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Case Presentation Geriatric
Case Presentation Geriatric
geriatric
His 2038
asthma
Name: nurdina afini binti izamudin
(031390)
Introduction
Definition:
Clinical syndrome characterized by attacks of
wheezing and breathlessness due to narrowing of
the intrapulmonary airways. Remission may be
spontaneous or as a result of treatment. During an
asthma attack, the muscles surrounding the airways
tighten. The lining of the air passages swells. Less
air is able to pass through as a result.
Types of asthma
EXTRINSIC (atopic)
INTRINSIC (non-atropic)
AETIOLOGY
The underlying causes of childhood asthma aren't
fully understood. Developing an overly sensitive
immune system generally plays a role. Some factors
thought to be involved include:
Inherited traits
Some types of airway infections at a very young age
Exposure to environmental factors, such as cigarette
smoke or other air pollution
pathology
Main pathological changes occur during an asthmatic attack
are:
Spasm of the smooth muscle in the walls of the bronchi and
bronchioles.
Oedema of the mucous membrane of the bronchi and
bronchioles.
Excessive mucus production.
the wall
Clinical featurs
Wheezing: A musical, high-pitched whistling sound
produced by airflow turbulence is one of the most common
symptoms of asthma. The wheezing is usually during
exhalation.
Cough: Usually, the cough is nonproductive and
nonparoxysmal; coughing may be present with wheezing
Cough at night or with exercise: Coughing may be the only
symptom of asthma, especially in cases of exercise-induced
or nocturnal asthma; children with nocturnal asthma tend to
cough after midnight, during the early hours of morning
Shortness of breath
Chest tightness: A history of tightness or pain in the chest
may be present with or without other symptoms of asthma,
especially in exercise-induced or nocturnal asthma
Sputum production
In an acute episode of asthma, symptoms vary according to the
episodes severity. Infants and young children suffering a severe
episode display the following characteristics:
Breathless during rest
Not interested in feeding
Sit upright to assist the accessory muscles of respiration. The
chest is held in inspiration.
Talk in words (not sentences)
Usually agitated
With imminent respiratory arrest, the child displays the
aforementioned symptoms and is also drowsy and confused.
However, adolescents may not have these symptoms until they
are in frank respiratory failure.
Cyanosis may occur centrally but not usually until the later
stages of the disease.
Dr.
management
Physical examination:
Diagnosis
ASTHMA MEDICINES
There are two basic kinds of medicine used to treat asthma.
Long-term control drugs are taken every day to prevent asthma
symptoms. Pt. should take these medicines even if no symptoms
are present. Some children may need more than one long-term
control medicine.
Types of long-termcontrol medicinesinclude:
Inhaled steroids (these are usually the first choice of treatment)
Long-acting bronchodilators (these are almost always used with
inhaled steroids)
Leukotriene inhibitors
Cromolyn sodium
pt.management
Aims of tx.
Assist in the removal of secretions.
Gain relaxation of the neck, shoulder girdle, and
upper chest muscles.
Teach the pt. breathing control
Maintain mobility of the neck, shoulder girdle,
thoracic spine and thorax.
Educate postural awareness.
Maintain or improve exercise tolerance.
Encourage a full, active lifestyle.
Removal of secretions
Postural drainage
Vibrations
Effective coughing
FET without increasing bronchospasm.
Suction
Relaxation and breathing control
lessness
references
www.mayoclinic.org
www.nlm.nih.gov
CASE
STUDY
Geriatric
aeba
Name: Mrs. T
Age: 65y/o
Gender: female
Race: Malay
R/N: 12234
Date of Admitted: 5 / 9 / 2014
Date of Assessment: 8/ 9 / 2014
Dr. Diagnosis:
AEBA
Dr mx:
Conservative mx. and refer physio
SUBJECTIVES ASSESSMENT
Problems:
Pt. c/o SOB and cough.
Pt. c/o unable to spit out phlegm.
Current hx:
h/o SOB on 5/9/2014. Seek for medical tx.Then
admitted to ward on the same day.Dr. refer her to
physio for further mx.
Past hx:NIL
Investigation:
Lab values: NIL
Ct-scan: NIL
MRI : NIL
Chest x-ray:NIL
Palpation:
Chest expansion:
Level
Symmetrical/assymetrical
Manobriosternal junction
Symmetrical
Xiphisternal junction
Symmetrical
10th rib
Symmetrical
Auscultation:
Level
Right
Left
Apical
Medial
Normal
Normal
Lower
Functional activity:
Bed mobility-well
ANALYSIS:
PT impression:
SOB d/t incorrect breathing pattern
Cough d/t secretion retention
Reduce breath sound d/t incorrect breathing
pattern
PLAN OF TREATMENT:
PLB
Relaxation position
Manual techniques-vibration,percussion,shaking
Breathing exs
ACBT
TME
Circulatory exs
Pt. edu.
HEP
INTERVENTIONS
Pt. in high sitt. on edge of bed, teach PLB 5x 2set
Pt. in high sitt. on edge of bed, breathing exs
diaphragmatic breathing- 3x 2set
Pt. in high sitt. on edge of bed, chest vibration
Pt. in high sitt. on edge of bed, ACBT 2x 2 set.
Pt. in high sitt. on edge of bed, TME, 3x 2 set.
Circulatory exs-ankle pumping 10x
Relaxation position , pt. in forward lean sitting.
Pt education: continue breathing exs, PLB is advice
when SOB; positioning- change every 2 hours;
HEP: Advise to do all exs. regularly at home.
EVALUATION:
Pt can tolerate all tx given
Pt feel tired after tx
Pt. able to cough affectively and productively.
Sputum analysis: Yellowish, thick, small amount.
REASSESSMENT:
Continue same tx as above
Focus more to breathing exs