Created by:

Afrina Reri W. P07120112002

Dwi Andriyani P07120112012
Karisma Dwijayanti P07120112023
Reyka Vikendari A. P07120112033
Rinta Praditawati P07120112035
Umu 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 allergic
2. 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 analysis
2. Hematologic studies
3. Pulmonary function testing
4. Chest x-ray
5. Arterial blood gas studies
6. Spirometry
7. Skin testing
8. 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