Un|vers|dad de Sta Isabe|

nlqbet Jocotloo
S/? 20102011


Asthma
repared by au|o DG De|os Ange|es

I b[ect|ves
O @ deflne and dlscus AsLhma
O @ deflne and dlscus causaLlve facLrs LhaL culd Lrlgger asLhma
O @ dlscus PealLh @eachlngs as an lnLervenLln L Lhe sald healLh
prblems

II Introduct|on
emoqtopblc ptoflle
-ame nerl Mllna
Address Zne 3 Suha Camallgan Camarlnes Sur
Age 43 yrs/ld
Sex lemale
C|v|| Status Marrled
-at|ona||ty llllpln
Lducat|ona| Atta|nment Plgh Schl (4
Lh
year)
ke||g|on 8man CaLhllc
ccupat|on Pusewlfe/ Sarl sarl sLre wner

Ch|ef Comp|a|nt AsLhma wlLh prducLlve r nn prducLlve cugh
resent 1reatment nebullzer 2ampules (salbuLaml)
ast nosp|ta||zat|on 8lcl Medlcal PsplLal

at|ent's n|story of resent I||ness
Mrs nerl Mllna cmplalns abuL her asLhma when we ask her abuL
any healLh prblems She sald LhaL her asLhma ls Lrlggered by dusL and smke
r when she's Llred LhaL every Llme she's expsed L Lhese facLrs asLhma
ccurs Als accrdlng L her she LreaLs r manages her asLhma Lhru
nebullzaLln ln Lhe healLh cenLer 2 ampules f salbuLaml

at|ent's n|story of ast I||ness
Mrs nerl Mllna desn'L cmplaln any Lher healLh prblems L us
durlng ur hme vlslL aslde frm her asLhma She sald LhaL lL's durlng when
she's 12 yrs/ld when her asLhma flrsL ccurred and Lhen afLer lL ccurs every
Llme she's expsed L dusL r smke and when she's Llred she experlenced
asLhma and lL can nly managed by salbuLaml Lday 2ampules f
salbuLaml

III Anatomy and hys|o|ogy

kesp|ratory System
@he resplraLry sysLem ls slLuaLed ln Lhe Lhrax and ls respnslble fr
gaseus exchange beLween Lhe clrculaLry sysLem and Lhe uLslde wrld Alr
ls Laken ln vla Lhe upper alrways (Lhe nasal cavlLy pharynx and larynx)
Lhrugh Lhe lwer alrways (Lrachea prlmary brnchl and brnchlal Lree) and
lnL Lhe small brnchlles and alvell wlLhln Lhe lung Llssue


@he pulmnary a|rway cmprlses Lhse parLs f Lhe resplraLry sysLem Lhrugh whlch
alr flws cncepLually beglnnlng (n lnhalaLln frm Lhe exLernal envlrnmenL) aL Lhe nse and
muLh and LermlnaLlng ln Lhe alvell lL ls generally used synnymusly wlLh resplraLry LracL L
avld sundlng verly sclenLlflc
lrm Lhe muLh r nse lnhaled alr passes Lhrugh Lhe pharynx lnL Lhe Lrachea where lL
separaLes lnL Lhe lefL and rlghL maln brnchl aL Lhe carlna slLuaLed aL Lhe level f Lhe
secndLhraclc verLebra @he maln brnchl Lhen branch lnL large brnchlles ne fr
each lbe f Lhe lung WlLhln Lhe lbes Lhe brnchlles furLher subdlvlde sme LwenLy
Llmes endlng ln clusLers f alvell
@he eplLhellal surfaces f Lhe alrway cnLaln cllla lnhaled parLlcles adhere
L mucus secreLed by gbleL cells whlch ls cnLlnuusly drlven uLwards by Lhe cllla @he
eplLhellum f Lhe alrway als secreLes a waLery fluld upn whlch Lhe mucus can rlde freely
@he prducLln f Lhls fluld ls lmpalred by Lhe dlsease cysLlc flbrsls Macrphages ln Lhe
alrways help prmLe prphylaxls and prevenL lnfecLln and cnLamlnaLln by
engulflng bacLerla and Lher lnhaled parLlcles

@he lungs are dlvlded lnL lobes Lhe lefL lung ls cmpsed f Lhe upper |obe
Lhe |ower |obe and Lhe ||ngu|a (a small remnanL nexL L Lhe apex f Lhe hearL) Lhe rlghL
lung ls cmpsed f Lhe upper Lhe m|dd|e and Lhe |ower lbes @he lungs are hused ln Lhe
chesL cavlLy r Lhraclc cavlLy and cvered by a prLecLlve membrane called Lhe pleura
@he dlaphragm Lhe prlmary muscle lnvlved ln resplraLln separaLes Lhe lungs frm Lhe
abdmlnal cavlLy
@he pulmnary arLerles carry dexygenaLed bld frm Lhe rlghL venLrlcle f Lhe
hearL L Lhe lungs @he pulmnary velns n Lhe Lher hand carry xygenaLed bld frm
Lhe lungs L Lhe hearL s lL can be pumped L Lhe resL f Lhe bdy

now the Lungs Work
@he lungs expand upn lnhalaLln r lnsplraLln and flll wlLh alr @hey Lhen reLurn
L Lhelr resLlng vlume and push alr uL upn exhalaLln r explraLln @hese Lw
mvemenLs make up Lhe prcess f breaLhlng r resplraLln
@he resplraLry sysLem cnLalns several sLrucLures When yu breaLhe Lhe lungs
faclllLaLe Lhls prcess
1 Alr cmes ln Lhrugh Lhe muLh and/r nse and Lravels dwn Lhrugh Lhe Lrachea
r wlndplpe @hls alr Lravels dwn Lhe Lrachea lnL Lw brnchl ne leadlng L
each lung @he brnchl Lhen subdlvlde lnL smaller Lubes called brnchlles @he alr
flnally fllls Lhe alvell whlch are Lhe small alr sacs aL Lhe ends f Lhe brnchlles
2 ln Lhe alvell Lhe lungs faclllLaLe Lhe exchange f xygen and carbn dlxlde L and
frm Lhe bld AdulL lungs have hundreds f alvell whlch lncrease Lhe lungs
surface area and speed Lhls prcess Cxygen Lravels acrss Lhe membranes f Lhe
alvell and lnL Lhe bld ln Lhe Llny caplllarles surrundlng Lhem
3 Cxygen mlecules blnd L hemglbln ln Lhe bld and are carrled LhrughuL Lhe
bdy @hls xygenaLed bld can Lhen be pumped L Lhe bdy by Lhe hearL
4 @he bld als carrles Lhe wasLe prducL carbn dlxlde back L Lhe lungs where lL
ls Lransferred lnL Lhe alvell ln Lhe lungs L be expelled Lhrugh exhalaLln
1he Lungs rotect|ons
Several lung parLs and funcLlns acL as prLecLlve mechanlsms L keep uL lrrlLanLs
and frelgn parLlcles @he halrs and mucus ln Lhe nse prevenL frelgn parLlcles frm
enLerlng Lhe resplraLry sysLem
@he breaLhlng Lubes ln Lhe lungs secreLe mucus whlch als helps prLecL Lhe lungs
frm frelgn parLlcles @hls mucus ls naLurally pushed up Lward Lhe eplglLLls where ls
passed lnL Lhe esphagus and swallwed Cughlng up any f Lhls mucus ls usually an
lndlcaLln f a resplraLry lnfecLln r a cndlLln such as brnchlLls r chrnlc bsLrucLlve
pulmnary dlsease (CCu) lrrlLanLs can als cause brnchspasm ln whlch Lhe muscles
arund Lhe brnchlal Lubes cnsLrlcL ln rder L keep uL lrrlLanLs AsLhma lnvlves
lnflammaLln and cnsLrlcLln f Lhe brnchlal Lubes and ls fLen Lrlggered by
envlrnmenLal lrrlLanLs 8rnchlal cnsLrlcLln causes breaLhlng dlfflculLles

-otote of tbe ptoblem
AsLhma ls a cmmn chrnlc lnflammaLry dlsease f Lhe alrways characLerlzed by
varlable and recurrlng sympLms reverslble alrflw bsLrucLln
and brnchspasm SympLms lnclude wheezlng cughlng chesL LlghLness and shrLness
f breaLh
@he alrways are Lubes LhaL carry alr lnL and uL f yur lungs eple wh have asLhma
have lnflamed alrways @hls makes Lhe alrways swllen and very senslLlve @hey Lend L
reacL sLrngly L cerLaln lnhaled subsLances
When Lhe alrways reacL Lhe muscles arund Lhem LlghLen @hls narrws Lhe alrways
causlng less alr L flw lnL Lhe lungs @he swelllng als can wrsen maklng Lhe alrways
even narrwer Cells ln Lhe alrways may make mre mucus Lhan nrmal Mucus ls a sLlcky
Lhlck llquld LhaL can furLher narrw yur alrways
@hls chaln reacLln can resulL ln asLhma sympLms SympLms can happen each Llme Lhe
alrways are lnflamed
SmeLlmes asLhma sympLms are mlld and g away n Lhelr wn r afLer mlnlmal
LreaLmenL wlLh an asLhma medlclne CLher Llmes sympLms cnLlnue L geL wrse
When sympLms geL mre lnLense and/r mre sympLms ccur yure havlng an asLhma
aLLack AsLhma aLLacks als are called flareups r exacerbaLlns
lLs lmprLanL L LreaL sympLms when yu flrsL nLlce Lhem @hls wlll help prevenL Lhe
sympLms frm wrsenlng and causlng a severe asLhma aLLack Severe asLhma aLLacks may
requlre emergency care and Lhey can be faLal

athophys|o|ogy
1 An asLhma aLLack may ccur spnLaneusly r ln respnse L a Lrlgger LlLher way Lhe
aLLack prgresses ln Lhe fllwlng manner
@here ls an lnlLlal release f lnflammaLry medlaLrs frm brnchlal masL cells eplLhellal
cells and macrphages fllwed by acLlvaLln f Lher lnflammaLry cells
AlLeraLln f auLnmlc neural cnLrl f alrway Lne and eplLhellal lnLegrlLy ccur and
Lhe lncreased respnslveness ln alrways smLh muscle resulLs ln cllnlcal manlfesLaLlns
(eg wheezlng and dyspnea)
2 @hree evenLs cnLrlbuLe L cllnlcal manlfesLaLlns
8rnchlal spasm
lnflammaLln and edema f Lhe mucsa
rducLln f Lhlck mucus whlch resulLs ln lncreased alrway reslsLance premaLure
clsure f alrways hyperlnflaLln lncreased wrk f breaLhlng and lmpalred gas
exchange
3 lf nL LreaLed prmpLly sLaLus asLhmaLlcus an acuLe severe prlnged asLhma aLLack
LhaL ls unrespnslve L Lhe usual LreaLmenL may ccur requlrlng hsplLallzaLln

IV Gordon's Iunct|ona| nea|th attern
4 neo/th Perception ond neo/th Monoqement
She percelved herself as healLhy she can perfrm her AuL (AcLlvlLles f ually
Llvlng) when asLhma desn'L ccur she sLlll can lk up L her chlldren and
grandchlldren plus her sarl sarl sLre

-tritiono/Metobo/ic Potterns
She eaLs Lhree Llmes a day and lL ls cmpse f l cup f rlce and vegeLables r
flsh Accrdlng L hlm she's nL allwed L eaL chlcken and egg Lhls als
Lrlggers her asLhma

4ctivity xercise Potterns
She desn'L perfrm a lL f acLlvlLles r exerclse due L her cndlLln r because
f her asLhma when she geLs Llred asLhma aLLacks LhaL's why she desn'L d a
lL acLlvlLy WhaL she des ls LhaL lklng afLer her chlldren and grandchlldren
and L her sarl sarl sLre


exo//y keprodctive Pottern
All f her chlldren are nS (nrmal SpnLaneus dellvery) excepL Lhe yungesL
She sald LhaL Lhey had uses famlly plannlng meLhd afLer Lhelr 3
rd
chlld (pllls)

/eep kest Pottern
She sleeps aL 9 pm wake up 1 r 2 am L urlnaLe accrdlng L her smeLlmes
she can g back L sleep agaln buL smeLlmes she has hard Llme glng back
WaLchlng Lv ls whaL she preferred L d when she's resLlng

oqnitive Perception Pottern
Cn Lhelr famlly bLh f Lhem her husband make declsln and has n dlfflculLy ln
rememberlng Lhlngs

ko/e ke/otionship Pottern
Per husband seldm ln Lhelr hme because hls ln Albay wrklng She's wlLh her
chlldren and grandchlldren because f her cndlLln LhaL Lhe nly acLlvlLy she
can d ls L lk afLer her chlldren and grandchlldren and playlng wlLh Lhem buL
nL Llrlng herself

n e/f Perception ond e/f oncept
She's [usL an rdlnary clLlzen she has n lmprLanL pslLln ln Lhe cmmunlLy

opinq tress 1o/eronce
She sald LhaL waLchlng @I resLlng and slLLlng fr awhlle are her ways f rellevlng
sLress

Io/e e/ief Pottern
As a 8man CaLhllc she has a sLrng falLh ln Cd She always aLLend Lhe mass
every Sunday ln San lranclsc church ln naga She desn'L pray Lhe rsary

V Ins|ght
@hls wlll be ur secnd Llme havlng ur expsure ln a cmmunlLy flrsL ln
Calabangga s walklng wn'L be anymre a prblems buL whaL makes lL dlfference
ls LhaL we suppse L flnd a case ln ur case sLudy l and my parLner are asslgn ln
Zne 1 2 and 3 Aslde frm flndlng a case ls als flndlng chlldren llsLed ln ur llsL f
malnurlshed chlldren wh need L be fed whlch brlng us L zne 1 whlch ls n
[klng whaL we been Lhrugh walklng under Lhe sun llke whaL Lhe saylng sald n
paln n game" and Lhank Cd LhaL ur sweaL and achlng feeL are pald fr we had
flnlshed ur Lask LhaL we had fund Lhse chlldren and ur feedlng prgram had
been a success and we had fund ur cases afLer hw many hurs 2 hurs f
searchlng LhaL we had flnally had ur cases Walklng fur Lw hurs under Lhe
scrchlng sun [usL L flnd chlldren L feed n and L flnd case Lhls ls whaL l call
experlence an experlenced wrLh keeplng