Asthma

Asthma Nursing Interventions and Care Plans

Asthma Nursing Diagnosis Care Plan NCLEX Review

Nursing Study Guide for Asthma

Asthma is a chronic condition that involves the narrowing and/or swelling of the airways, causing difficulty of breathing and triggering of cough. This may also include excessive production of mucus.

Asthma is sometimes referred to as reactive airway disease or bronchial asthma. There is no cure for asthma, but the symptoms can be managed and controlled effectively.

Asthma can interfere with a patient’s activities of daily living and also put him/her at risk for asthma attacks.

Signs and Symptoms of Asthma

  • Shortness of breath
  • Chest tightness or pain
  • Wheezing upon exhalation, especially in children
  • Coughing
  • Phlegm at times (most asthma cases are non-productive)
  • Sleeping problems due to coughing or breathlessness
  • Tiredness

Signs and Symptoms of Asthma Attacks

  • Non-stop coughing
  • Severe wheezing (both inhalation and exhalation)
  • Rapid breathing
  • Chest pain or pressure
  • Retractions – tightened neck and chest muscles
  • Difficulty talking
  • Feelings of anxiety or panic
  • Pale, sweaty face
  • Cyanosis – blue lips or fingernails

Asthma may be worsening if the patient experiences the signs and symptoms or has asthma attacks more frequently.

He/she may have more shortness of breath based on peak flow meter readings and may have to alleviate the symptoms using a quick-relief inhaler more frequently than usual.

Asthma
Asthma

Causes of Asthma

The exact cause of asthma is unknown. Experts believe that asthma is caused by a combination of genetic and environmental factors.

Asthma attacks or flare ups may be triggered by different environmental factors. Exercise-induced asthma may occur if the patient’s exercise and physical activity results to an asthma attack.

This becomes worse if the patient is exercising in a cold environment where the air is dry. Allergy-induced asthma happens when airborne substances such as mold spores, pollen, insect waste, pet dander, or skin particles trigger the asthma.

Occupational asthma occurs in the workplace where gases, dust, chemical fumes or other workplace irritants may be present.

Other triggers of asthma include respiratory infections, air pollutants such as cigarette smoke, vehicular smoke, emotional stress, some medications such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and naproxen, some sulfites and preservatives.

Gastroesophageal reflux disease (GERD) may also give rise to asthma symptoms.

Complications of Asthma

  1. Sleep deprivation and interference in activities of daily living
  2. Permanently narrowed airways that cause shortness of breath
  3. Frequent hospitalizations due to asthma attacks
  4. Medication-related side effects. Inhaled steroids may cause poor growth in children and decreased bone density.

Diagnosis of Asthma

  • Physical examination – auscultation of wheeze, inspection of ear, nose, throat and airways, looking for any chest retractions or signs of cyanosis, checking for respiratory rate and oxygen saturation levels
  • Lung function tests – spirometry and peak flow meter; done before and after taking a bronchodilator
  • Imaging – chest X-ray
  • Allergy testing
  • Sputum test – to check if there are any eosinophils in the sputum
  • Nitric oxide test – to check for elevated nitric oxide levels, which are indicative of narrowed airways

Treatment for Asthma

  1. Long-term asthma medications. These are used on a daily basis to control the asthma symptoms and prevent an asthma attack. These include:
  2. Inhaled corticosteroids such as budesonide, fluticasone, and beclomethasone
  3. Leukotriene modifiers, such as oral montelukast and zileuton
  4. Combination inhalers – combined corticosteroid and long-acting beta agonist, such as fluticasone-salmeterol (e.g. Advair HFA), budesonide-formoterol (Symbicort), formoterol-mometasone (Dulera) and fluticasone furoate-vilanterol (Breo Ellipta).
  5. Theophylline – relaxes the airway muscles, allowng the airways to remain open; requires blood tests to determine toxicity levels
  6. Quick-relief or rescue medications. These medications are used during asthma attack for short-term relief. They may be used prior to exercise.
  7. Short-acting beta agonists – bronchodilators such as albuterol and levalbuterol.
  8. Anticholinergic agents – also used in chronic broncitis and emphysema. These include ipratropium (Atrovent) and tiotropium (Spiriva)
  9. Oral and intravenous corticosteroids – alleviate airway inflammation. These include prednisone and methylprednisolone.
  10. Allergy medications for allergy-induced asthma
  11. Biologics for severe asthma include omalizumab (Xolair) and mepolizumab (Nucala)
  12. Bronchial thermoplasty. This procedure includes heating up the lung airways using an electrode. This is done over 3 clinic visits.

Nursing Care Plans for Asthma

  1. Ineffective Airway Clearance related to asthma as evidenced by shortness of breath, wheeze, SpO2 level of 85%, respiratory rate of 25, and productive cough

Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Assess breath sounds via auscultation.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Wheeze is one of the important signs of asthma.
Encourage coughing. Suction secretions as needed.To help clear thick phlegm that the patient is unable to expectorate.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Administer the prescribed asthma medications (e.g. bronchodilators, steroids, or combination inhalers / nebulizers).Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs.
Elevate the head of the bed and assist the patient to assume semi-Fowler’s position.Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Asthma Nursing Care Plan 1
  • Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand secondary to asthma as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent asthma attack by allowing the patient to pace activity and to have rest periods.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.
Asthma Nursing Care Plan 2

Other nursing diagnoses:

  • Anxiety related to asthma attack
  • Deficient Knowledge
  • Ineffective Breathing Pattern

References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.

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