Status Asthmaticus

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Definition

  • Status asthmaticus is severe and persistent asthma that does not respond to conventional therapy; attacks can occur with little or no warning and can progress rapidly to asphyxiation.
  • Infectionanxiety, nebulizer abuse, dehydration, increased adrenergic blockage, and nonspecific irritants may contribute to these episodes.
  • An acute episode may be precipitated by hypersensitivity to aspirin.
  • Two predominant pathologic problems occur: a decrease in bronchial diameter and a ventilation–perfusion abnormality.

Clinical Manifestations

  • Same as those in severe asthma.
  • No correlation between severity of attack and number of wheezes; with greater obstruction, wheezing may disappear, possibly signaling impending respiratory failure.

Assessment and Diagnostic Findings

  • Primarily pulmonary function studies and ABG analysis
  • Respiratory alkalosis most common finding

[box type=”warning”]NURSING ALERT: Rising PaCO2 to normal or higher is a danger sign, signaling respiratory failure.[/box]

Nursing Diagnosis

The following nursing diagnoses are applicable to patients with Status Asthmaticus:

Nursing Priorities

  1. Maintain/establish airway patency
  2. Assist with measures to facilitate gas exchange.
  3. Enhance nutritional intake
  4. Prevent complications and slow progression of condition.
  5. Provide information about disease process, prognosis, and treatment regimen.

Nursing Care Plans

Main Article: 5 Bronchial Asthma Nursing Care Plans

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Medical Management

  • Initial treatment: beta-2-adrenergic agonists, corticosteroids, supplemental oxygen and IV fluids to hydrate patient. Sedatives are contraindicated.
  • Highflow supplemental oxygen is best delivered using a partial or complete nonrebreather mask (PaO2 at a minimum of 92 mm Hg or O2 saturation greater than 95%).
  • Magnesium sulfate, a calcium antagonist, may be administered to induce smooth muscle relaxation.
  • Hospitalization if no response to repeated treatments or if blood gas levels deteriorate or pulmonary function scores are low.
  • Mechanical ventilation if patient is tiring or in respiratory failure or if condition does not respond to treatment.

Nursing Management

The main focus of nursing management is to actively assess the airway and the patient’s response to treatment. The nurse should be prepared for the next intervention if the patient does not respond to treatment.

  • Constantly monitor the patient for the first 12 to 24 hours, or until status asthmaticus is under control. Blood pressure and cardiac rhythm should be monitored continuously during the acute phase and until the patient stabilizes and responds to therapy.
  • Assess the patient’s skin turgor for signs of dehydration; fluid intake is essential to combat dehydration, to loosen secretions, and to facilitate expectoration.
  • Administer IV fluids as prescribed, up to 3 to 4 L/day, unless contraindicated.
  • Encourage the patient to conserve energy.
  • Ensure patient’s room is quiet and free of respiratory irritants (eg, flowers, tobacco smoke, perfumes, or odors of cleaning agents); nonallergenic pillows should be used.
Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

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