabilizes within the therapeutic range.

Note: High incidence of toxicity is associated with rectal suppository use due to erratic rate of absorption.

Monitor & record vital signs and I&O. A sudden, sharp, unexplained rise in heart rate may indicate toxicity.

Lab tests: Monitor serum theophylline levels.

Note: Older adults, acutely ill, and patients with severe respiratory problems, liver dysfunction, or pulmonary edema are at greater risk of toxicity due to reduced drug clearance.

DRUG NAME


Clusivol

OB

Clusivol OB

Generic Name

Multivitamins

Frequency

OD

Route

Oral

Dosage

1 tablet

Vitamin and mineral supplement for use during pregnancy, post-partum and lactation.

A dietary supplement.

May be taken with or without food

(May be taken w/ meals for better absorption or if GI discomfort occurs).

DRUG NAME


Pulmoxel

Pulmoxel

Generic Name

terbutaline sulfate

Frequency

q 4 hrs.

Route

Nebulization

Dosage

1cc + 2cc NSS

Relief of bronchial asthma, bronchitis, bronchospasm, emphysema, bronchiestasis, and other obstructive pulmonary disease where bronchoconstriction is a complicating factor.

Specific beta 2 receptor stimulant, resulting to bronchodilation and relaxation of peripheral vasculature. Minimum beta 1 activity. Action resembles that of isoproterenol.

Do not be confuse terbutaline with

terbinafine (antifungal) or tolbutamine (an oral hypoglycemic).

Discard unused portion after single client use.

Do not use if discoloured. Review and demonstrate

appropriate method for administration. Review use of spacer to administer therapy and peak flow meter to assess response to therapy.

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Asthma