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Asthma Nursing Care Plans (NCP)

Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways. Bronchial asthma is the more correct name for the common form of asthma.

Nursing Care Plans

This post contains 5 bronchial asthma nursing care plans.

1. Ineffective Airway Clearance

The presence of a foreign microorganism triggers the B lymphocyte to produce antibodies that are specific to that antigen. These antibodies then attach to mast cells in the lungs. The mast cells with the antibody attaches to the antigen and begins to degranulate. This degranulation causes the release of certain chemical mediators, namely, histamine, bradykinin, prostaglandin, and leukotriene. These chemical mediators cause bronchospasm leading to bronchoconstriction, increased vascular permeability leading to fluid leakage from the lung vasculature and increased mucus production. These lead to swelling of the bronchi, mucus buildup that plugs the airway and decreased bronchial diameter. This causes an increased airway resistance and a constricted pathway for air. Air cannot pass effectively and this manifests as a whistling sound. Coughing is a way to expel the obstruction (mucus plug) while dyspnea is a manifestation of the increased airway resistance.

Assessment

Patient may manifest

  • Difficulty breathing
  • Changes in depth and rate of respiration
  • Use of respiratory accessory muscles
  • Persistent ineffective cough with or without sputum production
  • Wheezing upon inspiration and expiration
  • Dyspnea
  • Coughing
  • Tachypnea, prolonged expiration
  • Tachycardia
  • Chest tightness
  • Suprasternal retraction
  • Restlessness
  • Anxiety
  • Cyanosis
  • Loss of consciousness

Nursing Diagnosis

  • Ineffective airway clearance RT bronchoconstriction, increased mucus production, and respiratory infection AEB wheezing, dyspnea,  and cough

May be related to

  • Increased production or retainment of pulmonary secretions
  • Bronchospasms
  • Decreased energy
  • Fatigue

Planning

  • Patient will maintain/improve airway clearance AEB absence of signs of respiratory distress
  • Patient will verbalize understanding that allergens like dust, fumes, animal dander, pollen, and extremes of temperature and humidity are irritants or factors that can contribute to ineffective airway clearance and should be avoided.
  • Patient will demonstrate behaviors that would prevent the recurrence of the problem.
Nursing Interventions Rationale
Keep the patient adequately hydrated. Systemic hydration keeps secretion moist and easier to expectorate.
Teach and encourage the use of diaphragmatic breathing and coughing exercises. These techniques help to improve ventilation and mobilize secretions without causing breathlessness and fatigue.
Instruct patient to avoid bronchial irritants such as cigarette smoke, aerosols, extremes of temperature, and fumes. Bronchial irritants cause bronchoconstriction and increased mucus production, which then interfere with airway clearance.
Teach early signs of infection that are to be reported to the clinician immediately. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of an asthmatic person. Early recognition is crucial.
Assist and prepare patient for postural drainage. Uses gravity to help raise secretions so they can be more easily expectorated.
Administer nebulization as ordered. This ensures adequate delivery of medications to the airways.
Administer medications as ordered. Antibiotics may be prescribed to treat the infection.

2. Ineffective Breathing Pattern

Presence of secretions in the bronchi will result into a blockage of air that will enter the body and thus producing insufficient air needed by the body. And inability to maintain clear airway. This obstruction is further heightened by  bronchospasm due to the contraction of the smooth muscles in the bronchi. This is caused by parasympathetic stimulation of the muscarinic m2 receptors as well as by chemical mediators released in response to the presence of allergens.

Assessment

Patient may manifest: 

  • wheezing upon inspiration and expiration
  • dyspnea
  • coughing
  • tachypnea
  • tachycardia
  • chest tightness
  • suprasternal retraction
  • restlessness
  • anxiety
  • cyanosis
  • loss of consciousness

Nursing Diagnosis

  • Ineffective breathing pattern r/t presence of secretions AEB productive cough and dyspnea

Planning

  • Patient will demonstrate pursed-lip breathing and diaphragmatic breathing.
  • Patient will manifest signs of decreased respiratory effort AEB absence of dyspnea
  • Patient will verbalize understanding of causative factors and demonstrate behaviors that would improve breathing pattern
Nursing Interventions Rationale
Assess patient’s respiratory rate, depth, and rhythm. Obtain pulse oximetry. To obtain baseline data
Monitor and record vital signs. Increase in respiratory rate could mean worsening condition.
Auscultate breath sounds and assess airway pattern to check for the presence of adventitious breath sounds
Elevate head of the bed and change position of the pt. every 2 hours. To  minimize difficulty in breathing
Encourage deep breathing and coughing exercises. To maximize effort for expectoration.
Demonstrate diaphragmatic and pursed-lip breathing. To decrease air trapping and for efficient breathing.
Encourage increase in fluid intake To prevent fatigue.
Encourage opportunities for rest and limit physical activities. To prevent situations that will aggravate the condition
Reinforce low salt, low fat diet as ordered. To mobilize secretions.

3. Impaired Gas Exchange

Bronchial asthma is a condition wherein the airway diameter is highly reduced. This is due to severe bronchospasm, mucosal edema and mucus plug formation. There is a rise in airway resistance which leads to decreased amount of air that enters upon inspiration as well as expiration. Thus, ventilation is impaired. In bronchial asthma, perfusion is not directly affected. However, the balance between ventilation and perfusion (V/Q ratio) is lost because despite the adequate perfusion (capillary circulation), not much gas is available to diffuse from the alveoli to the capillaries. Conversely, the gases in the capillaries do diffuse to the alveoli but since expiration is impaired, such gases fail to be ventilated out. Thus, gas exchange is impaired.

Assessment

Patient may manifest: 

  • wheezing upon inspiration and expiration
  • dyspnea
  • coughing, sputum is yellow and sticky
  • tachypnea, prolonged expiration
  • tachycardia
  • chest tightness
  • suprasternal retraction
  • restlessness
  • anxiety
  • cyanosis
  • Altered loc
  • Changes in ABGs

Nursing Diagnosis

  • Impaired gas exchange RT ventilation perfusion imbalance AEB dyspnea, tachypnea, and tachycardia

May be related to

  • altered delivery of inspired O2 or air trapping

Planning

  • Patient will improve gas exchange AEB absence of respiratory distress
  • Patient will demonstrate improved ventilation and adequate oxygenation of tissues by ABG’s within client’s normal limits and absence of symptoms of respiratory distress.
  • Patient will verbalize understand of causative factors and appropriate interventions (deep breathing, cough exercises, etc)
Nursing Interventions Rationale
Assess vital signs, noting respiratory rate, depth, and rhythm. To obtain baseline data
VS monitor and record Serve to track important changes
Auscultate breath sounds and assess airway pattern to check for the presence of adventitious breath sounds
Elevate head of the bed and change position of the pt. every 2 hours. To minimize difficulty in breathing and promote maximum lung expansion.
Encourage deep breathing and coughing exercises. To maximize effort for expectoration.
Demonstrate diaphragmatic and pursed-lip breathing. To decrease air trapping and for efficient breathing.
Encourage increase in fluid intake To prevent fatigue.
Encourage opportunities for rest and limit physical activities. To prevent situations that will aggravate the condition
Reinforce low salt, low fat diet as ordered. To mobilize secretions.

4. Fatigue

Fluid accumulation in the lungs makes it difficult to breathe. The fluid inside prohibits the lungs to expand thus it is harder to breathe. The client, to have adequate ventilation makes use of his accessory muscles to breathe to have sufficient air. With too much use of the accessory muscles, feeling of tiredness may be present resulting to fatigue which is experienced by the client

Assessment

Patient may manifest: 

  • Generalized weakness
  • Verbalization of overwhelming lack of energy
  • Inability to maintain usual routines
  • Tired
  • Lethargic
  • Compromised concentration
  • Decreased performance

Nursing Diagnosis

  • Fatigue r/t physical exertion to maintain adequate ventilation AEB use of accessory muscles to breathe

Planning

  • Patient will verbalize understand on health teachings given and report improved sense of energy.
  • Patient will perform ADL’s within client’s ability and participates in desired activities.
  • Patient will be able to identify basis of fatigue and be able to cope up with the problem.
Nursing Interventions Rationale
Establish rapport To gain patient’s trust
Monitor and record vital signs. For baseline data.
Provide environment conducive to relief of fatigue. Temperature and level of humidity are known to affect exhaustion.
Assist client to identify appropriate coping behaviors. Promotes sense of control and improves self-esteem.
Encourage patient to restrict activity and rest in bed as much as possible. Helps counteract effects of increased metabolism.
Avoid topics that irritate or upset patient. Discuss ways to respond to these feelings. Increased irritability of the CNS may cause patient to be easily excited, agitated and prone to emotional outbursts.
Discuss with the patient the need for activity. Plan schedule with patient and identify activities that lead to fatigue. Education may provide motivation to increase activity level even though patient may feel too weak initially.
Alternate activity with rest periods. Prevents excessive fatigue.
Monitor VS before and after activity. Indicates physiological levels of tolerance.
Increase patient participation in ADL’s as tolerated. Increases confidence level and/or self-esteem and tolerance level

5. Risk for Activity Intolerance

Inadequate oxygen in the circulation can develop weakness in our muscles. Muscles need oxygen to move and to do its function. If the patient cannot tolerate any activities because of the low oxygenation caused by the ventilation-perfusion imbalance caused by the pathological minimized lung expansion.

Assessment

  • Not applicable. Presence of signs and symptoms will establish an actual nursing diagnosis. 

Nursing Diagnosis

  • Risk for Activity Intolerance r/t decrease oxygenation

Planning

  • Patient will participate willingly in necessary/ desired activities such as deep breathing exercises.
  • Patient will perform ADL’s within client’s ability and participates in desired activities.
  • Patient will be able to increase activity tolerance AEB attendance of self-care needs.
  • Patient will be able to gradually increase activity within level of ability
Nursing Interventions Rationale
Monitor VS. For baseline data.
Assess motor function. To identify causative factors.
Note contributing factors to fatigue. To identify precipitating factors.
Evaluate degree of deficit. To identify severity.
Ascertain ability to stand and move about. To identify necessity of assistive devices.
Assess emotional or psychological factors Stress and/or depression may increase the effects of illness.
Plan care with rest periods between activities To reduce fatigue
Increase activity/exercise gradually such as assisting the patient in doing PROM to active or full range of motions. Minimizes muscle atrophy, promotes circulation, helps to prevent contractures
Provide adequate rest periods. To replenish energy.
Assist client in doing self care needs To promote independence and increase activity tolerance
Elevate arm and hand Promotes venous
Place knees and hips in extended position Maintains functional

Other Possible Nursing Care Plans

  • Anxiety—may be related to perceived threat of death, possibly evidenced by apprehension, fearful expression, and extraneous movements.
  • Risk for contamination—risk factors may include presence of atmospheric pollutants, environmental contaminants in the home.

See Also

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