Lorma Colleges

College of Nursing

Carlatan, City of San Fernando, La Union

S.Y. 2019-2020

ANEMIA SECONDARY TO HEMMORHAGIA

In Partial Fulfillment of the Requirements in

NCM 103 RLE

A case study

Presented by:

Cavaneyro, Metchelyn J.

BSN III-Patricia Benner

Presented to:

Sanglay, Meghan
Head Nurse

Ortaliza, Estela Marie, MAN

Clinical Instructor

Medical Ward

November 2019
 Chapter I

INTRODUCTION

Anemia describes the condition in which the number of red blood cells in the

blood is low. For this reason, doctors sometimes describe someone with anemia as

having a low blood count. A person who has anemia is called anemic.

Anemia is actually a sign of a disease process rather than bring a disease itself.

It is usually classified as either chronic or acute. Chronic anemia occurs over a long

period of time. Acute anemia occurs quickly. Determining whether anemia has been

present for a long time or whether it is something new, assists doctors in finding the

cause. This also helps predict how severe the symptoms of anemia may be. In chronic

anemia, symptoms typically begin slowly and progress gradually; whereas in acute

anemia symptoms can be abrupt and more distressing.

Symptoms vary depending on the severity of the anemia and how rapidly it

develops. Some people with mild anemia, particularly when it develops slowly, have no

symptoms at all. Other people may experience symptoms only during physical exertion.

More severe anemia may cause symptoms even when people are resting. Symptoms

are more severe when mild or severe anemia develops rapidly, such as when bleeding

that occurs when a blood vessel ruptures. Mild anemia often causes fatigue, weakness,

and paleness. In addition to these symptoms, more severe anemia may cause faintness,

dizziness, increased thirst, sweating, a weak and rapid pulse, and rapid breathing.

Severe anemia may cause painful lower leg cramps during exercise, shortness of

breath, and chest pain, especially if people already have impaired blood circulation in the

legs or certain types of lung or heart disease. Some symptoms may also give clues to

the cause of the anemia. For example, black tarry stools, blood in the urine or stool, or

coughing up blood suggests that anemia is caused by bleeding. Dark urine or jaundice

(a yellowish tinge to the skin or the whites of the eyes) suggests that red blood cell

destruction may be the cause of anemia. A burning or prickling feeling in the hands or

feet may indicate vitamin B12 deficiency.

Anemia may be caused by excessive bleeding. Bleeding may be sudden, as may

occur as a result of an injury or during surgery. Often, bleeding is gradual and repetitive
(chronic bleeding), typically due to abnormalities in the digestive or urinary tract or heavy

menstrual periods. Chronic bleeding typically leads to low levels of iron, which leads to

worsening anemia. Anemia may also result when the body does not produce enough red

blood cells (see also Formation of Blood Cells.). Many nutrients are needed for red blood

cell production. The most critical are iron, vitamin B12, and folate (folic acid), but the

body also needs trace amounts of copper, as well as a proper balance of hormones,

especially erythropoietin (a hormone that stimulates red blood cell production). Without

these nutrients and hormones, production of red blood cells is slow and inadequate, or

the red blood cells may be deformed and unable to carry oxygen adequately. Chronic

disease also may affect red blood cell production. In some circumstances, the bone

marrow space may be invaded and replaced (for example, by leukemia, lymphoma, or

metastatic cancer), resulting in decreased production of red blood cells. Anemia may

also result when too many red blood cells are destroyed. Normally, red blood cells live

about 120 days. Scavenger cells in the bone marrow, spleen, and liver detect and

destroy red blood cells that are near or beyond their usual life span. If red blood cells are

destroyed prematurely (hemolysis), the bone marrow tries to compensate by producing

new cells faster. When destruction of red blood cells exceeds their production, hemolytic

anemia results. Hemolytic anemia is relatively uncommon compared with the anemia

caused by excessive bleeding and decreased red blood cell production. Hemolytic

anemia may result from disorders of the red blood cells themselves, but more often it

results from other disorders that cause red blood cells to be destroyed.

The risk factors associated with anemia include: A diet lacking in certain vitamins

and minerals- A diet consistently low in iron, vitamin B-12 and folate increases your risk

of anemia. Intestinal disorders- Having an intestinal disorder that affects the absorption

of nutrients in your small intestine — such as Crohn's disease and celiac disease — puts

you at risk of anemia. Menstruation- In general, women who haven't had menopause

have a greater risk of iron deficiency anemia than do men and postmenopausal women.

Menstruation causes the loss of red blood cells. Pregnancy- If you're pregnant and aren't

taking a multivitamin with folic acid and iron, you're at an increased risk of anemia.

Chronic conditions- If you have cancer, kidney failure, diabetes or another chronic

condition, you could be at risk of anemia of chronic disease. These conditions can lead
to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or other source

within your body can deplete your body's store of iron, leading to iron deficiency anemia.

Family history- If your family has a history of an inherited anemia, such as sickle cell

anemia, you also might be at increased risk of the condition. A history of certain

infections, blood diseases and autoimmune disorders increases your risk of anemia.

Alcoholism, exposure to toxic chemicals, and the use of some medications can affect red

blood cell production and lead to anemia. Age- People over age 65 are at increased risk

of anemia.

Undiagnosed or untreated anemia can cause stress on all body tissues, with

decreased oxygenation, especially respiratory and cardiovascular systems. In addition, it

can cause decreased ability to concentrate, poor muscle development and decreased

performance on developmental tests. Pregnant women who are severely anemic have a

significant risk of complications, especially when they give birth afterwards. If a mother is

severely anemic, her baby is much more likely to be born prematurely and underweight.

Babies born to mothers with anemia are much more likely to have problems with anemia

themselves later on in infancy. Fatigue may have a considerable impact on the quality of

life of the patient. If the anemia is severe or untreated, the patient may feel too tired to

work, or carry out essential daily tasks. Long-term fatigue may eventually lead to clinical

depression.

The major goals for a patient include decreased fatigue, attainment or

maintenance of adequate nutrition, maintenance of adequate tissue perfusion,

compliance with prescribed therapy and or absence of complications. Nursing

interventions for management of fatigue includes assisting the patient in prioritizing

activities and establishing balance between activity and rest that would be acceptable to

the patient. To maintain adequate nutrition, interventions include informing the patient

that alcohol interferes with the utilization of essential nutrients and should. Furthermore,

encouraging the patient about a healthy diet packed with essential nutrients is also

necessary. To maintain adequate tissue perfusion, it is a must that nurses monitor the

patient’s vital signs and pulse oximeter readings closely. To enhance compliance with

prescribed therapy, the nurse should assist the patient to develop ways to incorporate

the therapeutic plan into everyday activities.

 Globally, anaemia affects 1.62 billion people (95% CI: 1.50–1.74 billion), which

corresponds to 24.8% of the population (95% CI: 22.9–26.7%). The highest prevalence

is in preschool-age children (47.4%, 95% CI: 45.7–49.1), and the lowest prevalence is in

men (12.7%, 95% CI: 8.6–16.9%). However, the population group with the greatest

number of individuals affected is non-pregnant women (468.4 million, 95% CI: 446.2–

490.6). In the Philippines, the over-all prevalence of anemia increased slightly to 30.9%

Infants 6 months to 1 year had the highest prevalence (56.6%), followed by pregnant

women (50.3%), male elderly (49.1%) and lactating women (45.7%). While the 1-5 year

old children as a group had relatively low prevalence of 29.6%, a disaggregation of this

population group into single age grouping revealed alarmingly high rates of 53.2% and

36.9% for 1 and 2 y old children, respectively.

PATIENT-CENTERED OBJECTIVES:

After 2-3 days of rendering holistic nursing care, the patient will be able:

1. To understand underlying condition and therapeutic regimen.

2. To be able to receive an effective nursing intervention in meeting her needs and in

aiding her recovery.

3. To be able to apply the health teachings for the continuity of care in her situation.

4. To be able to cooperate and comply with the treatment regimen for her recovery.

STUDENT-CENTERED OBJECTIVES:

After 2-3 days of rendering holistic nursing care, the student will be able:

1. To comprehend the risk factors, complications and nursing considerations for the

client.

2. To observe and identify potential complications and how to initiate appropriate

preventive or corrective actions.

3. To be able to provide health teachings to the client for continuity of care to the client.
4. To be able to provide nursing care that can contribute to the optimum health status of

the client.

Chapter II

NURSING HEALTH HISTORY

I. Biographic Data

The client’s name is M.C. E. She was born on December 28, 1975. She is 43

years old. She is a full-blooded Filipino and a Roman Catholic. She is married and is

currently an Elementary teacher. She lives in Sitio 2 Santiago Sur, Caba La Union. She

can fluently write, read and communicate in Tagalog, Iloko and English.

II. Reasons for Seeking Health Care

Patient M. C. E. was doing her laundry when she experienced dizziness that she

can no longer tolerate. She then decided to go to Lorma Medical Center in San

Fernando, La Union to have her check-up, hence, admission.

III. Family Health History

There was noted history of hypertension on the maternal side. No noted reported

family history of Diabetes Mellitus, Asthma, CAD, CVD or any malignancies. Patient is a

nonsmoker and nonalcoholic. There is no history of recent travel. No other house

members are experiencing the same signs and symptoms.

IV. History of Present Health Concern

One day prior to admission, patient felt body weakness aggravated by menstrual

period with associated dizziness and loss of balance, with occasional headache,

occipital region, dull rated 2/10 and loss of appetite. No associated trauma, no blurring of

vision, no fever, no cough, no colds, no epistaxis, no loss of consciousness, no weight

loss. She has maintenance of Iberet for 3 months as per doctor’s order when the last

time she had her check-up but she did not comply with the correct duration of the
ordered medication. Few hours prior to admission, patient still had weakness. Patient

sought consult in Lorma Medical Center, hence, admission.

V. Past Health History

Patient had no history of asthma, hypertension, diabetes mellitus, coronary artery

disease, arthritis or malignancies. No noted allergies to drugs or foods. Patient was

previously hospitalized due to anemia secondary to menorrhagia. Patient was taking

Iberet for one month but stopped a week ago. Her menarche was at 14 years old, lasted

for 3 days, and used 4-5 moderately soaked pads, with associated dysmenorrhea.

Subsequent menses were regular, occurring every 4-5 moderately soaked regular pads,

with no associated dysmenorrhea. Her last menstrual period is October 26, 2019 while

her previous menstrual period is August 2019 (unknown date).

VI. Lifestyle and Health Practices

A. Description of a Typical Day

Patient M. C. E. typically wakes up around 5:00 in the morning. She brushes her

teeth and takes a bath daily. She can prepare and insists on doing the cooking for the

family. She goes to school at 7:00 in the morning because she is an Elementary teacher

and usually goes home by 4:00 to 5:00 p.m. or sometimes tends to go home around

7:00 at night since she has to finish her lesson plan at school. She often sleeps around

10:00 p.m. to 1:00 a.m.

B. Nutrition and Weight Management

Patient M.C. E. eats at least 3 times a day and has snack too. Most of the time

she eats fried chicken because it is the favorite viand of her children. They seldom eat

vegetables or pork. Patient’s breakfast consists of bread and coffee. Her typical snacks

are biscuits and fried noodles that is accompanied with either juice or soft drinks. For

dinner, she and her family often eat a variety of fish and meat. In a day, she often have 1

to 2 cups of rice per meal, depending on her appetite. She often drinks 5 to 6 glasses of

water a day. The source of their drinking water comes from a water shop. She defecates

once or twice a day, usually occurring in the morning and urinates at least 4 to 5 times a

day.
 C. Activity Level and Exercise

Patient M.C.E. is active when it comes to teaching her students in class. She

may not be able to have her daily exercise but has the chance to whenever there is a

fitness program in school.

D. Sleep and Rest

Patient M.C.E. has an irregular sleeping pattern because she has a lot of things to

do. She said that being an Elementary teacher, she often has 5 to 6 hours of sleep

because of the preparations that she needs to do. However, she takes up to 8 hours of

sleep during the weekend to make up for the days she was unable to sleep properly.

E. Medications and Substance Use

Patient M.C.E. mentioned buying over-the-counter medications for her common

illnesses such as Solmux or Neozep for her cough and colds and Biogesic for when she

has fever and headache. She was prescribed an Iberet to be taken for 3 months last

2017 but did not comply with the order. Patient has no history of smoking. She doesn’t

believe in the benefits of herbal plants.

F. Self-concept and Self-care pattern

Patient M. C.E. is a proud mother and a wife to her husband. Aside from that, her

outlook about her daily living is always positive. However, due to her busy schedule as a

teacher, she often regrets the time lost because of her instead of utilizing her utmost

time to her precious family.

G. Social Activities

Patient M.C.E. often communicates with her friends or colleagues while in school

and often mingles with their neighbor when she has the time. To relieve the stress of

being a teacher, she said that her past time consists of watching television and spending

time on social media. Their barangay often holds events that bind them together as a

community by means of having barangay fiestas and having medical missions but
patient M.C.E. does not often engage in the said barangay activities because she is

busy with her work.

H. Role-Relationship Pattern

Patient M.C.E. is happily married to her husband who is working as a seaman for

a long time. They have a good relationship back then and is much stronger through the

years of their relationship. She also had a good relationship with her parents as well as

to her in-laws.

I. Values and Beliefs

Patient M.C.E. used to be a Roman Catholic but converted to Protestant and

often prays for supplications, adoration, contrition and thanksgiving. She attends the

mass on Sundays but is sometimes not able to. She does not believe in the works of

quack doctors, albularyo and hilot. She does not have any superstitions related to

health.

J. Education and/or Work

Patient M.C.E. is a graduate of Bachelor of Science in Education. She has been

working as an Elementary teacher for 17 years.

K. Stress Level and Coping Style

Patient M.C.E.‘s stress stems from the pressure of being a teacher, how to be a

a good mother and wife to her husband. She admits having an overwhelming feeling but

tries to overcome the challenges in her life by sharing her problems and feelings with

some of her friends and siblings, listening to music, sleeping and praying for courage

and guidance.

L. Environmental Living Sanitation

Patient M.C.E. and her family lives in a bungalow house in Barangay Sitio 2,

Santiago Sur, Caba La Union together with her three children. Their house is near the

highway. Their source of water for bath is from deep well and buys their drinking water

from the drinking water station nearby. The space of their house is enough for the family

and has pretty good green cover-it has some mango trees and flowers that are well-
maintained. They have a water-sealed, sewer/septic tank toilet facility that is exclusively

used by the household. They have a good garbage segregation system in their

community and garbage collection takes place every Wednesdays and Sundays.

VII. Developmental Task

According to Erikson’s Stages of Psychosocial Development: Stage 7, Generativity vs.

Stagnation

Generativity versus stagnation is the seventh of eight stages of Erik Erikson's

theory of psychosocial development. This stage takes place during during middle

adulthood (ages 40 to 65 yrs). People experience a need to create or nurture things that

will outlast them, often having mentees or creating positive changes that will benefit

other people. We give back to society through raising our children, being productive at

work, and becoming involved in community activities and organizations. Through

generativity we develop a sense of being a part of the bigger picture. Success leads to

feelings of usefulness and accomplishment, while failure results in shallow involvement

in the world. By failing to find a way to contribute, we become stagnant and feel

unproductive. These individuals may feel disconnected or uninvolved with their

community and with society as a whole. Success in this stage will lead to the virtue of

care.

For patient M.C.E., this is the stage when she developed good connections with

her friends and family. Furthermore, she was able to “make her mark” on this society by

creating or nurturing things that will outlast an individual since she is an Educator. As

someone who is currently in a relationship and having her own family, she believes that

being a mother molds her to be the person that her children would be surely be proud of.
She, being in the “generativity” stage develops a sense of being a part of the bigger

picture.

Chapter III

PHYSICAL ASSESSMENT

Last October 28, 2019 at around 8 in the morning, a Head-to-Toe Physical

Examination to patient M.C.E. was conducted.

General Survey

During the interview and observation, patient is awake and looking weak. She is

coherent and conversant. Facial expression is symmetric and correlate with mood and

topic discussed. The patient is also cooperative and purposeful in her interaction with

others. She maintains eye contact. Her speech is clear and appropriate. She is oriented

to person, place, time and events. During the interview we took her Vital Signs and

recorded it as follows: Blood Pressure: 110/70 mmHg, Pulse Rate: 69 beats/min;

Temperature: 36.7oC; and Respiratory Rate: 20 breaths/min.

Skin, Hair and Nails

Skin is brown in color and with no lesions on the skin. However, paleness is

noted. Skin is warm to touch and brings back slowly for about 2-3 seconds when

[Link] is dry in texture. The hair is black in color, smooth and equally distributed.

Nails are white to pink in color and well-trimmed. Upon assessing, she has a normal

capillary refill within 2 to 3 seconds.

Head, Neck and Lymph Nodes

Head is normocephalic, symmetric, and has full range of motion. Face is

normally symmetric and proportionate. Movements are equal bilaterally. The neck is

located midline. There were no lesions or mass noted. The trachea is in midline.

Mouth, Throat, Nose and Sinuses

The lips are pale-looking and dry. No ulcerations or lesions noted. The tongue

moves freely and not tender. The client possesses pink gums. No pockets between
gums and teeth seen and breath is fresh. The teeth are properly aligned with some

dental caries. Tonsils are easily seen. Nose is in midline, no discharges, no nasal

obstructions and both nares are patent. No bone and cartilage deviation noted on

palpation. No tenderness noted on palpation. No tenderness is palpated over sinuses.

Eyes and Eyebrows

The eyebrows are symmetrically aligned and equal in movement. Eyelashes are

equally distributed and curled slightly outward. Eyelids close symmetrically. There is no

swelling, discharge or lesions of eyelids. Eyeballs are symmetrically aligned. Pupils are

equally round, reactive to light and accommodation.

Ears

Ears are equal in size and similar to one another. The pinna recoils after folded.

There is no swelling and tenderness palpated. No foul discharges. Patient can respond

to sounds. Minimal swaying observed during Romberg’s test.

Thorax and Lungs

The chest is normal in diameter. The chest contour is symmetrical, and the spine

is vertically aligned. The chest wall is intact, no tenderness or no masses noted. Upon

auscultation, no adventitious sound is noted.

Heart

Heart has a strong and regular rhythm of 75 beats per minute. No heart murmurs

or extra heart sounds heard.

Abdomen

The abdomen is slightly globular and when skin pinched, it goes back less than 2

seconds. Bowel sounds heard in all quadrants.

Upper and Lower extremities

Both upper and lower extremities are normal in terms of size. No edema and

gross deformities noted and the capillary refill is less than 2 seconds.
Genitalia

Not assessed

Neurologic

The client is alert and coherent. She can do basic things independently. She is

responsive whenever she receives nursing care. She is participative and attentive during

interview. The Glasgow Coma Scale assesses the eye opening, verbal, motor response

of the client by observing how the client responds to each response behaviors. Thus,

using the Glasgow Coma Scale, we recorded a scale of 15/15; Motor – 6 because the

patient was able to obey commands. Verbal - 5 because the patient was oriented to

time, place and person, Eyes - 4 because the patient was able to open her eyes

spontaneously.
 Chapter IV

ANATOMY AND PHYSIOLOGY

The female reproductive system includes the ovaries, fallopian tubes, uterus,

vagina, vulva, mammary glands and breasts. These organs are involved in the

production and transportation of gametes and the production of sex hormones. The

female reproductive system also facilitates the fertilization of ova by sperm and supports

the development of offspring during pregnancy and infancy.

The ovaries are a pair of small glands about the size and shape of almonds,

located on the left and right sides of the pelvic body cavity lateral to the superior portion

of the uterus. Ovaries produce female sex hormones such as estrogen and

progesterone as well as ova (commonly called “eggs”), the female gametes. Ova are

produced from oocyte cells that slowly develop throughout a woman’s early life and

reach maturity after puberty. Each month during ovulation, a mature ovum is released.
The ovum travels from the ovary to the fallopian tube, where it may be fertilized before

reaching the uterus.

The fallopian tubes are a pair of muscular tubes that extend from the left and

right superior corners of the uterus to the edge of the ovaries. The fallopian tubes end in

a funnel-shaped structure called the infundibulum, which is covered with small finger-like

projections called fimbriae. The fimbriae swipe over the outside of the ovaries to pick up

released ova and carry them into the infundibulum for transport to the uterus. The inside

of each fallopian tube is covered in cilia that work with the smooth muscle of the tube to

carry the ovum to the uterus.

The uterus is a hollow, muscular, pear-shaped organ located posterior and

superior to the urinary bladder. Connected to the two fallopian tubes on its superior end

and to the vagina (via the cervix) on its inferior end, the uterus is also known as the

womb, as it surrounds and supports the developing fetus during pregnancy. The inner

lining of the uterus, known as the endometrium, provides support to the embryo during

early development. The visceral muscles of the uterus contract during childbirth to push

the fetus through the birth canal.

The vagina is an elastic, muscular tube that connects the cervix of the uterus to

the exterior of the body. It is located inferior to the uterus and posterior to the urinary

bladder. The vagina functions as the receptacle for the penis during sexual intercourse

and carries sperm to the uterus and fallopian tubes. It also serves as the birth canal by

stretching to allow delivery of the fetus during childbirth. During menstruation, the

menstrual flow exits the body via the vagina.

The vulva is the collective name for the external female genitalia located in the

pubic region of the body. The vulva surrounds the external ends of the urethral opening

and the vagina and includes the mons pubis, labia majora, labia minora, and clitoris. The

mons pubis, or pubic mound, is a raised layer of adipose tissue between the skin and

the pubic bone that provides cushioning to the vulva. The inferior portion of the mons

pubis splits into left and right halves called the labia majora. The mons pubis and labia

majora are covered with pubic hairs. Inside of the labia majora are smaller, hairless folds

of skin called the labia minora that surround the vaginal and urethral openings. On the
superior end of the labia minora is a small mass of erectile tissue known as

the clitoris that contains many nerve endings for sensing sexual pleasure.

The breasts are specialized organs of the female body that contain mammary

glands, milk ducts, and adipose tissue. The two breasts are located on the left and right

sides of the thoracic region of the body. In the center of each breast is a highly

pigmented nipple that releases milk when stimulated. The areola, a thickened, highly

pigmented band of skin that surrounds the nipple, protects the underlying tissues during

breastfeeding. The mammary glands are a special type of sudoriferous glands that have

been modified to produce milk to feed infants. Within each breast, 15 to 20 clusters of

mammary glands become active during pregnancy and remain active until milk is no

longer needed. The milk passes through milk ducts on its way to the nipple, where it

exits the body.

 Chapter V

LAB RESULTS

Date Requested: October 28, 2019

HEMATOLOGY

PARAMETER RESULT UNIT REF INTERPRETATION

RANGE
Eosinophils 0.07 g/L 0.00-0.05 Elevated levels often
mean your body is
sending more and
more white blood cells
to fight off infections.
Hematocrit 0.35 L/L 0.40-0.50 A low hematocrit
means the percentage
of red blood cells is
below the lower limits
of normal for that
person's age, sex, or
specific condition (for
example, pregnancy or
high-altitude living)
Erythrocytes 4.4 x10^9/L 4.0-5.4 NORMAL

WBC 5.38 x10^9/L 5-10 NORMAL

Hemoglobin 119 % 127-183 Low hemoglobin

means that a person's
hemoglobin level when
measured, is below the
lowest limits of normal
 for their age and sex
(see above normal
range of values).
Another term frequently
used in place of low
hemoglobin is anemia,
or the person is
described as being
anemic
Lymphocytes 0.45 % 0.20-0.40 High lymphocyte blood
levels indicate your
body is dealing with an
infection or other
inflammatory condition.
Monocytes 0.07 % 0.00-0.07 NORMAL

Platelet Count 220 x10^9/L 150-400 NORMAL

Date Verified: October 28, 2019

Exam: Transvaginal Scan

Measurements:

Uterus: 4.71 x 3.85 x 5.30 cm

Cervix: 2.67 x 3.48 x 2.74 cm

Endometrium: 0.69 cm

Right Ovary: 2.31 x 1.03 x 2.03 cm, Volume: 2.54 mL

Left Ovary: 2.38 x 1.15 x 2.45 cm, Volume: 3.52 mL

Reading:

The uterus is normal in size and anteverted with smooth contour and homogenous echo

pattern. No myometrial lesions seen. The endometrium is thickened and hyperechoic

with smooth and intact endometrial stripe. Real-time study showed fluid movement. Both

ovaries are normal in size with multiple immature follicles. No adnexal mass. No free

fluid in the cul-de-sac. Rectum and urinary bladder mucosa are intact.

Impression:

Normal-sized anteverted uterus

Thickened hyperechoic bleeding endometrium

Normal ovaries

No adnexal mass

No free fluid in the cul-de-sac

Intact rectum and bladder mucosa

 Chapter VIII

EVALUATION

All the data written in this case study are gathered by means of interview,

assessments and observations as well as from the patient’s data. Patient S.M.N. was

rushed to LORMA Medical Center last September 27, 2019 due to difficulty of breathing.

Upon admission, she was diagnosed by her physician, Dr. S.P.M. with Bronchial Asthma

in Acute Exacerbation. Patient underwent a diagnostic test of Complete Blood Count

(CBC) and Chest X-Ray. Nebulization was done to ensure of adequate oxygenation to

the patient and she was then hooked to venoclysis. Patient was given medications such

as Montelukast + Levocetirizine 5 mg TAB OD, taken at bedtime, Acetyl cysteine. Her

medications for her maintenance were also given.

We, the assigned student nurses for patient S.M.N. were able to handle her case

last September 30, 2019. On the first day of our encounter with the patient, it was a

challenge for us since patient is at her age that tends to be annoyed easily. We

monitored her vital signs and IVF as well as given her medications she needed. We also

considered important nursing considerations given to the patient such as limiting oral

fluid intake of 1.5 mL per day and making sure she is positioned at moderate back rest.

Furthermore, we also monitored her lung sounds and observed her secretions. Aside

from that, we were also able to impart health teaching for our patient and family

members for continuity of care as well as informing her of the importance of proper

hygiene, clean environment and avoidance of strenuous tasks that might trigger her

exacerbations.

The knowledge of the diagnosed condition of the client particularly its causes,

risk, prevention and management has improved since our first encounter as observed on

the feedback that we have provided to check for the understanding of the health

teachings we have imparted as well as her being able to have better airway patency and
reduced secretions. However, the assurance that the parents of the client that continuity

of care will be applied is not guaranteed.

Patient S.M.N. was discharged on October 2, 2019 and was given home

medications of Cefuroxime 250 mg TAB 3x daily for 7 days, NAC 600 mg 1 TAB

dissolved in ¼ glass water once daily, Furosemide 40 mg half TAB OD for 10 days,

Potassium Chloride/Kalium Durule 1 TAB OD for 7 days, Duavent Nebulization 1 cc 2x a

day for 1 week and continuation of maintenance medications such as Losartan 50 mg 1

Tab OD, Cilostazol 50 mg 1 Tab OD, Digoxin 0.25 mg 1 TAB OD and Montelukast 5 mg

1 TAB OD. Health teachings were also imparted about the administration of medications.

Follow-up check was never encountered.

In conclusion, this case study helped us achieve our student objectives of first,

being able to identify the problem of the patient and to be able to learn more about

Bronchial Asthma. We were able to identify the causes, risk factors and complications of

the said illness. Furthermore, we were able to establish one of the necessary nursing

roles- which is building rapport with our client and being able to provide the necessary

nursing care our patient needs for the optimum quality of his health. In addition, we were

able to share our knowledge to our patient and family for continuity of care. Finally, this

case study helped us, student nurses to understand the essence of working as a team

as this is one of the tasks we must remember to abide for the better progress of student-

patient relationship.