Asthma is a chronic inflammatory lung disease that causes airway hyperresponsiveness, mucus production, and mucosal edema resulting in reversible airflow obstruction. Allergens, air pollutants, cold weather, physical exertion, strong odors, and medications are common predisposing factors for asthma. When an individual is exposed to a trigger, an immediate inflammatory response with bronchospasm happens. This inflammatory process leads to recurrent episodes of asthmatic symptoms such as cough, dyspnea, wheezing, and increased mucus production.
Status asthmaticus is severe and persistent asthma that does not respond to usual therapy; attacks can occur with little or no warning and can progress rapidly to asphyxiation.
Nursing Care Plans
The nursing care plan focuses on preventing the hypersensitivity reaction, controlling the allergens, maintaining airway patency and preventing the occurrence of reversible complications.
- Ineffective Breathing Pattern
- Ineffective Airway Clearance
- Deficient Knowledge
- See Also and Further Reading
Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation
May be related to
- Swelling and spasm of the bronchial tubes in response to inhaled irritants, infection, drugs, allergies or infection.
Possibly evidenced by
- Loss of consciousness.
- Nasal flaring.
- Prolonged expiration.
- Respiratory depth changes.
- Use of accessory muscles.
- Client will maintain optimal breathing pattern, as evidenced by relaxed breathing, normal respiratory rate or pattern, and absence of dyspnea.
|Assess client’s vital signs as needed while in distress.||Increased BP, RR, and HR happens during the initial hypoxia and hypercapnia. And when it becomes severe, BP and HR drops and respiratory failure may result.|
|Assess the respiratory rate, depth, and rhythm.||Changes in the respiratory rate and rhythm may indicate an early sign of impending respiratory distress.|
|Assess client’s level of anxiety.||Anxiety may result from the struggle of not being able to breathe properly.|
|Assess breath sounds and adventitious sounds such as wheezes and stridor.||Adventitious sounds may indicate a worsening condition or additional developing complications such as pneumonia. Wheezing happens as a result of bronchospasm. Diminishing wheezing and indistinct breath sounds are suggestive findings and indicate impending respiratory failure.|
|Assess the relationship of inspiration to expiration.||Reactive airways allow air to move into the lungs more easily than out of the lungs. If the client is gasping for air, instruction for effective breathing is needed.|
|Assess for signs of dyspnea (flaring of nostrils, chest retractions, and use of accessory muscle).||These indicate respiratory distress. Once the movement of air into and out of the lungs becomes challenging, the breathing pattern changes.|
|Assess for conversational dyspnea.||Dyspnea during a normal conversation is a sign of respiratory distress.|
|Assess for fatigue.||Fatigue may indicate distress, leading to respiratory failure.|
|Assess the presence of paradoxical pulse of 12 mm Hg or greater.||Paradoxical pulse is an abnormally large decrease in systolic blood pressure and pulses wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg. A paradoxical pulse of 12 mm Hg or greater indicates a severe airflow obstruction.|
|Monitor oxygen saturation.||Oxygen saturation is a term referring to the fraction of oxygen-saturated hemoglobin relative to the total hemoglobin in the blood. Normal oxygen saturation levels are considered 95-100%.|
|Monitor peaked expiratory flow rates and forced expiratory volume as taken by the respiratory therapist.||The severity of the exacerbation can be measured objectively by monitoring these values. The peak expiratory flow rate is the maximum flow rate that can be generated during a forced expiratory maneuver with fully inflated lungs. It is measured in liters per second and requires maximal effort. When done with good effort, it correlates well with forced expiratory volume in 1 second (FEV1) measured by spirometry and provides a simple, reproducible measure of airway obstruction.|
|Monitor arterial blood gasses (ABG).||During a mild to moderate asthma attack, clients may develop respiratory alkalosis. Hypoxemia leads to increased respiratory rate and depth, and carbon dioxide is blown off. An ominous finding is a respiratory acidosis, which usually indicates that respiratory failure is pending and that mechanical ventilation may be necessary.|
|Plan for periods of rest between activities.||Fatigue is common with the increased work of breathing from the ineffective breathing pattern. Activity increases metabolic rate and oxygen requirements.|
|Maintain head of bed elevated.||This promotes maximum lung expansion and assists in breathing.|
|Encourage client to use pursed-lip breathing for exhalation.||Pursed lip breathing improves breathing patterns by moving old air out of the lungs and allowing for new air to enter the lungs.|
|Administer medication as ordered:|
|Short-acting beta-2-adrenergic agonist.
||Short-acting beta2-agonists are bronchodilators. They relax the muscles lining the airways that carry air to the lungs; treatment of choice for acute exacerbation of asthma.|
||Corticosteroids reduce inflammation in the airways that carry air to the lungs and reduce the mucus made by the bronchial tubes. Inhaled steroids should be given after beta-2-adrenergic agonist.|
|Anticipate the need for alternative treatment if life-threatening bronchospasm continues:|
||General anesthesia is used when there is both dynamic hyperinflation and profound hypercapnia that cannot be corrected by increasing minute ventilation.|
||Magnesium sulfate has bronchodilating and anti-inflammatory effects that are sometimes used in the treatment of moderate to severe asthma in children.|
||The use of helium (a less dense gas than nitrogen) causes decrease airway resistance thus lessens the work of breathing.|