Reactive Airway Disease RAD

Reactive Airway Disease RAD 4 Nursing Care Plans Diagnosis and Interventions

Reactive Airway Disease RAD NCLEX Review Care Plans

Nursing Study Guide on Reactive Airway Disease

Reactive airway disease (RAD) is a placeholder term used to describe a medical condition wherein the patient suffering has wheezes or bronchial spasm, but has not yet been properly diagnosed with asthma.

There are no clear definition of its use and can be used to describe other respiratory conditions with symptoms similar to asthma. One hallmark characteristics of patients with RAD is having bronchial tubes that overreact to an irritant.

Nursing Stat Facts 1

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Nursing Stat Facts 1

A RAD diagnosis is given to younger children (5 years and below) instead of an asthma diagnosis because they are too young to be able to complete assessment and confirmatory tests for asthma.

Signs and Symptoms of Reactive Airway Disease

The signs and symptoms of RAD typically reflect those of asthma. These include:

  • Wheezing
  • Coughing
  • Shortness of breath
  • Excessive mucus production, especially in the bronchial tubes
  • Swollen or inflamed mucous membranes in the bronchial tubes
  • Hypersensitive bronchial tubes

Causes and Risk Factors of Reactive Airway Disease

Reactive airway disease occurs most often after a bout of infection, similarly like in asthma. An irritant triggers the airways to overreact, thereby leading to swelling and narrowing. Some examples of these irritants are:

  • Pet hair
  • Dust
  • Pollen
  • Smoke
  • Mold or mildew
  • Exercise
  • Stress
  • Perfume, other strong odors
  • Changes in weather

A combination of two or more irritants can sometimes cause a reaction, however, may not trigger RAD as stand-alone hypersensitivity agents.

Complications of Reactive Airway Disease

The complications of uncontrolled reactive airway disease include the following:

  1. Mild to moderate exacerbations. This is characterized by having PEF of >50% and or oxygen saturation of >92% on room air.
  2. Severe exacerbations. This is characterized by having PEF of <50% and or oxygen saturation of <92% on room air. Also includes exacerbations that did not respond to first-line treatment.
  3. Status Asthmaticus. This condition is an acute exacerbation of asthma which is unresponsive to repeated courses of beta agonist therapy.
  4. Respiratory failure
  5. Death

Diagnosis of Reactive Airway Disease

Diagnosing RAD involves the following similar diagnostic procedures as that of asthma:

  1. Skin testing. Also known as scratch testing, skin testing involves exposing the skin to small amounts of allergy-causing substances (allergens). This method in turn helps in identifying allergy triggers such as pollen, dust mites, mold, etc. that may be causing reactive airway disease.
  2. Pulmonary lung function tests. These types of tests are non-invasive and are good assessment tools on how well the lungs are working. These tests are often used for older children and adults to confirm an asthma diagnosis. Some examples of pulmonary lung function tests include:
  • Spirometry – measures how much air the lungs can hold and the how forcefully one can breathe out
  • Lung volume test – measures the volume of air in the lungs and the residual air in the lungs at the end of a normal breath

Treatment for Reactive Airway Disease

The goal of management for RAD is to prevent an exacerbation from occurring. Recognizing the triggering factors (e.g., infection, weather, allergens, irritants, etc.) can aid in the prevention of an exacerbation event. However, if the patient develops exacerbations, the following are recommended:

  1. Pre-hospital care includes:
  • Oxygen supplementation during transport
  • Cardiorespiratory monitoring, including oxygen saturation levels
  • Nebulization utilizing beta-agonist agents
  • IV access for those with moderate to severe respiratory distress
  • Subcutaneous injection of terbutaline or epinephrine may be considered it the patient has severe distress with corresponding very poor air movement

2. Medications play a vital role in addressing RAD. The types of drugs used to manage RAD are listed below:

  • Medications play a vital role in addressing RAD. The types of drugs used to manage RAD are listed below:
  • Inhaled beta 2-adrenergic agonist agents – relieve bronchospasm by relaxing smooth muscles of the bronchi when given through the oral airway route
  • Anti-cholinergic agents – decrease the muscle tone in both the small and large pulmonary airways
  • Injected beta 2-adrenergic agonist agents – act on the small and large bronchial airways by decreasing their muscle tones
  • Methylxanthines – provide cellular level bronchodilation. The exact mechanism of action is unknown but has been proven beneficial for patients in impending respiratory failure
  • Magnesium salt – decreases acetylcholine release at the neuromuscular junction, consequently decreasing resting tone of smooth muscles.
  • Mast cell stabilizer – inhibits degranulation of sensitized mast cells following exposure from antigens
  • Leukotriene inhibitors – inhibit the synthesis of leukotriene (inflammatory substances arising from allergen exposure)
  • Corticosteroids – provide anti-inflammatory properties. They can be given in oral, injectable or inhaled forms
  • H2-receptor antagonists – utilized in combination with H1 antagonists for anaphylaxis that does not respond to H1 antagonists alone.
  • Monoclonal antibody – these may be considered for those with severe RAD conditions and those unresponsive to other treatments

Nursing Care Plans for Reactive airway disease

Nursing Care Plan 1

Ineffective Airway Clearance related to reactive airway disease as evidenced by shortness of breath, wheeze, SpO2 level of 85%, respiratory rate of 25, and unfavorable response to asthma management

Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to breathe effortlessly, 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 reactive airway disease.
Encourage coughing. Suction secretions as needed.To help clear the airway.
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 reactive airway disease medications (e.g., bronchodilators, steroids, or combination inhalers / nebulizers).Bronchodilators: To dilate or relax the muscles on the airways.
Anti-cholinergic agents: To decrease the muscle tone in both the small and large pulmonary airways.

Injected beta 2-adrenergic agonist agents – act on the small and large bronchial airways by decreasing their muscle tones  

Steroids: To reduce the inflammation in the lungs.

Inhaled Corticosteroids: beta 2-adrenergic agonist agents – To relieve bronchospasm by relaxing smooth muscles of the bronchi when given through the oral airway route  
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.

Nursing Care Plan 2

Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand secondary to reactive airway disease 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 reactive airway disease 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.

Nursing Care Plan 3

Nursing Diagnosis: Ineffective Breathing Pattern related to reactive airway disease as evidenced by shortness of breath, SpO2 level of 85%, chest tightness, and unresponsiveness to asthma interventions

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by 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.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
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 as set by the doctor.
Administer the prescribed  medications (e.g., bronchodilators, steroids, or combination inhalers / nebulizers) and antibiotic medications.Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Perform chest physiotherapy such as percussion and vibration, if not contraindicated. Nebulization using sodium chloride (NaCl) may also be done, as ordered by the physician. Steam inhalation may also be performed.To facilitate clearance of respiratory tract by soothing the airway inflammation.

Nursing Care Plan 4

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of reactive airway disease as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of reactive airway disease and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g., denial of diagnosis or poor lifestyle habits).To address the patient’s cognition and mental status towards the new diagnosis of reactive airway disease and to help the patient overcome blocks to learning.
Explain what reactive airway disease is and how it is managed. Avoid using medical jargons and explain in layman’s terms.To provide information on reactive airway disease and its pathophysiology in the simplest way possible.
Educate the patient about lifestyle changes that can help manage reactive airway disease, particularly the cessation of smoking. Refer to smoking cessation team.Smoking cessation may stop or slow down the progression of reactive airway disease. A smoking cessation team can provide further help and advice on how to stop smoking and can also monitor the patient’s progress when he/she is back in the community.
Inform the patient the details about the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) for reactive airway disease. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Educate the patient about pursed lip breathing and deep breathing exercises. Explain the importance of coughing up phlegm.To strengthen the respiratory muscles, reduce shortness of breath, and lower the risk for airway collapse.

Other nursing diagnoses:

Nursing 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.  Buy on Amazon

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

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.  Buy on Amazon

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

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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