Republic of the Philippines

ISABELA STATE UNIVERSITY

Echague, Isabela
COLLEGE OF NURSING

A CASE STUDY ON

HYPERACTIVE AIRWAY DISEASE

“REACTIVE AIRWAY DISEASE”

Presented to the Faculty of

the College of Nursing
In Partial Fulfillment in the Subject
NUR 312- Care of Client with Problems in Oxygenation, Fluid and Electrolytes, Infectious,
Inflammatory and Immunologic Response, Cellular Aberrations Acute and Chronic

Submitted by:
BAUIT, ANGELA C.
BERMUDEZ, JAZER
CADAVONA, MARIDEL R.
CADIZ, JANELLE V.
CALANGAN, ASHLEY C.
GASCON, LARENCE P.
JIMENEZ, JAZZEL JUDE B.
PINTO, JASLYNN ROSS B.
SUGUITAN, JERICO F.

Submitted to:

Clinical Instructors

S.Y. 2025-2026
I. OBJECTIVES OF THE STUDY

a. General Objectives
To analyze and understand the causes, clinical manifestations, triggering factors, diagnostic
considerations, and management strategies associated with Hyperactive Airway Disease AKA
Reactive Airway Disease (RAD) in order to enhance awareness and contribute to effective
prevention, early recognition, and appropriate treatment interventions.
b. Specific Objectives
1. To define Hyperactive Airway Disease and understand its epidemiology, etiologic factors,
common triggers, risk factors, clinical manifestations, diagnostic limitations, and prognosis.
2. To analyze the anatomy and physiology of the respiratory system affected by Hyperactive
Airway Disease and illustrate the possible pathophysiological responses using a diagram.
3. To understand the complete nursing management of Hyperactive Airway Disease, including
symptom monitoring, trigger avoidance, medication administration, and patient education.
4. To interpret the patient’s laboratory, diagnostic, or clinical findings and correlate them with
the suspected Hyperactive Airway Disease condition and symptoms.
5. To identify the pharmacologic treatments commonly used for Hyperactive Airway Disease,
such as bronchodilators or corticosteroids, including their mechanisms of action, indications,
contraindications, side effects, and appropriate nursing responsibilities.
6. To gather and record comprehensive demographic and health history relevant to Hyperactive
Airway Disease using proper assessment tools such as Gordon’s 11 Functional Health
Patterns.
7. To perform accurate, holistic physical assessments focusing on respiratory status and monitor
the patient’s response to treatment.
8. To develop a patient-centered nursing care plan based on assessment data, including accurate
nursing diagnoses, planning, interventions, rationales, and evaluation specific to Hyperactive
Airway Disease.
9. To formulate an individualized discharge care plan that includes medication adherence, diet
considerations, hygiene, trigger avoidance, home treatment strategies, exercise
recommendations, outpatient follow-up, and health teaching.
10. To reflect on the case study experience for continuous personal and professional growth in
caring for patients with respiratory conditions like Hyperactive Airway Disease.
II. OVERVIEW OF THE DISEASE

a. Definition
Hyperactive Airway Disease is a breathing problem that appears as wheezing, a
whistling noise in your airways. It may be caused by a viral or bacterial infection, allergies,
tobacco smoke, or something else in the environment. When you are around these triggers,
your body releases chemicals that make the airways get tight.

b. Epidemiology
GLOBAL
Globally, 4–8% of adults report experiencing wheezing in the past 12 months, many
of which may be labeled clinically as RAD. Common triggers include viral respiratory
infections, air pollution, smoking, occupational exposures, and allergens. Limited access to
spirometry or specialist evaluation contributes to the continued use of RAD as a provisional
diagnosis worldwide.
NATIONAL (Philippines)
In the Philippines, RAD is frequently used in primary-care settings for adults with
recurrent cough or wheezing when objective lung testing is unavailable. National surveys
suggest that approximately 6–7% of adults report wheezing in the previous year. Many adults
with recurrent airway symptoms do not receive a formal asthma or COPD diagnosis.
Environmental pollution, smoking, and occupational exposures are significant contributors,
while limited diagnostic access drives the use of RAD as a clinical label.

c. Causes/Risk Factors
 Infectious/Environmental Causes
- Hyperactive Airway Disease can be triggered by various infectious agents and
environmental factors. Common infectious triggers include:
 Viral Infections: Respiratory viruses, such as the common cold (rhinovirus) and respiratory
syncytial virus (RSV), can lead to airway inflammation and increased reactivity.
 Allergens: Pollen, dust mites, mold, and pet dander can provoke allergic reactions, leading to
airway constriction.
 Irritants: Tobacco smoke, air pollution, strong odors, and chemical fumes can irritate the
airways and exacerbate symptoms.
 Genetic/Autoimmune Causes
 There is evidence suggesting that genetic predisposition plays a role in the development of
Hyperactive Airway Disease. Individuals with a family history of asthma or allergies are at a
higher risk. Autoimmune factors may also contribute, as the immune system's response to
environmental triggers can lead to chronic inflammation of the airways.

 Lifestyle and Dietary Factors

- Lifestyle choices and dietary habits can influence the severity and frequency of
Hyperactive Airway Disease symptoms. Factors include:
 Obesity: Excess weight can exacerbate respiratory issues and increase the risk of developing
asthma-like symptoms.
 Diet: A diet low in fruits and vegetables may contribute to inflammation, while a diet rich in
antioxidants can help reduce airway reactivity.
 Physical Activity: Regular exercise can improve lung function and reduce symptoms, while a
sedentary lifestyle may worsen respiratory health.

 Key Risk Factors

Several risk factors can increase the likelihood of developing Hyperactive Airway Disease:
 Age: Children are more susceptible due to their developing respiratory systems.
 Gender: Males are generally at a higher risk during childhood, while females may have a
higher prevalence in adulthood.
 Geographic Location: Urban areas with higher pollution levels may see increased rates of
Hyperactive Airway Disease.
 Underlying Conditions: Individuals with allergies, eczema, or other respiratory conditions are
at a greater risk.

d. Clinical Manifestations
 Wheezing: A high-pitched whistling sound during breathing, particularly when exhaling.
 Coughing: Persistent cough, especially at night or after physical activity.
 Shortness of Breath: Difficulty breathing or a feeling of tightness in the chest.
 Chest Tightness: A sensation of pressure or constriction in the chest area.
Warning Signs for Immediate Medical Attention
Certain symptoms may indicate a severe exacerbation of RAD or a related condition, requiring
immediate medical attention:
- Severe Shortness of Breath: Inability to speak in full sentences due to breathlessness.
- Blue Lips or Fingernails: A sign of inadequate oxygenation.
- Rapid Breathing: Breathing that is significantly faster than normal.
- Persistent Coughing with Mucus: Especially if the mucus is discolored or blood-streaked.

e. Diagnostic Tests
 Spirometry: A common lung function test that measures how much air a person can exhale
and how quickly.
 Peak Flow Monitoring: A simple device that measures the maximum speed of expiration,
helping to monitor airway constriction.
 Allergy Testing: Skin or blood tests to identify specific allergens that may trigger symptoms.
 Imaging Studies: Chest X-rays or CT scans may be used to rule out other respiratory
conditions.

f. Nursing Management
 Encourage oral fluids (unless contraindicated) to keep airway secretions thin and easier to
expectorate.
 Teach the patient to avoid known airway irritants (smoke, fumes, dust, strong chemicals,
extreme temperatures, pollutants), use protective equipment if exposure cannot be avoided,
and ensure good ventilation at home or work.
 Demonstrate and supervise correct inhaler technique.
 Educate for self-management and early recognition of exacerbations: Teach signs of
worsening (worsening cough, wheezing, dyspnea, chest tightness) and when to seek medical
attention. Encourage patient to record a symptom diary and possible triggers to identify
patterns.
 If controller medications (e.g., ICS) are prescribed, ensure the patient understands the
importance of regular use, even when asymptomatic, to prevent chronic inflammation and
airway remodeling.
 Provide psychosocial support and counseling: Patients with RAD/RADS may be anxious due
to sudden symptoms, uncertain prognosis, and possible lifestyle or occupational changes
 (especially if exposure was work-related). Nurses can support coping, stress management,
and refer to specialists when needed.
 Coordinate with multidisciplinary team and refer appropriately.

g. Medical Management
 Bronchodilators and anti-inflammatory agents to relieve bronchoconstriction and reduce
airway inflammation.
 Inhaled corticosteroids (ICS) are often used when symptoms persist, or if there is repeated
airway inflammation, to reduce swelling and prevent chronic damage.
 In more severe cases (especially soon after exposure), systemic corticosteroids (oral or
systemic) may be indicated to manage acute inflammation.
 Avoidance of the irritant (trigger) is critical: Once the offending agent is identified (e.g.,
fumes, chemical vapors, smoke), further exposure should be prevented, either by removal
from the environment, use of protective equipment, or modification/relocation of work/home
environment.
 Pulmonary function monitoring and, if available, bronchial challenge testing, are used to
document airway hyperresponsiveness and to help guide diagnosis and therapy. In RADS
cases, many show sustained airway hyperreactivity on follow-up testing.
 Referral to a pulmonologist / respiratory specialist is recommended when RAD / RADS is
suspected, especially if the exposure was occupational or environmental, to ensure correct
diagnosis (occupational asthma vs. RADS vs. other airway diseases), proper monitoring, and
long-term management. Clinical sources emphasize the importance of specialist follow-up
given the long-term risk of airway remodeling or chronic airway disease.

h. Complication
If left untreated or poorly managed, Reactive Airway Disease can lead to several
complications:

 Short-Term Complications
 Acute Asthma Attacks: Severe exacerbations can lead to hospitalization and require
emergency treatment.
 Respiratory Infections: Increased susceptibility to infections due to compromised airway
function.
 Long-Term Complications
  Chronic Asthma: Persistent airway inflammation can lead to the development of chronic
asthma.
 Reduced Lung Function: Long-term airway reactivity may result in decreased lung capacity
and function over time.
 Quality of Life Impairment: Ongoing symptoms can affect daily activities, sleep, and overall
well-being.

i. Prognosis
The prognosis for reactive airway disease varies by age of onset and management. In
children, 50-70% of cases achieve remission by early adulthood, particularly those with mild
symptoms and no atopy. Adult-onset disease, often referring to reactive airways dysfunction
syndrome (RADS), tends to be more persistent and chronic, with low remission rates—around 5-
17% after five years—and up to 20% progressing to severe forms requiring intensive care. Early
intervention, such as prompt trigger identification and adherence to controller therapies, enhances
remission likelihood by mitigating airway remodeling. Conversely, comorbidities like obesity or
chronic rhinosinusitis adversely affect prognosis by increasing exacerbation frequency and
reducing lung function over time.

III. DEMOGRAPHIC DATA

 CATEGORY DETAILS

PATIENT C.B.V

AGE 66

SEX Female

CIVIL STATUS Married

RELIGION Roman Catholic

OCCUPATION Owner of Sari-sari store

WARD Private ward

DATE OF ADMISSION September 10, 2025

DIAGNOSIS Hyperactive Airway Disease

IV. NURSING HISTORY

a. Chief Complaint

Patient was admitted to the hospital with reports of cough, colds, and headache for 3 days.

b. History of present illness

Three days prior to admission, the patient experienced cough, colds, dizziness, and a mild
headache. The patient sought a medical check-up and was advised to monitor the symptoms. Early in
the morning before admission, the patient’s symptoms worsened; the patient experienced an episode
of difficulty of breathing accompanied by persistent cough, colds, and headache. Exposure to smoke
and dust from the environment is considered a triggering factor to the patient’s respiratory
symptoms.

c. History of past illness

The patient reported confirmed being vaccinated against influenza and COVID-19. She denies
having any known allergies or a history of accidents or injuries. Starting July, 2025, the patient was
admitted in one of the hospitals in Alicia. In August 2025, the patient experienced an episode of
difficulty of breathing and was admitted again to the hospital.
 d. Social health history

The patient is moderately active due to her daily responsibilities as a sari-sari store owner, which
include attending to customers and doing household tasks. She resides near a feeds factory, where
smoke and dust frequently accumulate, potentially triggering her respiratory symptoms. Her daily
routine involves sweeping, selling in the store, and resting while watching television. She also
attends mass every Sunday and occasionally attends birthday parties as part of her social activities.
The patient typically goes to sleep around 11:00 PM. She consumes three meals per day and is not a
picky eater. Although she does not participate in structured exercise, her primary form of physical
activity is sweeping the surroundings, which she performs regularly as part of her chores.

V. GENOGRAM

VI. GORDON’S 11 FUNCTIONAL HEALTH PATTERN

 AREAS OF BEFORE HOSPITALIZATION AFTER HOSPITALIZATION
FUNCTIONAL
PATTERN
Health Perception- Before hospitalization, she viewed During hospitalization, her health
Health Management herself as not healthy because perspective did not change and
she’s feeling sick. She stated that viewed herself in a vulnerable
for her, health is the absence of health state. The patient stated that
illness and can do all activity she will follow all medical
every day. She manages her regimens and doctor’s advices and
ailments like fever lasting 1-3 learnings to help her recover.
days with over-the-counter drugs
like paracetamol and using herbal
medicine like guava leaves. The
patient stated that she has no
vices. She is fully vaccinated with
COVID-19 vaccine and has no
known allergies. When the patient
sense that something is wrong
about her body she immediately
seeks medical attention.
Nutritional- Before hospitalization, the patient During hospitalization, the patient
Metabolic stated that she has good appetite, stated that “konti konti nalang
eating three full meals daily, and kinakain ko dahil mabilis akong
incorporating snacks in morning hingalin”. She barely finishes her
and afternoon. She starts her day meals given in the hospital instead
with milk and 2piece of bread. she eats snacks like turon as she
Her usual meal consists of 1cup of requested to her husband. Her water
rice and variety of dishes like intake remains the same and
seafood as her favorite dish, reported difficulty eating as she
adobo, or typically any filipino easily get tired.
dish. For her snacks, she always
eats banana or turon as her
favorite snack. Patient water
 intake consist of 7-8 glasses per
day, she doesn’t drink liquor. She
reported no allergies to food, no
difficulties in eating or digestion
and no known weight gain or loss
in past months.
Elimination Pattern Before hospitalization, the patient During hospitalization, the patient
stated that she voids 3-4 times voiding frequency has change, she
daily. As patient stated, her urine voids 5-7 times daily especially
appeared light yellow, with no early in the morning. She reported
foul odor. Bowel movements are her bowel movements increased to
regular once a day every morning, 2-3 times a day, with brown stool,
with usual brown semi formed soft and smooth appearance.
stool.
Activity-Exercise Before hospitalization, the patient During hospitalization, the patient
doesn’t engage in any exercise requires assistance in getting up in
routines, as she considered her bed and going to comfort room due
household chores like sweeping to her weakness and fatigue.
floor as her kind of exercise Walking inside her room is her only
because she get tired easily. Her physical activity and using her
routine was just walking in and phone and watching television to
outside the sari-sari store. If she entertain herself.
feels bored, she uses her phone or
watch television to ease her
boredom.
Cognitive- Before hospitalization, there are During hospitalization, the patient’s
Perceptual Pattern no other problem with her perceptual status remains the same.
perceptual abilities. The patient The patient is oriented to time,
says that she can recall everything place, and person but she takes 3
and can make decision on her seconds to answer every question
own. likely due to her shortness of
breath.
Sleep and Rest Before hospitalization, the patient During hospitalization, the patient
Pattern typically slept for about 9 hours reports a change in her usual sleep
per night, which she considered pattern. She now sleep earlier than
her usual and adequate amount of usual bedtime and wakes up early
rest. She usually goes to sleep at at around 6:00AM. Her sleep is
11:00 PM, after watching TV with frequently interrupted throughout
her grandson, and wakes up at the night due to nurse/doctor visits,
around 8:00 AM. She also takes a frequent urination that causes her to
daily afternoon nap from 2:00 PM get up during night and episodes of
to 4:00 PM. coughing that disrupt her ability to
She denies experiencing any maintain continuous sleep.
difficulty sleep, no history of
insomnia, and frequent
awakening.

Self-Perception- Self Before hospitalization, the patient During hospitalization, the patient
Concept Pattern viewed herself as a strong woman remains strong and motivated by her
that keeps fighting despite of her family to fight and have a will to
challenges. She always thinks survive.
positive and make her family as an
inspiration.

Role Relationship Before hospitalization, since the During hospitalization, the patient’s
Pattern patient easily get tired, it limits her role has undergone changes. Due to
ability to perform her usual her physical limitations, she now relies
responsibilities as a housewife. She on her husband and family members
was only able to do light household for support. With their help, the patient
chores such as sweeping the floor receives strong support system
while her husband and daughter took especially meeting all her needs during
over most of the household tasks. hospitalization.
Her relationship with her husband
and family members was mutually
supportive, especially in managing
responsibilities at home. She shares
that being a sari-sari store owner, this
 helps her to contribute financially.
Sexuality- Before hospitalization, the patient During hospitalization no major
Reproductive gave birth to one child, delivered via changes in sexuality and reproductive

Pattern normal spontaneous delivery (NSD). health status.

Her menstrual cycle start at the age
of 14 and continued regularly until
the age of 50, when it ceased,
marking the onset of menopause. The
patient did not report significant
issues with her menstrual cycle or
sexual health
Coping- Stress- The patient stated that through The patient continuous to rely on
Tolerance Pattern prayer, her problems and stress prayer as her primary coping
lessen, helping her forget her worries mechanism that provides her comfort,
and cope more effectively. She also strength, and helps lessen her worries
shared that family support and open about her illness. She manages stress
communication provide her with caused by her illness by resting and
additional strength. To unwind and adhering to medical advice. She also
manage stress, she enjoys watching uses her phone as a stress reliever,
TV with her grandson and using her serving as a source of distraction and
phone, which serve as her form of relaxation. During hospitalization, the
relaxation and distraction. patient also shares that family visits
greatly support her emotionally and
help her stay positive.

Values-Beliefs Before hospitalization, the patient as The patient stated that her faith in God
Pattern an active roman catholic who attends remains unchanged. She continues to
church every Sunday and has a place strong emphasis on prayer as a
strong faith in God. The patient source of comfort, strength, which
places significant value on prayer, helps her cope with her condition.
which she considers a major source Upon hospitalization, the patient report
of strength and guidance in having no use of herbal medicine.
recognizing blessings and facing
life’s challenges. Additionally, she
reports using herbal medicines, such
 as guava leaves, and believes in
consulting folk healers “manghihilot”
when necessary.
Diet Recall

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Break 1 cup of 1 cup of milk 1 glass of 1 glass of Sopas Egg and 1 glass of
fast milk Pandesal water water bread water
2 piece of
bread
Lunch Seafood boil 1 cup of rice ½ cup of rice ½ cup of rice 1 cup of ½ cup of ½ cup of
1 cup of rice Pritong isda Adobo Ginisang rice rice rice
2 glasses of 2 glasses of 2 glasses of sayote Nilagang inabraw Sinigang na
water water water 2 glasses of baboy 2 glasses bangus
water Saging of water 2 glasses of
2 glasses of water
water
Snack Turon Pansit Bananaque 1 glass of 1 glass of 2 pieces 2 pieces of
2 glasses of 2 glasses of 2 glasses of water water of orange buko roll
water water water 1 glass of
water
Dinner Pinakbet ½ cup of rice ½ cup of rice ½ cup of rice 1 cup of 1 cup of 1 cup of
1 cup of rice Monggo Chapsuey Beans and rice rice rice
2 glasses of 2 glasses of and tinola Adobo Chicken Adobong Salad na
water water 2 glasses of curry Sitaw kamote
water 2 glasses of with
water kamatis
Banana
2 glasses of
water

Activity Recall

8:00 AM Wake up
8:00-9:00 AM Breakfast
9:00-11:30 PM Sweeps the floor, Nagbabantay ng sari-sari store, using phone for entertainment
 Take a bath
11:30-:12:30 PM Lunch
12:30-2:00 PM Bantay on the sari-sari store, uses phone to ease her boredom
2:00-3:30 PM Take a nap
3:30-4:00 PM Snack time
4:00-6:00 PM Bantay on the sari-sari store
6:00-7:00 PM Dinner time
7:00-11:00 PM Bonding with family/ watch television with her grandson
11:00 PM Bedtime
VII. PHYSICAL ASSESSMENT

Date Performed: September 12, 2025

General Appearance: Patient seen lying flat on bed. Appears weak and fatigued, show sign of
headache and observe coughing during assessment. She is wearing t-shirt as well as pajama. With
IVF D5 PNSS, regulated at 100cc/hr via soluset, infusing well at right forearm. With the following
Vital Signs:

Temperature (axilla): 37.5 C

O2 sat: 84%

PR: 106 bpm

RR: 26 bpm

BP: 110/70 mmHg

PHYSICAL EXAMINATION FINDINGS

BODY METHOD FINDINGS INTERPRETATION

PARTS USED
SKIN INSPECTION Brown in color and less NORMAL
smooth and plump texture
with more wrinkles
PALPATION No edema and lesions NORMAL

Skin is warm to touch

Skin turgor return after 1-2 NORMAL

sec
NAILS INSPECTION Clean and well-trimmed NORMAL
Normal pink in color
Firm and Intact
Noted Melanonychia Presence of melanonychia
(horizontal brown line in indicates benign to
 nails) in pinky finger malignant and it is caused
by natural processes,
trauma,fungal or bacterial
infections, systemic issues
or cancer.
PALPATION Smooth in texture NORMAL
Capillary refill (less than 2
seconds)
HEAD INSPECTION Round and Symmetrical NORMAL

No masses and lumps are NORMAL

noted
PALPATION Head is non- NORMAL
tender,depression and
deformities
No presence of masses or NORMAL
nodules noted
FACE INSPECTION Face is symmetrical and NORMAL
rounded
Hyperpigmentation is noted Darkening the skin due to
overproduction of pigment
melanin, it is often
harmless and it is caused
by sun exposure,
inflammation, hormonal
changes during pregnancy
or certain medication
EYE INSPECTION Clear sclera, no discharges, NORMAL
lesions, discolorations and
lacerations
Color is brown and round NORMAL
shape
The iris are equal in size and NORMAL
color
 Pupils are equal,round and NORMAL
reactive to light and
accomodation
Extraocular movements are NORMAL
smooth and symmetrical
EYEBROW INSPECTION Eyebrows is black and NORMAL
equally distributed and
symmetrical

EYELASHES INSPECTION Eyelashes is black and NORMAL

equally distributed and
curled outward
EAR INSPECTION Ear are symmetrical and the NORMAL
color is same with the facial
skin
Preauricular Sinus is present
in the left ear
NOSE INSPECTION Nose is midline in NORMAL
face,nares is patent and have
presence of secretion
MOUTH INSPECTION No lesion and presence of NORMAL
any deformities
Palate is light pink in color NORMAL
and no presence of
discharges or secretions
LIPS INSPECTION Lip color is pink NORMAL

No presence of lesion,blister NORMAL

or pollar
PALPATION Soft and moist texture non NORMAL
dry
GUMS INSPECTION Firm and pale pink and no NORMAL
presence of lesion or thrush
TONGUE INSPECTION Moist and slightly rough NORMAL
 and in the midline of the
mouth
NECK INSPECTION Neck can move freely NORMAL

No presence of any lesions NORMAL

PALPATION No palpable lymph nodes NORMAL

THORAX INSPECTION Breathing rapidly and Tachypnea or rapid,

AND LUNGS shallow and uses accessory shallow breathing with
muscle in breathing accessory muscle use
indicates acute respiratory
distress and increased
work of breathing,
suggesting impaired gas
exchange or ineffective
breathing pattern.
Intercostal rib/clavicular Indicates increased work
retraction is noted of breathing and
significant respiratory
distress, suggesting
impaired gas exchange or
airway obstruction
AUSCUL Wheezing is heard during Indicates significant
TATION inspiration and expiration airway narrowing and
moderate to severe airway
obstruction, suggesting
impaired airflow and
respiratory distress
ABDOMEN INSPECTION Abdomen is prominent in NORMAL
supine position
PALPATION Abdomen is soft and free NORMAL
from pain, tenderness,
masses or rigidity
AUSCULTATIO Presence of gurgling bowel NORMAL
N sounds in the four quadrants
 PERCUSSION The abdomen is resonant NORMAL
with a clear and hollow
sound
UMBILICUS INSPECTION The umbilicus is inverted NORMAL
with the same color of the
abdomen, no presence of
rashes, redness or any
lesions
UPPER INSPECTION No presence of lesions and NORMAL
EXTREMITI equal arm circumference
ES with no edema
Full resistance equal NORMAL
bilaterally on all limb ROM
with no pain
Hyperpigmentation is Darkening the skin due to
presence in both arm overproduction of pigment
melanin, it is often
harmless and it is caused
by sun exposure,
inflammation, hormonal
changes during pregnancy
or certain medication
PALPATION Brachial and radial pulse 2+ NORMAL
force and equal bilateral
LOWER INSPECTION No presence of lesions and NORMAL
EXTREMI equal limb circumference
TIES
Full resistance equal NORMAL
bilaterally on all limb ROM
with no pain
PALPATION No presence of any lesion NORMAL
and edema
VIII. ANATOMY AND PHYSIOLOGY

Anatomy of the Respiratory system

 Location- the lungs is located in the thoracic cavity and on the either side of the
mediastinum. The center of it is occupied by the heart.
 Division -both lungs are divided into lobes by fissures, the right lung consists of 3 lobes and
the left lobe consists of 2 lobes.
 Functional Division- conducting zone and respiratory zone
 Conducting Zone- are pathways from and to the respiratory zone which are the nose,
pharynx, larynx, trachea, bronchi, and terminal bronchioles.
 Respiratory Zone- is the site of gas exchange which includes the respiratory bronchioles to
the alveoli
 Pleura – is a thin two layered membrane that surrounds the lungs and lines the chest wall.
 Parietal pleura -the outer layer that lines the inside of the chest cavity and the diaphragm
 Visceral pleura – the inner layer that covers the surface of the lungs.
 Pleural fluid – a small amount of fluid is secreted between the two layers which acts as a
lubricant.

The respiratory system consists of seven structures divided into the upper and lower respiratory
tract:

 Upper respiratory tract: external nose/nasal cavity, and pharynx.

 Lower respiratory tract: larynx, trachea, bronchi/bronchioles, lungs, and alveoli.
 Nose and nasal cavity – it houses the olfactory system, filters, and humidifies incoming air
then traps invading particles via mucus and cilia
 Pharynx -it is the passageway for air and food, and assists in speech and swallowing and it
also allows air to flow to the lower tract.
 Larynx – also known as the voice box, it protects the airway, and produces sound
 Trachea- it maintains an open airway for air to flow from and to the lungs.
 Bronchi- it distributes air throughout the lungs until it reaches the bronchioles and alveolar
sacs.
 Bronchioles- the smallest conducting passageway
 Lungs- it is the main organ for gas exchange, containing the bronchioles and alveolar units.
 Alveoli- tiny thin-walled sacs where gas exchange occurs.
Mechanics of Ventilation

-involves the coordinated function of the structures

 Inspiration begins when the diaphragm moves downward, increasing the vertical dimension
of the thoracic cavity. At the same time, the external intercostal muscles elevate the ribs,
expanding the chest.
 Expiration Is a process that occurs when the diaphragm and external intercostal muscles
relax. This relaxation reduces thoracic volume and allows the elastic recoil of the lungs and
chest wall to increase alveolar pressure above atmospheric pressure, pushing air out of the
lungs.

Other Functions:

 Regulation of Blood pH: The respiratory system helps maintain the body’s acid-base
balance by controlling the levels of carbon dioxide in the blood; increased CO₂ lowers pH,
while decreased CO₂ raises pH.
 Sound Production: Air passing through the vocal cords in the larynx generates sound,
enabling speech and communication.
 Olfaction (Sense of Smell): The nasal cavity contains specialized receptors that detect
airborne chemicals, allowing the perception of smell.
 Protection: The respiratory system protects the body by trapping dust, pathogens, and other
particles in mucus, moving them out with ciliary action, and expelling irritants through
coughing or sneezing.

IX. PATHOPHYSIOLOGY
X. LABORATORY RESULTS AND INTERPRETATION

PATIENT NAME: C.B.V

AGE: 66

SEX: Female
 CLINICAL CHEMISTRY
Date: September 10, 2025

TEST RESULT NORMAL ALUES INTERPRETATION

HDL - 1.090-2.290 mmol/L -

LDL - 0.000-3.400 mmol/L -
SGOT (AST) 81 (H) 0.000-35.000 u/L Elevated AST caused by liver or muscle
injury, which may be secondary to
hypoxia, respiratory muscle strain,
medication effects, or systemic infection
related to the patient's respiratory
condition
SGPT (ALT) 134 (H) 0.000-41.000 u/L Elevated ALT indicates hepatocellular
injury or liver inflammation, which may
be secondary to infection-related
inflammation, drug metabolism,
hypoxia, or other liver comorbidities in a
patient with respiratory problems
SODIUM - 135.000-145.000 -
mmol/L
POTASSIUM - 3.600-5.500 mmol/L -
CHLORIDE - 98.000-107.000 -
mmol/L
IONIZED - 1.150-1.330 mmol/L -
CALCIUM

TEST RESULT NORMAL VALUES INTERPRETATION

RBS 109 70.000-160.000mg/dL NORMAL
FBS - 82.000-115.000 mg/dL -
Total Cholesterol - 0.000-5.200 mmol/dL -
Triglycerides - 0.000-2.300 mmol/dL -
Uric Acid 360 155.000-360.000 umol/L NORMAL
 BUN 12.48 7.900-21.000 mg/dL NORMAL
Creatinine 74 45.000-97.000 umol/L NORMAL
HbA1c - 4.000-5.6000% -

TEST RESULT NORMAL VALUES INTERPRETATION

MYOGLOBIN - 0.000-58.000 ng/mL -
TROPONIN 1 <0.1 0.000-0.40 ng/mL NORMAL
CKMB 3.11 0.000-5.000 ng/mL NORMAL
Nt-proBNP 879 (H) 0.000-300.000 pg/mL NT-proBNP is
elevated, it indicates
that the respiratory
distress is related to
cardiac dysfunction
rather than purely
pulmonary causes.

Date: September 8, 2025

TEST RESULT
Panbio COVID-19 NEGATIVE
Antigen Rapid Test
(Nasopharyngeal)

HEMATOLOGY-A
Date: September 10, 2025

PARA NORMAL RESULTS INTERPRETATION

METERS VALUES
WBC 10^9/L 5.00-10.00 11.87 (H) Elevated WBC caused by
inflammatory processes such as an
 acute exacerbation with infection.
RBC 10^12/L 3.50-5.50 5.27 NORMAL

HGB g/dL 12.0-16.0 14.8 NORMAL

HCT % 36.0-45.0 44.8 NORMAL

MCV fL 80.0-100.0 84.9 NORMAL

MCH Pg 27.0-34.0 28.2 NORMAL

MCHC g/L 320-360 332 NORMAL

RDW-CV % 11.0-16.0 15.6 NORMAL

RDW-SD fL 35.0-56.0 47.5 NORMAL

PLT 1fL0^9/ 150-450 222 NORMAL

L
PDW 9.0-17.0 15.8 NORMAL

MPV fL 7.0-11.0 8.3 NORMAL

PCT % 0.108- 0.184 NORMAL

0.282
PARA NORMAL RESULTS INTERPRETATION
METERS VALUES
Neu# 10^9/L 2.00-7.00 9.12 (H) Elevated neutrophil counts caused by
an ongoing acute inflammatory
response

Lym# 10^9/L 0.80-4 1.14 NORMAL

Mon# 10^9/L 0.12-1.20 1.53(H) Elevated monocytes counts caused by
ongoing airway inflammation and
immune activation associated with
asthma exacerbation.
Eos# 10^9/L 0.002-0.50 0.007 NORMAL

Bas# 10^9/L 0.00-0.10 0.001 NORMAL

Neu% % 35.0-71.0 76.8(H) Elevated neutrophil counts cause by

an ongoing acute inflammatory
response
Lym% % 24.0-44.0 9.7(L) Decreased lymphocytes decreased due
to immune response exhaustion
Mon% % 1.0-10.0 12.9 (H) Elevated monocytes counts caused by
ongoing airway inflammation and
immune activation associated with
asthma exacerbation.
Eos% % 0.0-4.0 0.5 NORMAL
Bas% % 0.0-2.0 0.1 NORMAL
P-LCC 10^9/L 30-90 37 NORMAL
P-LCR % 11.0-45.0 16.4 NORMAL

URINALYSIS
Date: September 10, 2025

Physsical Characteristics INTERPRETATION

Color Light Yellow NORMAL
Transparency Clear NORMAL

Microscopic Examination INTERPRETATION

Results/HPF
White Blood 0-1 Epitheal RARE NORMAL
Cells cells
Red Blood 0-1 Mucus RARE NORMAL
Cells threads
Bacteria

CHEMICAL TESTS

CHEMICAL TESTS
pH 6.5 Specific Gravity 1.020 Amorphous
Protein - Nitrite - Casts/LPF
Glucose - Bilirubin - Crystals/HPF
Erythrocytes - Urobilinogen NORMAL
Leukocytes - Ascorbic Acid -
Ketone -

RADIOLOGY REPORT

September 10, 2025

CHEST PA:
Both lung fields are hyperaerated with low lying diaphragmatic leaflets

No active parenchymal infiltrate seen

Cardiac shadow is unenlarged

Atherosclerotic aortic knob

Clear Cotophrenic sulci

Included bone and soft tissue structure are unremarkable

IMPRESSION:

 Bilateral Pulmonary Hyperinflation

 Atherosclerotic aortic knob

CLINICAL CHEMISTRY
date:September 11, 2025

TEST RESULT NORMAL ALUES INTERPRETATION

HDL 0.99 (L) 1.090-2.290 Indicates not effectively clearing

mmol/L cholesterol from blood vessels
and increased risk for
cardiovascular diseases, such as
coronary artery disease, heart
attack, and stroke.

LDL 2.64 0.000-3.400 NORMAL

mmol/L

SGOT (AST - 0.000-35.000 u/L NORMAL

SGPT (ALT - 0.000-41.000 u/L NORMAL

SODIUM - 135.000-145.000 NORMAL

mmol/L

POTASSIUM - 3.600-5.500 NORMAL

 mmol/L

CHLORIDE - 98.000-107.000 NORMAL

mmol/L

IONIZED - 1.150-1.330 NORMAL

CALCIUM mmol/L

TEST RESULT NORMAL VALUES INTERPRETATION

RBS - 70.000-160.000mg/ NORMAL

dL

FBS 163 (H) 82.000-115.000 Increased FBS

mg/dL caused by
hyperglycemia, due
to stress response,
diabetes, or
medication effect,
placing the patient
at risk for delayed
recovery and
complications
during a respiratory
illness

Total Cholesterol 3.81 0.000-5.200 NORMAL

mmol/dL

Triglycerides 0.90 0.000-2.300 NORMAL

mmol/dL

Uric Acid - 155.000-360.000 NORMAL

umol/L

BUN - 7.900-21.000 mg/dL NORMAL

Creatinine - 45.000-97.000 NORMAL
umol/L

HbA1c - 4.000-5.6000% NORMAL

XI. COURSE IN THE WARD

DATE DOCTORS INDICATION NURSING RATIONALE

AND ORDER RESPONSIBILITIES
TIME

09-10-25 > Admit to > For continuous >Check the availability of >To allow patients to
ROC under the monitoring, the room and ensure choose their own room of
service of Dr. management, and comfort preferences.
X evaluation of the
 patient’s condition >Receive the patient and >To ensure proper
collaborate with the nursing supervision for the
station and housekeeping. patient’s chart,
preparation of hospital
needs and preparation of
the patient’s bed.
>Record baseline vital
signs. >To establish baseline
data for comparison.
>Orient the patient and
family about the hospital >To provide clear
unit, policies, procedure that understanding regarding
will be done upon hospital policies,
admission and during admission and procedure.
hospitalization and
attending physician.
> Secure >To have ethical >Be a witness in obtaining >To ensure legal
consent for consideration and also the consent. protection and ethical
admission and to protect their compliance.
management. freedom to make
healthcare decision
DAT, NPO for >Transition to NPO >Assess and record RR, 02 >High RR and
RR >40 cpm prevents aspiration saturation,work of desaturation compromise
or pneumonia and allows breathing regularly safe swallowing,
desaturation. respiratory increasing risk of
stabilization >Enforce NPO status once aspiration.
criteria are met
>NPO reduces chance of
>Inform the patient and food or liquid entering the
family about the reason for airway, preventing
NPO aspiration pneumonia.
IVF PNSS 1L >To maintain >Verify the doctors order >Confirm the order,
X 16 Hrs hydration and ensure patients details and
IVF accuss for regulation
medication.
>Prepare and administer >To save time, smoother
PNSS as ordered procedures and maintain
 adequate fluid balance

>Monitor IV flow rate and >Help to detect and

insertion site prevent infiltration and
phlebitis. Ensure that IV
fluid is being delivered
safely and effectively.
>Record intake and output >Evaluates hydration
status.
Hook 02 at 2-4 >To improve >Verify doctor’s order and >Supplemental oxygen
lpm via NC oxygenation, prevent ensure correct 02 source is increases the amount 02
hypoxia, and decrease functioning. avaiable for gas exchange
respiratory effort.
>Let 02 flow rate between >Correct placement
2-4 LPM and ensure proper ensures effective delivery
placement of nasal cannula. and prevents discomfort.

>Monitor Spo2E, RR, level

of consciousness, and work >Continuous monitoring
of breathing detects hypoxia.
DIAGNOSTIC CBC >Prepare the patient and >Explaining the procedure
TESTS -Assess oxygen explain the purpose and simply provides
carrying capacity and procedure understanding and reduces
-CBC detect infection. fear
-URIC ACID
-Creatinine URIC ACID >Verify physicians order >To ensure accuracy and
and BUN -To evaluate and patient identification safety of client in doing
-RBS NOW metabolic status and the procedure
-Chest X-ray possible evaluation
(PA-L) related to cell >Ensure the patient >Helps obtain more
-12-lead ECG breakdown and observes fasting if required accurate and reliable
-Troponin 1, inflammation. results
CK-MB >Collaborate with
ProBNP CREATININE AND laboratory technician >To schedule the patient
-SGPT, SGOT BUN for the laboratory exam.
-Lipid Profile - To assess renal
+ FBS function and
-Urinalysis hydration status. >Relay abnormal results to
the physician immediately >Dr. will be updated and
CHEST X-RAY (PA- give appropriate orders
L)
-To evaluate for
hyperinflammation,
pneumonia, or other
causes of airway
obstruction.

TROPONIN 1, CK-
MB ProBNP
-To rule out cardiac
ischemia or heart
failure contributing to
dyspnea.

SGPT, SGOT
-To assess liver
function and check for
congestion from
chromic hypoxia.

Lipid Profile + FBS

-To evaluate
cardiovascular risk
and metabolic
comordities.

URINALYSIS
-For hydration status
and infection
screening.
 RBS NOW
-To check immediate >Perform bedside >Provides immediate
blood glucose. glucometer test as ordered. glucose reading

>Ensure proper hand

hygiene and clean site. >Prevents infection and
improves accuracy

>Document value and time >For proper

taken documentation

Tx. 12 LEADantibiotic
>Empiric ECG >Check for allergy to >Monitoring prevents
Ceftriaxone 2g for suspected bacterial cephalosporins/penicillin complications like
TIV OD ANST respiratory infection before administration. hypersensitivity or super
contributing to airway infection
inflammation and >Monitor CBC, liver
systemic response function, and renal
function.

>Assess injection site for

pain, swelling, or phlebitis.
 >Observe for signs of
superinfection (oral thrush,
diarrhea)
Levofloxacin Broad- spectrum >Check for allergy to >To prevent adverse
500 1 tab OD antibiotic for fluoroquinolones. reactions, avoid toxicity,
PO respiratory tract and ensure proper drug
infection with >Assess renal function; absorption.
suspected bacterial adjust dose if needed.
involvement in the
hyper reactivity >Monitor for tendon
pain/tendon rupture.

>Avoid giving with

antacids or dairy

>Observe for CNS effects

(dizziness, confusion).
NAC 600 mg >Mucolytic for thick >Assess breath sounds and >Ensures effectiveness in
BID secretions sputum before and after thinning secretions and
monitors improvement
>Watch for bronchospasm
>NAC may trigger
>Give after meals to reduce bronchoconstriction
nausea
>It can cause nausea or
>Monitor for side effects upset stomach

>Early detection prevents

>Document respiratory complications
respiratory response
>Tracks medication
effectiveness and guides
treatment adjustment
Salbutamol Relieve acute wheeze >Check HR, RR, and lung >To evaluate effectiveness
Neb q6 and airflow sounds before and after (bronchodilation), prevent
obstruction side effects, and optimize
 neb. airway expansion.

>Monitor for tachycardia,

tremors, or palpitations.

>Ensure correct nebulizer

technique and dosing.

>Position patient in high

Fowler’s.
Budesonide >As a preventative in >Assess breath sounds & >To prevent infection,
neb q12 maintenance of respiratory status. ensure proper drug use,
asthma and minimize systemic
>Rinse mouth after steroid effects.
nebulization to prevent oral
thrush.

>Monitor for corticosteroid

side effects
(hyperglycemia,
hoarseness).
1:21 pm Shift >Empiric coverage for >Check for allergy to >To prevent allergic
Levofloxacine atypical respiratory macrolides. reactions, improve
to pathogens; adjunct absorption, and avoid
Azithromycin anti-inflammatory >Give 1 hr before or 2 hrs cardiac/hepatic
500 mg tab effect in airway after meals unless GI upset. complications.
OD disease
>Monitor liver function
tests.

>Assess for diarrhea or

arrhythmias
10 pm Shift >Broadened coverage >Screen for allergy to >To prevent
(+) Ceftriaxone to if severe or penicillins or hypersensitivity, toxicity,
productive piperacillin nosocomial risk cephalosporins. and complications related
cough tazobactam 4.5 emerges to prolonged antibiotics.
(+) SOB gm IV q6 (40 >Assess renal function;
IEF infusion) adjust dosing.
(-) fever
(-) HTN >Monitor for bleeding
(-) DM tendencies
Conscious,
coherent, >Observe for signs of
afebrile superinfection
(+)
crackles L
base
Start >Adjunct therapy for >Assess airway status, >To enhance therapeutic
Levocetirizine bronchial asthma allergies, and history of effect on allergic
+ Montelukast asthma. symptoms and maintain
ODHS safety.
>Give during evening for
best effect (montelukast).

>Monitor for mood

changes or agitation

>Avoid alcohol and CNS

depressants.
Stat >Stress ulcer >Give before meals To optimize effect on
Omeprazole prophylaxis, gastric acid suppression
400g IV now especially with >Assess for abdominal and avoid complications.
OD AC in Am systemic steroids pain, GI bleeding, or black
stools.

>Monitor for diarrhea

Stat procaterol >Management of >Check HR, BP, and lung >To assess bronchodilator
25 mg other reversible sounds pre/post effectiveness and prevent
½ tab BID obstructive airway administration. overstimulation
disease symptoms.
>Monitor for tremors,
 palpitations, or
nervousness.

>Ensure proper inhalation

technique.

>advice the patient to avoid

drinking caffeine
Regulate IVF >To keep the IV line >Regulate to minimal flow >Ensure safety and correct
to KVO patent for meds or infusion
emergency access
>Monitor IV site for >Maintains vein patency
redness, swelling, or pain without over hydration

>Check drip rate regularly >Early detection of

infiltration or phlebitis
>Document amount, rate,
and patient response >Provides continuity of
care
09-11-25 Decrease >Patient shows >Verify doctor’s order >Ensures accurate
Salbutamol + improvement in medication timing and
Ipratropium to airway status safe therapy
q12
>Assess breath sounds, RR, >Monitoring ensures
O² sat and presence of bronchodilation is
wheezing effective at a reduced
frequency

>Document response and >Early detection of

respiratory findings adverse effects or
respiratory decline
Start >To provide long- >Teach proper inhaler >Ensures effective
Salmeterol acting bronchodilation technique. delivery of medication.
Fluricasone and reduce airway
250 mcg , 2 inflammation >Instruct patient to gargle >Rinsing prevents oral
puffs BID and rinse mouth after use. thrush from inhaled
(gargle after
 use) steroids.
>Monitor breath sounds,
RR, and O₂ sat. >Monitoring checks
therapeutic effect and
>Observe for side effects adverse reactions.
(hoarseness, oral thrush,
tremors).
IVF PNSS 1L >To maintain IV line >Verify the doctor’s order >Ensures correct, safe
X KVO patency for meds or infusion at prescribed rate
emergency access.
>assess the IV site for >Ensure IV line is
patency, signs of functioning properly and
infiltration, or phlebitis prevents complication.
.
09-12-25 Still for 2D >To evaluate cardiac > Explain the procedure to >Proper explanation and
echo structure and function the patient preparation reduce anxiety,
(+) improving image quality
crackles >To determine
(-) fever ejection fraction >Document and >it helps the doctor to
especially in patients communicate findings know the patients
with respiratory condition and plan the
distress right care.

>To rule out cardiac

causes of dyspnea co-
existing with
obstructive airway
disease
Please revise >Ensures accurate >Prepare soluset and infuse >Soluset allows precise
IVF to 100 cc delivery of 100 cc as ordered, 6 doses control of small volume
in soluset X medications or fluids RTC infusions to avoid rapid
6(RTC) in small, measured overload
amounts
>Monitor patency of IV >Regular monitoring of
line and check for signs of the IV site maintains
infiltration vascular access integrity
and prevents
 complications

>Accurate infusion and

>Regulate flow rate as documentation ensure safe
prescribed and ensure fluid therapy and guide
complete infusion further management
Start >For fluid overload; >Verify order and check >Ensures safe diuretic
Furosemide promotes diuresis to baseline BP, HR, I&O, and administration.
20mg TIV q12 reduce edema or electrolytes.
with BP improve breathing. >BP monitoring prevents
precaution >Monitor BP closely hypotension.

>Document dose, BP >it serves as a baseline

readings, and patient data for further
response. intervention
Paracetamol to >used to treat mild to >Verify doctor’s order and >Ensures safe dosing and
250 mg moderate pain and correct dose. effective symptom relief.
1 tab BID also used to reduce or
treat fever >assess for pain or fever >reduces fever and
before and after analgesic effect
administration

>Document medication > it serves as a baseline

given and patient response. data for further
intervention
CBG >To monitor glucose >Perform capillary blood >Regular monitoring
monitoring levels and detect glucose TID as ordered. ensures timely detection of
TID refer if < hypoglycemia early. low glucose.
80
>Observe for symptoms of >Early reporting prevents
hypoglycemia (sweating, complications and allows
dizziness, shakiness). prompt treatment.

>Refer/report immediately
if CBG <80, document >For rapid corrective
results. treatment.
 XI. DRUG STUDY

DRUG CLASSIFICA MECHANISM OF INDICATION CONTRA SIDE EFFECTS/ NURSING

NAME TIONS ACTION INDICATION ADVERSE RESPONSIBILITIES
EFFECTS
Generic Name: Therapeutic  Inhibits cell  Empiric  In patients  Diarrhea Before:
Ceftriaxone class: wall synthesis, antibiotic for hypersensiti  Increased  Assess for allergy
Sodium Antibiotics promoting suspected vity to BUN level to cephalosporins
osmotic bacterial ceftriaxone  Thrombocyto or penicillins.
Dosage: Pharmaco instability; respiratory or it’s sis,  Review renal and
logical class: usually infection components. leukopenia hepatic function.
2 gms OD
Third- bactericidal. contributing  Neonates  Increased  Check baseline
generation to airway with transaminase PT/INR if patient
Route: Cephalosporin hyperbilirub
inflammation level has impaired vit.
IV s and systemic inemia.  Pain, K synthesis or
response.  History of tenderness at low vit. K stores.
biliary injection site  Ensure patient is
sludge or  Hypersensitiv adequately
gallbladder ity reactions. hydrated to reduce
disease. risk of
 Premature nephrotoxicity.
infants due  Verify correct
to immature drug name to
liver and avoid
kidney look-alike/sound-
function. alike confusion
with other
cephalosporins.
During:
 Monitor for
hypersensitivity
reactions (rash,
urticaria,
anaphylaxis).
 Monitor PT/INR
levels in patients
at risk of
bleeding.
  Ensure proper IV
infusion technique
to minimize
injection site pain
or phlebitis.
After:
 Continue
monitoring for
delayed adverse
reactions: fever,
chills,
eosinophilia,
diarrhea.
 Reassess
hydration status
and renal
function.
 Educate patient to
report any unusual
symptoms such as
rash, bleeding, or
persistent
diarrhea.
 Document
response to
therapy and any
side effects
observed.
Generic name: Therapeutic  Inhibits  Broad-  In patients  Dizziness, Before:
Levofloxacin class: bacterial DNA spectrum hypersensitiv headache,  Obtain specimen
Antibiotics gyrase and antibiotic for e to drug, or fever, for culture and
Dosage: prevents DNA respiratory it’s insomnia sensitivity.
500 mg/tab Pharmacologi replication, tract infection components,  Edema, chest  Assess renal
1 ½ tab OD c class: transcription, with or other pain. function and
Fluoroquinolo repair and suspected fluoroquinolo  Burning hydration status.
Route: nes recombination bacterial nes. sensation in  Review for drug
Oral in susceptible involvement  Use the eye, eye interactions (like;
bacteria. in the cautiously in pain, blurred antacids, iron,
 hyperreactivit patients with vision, vision multivitamins).
y. history of loss, ocular During:
seizure infection.  Give with plenty
disorders or  Abdominal of fluids to
other CNS pain, prevent
diseases, such diarrhea, crystalluria.
as cerebral constipation,  Administer 2 hrs
arteriosclerosi dyspepsia, before or after
s. nausea, antacids or
 History of vomiting. sucralfate.
tendon  Vaginitis  Monitor for
disorders  Hypoglycemi dizziness, allergic
related to a reactions, and
fluoroquinolo  Back pain, peripheral
nes. tendon neuropathy.
 Avoid in rupture After:
pregnant  Allergic  Monitor urine
women and pneumonitis, output and kidney
children dyspnea. function.
(unless  Educate patient to
absolutely avoid sunlight and
necessary), alcohol.
due to risk  Advise on missed
of tendon dose timing and
damage. not to double
doses.
Generic name: Therapeutic  Binds to the  Empiric  Allergy to  Fatigue, Before:
Azithromycin class: 50S subunit of coverage for azithromycin headache,  Tell patient to
Antibiotics bacteria atypical or other somnolence, take drug as
Brand Name: ribosomes, respiratory macrolides. dizziness, prescribed, even
Zithromax Pharmacologi blocking pathogens;  Patients with dysgeusia, after feeling
c class: protein adjunct anti- history of fever. better.
Dosage: Macrolides synthesis; inflammatory liver injury  Chest pain,  Obtain specimen
500 mg tab bacteriostatic effect in from palpitations, for culture and
1 tab or bactericidal, airway azithromycin. edema. sensitivity before
depending on disease  Heart rhythm  Eye irritation, first dose.
Route: concentration. disorders. oral During:
Oral  Severe liver candidiasis  Teach proper drug
 or kidney  Abdominal administration
disease pain, and handling.
anorexia,  Inform that
diarrhea, tablets/suspension
constipation, can be taken with
nausea, or without food.
vomiting,  Monitor for
stomatitis, adverse reactions
dyspepsia, and irregular
enteritis, heartbeat.
gastritis, After:
flatulence,  Advise to
melena. complete full
 Bronchospas course of therapy.
m, cough,  Instruct to avoid
pleural excessive sunlight
effusion. and use
 Photosensitivi sunscreen.
ty reaction,  Instruct to
rash, eczema, promptly report
dermatitis, adverse reactions.
pruritis.
Generic name: Therapeutic Piperacillin  Broadened  Hypersensitiv  Nausea Before:
Piperacillin + Class:  Works by coverage of ity to  Diarrhea  Assess for allergy
Tazobactam Antibiotic inhibiting severe piperacillin,  Headache to penicillins or
bacterial cell respiratory or any other  Rash beta-lactams.
Brand name: Pharmacologi wall synthesis, infection. penicillin  Allergic  Review renal
Zosyn c Class: leading to cell antibiotics. reactions function and
-Piperacillin lysis and death.  Caution in  Superinfectio CBC.
Dosage: Extended- patients with n (due to  Obtain culture and
4.5 grm q6 hr spectrum Tazobactam a history of prolonged sensitivity before
Penicillin  It helps to allergy to use) first dose
Route: protect beta-lactam  Hematologic During:
IV -Tazobactam piperacillin antibiotics. reactions  Administer IV as
Beta-lactamase from  Use with (leukopenia, prescribed;
inhibitor degradation by caution in thrombocytop monitor for
beta-lactamase patients with enia) infusion reactions.
enzymes renal  Renal  Watch for allergic
 produced by impairment. impairment. reactions, rash,
resistant and GI symptoms.
bacteria,  Monitor for signs
thereby of superinfection
extending the and
spectrum of thrombocytopenia
activity of After:
piperacillin.  Reassess infection
symptoms and lab
results.
 Educate patient to
report diarrhea,
rash, or unusual
bleeding.
 Monitor renal
markers and CBC
regularly.
Generic Name: Therapeutic  Exhibits potent  As a  In patients  Headache, Before:
Budesonide Class: glucocorticoid preventative hypersensiti asthenia,  Assess respiratory
(inhalation, Corticosteroids activity and in ve to drug, fever, status and history
intranasal) weak maintenance in those with hypertonia, of corticosteroid
Pharmacologi mineralocortic of asthma. severe insomnia, use.
Brand Name c class: oid activity. hypersensiti pain,  Educate patient:
Pulmicort Corticosteroids  Inhibits mast vity to milk emotional not for acute
cells, proteins lability. asthma attacks.
Dosage: macrophages, (powder for  Chest pain  Review recent
1 neb q 12hr and mediators inhalation)  Conjunctivitis exposure to viral
(such as and in those , infections (like;
leukotrienes) with status nasopharyngit chickenpox,
involved in asthmaticus is, nasal measles).
inflammation. or other congestion, During:
acute asthma oral  Administer as
episodes. candidiasis, prescribed,
otitis media, usually twice
sinusitis, daily at regular
rhinitis, dry intervals.
mouth  Monitor for oral
(inhalation), candidiasis, local
 epistaxis, irritation, and
nasal hypersensitivity.
irritation  Observe for signs
(intranasal). of adrenal
 Abdominal suppression or
pain, hypercorticism in
dyspepsia, long-term use.
diarrhea, After:
gastroenteritis  Instruct patient to
, nausea, rinse mouth after
vomiting, each use.
anorexia.  Monitor lung
 Respiratory function
tract improvement and
infection, symptom control.
bronchospas  Educate on
m, increased hygiene, infection
cough, prevention, and
stridor. when to report
worsening
symptoms.
Generic name: Therapeutic  Not clearly  Systemic  In patients  Hyperglycem Before:
Hydrocortisone class: defined. steroid for hypersensitiv ia  Determine if
sodium Corticosteroid  Decreases moderate to e to drug or  Fluid patient is sensitive
succinate inflammation, severe airway it’s retention, to corticosteroids.
Pharmacologi mainly by inflammation ingredients, in edema  Monitor weight,
Brand name: c class: stabilizing during acute those with  Hypertension Blood Pressure,
Solu- Cortef glucocorticoid leukocyte exacerbation. systemic  Insomnia and electrolytes
s lysosomal fungal  Increased (Na⁺, K⁺, Ca²⁺).
Dosage: membranes, infections, infection risk  Reconstitute
250 mg suppresses and in those  GI upset, properly; do not
100 mg q6hr x 4 immune receiving peptic ulcers use discolored
doses response; immunosuppr  Hypokalemia, solution.
stimulates bone essive doses hypernatremi  Give in the
Route: marrow; and together with a morning for less
IV influences live virus  Adrenal toxicity.
protein, fat, vaccine. suppression  Use only
and  IM  Osteoporosis hydrocortisone
carbohydrates corticosteroid  sodium succinate
metabolism. s are for IV
contraindicate During:
d for ITP.  Administer IV
slowly (≥500 mg
over 10 mins;
intermittent
infusion over 20–
30 mins).
 Monitor for
cushioned effects,
infection masking,
mood changes,
and glucose
levels.
 Watch for signs of
adrenal
insufficiency and
psychiatric
symptoms.
After:
 Educate patient
not to stop drug
abruptly.
 Advise on
infection
avoidance and
oral hygiene.
 Recommend eye
exams,
calcium/vitamin
D, and report
sudden weight
gain or swelling.
 Monitor bone
density in long-
term use.
Generic name: Therapeutic Salmeterol  Maintenance  Hypersensitiv  Oral thrush Before:
Salmeterol Class:  Stimulates therapy to ity to (oropharynge  Assess respiratory
fluticasone Bronchodilator beta- 2 prevent future salmeterol, al status and history
and adrenergic exacerbations fluticasone or candidiasis) of cardiovascular,
Brand name: Corticosteroid receptors in the and stabilize any it’s  Hoarseness seizure, or thyroid
Advair bronchial airway component.  Cough disorders.
Pharmacologi smooth muscle, inflammation.  Should not be  Headaches  Educate patient on
Dosage: c Class: leading to used as a  Tremors proper inhaler use
250 mcg 2 puffs -Salmeterol bronchodilatio rescue (especially and not to use as
BID Long-acting n and relief of medication with rescue
beta-2 bronchospasm. for acute salmeterol) medication.
Route: adrenergic asthma or  Paradoxical During:
Inhalation agonist Fluticasone COPD risk of  Monitor for oral
 Reduced symptoms. pneumonia thrush,
-Fluticasone inflammation  Caution in (especially in hoarseness, and
Inhaled in the airways patients with COPD tremors.
Corticosteroid through the cardiovascula patients)  Check heart rate
inhibition of r disorders,  Cardiovascul and breathing
inflammatory seizures, or ar effects pattern.
cells and hyperthyroidi (increased  Ensure correct
mediators, sm heart rate, inhalation
improving the (salmeterol). palpitations) technique and
frequency of mouth rinsing
asthma after use.
exacerbations. After:
 Reassess asthma
control and
frequency of
exacerbations.
 Encourage regular
follow-up and eye
exams (risk of
cataracts/glaucom
a).
 Monitor for
pneumonia signs,
especially in
COPD patients.
Generic name: Therapeutic  Stimulates beta  To relief of  Hypersensitiv  Tremors Before:
Procaterol class: 2 adrenergic symptoms, e to procaterol  Nervousness  Assess history of
hydrochloride Bronchodilator receptors in the such as or any of it’s  Palpitations cardiovascular
lungs, leading dyspnea components.  Headache disease, diabetes,
Brand name: Pharmacologi to (shortness of  Severe  Dizziness or hypertension.
Meptin c class: bronchodilatio breath), allergic  Tachycardia  Perform baseline
Beta-2 n and improved caused by reactions  Hypokalemia respiratory
Dosage: adrenergic airflow. reversible (anaphylaxis)  Increased assessment (ex.
25 mg agonist  Reduces airway  Patients with blood glucose lung auscultation).
1 tab BID airway obstruction in hypertension levels  Review current
resistance and various or  Allergic medications for
Route: enhances respiratory cardiovascula reactions interactions.
Oral oxygen diseases. r disorders (rash, itching,  Educate patient on
exchange. may require swelling) proper use and
caution.  Cardiac side effects.
Not arrythmias During:
recommended  Monitor
for use during therapeutic
pregnancy, response (like;
unless clearly relief of dyspnea,
needed. decreased
wheezing,
improved
oxygenation).
 Observe for
adverse effects
(tachycardia,
tremors,
nervousness,
insomnia).
 Encourage
hydration.
After:
 Continue
assessing
respiratory status
and breathing
improvement.
  Monitor for
adverse reactions
post-
administration.
Generic name: Therapeutic  Salbutamol:  Relieve acute  Hypersensitiv  Dry mouth Before:
Salbutamol + class: Works by wheeze and ity to  Throat  Assess respiratory
Ipratropium Bronchodilator stimulating airflow salbutamol, irritation status and history
beta- 2 obstruction. ipratropium,  Cough of glaucoma or
Brand name: Pharmacologi receptors in the or any of it’s  Tremors cardiac
Combivent and c class: bronchial components.  Nervousness conditions.
DuoNeb -Salbutamol: smooth muscle,  Patient’s with  Tachycardia  Review current
Beta 2 leading to a history of  Palpitations medications for
Dosage: adrenergic relaxation. severe  Increased interactions.
1 neb q12 hr agonist allergic intraocular  Educate patient on
 Ipratropium: reactions. pressure proper inhalation
Route: -Ipratropium:  Acts as  Caution in (especially in technique and side
Inhalation anticholinergic anticholinergic patients with patients with effects.
agent agent, glaucoma, glaucoma) During:
inhibiting the prostate  Anaphylactic  Monitor vital
action of enlargement, reaction signs, especially
acetylcholine at or bladder  Cardiac heart rate and BP.
parasympatheti neck arrythmias  Observe for
c sites in obstruction. (rare) tremors, dry
bronchial mouth, and
smooth muscle, allergic reactions.
thereby  Ensure correct
producing use of nebulizer
bronchodilatio or inhaler.
n. After:
 Reassess
breathing and
reduction in
wheezing.
 Encourage mouth
rinsing to reduce
irritation.
 Monitor for
delayed side
 effects like
palpitations or
dizziness.
Generic name: Therapeutic  Works by  Mucolytic to  Hypersensitiv  Nausea Before:
N- class: replenishing loosen thick ity to N-  Vomiting  Assess history of
Acetylcysteine Pulmonary glutathione, a secretions and acetylcysteine  Diarrhea asthma or
(NAC) agent powerful improve or any of it’s  Abdominal bronchospasm
antioxidant, airway components. pain risk (since NAC
Brand name: Pharmacologi and directly clearance in  In children  Flushing may trigger
Acetadote c class: breaking mucus under 2 years  Anaphylactic bronchospasm).
Mucolytic disulfide bonds plugging. old. reactions  Review allergy
Dosage: agent in mucus,  With active (rare) history and GI
600 mg/ sachet leading to the peptic  Bronchospas conditions.
BID depolymerizati ulceration. m (especially  Educate patient on
on of mucus,  Caution in with purpose;
Route: making it less patients with inhalation) mucolytic to
Inhalation vicious. asthma  Rashes loosen thick
(administerin  Increased mucus and
g by liver enzyme improve airway
inhalation (in rare cases) clearance.
may cause During:
bronchospas  Administer via
m). nebulizer as
prescribed.
 Monitor for
bronchospasm,
nausea, or
vomiting.
 Observe
respiratory status:
breath sounds,
cough
effectiveness,
SpO₂
After:
 Reassess
breathing and
reduction in
 wheezing/cough.
 Monitor for
delayed adverse
reactions (rash, GI
upset).
Educate patient to report
persistent side effects or
worsening SOB.
Generic name: Levocitirizine Levocitirizine  For relief and  Hypersensitiv  Drowsiness Before:
Levocetirizine Hydrochlorid Hydrochloride: treatment of ity to or sedation  Assess allergy
Hydrochloride + e:  Inhibits respiratory levocetirizine, (more history and renal
Montelukast Second- histamine disorders. montelukast common with function.
Sodium Generation receptors, or any of the levocetirizine  Check baseline
antihistamine reducing drug ). respiratory status
Brand name: allergic components.  Dry mouth (respiration rate,
Levomont, Montelukast symptoms such  Caution in  Headache lung sounds,
Sodium: as sneezing, patient with  Fatigue presence of
Dosage: Leukotriene itching and moderate to  Allergic wheezing).
1 tab receptor nasal severe renal reactions  Review current
antagonist. congestion. impairment.  Mood medications for
Route:  Montelukast changes interactions.
oral Montelukast Sodium: is not used for (agitation,  Educate patient on
 Blocks acute depression) proper use and
leukotriene bronchospas  Liver possible mood
receptors in the m. function changes.
airways, alteration. During:
preventing  Monitor for
inflammation, drowsiness,
bronchoconstri headache, and dry
ction, and mouth.
mucus  Observe for mood
production. changes
(agitation,
depression).
 Ensure
medication is
taken as
prescribed.
 After:
 Check if allergic
manifestations or
asthma episodes
are reduced.
 Document effects,
such as; symptom
relief, side effects
and patient
feedback.
Encourage regular check-
ups.
Generic name: Therapeutic  Inhibits proton  Stress ulcer  In patients  Asthenia, Before:
Omeprazole class: pump activity prophylaxis, hypersensitiv dizziness,  Assess GI history
Antiulcer by binding to especially e to drug or headache. and indication for
Brand name: drugs hydrogen- with systemic it’s  Abdominal stress ulcer
Losec potassium steroids. components pain, prophylaxis.
Pharmacologi adenosine and patients constipation,  Review renal and
Dosage: c class: triphosphate, receiving diarrhea, hepatic function.
40 mg OD PPIs located at the rilpivirine- flatulence,  Check for drug
secretory containing nausea, interactions (like;
Route: surface of products. vomiting, rilpivirine).
IV gastric parietal  Undiagnosed acid  Give on an empty
cell, to gastric regurgitation. stomach, before
suppress malignancy  Back pain, meals
gastric acid  Severe weakness. During:
secretion. hepatic  Cough, URI  Administer IV
impairment.  rash slowly as
prescribed.
 Monitor for
dizziness,
headache, and GI
symptoms.
 Watch for signs of
hypomagnesemia
and osteoporosis
(long-term use).
After:
  Educate patient to
report persistent
GI symptoms.
 Monitor bone
density and
magnesium levels
periodically.
 Reassess need for
continued PPI
therapy.
Generic name: Therapeutic  Inhibits sodium  Relief of  In patients  Vertigo, Before:
Furosemide class: and chloride dyspnea hypersensitiv headache,  Monitor weight,
Antihypertensi reabsorption at related to e to drug and dizziness, Blood Pressure,
Brand name: ves the proximal cardiac in those with weakness, and renal
Lasix and distal strain/volume anuria. restlessness, function.
Pharmacologi tubules and overload  Severe fever.  Check
Dosage: c class: ascending loop suggested by electrolyte  Orthostatic electrolytes:
20 mg q12hr Loop Diuretics of henle. elevated NT- imbalance hypotension, potassium (K⁺),
proBNP. (like; thrombophleb sodium (Na⁺),
Route: hypokalemia, itis (IV) calcium (Ca²⁺),
IV hyponatremia  Blurred or magnesium
). yellow vision, (Mg²⁺).
 Severe transient  Review BUN,
hepatic coma deafness, uric acid, and
or pre-coma. tinnitus. glucose levels.
 Marked renal  Abdominal  Give in the
impairment discomfort morning to
with rising and pain, GI prevent nocturia.
BUN/creatini irritation,  Assess for
ne. diarrhea, hearing loss and
anorexia, gout history.
nausea, During:
vomiting,  Administer IV
constipation. slowly (max 4
 Nocturia, mg/min) to avoid
polyuria, ototoxicity.
frequent  Monitor fluid
urination, intake/output.
 bladder  Watch for signs of
spasm, hypokalemia
oliguria. (muscle cramps,
 Aplastic weakness),
anemia, hypocalcemia,
leukopenia, and
thrombocytop hypomagnesemia.
enia, anemia.  Observe for
Liver dizziness,
dysfunction, hypotension, and
jaundice, rash.
increased After:
liver enzyme.  Educate patient to
stand slowly and
avoid alcohol.
 Advise on
potassium-rich
diet if needed.
 Monitor for
unusual bleeding,
weakness, or
electrolyte
imbalance
Generic name: Therapeutic  Inhibits  For mild to  Hypersensitiv  Nausea Before:
Paracetamol Class: prostaglandin moderate pain ity to  Vomiting  Assess baseline
(acetaminophen Analgesics, synthesis in the relief and paracetamol  Rash liver function and
) Antipyretic CNS and fever or any  Pruritus. history of alcohol
blocks pain reduction. component.  Hepatotoxicit use.
Brand name: impulse  Severe y with  Verify correct
Panadol and generation; acts hepatic overdose. dosage to avoid
Tylenol on impairment or  Thrombocyto overdose.
hypothalamic active liver penia,
Dosage: heat-regulating disease. leukopenia. During:
250 mg center to  Chronic (rare)  Monitor
1 tab BID produce alcohol use temperature, pain
antipyresis. level, and signs of
Route: allergic reaction.
Oral  Observe for
nausea or rash.

After:
 Educate patient to
avoid exceeding
maximum daily
dose.
 Instruct to report
persistent fever,
pain, or signs of
liver toxicity
(yellowing of
skin/eyes, dark
urine).
 Document
effectiveness and
adverse effects.
 ASSESMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUDATION
SUBJECTIVE: Ineffective After 30 of nursing - Position patient in High- - to allow the lungs to fully After 30 minutes of
“konti-konti nalang Breathing Pattern intervention, the Fowlers Position during expand that makes it easier to nursing intervention, the
kinakain ko dahil related to increased patient will meals. breath. patient demonstrated
mabilis akong metabolic demand as demonstrate energy- energy-conserving
hingalin” evidenced by conserving - this reduces the workload on techniques during meals
Tachycardia (RR:26) techniques during - Encourage the patient to respiratory muscle by preventing and established a normal
OBJECTIVE: meals and establish eat slowly and in small breath-holding and rapid and effective respiratory
Use of accessory a normal and bites. breathing while chewing. pattern.
muscle effective respiratory
pattern. - Provide rest periods -to reserve energy and reduce
VS: during meals oxygen consumption, preventing
RR: 26 fatigue and shortness of breath
SpO2: 84% during meal.

- Provide foods that are soft -it reduces effort needed to

and easy to chew. chew, decreasing respiratory
stress and energy use.

- Educate the patient and - Understanding proper

family on techniques to techniques empowers the patient
conserve energy during to manage symptoms and
meals prevent breathlessness while
eating.

- Collaborate with a - Nutrient-dense meals ensure

dietitian for high-calorie, the patient meets nutritional
nutrient-dense meals like needs even if they eat smaller
Mashed potatoes with amounts or get tired easily.
butter or cheese.

XIII. NURSING CARE PLAN

1. Ineffective Breathing Pattern related to increased metabolic demand as evidenced by Tachycardia (RR:26)
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
SUBJECTIVE: Ineffective Airway After 30 minutes of - Assess respiratory status - Monitoring identifies changes After 30 minutes of
“Inuubo pa rin ako Clearance related to nursing intervention, (RR, Breath Sounds, sPO2) in airway obstruction, nursing intervention, the
hanggang ngayon” excessive mucous the patient will every 4 hrs. effectiveness of coughing, and patient maintained airway
production as maintain airway need for additional patency and demonstrated
OBJECTIVE: evidenced by (+) patency and interventions. behaviors to improve
(+) Wheezing Wheezing and demonstrate airway clearance.
- Shallow respiration episodes of cough behaviors to - Encourage effective - Proper techniques help
- Use of accessory observed during improve airway coughing techniques like mobilize and expel secretions
muscle assessment. clearance. huff coughing. from the airway, improving
-Episodes of ventilation.
coughing observed
during assessment - Maintain adequate - Fluids help thin secretions,
hydration as making them easier to cough
allowed/tolerated. out.

- Position the patient in - Upright positioning promotes

High-Fowler’s or semi- lung expansion and improves
Fowler’s. the ability to clear secretions.

- Perform chest - to loosens secretions in the

physiotherapy if ordered. lungs so they can be coughed
out more effectively.

- Administer prescribed - to reduce airway inflammation,

medications such as loosen mucus, and improve
expectorants, mucolytics, airflow.
or bronchodilators.

- provide humidified - Moist air prevents airway

oxygen or use humidifier if dryness and helps thin secretions
applicable. for easier clearance.

2. Ineffective Airway Clearance related to excessive mucous production as evidenced by (+) Wheezing and episodes of cough observed during
assessment.
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION
SUBJECTIVE: Fatigue related to After 30 mins of - Encourage rest periods - to conserve energy and After 30 mins of nursing
“Nagpapatulong ako increased work of nursing intervention, before, during, and after prevents excessive fatigue due intervention, the patient
sa asawa ko tuwing breathing as the patient will activities. to increased work of breathing. verbalized understanding
pupunta ng CR kasi evidenced by verbalize of strategies to manage
hindi ko kayang shallow breathing understanding of - Educate patient about - to help patient manage fatigue fatigue.
mag-isa dahil madali strategies to manage pacing and energy- and reduce energy expenditure.
akong mapagod” fatigue. conserving techniques like
Taking deep, slow breaths
OBJECTIVE: while walking to the
Shallow breathing bathroom and taking
breaks).
VS:
RR: 26 - to maintain energy levels and
SpO2: 84% - Encourage adequate prevents dehydration, which can
hydration and small, worsen fatigue.
INSPECTION: frequent meals.
Seen weak during
assessment. - to improve oxygen delivery to
Takes time to answer - Administer supplemental tissues, reducing fatigue from
question. oxygen as prescribed hypoxia.
during activity.

- Educate patient and - to promote self-management

family about recognizing and early reporting of fatigue or
signs of overexertion. dyspnea.
3. Fatigue related to increased work of breathing as evidenced by shallow breathing
XIII. DISCHARGE PLANNING

MEDICATION  Instruct the patient to continue prescribed medications:

Levocetirizine + Montelukast, Procaterol, Omeprazole,
and Furosemide (if needed).

 Educate on proper dosage, timing, and method of

administration.

 Watch for side effects: palpitations, dizziness, GI upset,

mood changes.

 Encourage immediate consultation if symptoms worsen

or adverse effects occur.
TEACHING  Monitor symptoms: cough, wheezing, dyspnea, fatigue.

 Instruct on continue CBG monitoring TID; refer if <80

or >180.

 Track daily respiratory rate, oxygen saturation, and

blood pressure.

 Recognize warning signs: cyanosis, chest tightness,

severe dyspnea.

 Encourage elevating head during sleep to reduce

nighttime coughing.

 Advise wearing loose, breathable clothing to ease chest

expansion.

 Reinforce the importance of follow up with

pulmonologist within 1–2 weeks.
HYGIENE  Reinforce daily bathing and maintain proper hand
 hygiene.

 Keep the home environment clean and free from

dust,smoke, and other respiratory irritants

 Teach the patient the importance of practicing oral

hygiene, especially after inhaler use.

 Instruct the patient to avoid smoking and secondhand

smoke exposure.

EXERCISE  Advise the patient to avoid strenuous activities like

running or heavy lifting.

 Encourage light walking and breathing exercises as

tolerated.

 Instruct the patient of gradual resumption of daily

activities gradually with rest periods.

 Advise the patient to stop activity if chest tightness,

palpitations, or dizziness occurs.
DIET  Encourage patient to continue a diet as tolerated to meet
energy needs.

 Advise small, frequent meals to prevent fatigue.

 Instruct avoidance of salty and processed foods (canned

goods, chips, instant noodles, cured meats).

 Reinforce hydration unless restricted (6–8 glasses/day).

 Advise the patient to avoid alcohol and caffeinated

 beverages.
SPIRITUALITY  Encourage the continuation of personal or family
spiritual practices such as prayer, meditation, or quiet
reflection for emotional and psychological support.

 Recognize and reinforce the role of faith and family in

coping with chronic illness.

 Promote hope, acceptance, and inner strength as

essential aspects of recovery and adherence to the
treatment plan.
OUTPATIENT  Instruct the patient to attend follow-up with
REFERRAL pulmonologist within 1–2 weeks.

 Teach the patient the importance of monitoring and

recording symptoms: cough, wheezing, dyspnea, fatigue.

 Refer the patient to nutritionist and physical therapist as

needed.

 Report immediately if warning signs occuir.

 Advised the patient to have immediate consultation if

worsening symptoms: chest pain, fainting, rapid weight
gain.