Created by:

Afrina Reri W. P07120112002Dwi Andriyani P07120112012Karisma Dwijayanti P07120112023Reyka Vikendari A. P07120112033Rinta Praditawati P07120112035Umu Habibah P07120112040

A 37 y/o black female with a history of asthma, presents to the ER (Emergency Room) with tachypnea, and acute shortness of breath with audible wheezing. Patient has taken her prescribed medications of Cromolyn Sodium and Ventolin at home with no relief of symptoms prior to coming to the ER. A physical exam revealed the following: HR 110, RR 40 with signs of accessory muscle use. Ausculation revealed decreased breath sounds with inspiratory and expiratory wheezing and patient was coughing up small amounts of white sputum. SaO2 was 93% on room air. An arterial blood gas (ABG) was ordered with the following results: pH 7.5, PaCO2 27, PaO2 75.

An aerosol treatment was ordered and given with 0.5 cc albuterol with 3.0 cc normal saline in a small volume nebulizer for 10 minutes. Peak flows done before and after the treatment were 125/250 and ausculation revealed loud expiratory wheezing and better airflow. 20 minutes later a second treatment was given with the above meds. Peak flows before and after showed improvements of 230/360 and on ausculation there was clearing of breath sounds and much improved airflow. RR was 24 at this time and HR 108. Symptoms resolved and patient was given prescription for inhaled steroids to be used with current home meds. Instruction was given for use of inhaled steroids and the patient was sent home.

Asthma is a reversible airway obstruction that is characterized by hyperirritability of the airways. Substances that have no effect when inhaled by normal individuals cause bronchoconstriction in patients with asthma.

Asthma does not cause emphysema or other chronic diseases but alone may be a significant cause of disability. A principal feature of asthma is its extreme variability, both from patient to patient and from time to time in the same patient.

1. Child-Onset Asthma happens because a child becomes sensitized to common allergens in the environment - most likely due to genetic reasons.

2. Adult-Onset Asthma adult-onset asthma affects women more than men, and it is also much less common than child-onset asthma.

Etiologic or pathologic classification of the disease is difficult; however, asthma traditionally is divided into two forms.1.Extrinsic form atopic or allergic2.Intrinsic form cryptogenic

(+) In patients in whom the evidence of immediate hypersensitivity to antigen is equivocal.

The most common asthma symptoms are:

1.Shortness of breath.2.Wheeze.3.Chest tightness.4.A dry, irritating and continual cough (especially at night/early in the morning, or with exercise or activity.5.Accessory muscle use.

1. Pathophysiologically, asthma is characterized by constriction of airway smooth muscle, hyper secretion of mucus, edema and inflammatory cell infiltration of the airway mucus, and thickening of the basement membrane underlying the airway epithelium.

2. These pathophysiologic changes are not uniformly distributed. Some airways may display a predominance of bronchospasm, others may be occluded by mucous plugging, and still others may appear unaffected.

1. Sputum analysis2. Hematologic studies3. Pulmonary function testing4. Chest x-ray5. Arterial blood gas studies6. Spirometry7. Skin testing8. Serum IgE level

Obtain history about previous attacks. Place the patient in high Fowlers position. Evaluate wheezes for location,duration and phase of

respiration when they occur. Monitor pulse oximetry and ABG for oxygenation

and acid-base balance. Identifies medications the patient is currently taking Administer medications as prescribed and monitors

the response of patient to those medication. Administer fluids if the patients is dehydrated Assess frequently the vital sign as clients condition

dictates. Provide reassurance to relieve anxiety. Emergency Interventions