Asthma is a chronic inflammatory disorder of the To verify the presence of Status asthmaticus, the

airways. It involves airway obstruction that causes following assessment and diagnostic tools are used:

wheezing, cough and dyspnea. With treatment,

 Pulmonary function studies – this test proves to
however, it can be alleviated and controlled. In some
be the most accurate tool to assess any airway
cases however, asthma can be unresponsive
obstruction
to treatment, and this condition is called Status
 Arterial blood gas studies – this test is
Asthmaticus.
performed when the patient could not perform
Status Asthmaticus is a severe and persistent asthma
pulmonary function maneuvers
that is non reactive to initial and
 Respiratory Alkalosis – low PaCO2
conventional treatment. Usually, the attack can last
Management
up to 24 hours. Conditions that could precipitate
Medical Management includes the following:
status asthmaticus can be non – specific irritants,

increased adrenergic blockage, anxiety, infection, 1. Patient is given a short acting beta adrenergic
nebulizer abuse, dehydration and hypersensitivity to agonist initially.
aspirin. 2. Status asthmaticus is also treated

with corticosteroids.
Pathophysiology
3. Supplemental oxygen is given. This will act

control dyspnea, central cyanosis and

Asthma per se is the constriction of the bronchial
hypoxemia.
smooth muscles, swelling of the bronchial mucosa
4. Intravenous therapy is started to treat any
linings and thickened sputum. With these happening,
dehydration.
it narrows the bronchial tree, and is apparent
5. PaCO2 should be maintained between 65 mm
tobronchial asthma. This results to hypoxemia,
Hg to 85 mm Hg.
respiratory alkalosis (there will be decreasing PaO2
Nursing Management includes the following:
and respiratory alkalosis, a decreased PaCO2 and an

increased pH) and respiratory acidosis (PaCO2 1. The nurses are responsible in monitoring the
increase as the status asthmaticus worsens) thereafter. patient especially for the first 12 – 24 hours.

2. Continuous monitoring is required until the

status asthmaticus is controlled.

Manifestations 3. Signs of dehydration are monitored, skin turgor

and daily output is monitored.

 Wheezing 4. Fluid therapy is initiated, this is to prevent
 Labored breathing dehydraton, it also facilitates expectoration of
 Prolonged exhalation secretions. Fluids can be up to three to four
 Neck engorgement liters or as indicated.
Assessment and Diagnosis
5. Assist the patient in any activity he is doing,  fatigue, headache, irritability

conservation of the patients energy  satiety

6. is required and further exhaustion should be  muscle spasms or cramps

avoided.  muscle weakness

7. The environment should be free of irritants  nausea, vomiting

(dust, flowers, pollens, perfumes,  restlessness

Treatment:
Hyponatremia
 Correct underlying disorder associated with

hyponatremia.
 Sodium is essential to maintain osmotic
 Intravenous fluid administration.
pressure and acid-base balance chemically and
 Give sodium tablets.
to transmit nerve impulses.
 Water restriction.
 Sodium levels are obtained through venous
 When exercising, keep hydrated.
blood extraction.
Nursing Considerations:
 It is a metabolic disorder wherein the level of

sodium in the blood is lower than normal (<

1. Strictly monitor fluid intake and output.
135 mEq/L).
2. Observe for dehydration. Accurately record
 It is a result of one of the following:
state of hydration.
 Severe burns
3. Observe for neuromuscular changes such as
 Congestive heart failure
declining levels of consciousness, fatigue and
 Excessive fluid loss such as severe
muscular weakness.
diarrhea, vomiting
4. Monitor for signs of edema and hypertension.
 Excessive IV induction of nonelectrolyte
5. Ensure adequate dietary sodium intake of 90 to
fluids such as glucose
250 mEq/day.
 Addison’s disease

 Severe nephritis
Diabetes insipidusis an endocrine disorder
 Pyloric obstruction
characterized by the inability of the kidney to
 Malabsorption syndrome
conserve water. This leads to excessive urination and
 Diabetic acidosis
thirst of the person affected. The word diabetes
 Drugs such as diuretics
comes from the Greek word diabainein, which means
 Edema
to stand with legs apart (as in urination) or to go
 Large amounts of water per orem
through. Insipidus is originated from a Latin word
 Hypothyroidism
meaning without taste. The urine excreted in diabetes
 Excessive ADH production
insipidus is tasteless (because it has relatively low
Symptoms:
sodium content) whilst in Diabetes Miletus a sweet
 altered mental status, restlessness
urine (glucose content) is excreted.
 convulsions
 Pathophysiology

Types Causes

There are different types of Diabetes Insipidus, each Pituitary or Neurogenic or Central Diabetes Insipidus

has a different cause. The most common types are the  Head trauma

following:  Brain tumor

 Surgical ablation of the pituitary gland

 Central Diabetes Insipidus – caused by the
 Irradiation of the pituitary gland
deficiency of antidiuretic hormone (ADH). This
 Infection to the CNS (meningitis, encephalitis)
type of diabetes insipidus is also
 Tumors (metastatic disease)
called pituitary diabetes insipid or
Nephrogenic Diabetes Insipidus
neurogenic diabetes insipidus.
 Hypokalemia
 Nephrogenic Diabetes Insipidus – caused an
 hypercalcemia
insensitivity of the kidneys to the ADH.
 Medications (lithium, demecleocyclin,

amphotericin B)
Review of Related Anatomy and Physiology

Clinical Manifestations
The antidiuretic hormone (ADH) or vasopressin is
 Polyuria
secreted by the posterior pituitary or
 Polydipsia
neurohypophysis. It targets the kidney to conserve or
 Diluted urine with a specific gravity of 1.001-
retain water in the body. This hormone is very
1.005
helpful in regulating the fluid volume and urine
 Signs of dehydration
output by decreasing the amount of urine excreted

and increasing water reabsorption. Through the said

Diagnostic Evaluation
mechanism, the extracellular fluid volume rises
 Radiography, CT scan or ultrasound of the skull
resulting in a vasoconstrictor effect (increased BP).
 Urinalysis
In cases where the vascular volume drops more ADH

is released.
Treatment

Anxiety, trauma and pain all contributes to the Pituitary or Neurogenic or Central Diabetes Insipidus

release of ADH from the neurohypophysis. When a The goals of the treatment are focused on the

person changes position (from lying to standing) and following:

when the body is exposed to high temperatures, ADH

 Fluid replacement
secretion is also augmented. When the level of ADH
 Vasopressin replacement with Desmopressin
falls, minimal or no water reabsorption will occur
(DDVAP), which is a synthetic vasopressin
thereby, increasing the urine output and might lead to
without the vascular effects of the natural ADH.
dehydration.
 Correct the underlying disease process
Nephrogenic Diabetes Insipidus passed on in families) and environmental factors

 Fluid replacement involved. Research has shown that some people who

 Thiazide diuretics develop diabetes have common genetic markers. In

 Prostaglandin inhibitors (indomethacin, Type I diabetes, the immune system, the body’s

ibuprofen) defense system against infection, is believed to be

 Stopping the medication (if the drugs given are triggered by a virus or another microorganism that

causing the disease) destroys cells in the pancreas that produce insulin. In

Type II diabetes, age, obesity, and family history of

Diabetes mellitus is a condition in which the diabetes play a role.

pancreas no longer produces enough insulin or cells

In Type II diabetes, the pancreas may produce
stop responding to the insulin that is produced, so
enough insulin, however, cells have become resistant
that glucose in the blood cannot be absorbed into the
to the insulin produced and it may not work as
cells of the body. Symptoms include frequent
effectively. Symptoms of Type II diabetes can begin
urination, lethargy, excessive thirst, and hunger. The
so gradually that a person may not know that he or
treatment includes changes in diet, oral medications,
she has it. Early signs are lethargy, extreme thirst,
and in some cases, daily injections of insulin.
and frequent urination. Other symptoms may include

The most common form of diabetes is Type II, It is sudden weight loss, slow wound healing, urinary tract

sometimes called age-onset or adult-onset diabetes, infections, gum disease, or blurred vision. It is not

and this form of diabetes occurs most often in people unusual for Type II diabetes to be detected while a

who are overweight and who do not exercise. Type II patient is seeing a doctor about another health

is considered a milder form of diabetes because of its concern that is actually being caused by the yet

slow onset (sometimes developing over the course of undiagnosed diabetes.

several years) and because it usually can be Individuals who are at high risk of developing Type

controlled with diet and oral medication. The II diabetes mellitus include people who:

consequences of uncontrolled and untreated Type II

 are obese (more than 20% above their ideal
diabetes, however, are the just as serious as those for
body weight)
Type I. This form is also called noninsulin-dependent
 have a relative with diabetes mellitus
diabetes, a term that is somewhat misleading. Many
 belong to a high-risk ethnic population
people with Type II diabetes can control the
(African-American, Native American, Hispanic,
condition with diet and oral medications, however,
or Native Hawaiian)
insulin injections are sometimes necessary if
 have been diagnosed with gestational
treatment with diet and oral medication is not
diabetes or have delivered a baby weighing
working.
more than 9 lbs (4 kg)

The causes of diabetes mellitus are unclear, however,  have high blood pressure (140/90 mmHg or

there seem to be both hereditary (genetic factors above)

  have a high density lipoprotein cholesterol level mmol/L) or higher indicates diabetes. The test

less than or equal to 35 mg/dL and/or a is done by taking a small sample of blood from

triglyceride level greater than or equal to 250 a vein or fingertip. It must be repeated on

mg/dL another day to confirm that it remains

 have had impaired glucose tolerance or abnormally high (see “Criteria for diagnosis”

impaired fasting glucose on previous testing below).

 Hemoglobin A1C test (A1C) — The A1C blood

Diabetes mellitus is a common chronic disease test measures the average blood glucose level

requiring lifelong behavioral and lifestyle changes. It during the past two to three months. It is used to

is best managed with a team approach to empower monitor blood glucose control in people with

the client to successfully manage the disease. As part known diabetes, but is not normally used to

of the team the, the nurse plans, organizes, and diagnose diabetes. Normal values for A1C are 4

coordinates care among the various health disciplines to 6 percent (show figure 3). The test is done by

involved; provides care and education and promotes taking a small sample of blood from a vein or

the client’s health and well being. Diabetes is a major fingertip.

public health worldwide. Its complications cause  Oral glucose tolerance test — Oral glucose

many devastating health problems. tolerance testing (OGTT) is the most sensitive

test for diagnosing diabetes and pre-diabetes.

DIAGNOSTIC TEST:
However, the OGTT is not routinely
Several blood tests are used to measure blood glucose
recommended because it is inconvenient
levels, the primary test for diagnosing diabetes.
compared to a fasting blood glucose test.
Additional tests can determine the type of diabetes

and its severity.

The standard OGTT includes a fasting blood glucose
 Random blood glucose test — for a random
test. The person then drinks a 75 gram liquid glucose
blood glucose test, blood can be drawn at any
solution (which tastes very sweet, and is usually cola
time throughout the day, regardless of when the
or orange-flavored). Two hours later, a second blood
person last ate. A random blood glucose level
glucose level is measured.
of 200 mg/dL (11.1 mmol/L) or higher in

persons who have symptoms of high blood Oral glucose tolerance testing is routinely performed

glucose (see “Symptoms” above) suggests a at 24 to 28 weeks of pregnancy to screen for

diagnosis of diabetes. gestational diabetes; this requires drinking a 50 gram

 Fasting blood glucose test — fasting blood glucose solution with a blood glucose level drawn

glucose testing involves measuring blood one hour later. For women who have an abnormally

glucose after not eating or drinking for 8 to 12 elevated blood glucose level, a second OGTT is

hours (usually overnight). A normal fasting performed on another day after drinking a 100 gram

blood glucose level is less than 100 mg/dL. A glucose solution. The blood glucose level is

fasting blood glucose of 126 mg/dL (7.0

measured before, and at one, two, and three hours some insulin on its own. Second-generation

after drinking the solution. sulfonylureas such as glipizide (Glucotrol, Glucotrol

XL), glyburide (DiaBeta, Glynase PresTab,

MEDICATIONS:
Micronase) and glimepiride (Amaryl) are prescribed

most often. The most common side effect of

When diet, exercise and maintaining a healthy weight
sulfonylureas is low blood sugar, especially during
aren’t enough, you may need the help of medication.
the first four months of therapy. You’re at much
Medications used to treat diabetes include insulin.
greater risk of low blood sugar if you have impaired
Everyone with type 1 diabetes and some people with
liver or kidney function.
type 2 diabetes must take insulin every day to replace
· Meglitinides. These medications, such as
what their pancreas is unable to produce.
repaglinide (Prandin), have effects similar to
Unfortunately, insulin can’t be taken in pill form
sulfonylureas, but you’re not as likely to develop low
because enzymes in your stomach break it down so
blood sugar. Meglitinides work quickly, and the
that it becomes ineffective. For that reason, many
results fade rapidly.
people inject themselves with insulin using a syringe
· Biguanides. Metformin (Glucophage, Glucophage
or an insulin pen injector,a device that looks like a
XR) is the only drug in this class available in the
pen, except the cartridge is filled with insulin. Others
United States. It works by inhibiting the production
may use an insulin pump, which provides a
and release of glucose from your liver, which means
continuous supply of insulin, eliminating the need for
you need less insulin to transport blood sugar into
daily shots.
your cells. One advantage of metformin is that is
The most widely used form of insulin is synthetic
tends to cause less weight gain than do other diabetes
human insulin, which is chemically identical to
medications. Possible side effects include a metallic
human insulin but manufactured in a laboratory.
taste in your mouth, loss of appetite, nausea or
Unfortunately, synthetic human insulin isn’t perfect.
vomiting, abdominal bloating, or pain, gas and
One of its chief failings is that it doesn’t mimic the
diarrhea. These effects usually decrease over time
way natural insulin is secreted. But newer types of
and are less likely to occur if you take the medication
insulin, known as insulin analogs, more closely
with food. A rare but serious side effect is lactic
resemble the way natural insulin acts in your body.
acidosis, which results when lactic acid builds up in
Among these are lispro (Humalog), insulin aspart
your body. Symptoms include tiredness, weakness,
(NovoLog) and glargine (Lantus).
muscle aches, dizziness and drowsiness. Lactic

A number of drug options exist for treating type 2 acidosis is especially likely to occur if you mix this

diabetes, including: medication with alcohol or have impaired kidney

function.
· Sulfonylurea drugs. These medications stimulate
· Alpha-glucosidase inhibitors. These drugs block
your pancreas to produce and release more insulin.
the action of enzymes in your digestive tract that
For them to be effective, your pancreas must produce
break down carbohydrates. That means sugar is
absorbed into your bloodstream more slowly, which NURSING INTERVENTIONS:

helps prevent the rapid rise in blood sugar that  Advice patient about the importance of an

usually occurs right after a meal. Drugs in this class individualized meal plan in meeting weekly

include acarbose (Precose) and miglitol (Glyset). weight loss goals and assist with compliance.

Although safe and effective, alpha-glucosidase  Assess patients for cognitive or sensory

inhibitors can cause abdominal bloating, gas and impairments, which may interfere with the

diarrhea. If taken in high doses, they may also cause ability to accurately administer insulin.

reversible liver damage.  Demonstrate and explain thoroughly the

· Thiazolidinediones. These drugs make your body procedure for insulin self-injection. Help patient

tissues more sensitive to insulin and keep your liver to achieve mastery of technique by taking step

from overproducing glucose. Side effects of by step approach.

thiazolidinediones, such as rosiglitazone (Avandia)  Review dosage and time of injections in

and pioglitazone hydrochloride (Actos), include relation to meals, activity, and bedtime based

swelling, weight gain and fatigue. A far more serious on patients individualized insulin regimen.

potential side effect is liver damage. The  Instruct patient in the importance of accuracy of

thiazolidinedione troglitzeone (Rezulin) was taken insulin preparation and meal timing to avoid

off the market in March 2000 because it caused liver hypoglycemia.

failure. If your doctor prescribes these drugs, it’s  Explain the importance of exercise in

important to have your liver checked every two maintaining or reducing weight.

months during the first year of therapy. Contact your  Advise patient to assess blood glucose level

doctor immediately if you experience any of the signs before strenuous activity and to eat

and symptoms of liver damage, such as nausea and carbohydrate snack before exercising to avoid

vomiting, abdominal pain, loss of appetite, dark hypoglycemia.

urine, or yellowing of your skin and the whites of  Assess feet and legs for skin temperature,

your eyes (jaundice). These may not always be sensation, soft tissues injuries, corns, calluses,

related to diabetes medications, but your doctor will dryness, hair distribution, pulses and deep

need to investigate all possible causes. tendon reflexes.

· Drug combinations. By combining drugs from  Maintain skin integrity by protecting feet from

different classes, you may be able to control your breakdown.

blood sugar in several different ways. Each class of  Advice patient who smokes to stop smoking or

oral medication can be combined with drugs from reduce if possible, to reduce vasoconstriction

any other class. Most doctors prescribe two drugs in and enhance peripheral flow.

combination, although sometimes three drugs may be

prescribed. Newer medications, such as Glucovance,

which contains both glyburide and metformin,

combine different oral drugs in a single tablet.

Cystic Fibrosis 13. Hyperglycemia, glucosuria with polyuria,

and weight loss.

 Is an autosomal recessive disorderaffecting the
14. Sterility in males.
exocrine glands, in which their secretions
Diagnostic Evaluation:
become abnormally viscous and liable to
1. Sweat chloride test measures sodium and
obstruct glandular ducts.
chloride level in sweat.
 It primarily affects pulmonary and GI function.
 Chloride level of more than 60 mEq/L is
 The average life expectancy for the cystic
virtually diagnostic.
fibrosis patient is currently age 30 to 40. Death
 Chloride level of 40 to 60 mEq/L is
may occur because of respiratory infection and
borderline and should be repeated.
failure.
2. Duodenal secretions: low trypsin concentration
 Other complications include esophageal
is virtually diagnostic.
varices, diabetes, chronic sinusitis, pancreatitis,
3. Stool analysis:
rectal polyps, intussusceptions, growth
 Reduced trypsin and chymotrypsin levels-
retardation, and infertility.
used for initial screening for cystic
Assessment:
fibrosis.
1. Usually present before age 6 months but
 Increased stool fat concentration.
severity varies and may present later.
 BMC ( Boehringer-Mannheim Corp.)
2. Meconium ileus is found in neonate.
meconium strip test for stool includes
3. Usually present with respiratory symptoms,
lactose and protein content; used for
chronic cough, and wheezing.
screening.
4. Parents may report salty taste when skin is
4. Chest X-ray may be normal initially; later
kissed.
shows increased areas of infection,
5. Recurrent pulmonary infections.
overinflation, bronchial thickening and
6. Failure to gain weight or grow in the presence
plugging, atelectasis, and fibrosis.
of a good appetite.
5. Pulmonary function studies (after age 4) show
7. Frequent, bulky, and foul smelling stools
decreased vital capacity and flow rates and
(steatorrhea), excessive flatus, pancreatitis and
increased residual volume or increased total
obstructive jaundice may occur.
lung capacity.
8. Protuberant abdomen, pot belly, wasted
6. Diagnosis is made when a positive sweat test is
buttocks.
seen in conjunction with one or more of the
9. Bleeding disorders.
following:
10. Clubbing of fingers in older child.
 Positive family history of cystic fibrosis.
11. Increased anteroposterior chest diameter (barrel
 Typical chronic obstructive lung disease.
chest).
 Documented exocrine pancreatic
12. Decreased exertional endurance.
insufficiency.
 7. Genetic screening may be done for affected 3. To promote airway clearance, employ

families. intermittent aerosol therapy three to four times

Pharmacologic Interventions: per day when the child is symptomatic.

1. Antimicrobial therapy as indicated for 4. Perform chest physical therapy three to four

pulmonary infection. times per day after aerosol therapy.

 Oral or I.V. antibiotics as required. 5. Help the child to relax to cough more easily

 Inhaled antibiotics, such as gentamicin or after postural drainage.

tobramycin, may be used for severe lung 6. Suction the infant or young child when

disease or colonization of organisms. necessary, if not able to cough.

2. Bronchodilators to increase airway size and 7. Teach the child breathing exercises using

assist in mucus clearance. pursed lips to increase duration of exhalation.

3. Pulmozyme recombinant human DNase (an 8. Provide good skin care and position changes to

enzyme) administered via nebulization to prevent skin breakdown in malnourished child.

decrease viscosity of secretions. 9. Provide frequent mouth care to reduce chances

4. Pancreatic enzyme supplements with each of infection because mucus is present.

feeding. 10. Restrict contact with people with respiratory

 Favored preparation is pancrelipase. infection.

 Occasionally, antacid is helpful to 11. Encourage diet composed of foods high in

improve tolerance of enzymes. calories and protein and moderate to high in fat

 Favorable response to enzymes is based because absorption of food is incomplete.

on tolerance of fatty foods, decreased 12. Administer fat-soluble vitamins, as prescribed,

stool frequency, absence of steatorrhea, to counteract malabsorption.

improved appetite, and lack of abdominal 13. Increase salt intake during hot weather, fever,

pain. or excessive exercise to prevent sodium

5. Gene therapy, in which recombinant DNA depletion and cardiovascular compromise.

containing a corrected gene sequence is 14. To prevent vomiting, allow ample time for

introduced into the diseased lung tissue by feeding because of irritability if not feeling well

nebulization, is in clinical trials. and coughing.

Nursing Interventions: 15. Encourage regular exercise and activity to

1. Monitor weight at least weekly to assess foster sense of accomplishments and

effectiveness of nutritional interventions. independence and improve pulmonary function.

2. Monitor respiratory status and sputum 16. Provide opportunities for parents to learn all

production, to evaluate response to respiratory aspects of care for the child.

care measures. 17. Teach the parents about dietary regimen and

special need for calories, fat, and vitamins.

18. Discuss need for salt replacement, especially on

hot summer days or when fever, vomiting, and

diarrhea occur.