Which condition should I prepare first in the attached nursing care-plan format? · If not listed above, select the group containing your condition.

~/

"Asthma"[MeSH Terms] AND nursing

GINA 2025 asthma strategy report patient education acute exacerbation assessment

https://ginasthma.org/wp-content/uploads/2026/07/GINA-Summar…

python -c "import pdfplumber; p='/tmp/workspace/attachments/c8e4a815-b601-4787-a3f9-4fc241433a14/Nursing care plan on CKD .pdf'; pdf=pdfplumber.open(p); print('PAGES',len(pdf.pages)); print('\\n---PAGE 1---\\n'+(pdf.pages[0].extract_text() or '')[:12000])"

mkdir -p "/tmp/workspace/asthma-nursing-care-plan/src" "/tmp/workspace/asthma-nursing-care-plan/output" && python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/asthma-nursing-care-plan/src/create_asthma_ncp.py') p.write_text(r'''from docx import Document from docx.shared import Inches, Pt, RGBColor from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.enum.section import WD_SECTION from docx.enum.table import WD_TABLE_ALIGNMENT, WD_CELL_VERTICAL_ALIGNMENT from docx.oxml import OxmlElement from docx.oxml.ns import qn from docx.enum.style import WD_STYLE_TYPE OUT='/tmp/workspace/asthma-nursing-care-plan/output/Asthma_Nursing_Care_Plan.docx' doc=Document() sec=doc.sections[0] sec.top_margin=Inches(.55); sec.bottom_margin=Inches(.55); sec.left_margin=Inches(.6); sec.right_margin=Inches(.6) styles=doc.styles styles['Normal'].font.name='Arial'; styles['Normal']._element.rPr.rFonts.set(qn('w:eastAsia'),'Arial'); styles['Normal'].font.size=Pt(9) for name,size,color in [('Title',16,'17365D'),('Heading 1',12,'17365D'),('Heading 2',10,'1F4E79')]: s=styles[name]; s.font.name='Arial'; s.font.size=Pt(size); s.font.bold=True; s.font.color.rgb=RGBColor.from_string(color) s._element.rPr.rFonts.set(qn('w:eastAsia'),'Arial') # footer f=sec.footer.paragraphs[0]; f.alignment=WD_ALIGN_PARAGRAPH.CENTER f.add_run('Asthma Nursing Care Plan | Educational sample case').font.size=Pt(8) def shade(cell,fill): tcPr=cell._tc.get_or_add_tcPr(); shd=OxmlElement('w:shd'); shd.set(qn('w:fill'),fill); tcPr.append(shd) def borders(table): tblPr=table._tbl.tblPr; b=OxmlElement('w:tblBorders') for e in ['top','left','bottom','right','insideH','insideV']: x=OxmlElement('w:'+e); x.set(qn('w:val'),'single'); x.set(qn('w:sz'),'4'); x.set(qn('w:color'),'808080'); b.append(x) tblPr.append(b) def table(headers, rows, widths=None, fs=8): t=doc.add_table(rows=1, cols=len(headers)); t.alignment=WD_TABLE_ALIGNMENT.CENTER; t.style='Table Grid'; borders(t) for i,h in enumerate(headers): c=t.rows[0].cells[i]; c.text=h; shade(c,'D9EAF7'); c.vertical_alignment=WD_CELL_VERTICAL_ALIGNMENT.CENTER for r in c.paragraphs[0].runs: r.bold=True; r.font.size=Pt(fs) if widths: c.width=Inches(widths[i]) for row in rows: cells=t.add_row().cells for i,x in enumerate(row): cells[i].text=x cells[i].vertical_alignment=WD_CELL_VERTICAL_ALIGNMENT.TOP for p in cells[i].paragraphs: p.paragraph_format.space_after=Pt(0) for r in p.runs: r.font.size=Pt(fs) if widths: cells[i].width=Inches(widths[i]) doc.add_paragraph().paragraph_format.space_after=Pt(1) return t def title(txt): p=doc.add_paragraph(); p.alignment=WD_ALIGN_PARAGRAPH.CENTER r=p.add_run(txt); r.bold=True; r.font.name='Arial'; r.font.size=Pt(16); r.font.color.rgb=RGBColor(23,54,93) def h(txt,l=1): doc.add_heading(txt,level=l) def p(txt,boldlead=None): para=doc.add_paragraph(); para.paragraph_format.space_after=Pt(3) if boldlead and txt.startswith(boldlead): para.add_run(boldlead).bold=True; para.add_run(txt[len(boldlead):]) else: para.add_run(txt) def bullets(items): for x in items: pa=doc.add_paragraph(style='List Bullet'); pa.paragraph_format.space_after=Pt(1); pa.add_run(x) # cover title('DEPARTMENT OF MEDICAL-SURGICAL NURSING') p0=doc.add_paragraph(); p0.alignment=WD_ALIGN_PARAGRAPH.CENTER; rr=p0.add_run('NURSING CARE PLAN'); rr.bold=True; rr.font.size=Pt(14) p0=doc.add_paragraph(); p0.alignment=WD_ALIGN_PARAGRAPH.CENTER; rr=p0.add_run('CASE: BRONCHIAL ASTHMA'); rr.bold=True; rr.font.size=Pt(13); rr.font.color.rgb=RGBColor(31,78,121) doc.add_paragraph('\n') table(['Student details','Information'],[['Name','____________________________'],['Roll number','____________________________'],['Class / year','____________________________'],['Clinical area / ward','Medical ward'],['Date','____________________________']], [2.1,4.6],9) p('Important: This is a fictional academic sample. Replace demographic data, clinical findings, investigation results, and medication orders with details from the actual patient record and prescriber orders. Do not use it as an individual treatment prescription.') doc.add_page_break() h('1. Patient Demographic Data') table(['Item','Details'],[ ['Name','Mr. R.K. (initials used for confidentiality)'],['Age / sex','24 years / Male'],['Address','Urban residence, Karnataka'],['Religion','Hindu'],['Marital status','Unmarried'],['Occupation','College student'],['Source of health care','Emergency department referral'],['Date and time of admission','12 September 2026, 08:30 AM'],['Ward / bed number','Medical ward / Bed 12'],['Provisional medical diagnosis','Acute exacerbation of bronchial asthma'],['Date of surgery','Not applicable']], [2.2,4.5]) h('2. Chief Complaint / Presenting Complaints') bullets(['Shortness of breath with wheeze for 8 hours.', 'Chest tightness and productive cough with scanty white sputum since morning.', 'Difficulty sleeping due to breathlessness during the night.']) h('3. History of Illness') h('History of Present Illness',2) p('The patient was apparently well until the previous evening, when he developed repeated cough, chest tightness, and gradually increasing breathlessness after exposure to dust while cleaning a storeroom. Wheeze became audible and he used his reliever inhaler twice with only temporary relief. Symptoms worsened overnight, prompting hospital attendance. There is no fever, pleuritic chest pain, hemoptysis, facial swelling, or recent travel.') h('Present Medical History',2) p('Known case of bronchial asthma for 8 years. He uses an inhaled corticosteroid-containing controller inconsistently and uses a reliever inhaler when symptomatic. Previous asthma exacerbation requiring emergency treatment 1 year ago. No history of tuberculosis, diabetes mellitus, hypertension, cardiac disease, or chronic obstructive pulmonary disease.') h('Past Medical History',2) p('Seasonal allergic rhinitis. No previous history of pneumonia, hospitalization in the past year, or drug allergy reported.') h('Past Surgical History',2) p('No history of surgery, blood transfusion, or anesthesia exposure.') h('Present Surgical History',2) p('Not applicable. No surgical procedure is planned.') h('4. Family History') p('Father has allergic rhinitis. No known family history of tuberculosis, diabetes, hypertension, epilepsy, or hereditary respiratory disease. The patient lives with parents and one sibling in a well-ventilated home.') h('5. Dietary History') p('Mixed diet. Appetite is fair. Takes three meals per day and approximately 1.5 to 2 L of fluid daily. Avoids cold beverages because they sometimes precipitate cough. No known food allergy reported.') h('6. Social and Economic History') p('Middle socioeconomic status. Family income is adequate for medical care. Nonsmoker and denies alcohol, tobacco chewing, vaping, or recreational drug use. No biomass-fuel exposure. Reports intermittent exposure to dust and traffic pollution. Sleeps 5 to 6 hours during examinations. Family support is available.') h('7. Physical Examination with Date and Time') p('Date/time: 12 September 2026, 09:00 AM. Patient is conscious, oriented, anxious, and sitting upright. Build is average; nutritional status is adequate.') table(['Assessment area','Findings'],[ ['Vital signs','Temperature 37.1°C; pulse 108/min, regular; respiratory rate 30/min; blood pressure 124/78 mmHg; SpO₂ 92% on room air.'], ['General appearance','Dyspnea present; speaks in short phrases; mild use of accessory muscles; no cyanosis at rest.'], ['Skin / integument','Warm, intact; no edema, clubbing, or rash; capillary refill <2 seconds.'], ['Head and neck','Head normal. Nasal mucosa mildly congested; no sinus tenderness. Oral mucosa moist. Neck supple; no lymphadenopathy.'], ['Thorax and lungs','Chest expansion bilaterally reduced during expiration. Respiratory rhythm tachypneic. Percussion resonant. Bilateral diffuse expiratory wheeze with reduced air entry at bases; no crackles. Cough present with scanty mucoid sputum.'], ['Heart','Tachycardia 108/min; S1 and S2 audible; no murmur.'], ['Abdomen','Soft, non-tender, bowel sounds present.'], ['Musculoskeletal','Normal tone and power in all limbs; no joint swelling.'], ['Neurological','GCS 15/15; pupils equal and reactive; no focal deficit.']], [2.1,4.6]) doc.add_page_break() h('8. Investigation Table') table(['Date','Investigation done','Normal value / expected','Patient value','Inference'],[ ['12 Sep 2026','Pulse oximetry (room air)','95% to 100%','92%','Mild hypoxemia during exacerbation.'], ['12 Sep 2026','Peak expiratory flow (PEF)','Personal best / predicted','250 L/min; about 50% predicted','Airflow limitation consistent with moderate exacerbation.'], ['12 Sep 2026','Complete blood count','WBC 4,000 to 11,000/mm³; eosinophils 1% to 6%','WBC 8,900/mm³; eosinophils 7%','No leukocytosis; mild eosinophilia may support allergic airway inflammation.'], ['12 Sep 2026','Chest X-ray','No acute cardiopulmonary abnormality','Mild hyperinflation; no focal infiltrate','No radiographic evidence of pneumonia.'], ['After initial treatment','PEF and SpO₂ reassessment','SpO₂ ≥94%; improving PEF','SpO₂ 96% with oxygen; PEF 330 L/min','Clinical improvement.']], [0.75,1.35,1.45,1.25,1.9],7.5) h('9. Drug Chart / Treatment') p('Illustrative inpatient orders only. Verify dose, device, frequency, contraindications, and local protocol with the prescriber before administration.') table(['No.','Drug (pharmacological name)','Dose / route / frequency','Action','Important adverse effects / interactions','Nursing responsibility'],[ ['1','Salbutamol (albuterol), short-acting β₂ agonist','Nebulized 2.5 mg with oxygen-driven nebulizer; repeat as prescribed during acute episode','Relaxes bronchial smooth muscle and relieves bronchospasm.','Tremor, palpitations, tachycardia, hypokalemia. Caution with other sympathomimetics.','Assess RR, breath sounds, pulse, SpO₂ and response before/after; observe for tremor and tachycardia; teach correct reliever use.'], ['2','Ipratropium bromide, short-acting muscarinic antagonist','Nebulized 0.5 mg with salbutamol, as prescribed','Reduces vagally mediated bronchoconstriction.','Dry mouth, blurred vision if aerosol reaches eyes; urinary retention rarely.','Ensure mask fit; avoid eye exposure; monitor response and mouth dryness.'], ['3','Prednisolone, systemic corticosteroid','40 mg orally once daily for a short course, as prescribed','Reduces airway inflammation and relapse risk.','Dyspepsia, mood change, elevated glucose; infection risk. NSAIDs can increase GI risk.','Administer after food; monitor glucose if indicated and infection symptoms; explain short course and adherence.'], ['4','Budesonide-formoterol, inhaled corticosteroid + long-acting β₂ agonist','Strength/device and regimen strictly as prescribed for maintenance and/or reliever plan','ICS controls airway inflammation; formoterol bronchodilates.','Oral candidiasis, dysphonia, tremor/palpitations. Not a substitute for a written individualized action plan.','Check technique and adherence; rinse and spit after ICS-containing inhalation; do not duplicate LABA-containing inhalers.'], ['5','Oxygen therapy','Titrate as prescribed to maintain target SpO₂, commonly 93% to 95% in acute asthma','Corrects hypoxemia.','Dryness; fire risk; excessive oxygen without monitoring.','Use prescribed delivery device; monitor SpO₂ continuously or frequently; document flow/device and clinical response.']], [0.35,1.25,1.25,1.15,1.55,1.85],7) h('10. Nursing Diagnoses - Five') table(['Priority','Nursing diagnosis','Related to / evidenced by'],[ ['1','Ineffective Airway Clearance','Related to bronchospasm and increased airway secretions, as evidenced by bilateral expiratory wheeze, cough with scanty sputum, dyspnea, and reduced air entry.'], ['2','Impaired Gas Exchange','Related to ventilation-perfusion imbalance secondary to acute bronchospasm, as evidenced by SpO₂ 92% on room air, tachypnea, and dyspnea.'], ['3','Ineffective Breathing Pattern','Related to bronchoconstriction and anxiety, as evidenced by respiratory rate 30/min, use of accessory muscles, and inability to speak full sentences.'], ['4','Anxiety','Related to breathlessness and unfamiliar hospital environment, as evidenced by restlessness and verbalized fear.'], ['5','Deficient Knowledge','Related to inconsistent controller use and inadequate understanding of trigger avoidance/inhaler technique, as evidenced by reported irregular use of maintenance inhaler.']], [0.7,2.0,4.7]) doc.add_page_break() h('11. Nursing Process / Nursing Care Plans') p('Patient name: Mr. R.K. (initials) Date: 12 September 2026 Ward: Medical ward') h('NCP 1: Ineffective Airway Clearance',2) table(['Assessment','Nursing diagnosis','Objective / expected outcome','Plan of care and rationale','Implementation','Evaluation'],[[ 'S: “I cannot bring out the cough.”\nO: RR 30/min; bilateral expiratory wheeze; reduced air entry; cough with scanty mucoid sputum.', 'Ineffective Airway Clearance related to bronchospasm and increased airway secretions as evidenced by wheeze, cough, dyspnea, and reduced air entry.', 'Within 4 hours, patient will demonstrate improved airway clearance: effective cough, reduced wheeze, improved air entry, RR 12 to 20/min or near baseline, and PEF trending upward.', '1. Assess RR, respiratory effort, chest movement, breath sounds, sputum, PEF, and SpO₂ at baseline and after interventions. This detects deterioration and response.\n2. Position in high-Fowler’s or supported upright position. This promotes diaphragmatic expansion.\n3. Encourage calm, controlled breathing and effective coughing; provide fluids if not contraindicated. This assists secretion mobilization and reduces work of breathing.\n4. Administer prescribed bronchodilator and corticosteroid therapy; reassess response. These reduce bronchospasm and airway inflammation.\n5. Escalate promptly for silent chest, worsening fatigue, confusion, falling SpO₂, or poor response. These can indicate severe/life-threatening asthma.', 'Focused respiratory assessment performed. Patient positioned upright; coached in pursed-lip breathing and supported cough. Nebulized salbutamol plus ipratropium administered as ordered; oral prednisolone given after food. PEF, breath sounds, pulse, and SpO₂ reassessed and documented.', 'After 4 hours, cough more effective, wheeze decreased, air entry improved; RR 22/min, PEF 330 L/min. Continue monitoring until stable.' ]], [1.1,1.15,1.2,2.4,1.6,1.4],6.8) h('NCP 2: Impaired Gas Exchange',2) table(['Assessment','Nursing diagnosis','Objective / expected outcome','Plan of care and rationale','Implementation','Evaluation'],[[ 'S: Reports breathlessness and chest tightness.\nO: SpO₂ 92% room air, tachypnea, accessory-muscle use.', 'Impaired Gas Exchange related to ventilation-perfusion imbalance secondary to acute bronchospasm as evidenced by low oxygen saturation, dyspnea, and tachypnea.', 'Within 1 to 2 hours, patient will maintain SpO₂ at the prescribed target (commonly 93% to 95% in acute asthma), show decreased work of breathing, and remain alert and oriented.', '1. Monitor SpO₂, respiratory rate, mental status, color, pulse, and ability to speak. These assess oxygenation and identify deterioration.\n2. Administer controlled oxygen as prescribed and titrate to target saturation. This corrects hypoxemia while allowing ongoing assessment.\n3. Maintain upright position and reduce unnecessary activity. This decreases oxygen demand and supports ventilation.\n4. Obtain ordered tests and report concerning findings. PEF and, when indicated, blood gases help assess severity.\n5. Prepare for emergency escalation if severe distress, exhaustion, cyanosis, altered consciousness, or silent chest occurs.', 'Oxygen initiated by prescribed device; SpO₂ monitored. Patient kept upright with reassurance and clustered care. PEF repeat documented after bronchodilator. Medical officer informed of initial saturation and clinical response.', 'Within 90 minutes SpO₂ increased to 96% with prescribed oxygen; patient alert, accessory-muscle use reduced. Continue titration and observation.' ]], [1.1,1.15,1.2,2.4,1.6,1.4],6.8) h('NCP 3: Deficient Knowledge',2) table(['Assessment','Nursing diagnosis','Objective / expected outcome','Plan of care and rationale','Implementation','Evaluation'],[[ 'S: States, “I take my preventive inhaler only when I feel breathless.”\nO: Inconsistent controller use; unable to describe action plan.', 'Deficient Knowledge related to inadequate information about asthma self-management, trigger avoidance, and inhaler use as evidenced by irregular controller use and inability to describe an action plan.', 'Before discharge, patient and family will correctly demonstrate inhaler technique, distinguish controller from reliever treatment, identify at least three triggers/red flags, and describe the follow-up and written action plan.', '1. Assess current beliefs, literacy, prior technique, adherence barriers, and access to medicines. Teaching should be individualized.\n2. Explain difference between controller and reliever medicines using simple language. This supports adherence and prevents over-reliance on symptom relief.\n3. Demonstrate inhaler technique, then use teach-back. Observation is required to confirm correct use.\n4. Develop/review a written asthma action plan with prescriber. Written instructions state usual medication, treatment changes for worsening symptoms, and when to seek urgent care.\n5. Teach trigger reduction and follow-up. Reducing exposures and review of control help prevent exacerbations.', 'Patient assessed for barriers. Demonstrated prescribed inhaler device; patient returned demonstration with correction of breath timing. Patient and mother received simple written instructions on medicines, triggers, emergency signs, and review appointment.', 'Patient correctly explained daily controller purpose, demonstrated technique, named dust, smoke, and respiratory infection as triggers, and stated emergency signs. Learning goal met; reinforce at follow-up.' ]], [1.1,1.15,1.2,2.4,1.6,1.4],6.8) h('12. Health Education') bullets([ 'Use asthma medicines exactly as prescribed. A controller inhaler treats airway inflammation and is usually taken regularly even when symptoms are absent. Do not stop or change treatment without clinician advice.', 'Learn and demonstrate the correct technique for the prescribed inhaler and spacer. If the inhaler contains corticosteroid, rinse the mouth and spit after use.', 'Keep a written, digital, or pictorial asthma action plan. It should state usual medicines, what to do when symptoms worsen, and when to obtain urgent care.', 'Recognize warning signs: increasing breathlessness, difficulty speaking, rapidly increasing reliever need, reduced PEF, blue lips, drowsiness/confusion, exhaustion, or a quiet/silent chest. Seek urgent emergency care immediately for severe symptoms or poor response to reliever medication.', 'Avoid personal triggers where possible: tobacco smoke and vaping, dust, strong perfumes/sprays, pollution, and known allergens. Use a mask or avoid dusty cleaning; keep bedding and room clean and well ventilated.', 'Attend follow-up for review of symptoms, inhaler technique, adherence, peak-flow/action plan where used, adverse effects, and vaccinations as advised.', 'Maintain adequate fluid intake, balanced diet, sleep, appropriate exercise when controlled, and healthy weight. Treat allergic rhinitis or reflux as advised because these may worsen asthma control.' ]) h('References',1) p('Murray & Nadel’s Textbook of Respiratory Medicine, 2-Volume, section “Evaluation and Treatment of Asthma,” pp. 120-150 (library block lines 120-150).') p('Global Initiative for Asthma (GINA). Summary Guide for Asthma Management and Prevention, 2026. Education content informed by the current GINA guidance on written action plans, inhaler technique, adherence, and acute-exacerbation assessment.') p('Educational evidence update: Alexandre-Sousa P, et al. Nurses’ Role in the Control and Treatment of Asthma in Adults: A Systematic Literature Review. Adv Respir Med. 2024. PMID: 38804437.') doc.save(OUT) print(OUT) ''') PY python "/tmp/workspace/asthma-nursing-care-plan/src/create_asthma_ncp.py" && ls -lh "/tmp/workspace/asthma-nursing-care-plan/output/Asthma_Nursing_Care_Plan.docx"

python - <<'PY' from docx import Document p='/tmp/workspace/asthma-nursing-care-plan/output/Asthma_Nursing_Care_Plan.docx' d=Document(p) print('paragraphs',len(d.paragraphs),'tables',len(d.tables)) for i,t in enumerate(d.tables,1): print(i, len(t.rows), len(t.columns), t.cell(0,0).text[:45]) print('headings:') for x in d.paragraphs: if x.style.name.startswith('Heading') or 'NURSING CARE PLAN' in x.text: print(x.text) PY