College of Nursing

Silliman University Dumaguete City

Kardex
Cues and Evidences Objectives Interventions

Subjective: Kagahapon dai, gakalisod jud ko og ginhawa pero karon okey na kaayo ko, as claimed. Nagpa check-up ra unta ko sa doctor pero ni ingon siya na e.admit nalang kuno ko ky kuyaw daw ky mabdos ko. Mao gapa admit nalang pud ko ky mahadlok pud ko na maapektuhan ang bata, as claimed. Within our care, the client will be able to acknowledge and discuss fears /concerns, appear relaxed and reports that anxiety felt is reduced to a manageable level, verbalize awareness of feelings of anxiety and healthy ways to deal with them. Objective: Vital Signs: (0800) Temperature : 36.5 C Pulse Rate : 92 bpm, strong and bounding
Assist with the use of respiratory devices and treatments such as nebulizer. Note palpitations, elevated pulse / respiratory Acknowledge clients fear / anxieties. Assess degree reality of threat to client and level of anxiety by observing clients behavior

After 5 hours of duty, client will be able to: Monitor vital signs. Avoid allergenic foods that might cause or trigger asthma.

Assist client to use the energy of anxiety for coping with the situation whenever possible.

 Respiration Rate: 17 cpm, without the use of accessory muscles (1200) Temperature : 37.1 C Pulse Rate : 93 bpm, strong and bounding Respiration Rate: 17 cpm, without the use of accessory muscles BP : 110 / 70 mmHg Lips are not dry BP : 110 / 70 mmHg

Encourage deep breathing exercises.

General survey: Upon entering the room, client was lying in bed with infused IV. Showed no signs of distress. Client was alert, coherent,participative and had presence of mind. Fear related to stress threat of abortion.

Fetal surveillance An ultrasound exam is recommended between 12 and 20 weeks to serve as a baseline for evaluation of fetal growth restriction and the risk of preterm birth.2,14 Serial ultrasound exams to evaluate fetal activity and growth should be considered at 32 weeks gestation in women with poorly controlled asthma, moderate-to-severe asthma, and for women recovering from a severe asthma exacerbation.2 Also, consider antenatal surveillance of fetal well-being and instruct all patients in monitoring fetal activity.2 Intrapartum considerations Continue asthma medication throughout labor and delivery. Keep the mother wellhydrated and provide adequate anesthesia to prevent bronchospasm.2 Lumbar anesthesia can reduce oxygen consumption and minute ventilation during labor.2 However, avoid high levels of analgesia that may cause airway compromise in those with lung disease.26 Cesarean section is rarely needed for an acute exacerbation; however, delivery may improve the mother's respiratory status.2 Ergot alkaloids such as methylergonovine, which

are sometimes used to prevent or treat intrauterine bleeding after childbirth or abortion, have been associated with an increase risk of bronchospasm in the asthmatic patient and should be avoided when possible.3,26 Pain is the most potent trigger of the hypothalamic-pituitary-adrenal (HPA) axis and can stimulate cortisol levels up to 100 mg daily with major surgery.27 The process of labor can potentially induce adrenal crisis in those with suppression of the HPA axis. High-risk patients include those taking more than 20 mg daily of prednisone (or equivalent) for more than 3 weeks and those who appear cushingoid.27 HPA axis suppression may occur on intermediate doses of oral corticosteroids or high doses of ICS.4 Therefore, the clinician must monitor for signs and symptoms during labor, delivery, and the early postpartum period. Those at risk should receive a stress dose of hydrocortisone 100 mg every 8 hours during labor and for 24 hours after delivery to prevent adrenal crisis.2 Breastfeeding Only small amounts of asthma medications enter breast milk and are not contraindicated during breastfeeding. Prednisone, theophylline, antihistamines,

ICSs, beta-agonists, and cromolyn are considered safe to use while breastfeeding.3 However, maternal use of antihistamines has been associated with infant paradoxical central nervous stimulation depending on the dose, frequency, and timing of the medication. While breastfeeding, women should be encouraged to use the least amount of medication effective for controlling their symptoms and take medications just after breastfeeding when possible to minimize infant exposure.28 Improving outcomes Healthcare providers are pivotal in improving outcomes for the mother and fetus by instituting evidence-based practice guidelines for the care and management of their asthmatic patients. Optimal asthma control is dependent on healthcare providers performing symptom assessment, objective testing, stepwise medication adjustment, and education at each visit. Patients should receive an asthma action plan and education on selfmanagement skills for the early identification and treatment of worsening asthma. Each plan should be specific and tailored to the individual patient. Pregnant women and those contemplating pregnancy will likely require frequent and consistent education about the safety and

importance of their asthma therapy. The authors gratefully acknowledge the assistance of Tim Eubanks, PhD, for developing the figures used in the article and Jonathan Parsons, MD, MSc, for manuscript review and recommendations. REFERENCES

What is asthma?
Asthma is a chronic respiratory disease that affects the airways and causes them to swell and get inflamed. Due to the swelling and inflammation there is a reduction in air flow to your lungs. The reduction in air flow causes wheezing, breathlessness, coughing and chest tightness.

How common is asthma is pregnancy?

Asthma is one of the most common lung problems in pregnancy. The effects of pregnancy on asthma vary from person to person. If you were already being treated for asthma before you conceived, you may need to continue with your medicines in order to control asthma and reduce any risks to your baby. Make sure you review your treatment with your doctor as your dosage may need to be adjusted based on

how pregnancy is affecting your asthma. Studies have shown that the number of women reporting worsening symptoms do so mainly during weeks 24 to 34 of pregnancy. It has also been seen that only one in ten women suffering from asthma have an attack during labor.

What are the symptoms of asthma?

Symptoms may vary from person to person. Pregnancy worsens the symptoms in some women whereas some others find an improvement in their condition. However the most common symptoms are a runny or stuffy nose, shortness of breath, wheezing or a whistling sound when you breathe, chest tightness, rapid or noisy breathing, or a consistent cough that is worse at night. These symptoms may also be accompanied by headache, fatigue, or insomnia. Symptoms may vary from mild to life-threatening so it is advisable to get in touch with your doctor as soon as the symptoms appear so that appropriate action may be taken.

What causes asthma?

Asthma in most people is a reaction to a trigger --

usually tobacco smoke, pet fur, mold spores, dust mites, or pollen (although respiratory infections and exercise in cold air can also trigger an attack). As in other types of allergies, the trigger stimulates IgE (Immunoglobulin E) antibodies to produce histamine and other chemical mediators. It's the location of the chemical reactions -- in the lungs -- which distinguishes asthma. Chemicals released by the antibodies swell the lung's lining and tighten the muscles of the airway, and they also start producing mucus. Genetics, lowered immunity levels, and exposure to triggers are also said to cause asthma.

What are the risks of asthma in pregnancy?

Most women who suffer from asthma have perfectly normal, healthy babies. However if asthma is not controlled, it can result in too little oxygen getting to the baby, which increases the risk of low birthweight. Uncontrolled asthma can also increase the risk of pregnancy complications, such as premature labor, stillbirth, pre-eclampsia (development of

swelling, high blood pressure, and protein in the urine), and excessive vomiting.

How is asthma diagnosed?

The doctor will discuss your symptoms, the frequency and intensity of your attacks and will go through your medical history. If you have close relatives with a history of eczema, hay fever and asthma, the chances of you having asthma are higher. Your doctor will also check your breathing patterns using a peak flow meter or a spirometer. The spirometry test requires you to blow air in and out of a tube. This is done to assess the time taken by your lungs to take in and expel the air. The readings taken by the machine will determine how effectively your lungs are working. Peak flow meter: A peak flow meter is a hand held device with a plastic tube and is used to check the amount of force which is needed to breathe in and blow out air from lungs.

During an attack, more force is needed to breathe in and expel air. This device is often prescribed to asthmatics as it can detect the reduced passage of air even before an attack and help in taking timely medication. In addition he may also check that all is well with your baby through ultrasound or fetal monitoring.

Can asthma be cured?

Asthma is a chronic condition, and there is no known permanent cure. However, asthma can be successfully controlled and managed with medicines, and by reducing the exposure to the trigger for the asthma when possible. Asthma should be treated as soon as it is detected -- even if it is in the first trimester. Most of the asthma drugs prescribed by doctors are considered safe in pregnancy. However, oral steroids are generally avoided in the first trimester. Your doctor will be the best person to judge your situation so ensure that you discuss your symptoms, the frequency and intensity of your attacks properly.

How do I control asthma in pregnancy?

The most effective way to control asthma is to

control the triggers. If you know what your triggers are you are at a great advantage. Keep your home dust-free and frequently change and wash bed linen. As far as possible keep your surroundings free from dust mites, cockroaches, indoor and outdoor molds. Stay away from furry or feathered pets. Take care of your health and immunity levels as infections like colds, sinus, and flu may increase the symptoms of asthma. If your asthma is brought on by seasonal triggers such as pollen and spores, try to stay indoors or wear a protective mask when stepping outdoors. Some women find that extreme cold weather conditions or drinking cold and iced drinks trigger an attack. Take the necessary precautions and stay warm and drink fluids at room temperature.

 If exertion or exercise causes asthma, check with your doctor who will advise an alternate exercise plan for you. In some sensitive individuals food coloring, processed/canend food and preservatives may trigger asthma. Be watchful of what you eat especially if you are using convenience foods. Strong smelling perfumes, deodorants, cleaning fluids, paints and sprays should be avoided. Avoid contact with fine powders such as a kitchen flour grinding mill, saw dust, finely powdered spices and talcum powder. Smoking triggers asthma. Not just tobacco smoke but even kitchen fumes, air pollution, and vehicular exhaust, smoke from fireworks, crackers, "agarbatties" or "dhoop" can be triggers. Make sure there is passage of fresh air and avoid sitting in cramped smoky areas. Stress and anxiety too may trigger an attack in some sensitive individuals. Try to stay stress free and calm. Yoga and pranayam are excellent

ways of controlling stress -- however make sure you see an experienced instructor who specialises in pregnancy yoga. Some studies have also suggested that including apples and fish in your diet may lower the risk of asthma.

Can I if baby medication? continue Im on asthma to breastfeed my

Yes, absolutely. The medication does not cause any adverse effects on an infant. Some mothers choose to take their medication after they feed their babies though there is no proven research to suggest that the presence of medication levels in breast milk are reduced if taken after feeding your baby. It is important to remember that management of asthma is of prime importance. Do continue to take your medication on time. You may have well meaning relatives telling you that asthma drugs and inhalers are addictive and may have harmful effects - but remember that there is no cure for asthma and preventive therapy is the only protection for you and your baby.