1. Prepared by :Braa Shareef. Presented to : RN. Dalal.

2. Female pt,48 yrs old,admitted in15.2.2016 to almkassed hospital. *chief complaint : Shortness of breath -Headache-Chest pain - allergic.rhinitis (hay fever) -cough *Diagnosis: Asthma Medical history : Free past medical history

3. Is a chronic inflammatory disease of the air way, Airways become smaller or narrower, due to: - Underlying inflammation or swelling - Increased mucus production - Contraction of muscles around the airways, or.bronchospasm Asthma can't be cured, but its symptoms can be controlled.

5. :Asthma classification Mild intermittent : Mild symptoms up to two days a week and up to two nights a month :Mild persistent Symptoms more than twice a week, but no more than once in a single day :Moderate persistent Symptoms once a day and more than one night a week Severe persistent : Symptoms throughout the day on most days and frequently at night

6. .-Coughing.-Wheezing -Chest tightness or pain. -Shortness of breath..-Excessive fatigue Symptoms and severity of symptoms can change over the time may not have all of the above symptoms

7. It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and genetic.(inherited) factors when symptoms occur: At night or early morning During or after exercise During certain seasons After laughing or crying When exposed to common asthma trigger s

8. -Having a blood relative (such as a parent or sibling) with asthma -Having another allergic condition, such as atopic dermatitis or allergic rhinitis - Being overweight - Being a smoker - Exposure to secondhand smoke - Exposure to pollution - Exposure to occupational triggers.

9. *Allergens Animal dander,Cockroach droppings, Dust mites,Pollen. *Irritants -Environmental tobacco smoke or second hand smoke. -Air pollution -Chemicals and strong smells

11. Weather changes Upper respiratory infections Strong emotions Exercise

12. 1.Asthmaticus 2.Respiratory failure 3.Pneumonia 4.Airway obstruction

13. Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.

14. Peak flow: A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse.

15. *Long-term asthma control medication Inhaled corticosteroids :These anti-inflammatory.1 drugs include Fluticasone(flovent) *side effect: cough,dysphonia(disorder of the voice),headache. In high dose :osteoporosis,skin thinning,easy bruising. 2.Long-acting beta2 agonists. These inhaled medications, (bronchodilator ),which include salmeterol (Serevent) *side effect: tachycardia, muscle tremor, hypokalemia, ECG changes with over dose.

16. 3.Short-acting beta agonists. These inhaled, quick- relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack They include albuterol (ProAir HFA, Ventolin HFA, others). 4.Theophylline: is a daily pill that helps keep the airways open (bronchodilator) by relaxing the muscles around the airways. It's not used as often now as in past years. (Elixophyllin, others). *side effect :tachycardia, vomiting,nausea, headache.

17. 5.Anti cholinergics : Bronchodialtor,reducation of vagal tone of air way, Decrease mucous secretion. -iprattropium(arrovent) *side effect: dryness of mouth, respiratory secretions may cause wheezing in some pt.

18. Nursing diagnosis: Ineffective airway clearance related to airway spasm, secretion retention, amount of mucus. Nursing intervention : 1. Airway management: Free the airway (suction) Monitor the chest wall retraction Monitor respiration rate Give a semi-Fowler position

19. 2. Clear the airway: -Listen to lung sounds -Encourage the patient to drink warm -Do suction -Monitor oxygen delivery -Evaluation of lung sounds after suction

20. Nursing diagnosis: Impaired gas exchange related to ventilation- perfusion inequality. Nursing intervention: 1.Administer bronchodilators as prescribed. 2. Evaluate effectiveness of nebulizer and assess for decrease shortness of breath, loosened secretions,decrease anxiety. 3.Istruct and encourage pt in diaphragmatic breathing and effective coughing.

21. nursing diagnosis: Knowledge deficit: about asthma, related to lack of information sources. Nursing intervention : 1. Assess the things that have been known to patients 2. Assess the patient's condition before health education, do not provide health education, while patients in the state of attack. 3. Education Explain the meaning of asthma, Explain the trigger factor Describe the things that need to be avoided.Explain how the handler during an asthma attack at home