DAVAO DOCTORS COLLEGE

Gen. Malvar St., Davao City

BACHELOR OF SCIENCE IN NURSING

Individual Case Presentation of

ALLERGIC RHINITIS

Presented to the Nursing Clinical Instructor of

Davao Doctors College

In partial Fulfillment of the Requirements in

Nursing Care Management 103

Related Learning Experience

Christine Joy Catacata, SN

July 2015

TABLE OF CONTENTS

I. Patient’s Profile

Comprehensive Assessment

II. Anatomy and Physiology

III. Brief Pathophysiology

IV. Medical Management / Course in the Ward

V. Nursing Management (Nursing Care Plan )

VI. Pharmacology

PATIENT’S PROFILE

Name: Jumamil, Nenita Dimalaluan Hospital Number: 00261058

Address: B7, L25, P2, Aguila St., Patient Number: IP15-008715

Awang Subd, Bacaca, DVO

Age: 61Y3M3D Attending Physician: Dr. Batalla

Sex: Female

Nationality: Filipino

Civil Status: Married

Religion: Christian

Occupation: Govt. Employee

Chief Complain: Cough and Fever

Admission Diagnosis: Urticaria, SVI, allergic rhinitis; ess hpn

Past Health History:

Patient was known having thyroid disorder, essential hypertension that started 11

years ago. She is taking Losartan 50mg, once per day as her maintenance. She

had undergone TAHBSO in the early 1990’s as well as Laparoscopic

Cholecystectomy last 2013. She had bronchial asthma that started last year and

taking Avamyst as her emergency drug but effect has poor compliance. She has

allergy in Levofloxacin.

3 days prior to admission, patient had onset of fever with a temperature of 38.

4*C associated with productive cough with yellow phlegm seen. Patient self

medicated Paracetamol 500 mg/tab and Sinecod(Ambroxol) which only provided

temporary relief. Patient also noticed muscle pain on the same day, medicated

with Norgesic Forte, still temporary relief was provided. On the night prior to

admission, patient still have persisted condition, hence the admission.

Present Medical History: During rounds, Patient was received lying on bed in

moderate high back rest. With ongoing #1 PNSS @ 80cc/hr at her left

metacarpal vein. Patient was alert, conscious and coherent during interaction

and can clearly verbalize her thoughts and concerns. Non productive cough was

observed. Patient still complained about chest pain during coughing.

Family History: On the paternal side,

Current Lifestyle:

ANATOMY

BRIEF PATHOPHYSIOLOGY

In allergic rhinitis, your body overreacts to some stimulus in the environment that

stimulus is called an allergen. The most common culprit is pollen. Pollen can

come from trees or grass. Pollen also tends to be seasonal. In other words, some

types of pollen are out in the type of environment with different temperature and

that gives rise to yet another term that’s synonymous with allergic rhinitis or

seasonal allergies. Basically anything that can get into the air that you can inhale

can act as an allergen to somebody who suffers from allergic rhinitis. When

allergen goes into the nose and that allergen is going to come into contact with

this mast cell over here. Being a mast cell or basophil, on its surface it has a

particular protein that’s shaped like a Y and that protein is called an Immune

Globulin which is shorten to “Ig” and this particular type of immune globulin is

called IgE. This pollen is going to get bound by this IgE molecule, and that IgE

molecule, just a protein sitting on the surface of this basophil is going to alert that

cell to its presence. In a person with allergic rhinitis this cell over reacts and it

overreacts big time. And when it sees that pollen grain it starts letting out little

molecules into its environment that tell all the celld around it to get excited as

well. So this whole group of nasal mucosa gets overreacted. The most common

type of molecule that gets excited is called histamine. Histamine is going to

cause all sorts of problems with inflammation and it can be really severe that the

mucosa can thicken up big time and get really engorged and edematous, swollen

that happens all through out the nose because these basophils or mast cells

arent just sitting in one particular area but they are scattered everywhere. In

adittion on being swollen, this mucosa is going to start to produce mucus, the

mucus is going to drip down along the turbinates that is going to drip down the

sides of the nose. Its going to pull on the base of your nasal cavity, as this mucus

pulls down in your nasal cavity it’s going to head down towards your throat so

you can cough up as well. Also as the mucosa swells up, it can swell the

nasolacrimal duct and shut, leading to watery eyes. Also when the eustachian

tube gets swollen bad enough, it can block the tube and cause fluid to back up

and that’s going to lead to symptoms that are stiffness and decreased ability to

hear. Ofcourse theres also nerves in your nose that ultimately end in your brain

and as they get inflamed with all the process that’s happening in your nose, they

become irritated and send signals to your body particularly the signal to sneeze

and then swelling continues to get bigger and more pronounce and more

pronounced and it can actually completely block off this entire nose. When that

happens air cant get by and when that happens breathing will become a

problem.

COURSE IN THE WARD

LABORATORY TESTS

URINALYSIS

EXAMINATION RESULT RANGE REMARKS/ JUSTIFICATION

RBC 229^/uL 0-11 High. Some crenated

RBC

Conventional

41^HPF 0-2 High

CBC,PLT

EXAMINATION RESULT RANGE REMARKS/ JUSTIFICATION

Heemoglobin 142^g/L 120-140 High

Neutrophils 0.50 0.55-

0.65

Low.

Lymphocyte 0.32 0.35-

0.45

Low.

Monocyte 0.14 0.6-0.12 High.

Absolute

Monocyte

0.9 0.0-0.8 High.

CHEST XRAY

INTERPRETATION:

A comparison with the radiograph dated Feb 19,2015 discloses the same pleural

thickening in the left lateral hemithorax. Both lungs are clear lungs. The lateral

costrophenic sinuses are sharp. Heartsize is within normal limits. The

configuration is unremarkable. Pulmonary vascularity is normal. Hili are not

enlarged. Degenerative joint changes are again appreciated.

MEDICATIONS

PRN MEDICATIONS

DATE MEDICATION TIME

July 27, 15 Losartan 50mg, 1tab, OD 8AM

Xanor 250mcg, OD 9PM

Montelukast+Levocitirizine10/5mg

1tab,OD, HS

9PM

Levopront 10mL, TID, PO 8AM, 2PM,8PM

DATE MEDICATION TIME

July 27, 15 Paracetamol 1tab (for fever) PRN

Norgesic Forte 1tab (for body pain) PRN