NURSING MANAGEMENT OF ASTHMA PATIENT

Mdm. Nurhayati Mohamad Nor
RN, Dip. In Nsg, Bac. Of Nsg (Critical Care),

Msc Clinical (Surgery Gastro)

Contents
Description .............................................................................................................................................. 2
Types of Asthma ..................................................................................................................................... 3
Asthma Diagnosis ................................................................................................................................... 3
Pathophysiology ...................................................................................................................................... 4
Causes .................................................................................................................................................... 4
Stages of Asthma And Treatments For Asthma Stages ......................................................................... 4
Clinical Manifestations ............................................................................................................................ 5
Common signs and symptoms of asthma: .............................................................................................. 6
Prevention ............................................................................................................................................... 6
Complications.......................................................................................................................................... 6
Assessment and Diagnostic Findings ..................................................................................................... 7
Medical Management.............................................................................................................................. 7
Pharmacologic Therapy .......................................................................................................................... 7
Peak Flow Monitoring.............................................................................................................................. 8
Nursing Management.............................................................................................................................. 8
Discharge and Home Care Guidelines ................................................................................................. 10
Documentation Guidelines .................................................................................................................... 10
Nursing Diagnosis ................................................................................................................................. 11

1

Description
Asthma affects people in their different stages in life, yet it can be avoided and treated.
Asthma is a long-term complex chronic disease of the airways, which makes breathing difficult.
It causes airway inflammation that is characterized by airways obstruction, recurrent, and
reversible. Airways inflammation results in hyperactivity, which further causes airways to
restrict the response to stimuli. In simple words, it is a clinical syndrome of the airway, which
makes breathing process difficult.
Asthma is a chronic disease in which bronchial tubes become swollen or inflamed. The
swelling or inflammation caused in the tubes due to asthma makes airways extremely sensitive
to irritations and increases the sensitivity to an allergic reaction. It is hard to cure asthma
completely but knowing Asthma diagnosis and its methods can help a person with asthma to
lead a full and active life.

• Asthma is a chronic inflammatory disease of the airways that causes airway
hyperresponsiveness, mucosal edema, and mucus production.

• Inflammation ultimately leads to recurrent episodes of asthma symptoms.
• Patients with asthma may experience symptom-free periods alternating with acute

exacerbations that last from minutes to hours or days.
• Asthma, the most common chronic disease of childhood, can begin at any age.

2

Types of Asthma
There are different reasons for asthma, but both adults and children have some common
triggers for symptoms that set off an allergic response. There are several types of asthma.
Some of them are:
Childhood asthma
Children are more probably to have an intermittent form of asthma. Some children face daily
symptoms of asthma, whereas some have a very heightened sensitivity to some substances
that causes allergy. The major Causes Of Childhood Asthma is second-hand tobacco
smoke. More than 1 million across the world suffer to this disease due to this. Mild asthma
can be resolved at childhood, but moderate and severe can cause severe difficulty at later
ages.
Adult-onset asthma
Asthma in adults is very often and is and requires daily management for preventing symptoms.
Some people don’t show any type of symptoms of asthma until they become adult; this type
of asthma is called Adult-onset asthma. The major cause of this type of asthma is obesity, and
women are more likely to develop this condition after the age of 25 years. Sometimes a viral
infection can also unmask asthma in adults; for example, they have some respiratory infection.
Occupational Asthma
This is a type of asthma which results due to your job or profession. People are suffering from
this type of asthma usually workaround chemical fumes, crackers making industry or dust from
wood, grain, and flour. According to the reports of The Occupational Safety and Health
Administration (OSHA), around 15 percent of the total jobs can cause occupational asthma.
Seasonal Asthma
Some people face the problem of asthma during a particular season it may be during foggy
winter or pollen during hay fever season; this type of asthma is called seasonal asthma. Most
of the patient suffering from this type of asthma don’t face much problem throughout the year.

Asthma Diagnosis
Proper cure for asthma is not available till date, but still, there are some ways which help to
cure asthma. They are as follows:

• Doctors take a physical exam in which they check nose, throat, and upper ways.
Also, they check the skin for allergy symptoms like eczema. Doctors perform some
test to confirm asthma; these include:

o Lungs function test
o Spirometry
o Methacholine challenge
o Peak flow
o Exhaled nitric oxide test
o Chest X-ray

3

Pathophysiology
The underlying pathophysiology in asthma is reversible and diffuse airway inflammation that
leads to airway narrowing.

• Activation. When the mast cells are activated, it releases several chemicals
called mediators.

• Perpetuation.These chemicals perpetuate the inflammatory response, causing
increased blood flow, vasoconstriction,, fluid leak from the vasculature, attraction of
white blood cells to the area, and bronchoconstriction.

• Bronchoconstriction. Acute bronchoconstriction due to allergens results from
a release of mediators from mast cells that directly contract the airway.

• Progression. As asthma becomes more persistent, the inflammation progresses and
other factors may be involved in the airflow limitation.

Causes
• Allergy. Allergy is the strongest predisposing factor for asthma.
• Chronic exposure to airway irritants. Irritants can be seasonal (grass, tree, and
weed pollens) or perennial (mold, dust, roaches, animal dander).
• Exercise. Too much exercise can also cause asthma.
• Stress/ Emotional upset. This can trigger constriction of the airway leading to
asthma.
• Medications. Certain medications can trigger asthma.

Stages of Asthma And Treatments For Asthma Stages
Asthma, like other diseases, is further classified into different stages or grades. According to
NIH (National Institute of Health), asthma has four stages that are created to help practitioners
classify and treat asthma. Below are the four main stages of asthma explained with treatments
for asthma stages.
Stage 1: Intermittent Asthma
The first stage is called “intermittent” because of the symptoms like frequent wheezing. This
stage of asthma is defined only by symptoms repeatedly occurring two times a week or by
night awakening.
Treatment-The initial treatment for intermittent asthma involves Albuterol. Albuterol is a class
of special drug which widens the path of airways by inhaling.

Stage 2: Mild Persistent Asthma
The second stage of asthma is known as “mild persistent” as which occur for more than two
days a week but not regularly, and it troubles affected person by four to five times night
awakening.
Treatment-The treatment for mild persistent includes a short-acting inhaler and long-acting
medication.
Stage 3: Moderate Persistent Asthma
In this stage, the affected commonly experiences daily symptoms such as nighttime
awakening, chest tightness, shortness of breath, and they usually require immediate short-
acting medication.
Treatment- Moderate persistent treatment includes either long-acting agonist or low-dose
steroid.
Stage 4: Severe Persistent Asthma

4

In this stage, symptoms repeatedly occur throughout and in worst cases every night. To
control severe persistent, a short-acting drug is always required. In most cases, the lung
functioning of the asthmatic person is reduced.
Treatment-Treatment for severe persistent includes high-dose inhaling of steroids and long-
acting agonist. If the situation is out of control, oral steroids are prescribed.

Clinical Manifestations
The signs and symptoms of asthma can be easily identified, so once the following symptoms
are observed, a visit to the physician is necessary.

• Most common symptoms of asthma are cough (with or without mucus production),
dyspnea, and wheezing (first on expiration, then possibly during inspiration as well).

• Cough. There are instances that cough is the only symptom.
• Dyspnea. General tightness may occur which leads to dyspnea.
• Wheezing. There may be wheezing, first on expiration, and then possibly during

inspiration as well.
• Asthma attacks frequently occur at night or in the early morning.
• An asthma exacerbation is frequently preceded by increasing symptoms over days,

but it may begin abruptly.
• Expiration requires effort and becomes prolonged.
• As exacerbation progresses, central cyanosis secondary to severe hypoxia may

occur.
• Additional symptoms, such as diaphoresis, tachycardia, and a widened pulse

pressure, may occur.
• Exercise-induced asthma: maximal symptoms during exercise, absence of nocturnal

symptoms, and sometimes only a description of a “choking” sensation during
exercise.
• A severe, continuous reaction, status asthmaticus, may occur. It is life-threatening.
• Eczema, rashes, and temporary edema are allergic reactions that may be noted with
asthma.

5

Common signs and symptoms of asthma:
• Difficulty in breathing
• Coughing, especially during exercise or at night
• Shortness of breath
• Chest tightness

Wheezing (a squeaky or whistling sound in the chest during breathing, especially during
exhaling out)
https://www.youtube.com/watch?v=7oTfvJff7go
Signs and symptoms of asthma are generally triggered by contact to an allergen (like pollen,
ragweed, dust mites or animal dander), pollutants in the air (like strong odors, chemical fumes
or smoke) or extreme harsh environmental conditions. An illness or exercise- particularly flu
or respiratory disease can also cause asthma.
Strong emotion or physical movements that affect the breathing patterns- like crying,
laughing, or shouting- can also trigger asthma. According to researches, it has been found
out that rapid breathing with strong emotions or physical display can cause narrowing in the
bronchial tubes and can worsen the Asthma Attack Symptoms. Asthma can occur at any
time. If the episode is mild, it will take only a few minutes and can be easily resolved without
medication but in severe episode generally, last from days to months.

Prevention
Patients with recurrent asthma should undergo tests to identify the substances that
precipitate the symptoms.

• Allergens. Allergens, either seasonal or perennial, can be prevented through
avoiding contact with them whenever possible.

• Knowledge. Knowledge is the key to quality asthma care.
• Evaluation. Evaluation of impairment and risk are key in the control.

Complications
Complications for asthma include the following:

• Status asthmaticus. Airway obstruction in status asthmaticus often results in
hypoxemia.

• Respiratory failure. Asthma, if left untreated, progresses to respiratory failure.
• Pneumonia. Mucus that pools in the lungs and becomes infected can lead to the

development of pneumonia.

6

Assessment and Diagnostic Findings
To determine the diagnosis of asthma, the clinician must determine that episodic symptoms
of airway obstruction are present.

• Positive family history. Asthma is a hereditary disease, and can be possibly
acquired by any member of the family who has asthma within their clan.

• Environmental factors. Seasonal changes, high pollen counts, mold, pet dander,
climate changes, and air pollution are primarily associated with asthma.

• Comorbid conditions. Comorbid conditions that may accompany asthma may
include gastroeasophageal reflux, drug-induced asthma, and allergic
broncopulmonary aspergillosis.

Medical Management
Immediate intervention may be necessary, because continuing and progressive dyspnea
leads to increased anxiety, aggravating the situation.
Pharmacologic Therapy

• Short-acting beta2 –adrenergic agonists. These are the medications of choice for
relief of acute symptoms and prevention of exercise-induced asthma.

• Anticholinergics. Anticholinergics inhibit muscarinic cholinergic receptors and
reduce intrinsic vagal tone of the airway.

• Corticosteroids. Corticosteroids are most effective in alleviating symptoms,
improving airway function, and decreasing peak flow variability.

• Leukotriene modifiers. Anti Leukotrienes are potent bronchoconstrictors that also
dilate blood vessels and alter permeability.

• Immunomodulators. Prevent binding of IgE to the high affinity receptors of
basophils and mast cells.

7

Peak Flow Monitoring

Peak Flow Meter. Image via: medlineplus.gov
• Peak flow meters. Peak flow meters measure the highest airflow during a forced

expiration.
• Daily peak flow monitoring. This is recommended for patients who meet one or

more of the following criteria: have moderate or severe persistent asthma, have poor
perception of changes in airflow or worsening symptoms, have unexplained response
to environmental or occupational exposures, or at the discretion of the clinician or
patient.
• Function. If peak flow monitoring is used, it helps measure asthma severity and,
when added to symptom monitoring, indicates the current degree of asthma control.

Nursing Management
The immediate care of patients with asthma depend on the severity of the symptoms.
Nursing Assessment
Assessment of a patient with asthma includes the following:

• Assess the patient’s respiratory status by monitoring the severity of the symptoms.
• Assess for breath sounds.
• Assess the patient’s peak flow.
• Assess the level of oxygen saturation through the pulse oximeter.
• Monitor the patient’s vital signs.
Nursing Diagnosis
Based on the data gathered, the nursing diagnoses appropriate for the patient with asthma
include:
• Ineffective airway clearance related to increased production of mucus and

bronchospasm.
• Impaired gas exchange related to altered delivery of inspired O2.
• Anxiety related to perceived threat of death.

8

Nursing Care Planning & Goals
To achieve success in the treatment of a patient with asthma, the following goals should be
applied:

• Maintenance of airway patency.
• Expectoration of secretions.
• Demonstration of absence/reduction of congestion with breath sounds clear,

respirations noiseless, improved oxygen exchange.
• Verbalization of understanding of causes and therapeutic management regimen.
• Demonstration of behaviors to improve or maintain clear airway.
• Identification of potential complications and how to initiate appropriate preventive or

corrective actions.

Nursing Interventions
The nurse generally performs the following interventions:

• Assess history. Obtain a history of allergic reactions to medications before
administering medications.

• Assess respiratory status. Assess the patient’s respiratory status by monitoring
the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.

• Assess medications. Identify medications that the patient is currently
taking. Administer medications as prescribed and monitor the patient’s responses to
those medications; medications may include an antibiotic if the patient has an
underlying respiratory infection.

• Pharmacologic therapy. Administer medications as prescribed and monitor
patient’s responses to medications.

• Fluid therapy. Administer fluids if the patient is dehydrated.

Evaluation
To determine the effectiveness of the plan of care, evaluation must be performed. The
following must be evaluated:

• Maintenance of airway patency.
• Expectoration or clearance of secretions.
• Absence /reduction of congestion with breath sound clear, noiseless respirations,

and improved oxygen exchange.
• Verbalized understanding of causes and therapeutic management regimen.
• Demonstrated behaviors to improve or maintain clear airway.
• Identified potential complications and how to initiate appropriate preventive or

corrective actions.

9

Discharge and Home Care Guidelines
A major challenge is to implement basic asthma management principles at the home and
community level.

• Collaboration. The complex therapy of treating asthma at home needs collaboration
between the patient and the health care provider to determine the desired outcomes
and to formulate a plan to achieve those outcomes.

• Health education. Patient teaching is a critical component of care for patients with
asthma. Teach patient and family about asthma (chronic inflammatory), purpose and
action of medications, triggers to avoid and how to do so, and proper inhalation
technique. Instruct patient and family about peak-flow monitoring. Obtain current
educational materials for the patient based on the patient’s diagnosis, causative
factors, educational level, and cultural background.

• Compliance to therapy. Nurses should emphasize adherence to the prescribed
therapy, preventive measures, and the need to keep follow-up appointments with
health care providers. Teach patient how to implement an action plan and how and
when to seek assistance.

• Home visits. Home visits by the nurse to assess the home environment for allergens
may be indicated for patients with recurrent exacerbations.

Documentation Guidelines
Documentation is a necessary part of the nursing care provided, and the following data must
be documented:

• Related factors for individual client.
• Breath sounds, presence and character of secretions, and use of accessory muscles

for breathing.
• Character of cough and sputum.
• Respiratory rate, pulse oximetry/o2 saturation, and vital signs.
• Plan of care and who is involved in planning.
• Teaching plan.
• Client’s response to interventions, teaching, and actions performed.
• Use of respiratory devices/airway adjuncts.
• Response to medications administered.
• Attainment or progress towards desired outcomes.
• Modifications to the plan of care.
.

10

Nursing Diagnosis : Ineffective Breathing Pattern

Related Factors
The following are the common related factors for the nursing diagnosis I

• Swelling and spasm of the bronchial tubes in response to inha

Defining Characteristics
The common assessment cues that could serve as defining characterist

• Cough
• Cyanosis
• Dyspnea
• Loss of consciousness
• Nasal flaring
• Prolonged expiration
• Respiratory depth changes
• Tachypnea
• Use of accessory muscles

Desired Outcomes
Common goals and expected outcomes:
Patient will maintain optimal breathing pattern, as evidenced by relaxed

Ineffective Breathing Pattern.
aled irritants, infection, drugs, allergies or infection.
tics or part of your “as evidenced by” in your diagnostic statement.

breathing, normal respiratory rate or pattern, and absence of dyspnea

11

Ineffective Breathing Pattern
Nursing Interventions and Rationales
Here are the nursing assessment and interventions for this asthma nursi

Nursing Interventions

Nursing

Assess the client’s vital signs as needed while in distress. In
An
Assess the respiratory rate, depth, and rhythm. re
Assess the client’s level of anxiety.
Assess breath sounds and adventitious sounds such as wheezes Ch
and stridor. im

Assess the relationship of inspiration to expiration. An

Assess for signs of dyspnea (flaring of nostrils, chest retractions, Ad
and use of accessory muscle). de
Assess for conversational dyspnea. of
ssess for fatigue. su
Assess the presence of paradoxical pulse of 12 mm Hg or
greater. Re
lun
Monitor oxygen saturation. ne

Th
th

Dy

Fa

Pa
an
les
se

O
he
sa

ing care plan.

Rationale

Assessment

ncreased BP, RR, and HR occur during the initial hypoxia and hypercapnia.
nd when it becomes severe, BP and HR drops and respiratory failure may
esult.
hanges in the respiratory rate and rhythm may indicate an early sign of
mpending respiratory distress.
nxiety may result from the struggle of not being able to breathe properly.
dventitious sounds may indicate a worsening condition or additional
eveloping complications such as pneumonia. Wheezing happens as a result
f bronchospasm. Diminishing wheezing and indistinct breath sounds are
uggestive findings and indicate impending respiratory failure.
eactive airways allow air to move into the lungs more easily than out of the
ngs. If the client is gasping for air, instruction for effective breathing is
eeded.
hese indicate respiratory distress. Once the movement of air into and out of
he lungs becomes challenging, the breathing pattern changes.
yspnea during a normal conversation is a sign of respiratory distress.
atigue may indicate distress, leading to respiratory failure.
aradoxical pulse is an abnormally large decrease in systolic blood pressure
nd pulses wave amplitude during inspiration. The normal fall in pressure is
ss than 10 mm Hg. A paradoxical pulse of 12 mm Hg or greater indicates a
evere airflow obstruction.
xygen saturation is a term referring to the fraction of oxygen-saturated
emoglobin relative to the total hemoglobin in the blood. Normal oxygen
aturation levels are considered 95-100%.

12

Monitor peaked expiratory flow rates and forced expiratory Th
volume as taken by the respiratory therapist. th
ca
lun
do
se
m

Monitor arterial blood gasses (ABG). Du
alk
ca
wh
th

Therapeuti

Plan for periods of rest between activities. Fa
br
re

Maintain head of bed elevated. Th

Encourage client to use pursed-lip breathing for exhalation. Pu
lun

Administer med

Short-acting beta-2-adrenergic agonist. Sh
lin
• Albuterol (Proventil, Ventolin). ex
• Levalbuterol (Xopenex).
• Terbutaline (Brethine).

Inhaled Corticosteroids.

• Budesonide (Pulmicort). Co
• Fluticasone (Flovent). an
• Beclomethasone (Vancenase). be
• Mometasone (Asmanex Twisthaler).

Anticipate the need for alternative treatme

he severity of the exacerbation can be measured objectively by monitoring
hese values. The peak expiratory flow rate is the maximum flow rate that
an be generated during a forced expiratory maneuver with fully inflated
ngs. It is measured in liters per second and requires maximal effort. When
one with good effort, it correlates well with forced expiratory volume in 1
econd (FEV1) measured by spirometry and provides a simple, reproducible
measure of airway obstruction.

uring a mild to moderate asthma attack, clients may develop respiratory
kalosis. Hypoxemia leads to increased respiratory rate and depth, and
arbon dioxide is blown off. An ominous finding is a respiratory acidosis,
hich usually indicates that respiratory failure is pending and
hat mechanical ventilation may be necessary.

ic Interventions

atigue is common with the increased work of breathing from the ineffective
reathing pattern. Activity increases metabolic rate and oxygen
equirements.

his promotes maximum lung expansion and assists in breathing.

ursed lip breathing improves breathing patterns by moving old air out of the
ngs and allowing for new air to enter the lungs.

dication as ordered:

hort-acting beta2-agonists are bronchodilators. They relax the muscles
ning the airways that carry air to the lungs; treatment of choice for acute
xacerbation of asthma.

orticosteroids reduce inflammation in the airways that carry air to the lungs
nd reduce the mucus made by the bronchial tubes. Inhaled steroids should
e given after beta-2-adrenergic agonist.

ent if life-threatening bronchospasm continues:

13

• General anesthesia. G
pr
• Magnesium sulfate. ve
• Heliox (a helium-oxygen mixture).
M
so

Th
re

eneral anesthesia is used when there is both dynamic hyperinflation and
rofound hypercapnia that cannot be corrected by increasing minute
entilation.
Magnesium sulfate has bronchodilating and anti-inflammatory effects that are
ometimes used in the treatment of moderate to severe asthma in children.
he use of helium (a less dense gas than nitrogen) causes decrease airway
esistance thus lessens the work of breathing.

14

1. Nursing Diagnosis : Ineffective Airway Clearance
Related Factors
Common related factors for this nursing diagnosis:

• Bronchospasms
• Increased pulmonary secretions
• Ineffective cough
• Mucosal edema

Defining Characteristics
The common assessment cues that could serve as defining characterist

• Abnormal arterial blood gasses
• Adventitious lung sounds (Wheezes, Rhonchi)
• Changes in respiratory rate and rhythm
• Chest tightness
• Cough
• Cyanosis
• Dyspnea; orthopnea
• Retained secretions

Desired Outcomes
Common goals and expected outcomes:
Patient will verbalize understanding of cause and therapeutic manageme
Patient will maintain airway patency as evidenced by clear breath sound
and ability to effectively cough out secretions.

tics or part of your “as evidenced by” in your diagnostic statement.

ent regimen.
ds, improved oxygen exchange, normal rate and depth of respiration,

15

Nursing Interventions and Rationales
Here are the nursing assessment and interventions for this asthma nursi

Nursing Interventions

Nursing A

Assess respiratory rate, depth, and rhythm.

Assess for color changes in the buccal mucosa, lips, and nail beds.

Auscultate lungs for adventitious breath sounds (wheezes and
rhonchi).

Assess the effectiveness of cough.

Assess the amount, color, odor and viscosity of the secretions.

Monitor and record intake and output (I&O) adequately.

Monitor oxygen saturation using pulse oximetry.

Monitor chest x-ray results.

Monitor laboratory

• White blood cell count
• Potassium

ing care plan.

Rationale

Assessment

Changes in the respiratory rate and rhythm may indicate an early sign
of impending respiratory distress.

Cyanosis indicates low oxygenation and that breathing is ineffective to
maintain adequate tissue oxygenation.

Wheezes suggest partial obstruction or resistance. While rhonchi may
indicate retained secretions in the lungs.

Coughing is a natural way to clear the throat and breathing passage of
foreign particles, irritants, and mucus. Severe bronchospasm, thick
secretions, and respiratory muscle fatigue are some of the causes of
an ineffective cough.

Normal secretion is clear or gray and minimal; abnormal sputum is
green, yellow, or bloody; malodorous; often copious. Thick tenacious
secretions increase airway resistance.

Provides information on the fluid balance of the
patient. Dehydration can contribute in viscous secretions and may
result to decrease airway clearance.

Oxygen saturation of less than 90% indicates problems with
oxygenation.

A chest x-ray provides information regarding the presence of infiltrates,
lung inflation, or the presence of barotrauma.

y results as indicated:

Increased WBC count indicates an infection.

The use of beta-adrenergic agonists shift potassium into the cell and
cause hypokalemia.

16

• Theophylline level (if on theophylline therapy)
Monitor arterial blood gasses (ABGs).

Obtain peak expiratory flow rate (PEFR) or forced expiratory volume in
1 second (FEV1) before and after respiratory treatment.

Therapeutic

Pace the client’s activities.

Encourage deep breathing and coughing exercises.

Encourage increased fluid intake of up to 3000 ml/day within cardiac
or renal reserve.

Limit alcohol and caffeinated drinks.

Administer IV fluids and medication as ordered.

Administer oxygen as ordered.
Anticipate the need for intubation and mechanical ventilation.

Therapeutic range of theophylline is between 10 to 20 mcg/mL. Signs
of toxicity include hypotension, tachycardia, GI symptoms, and
restlessness.
Retention of carbon dioxide happens due to fatigue from labored
breathing caused by bronchospasm. Once the client is mechanically
ventilated, permissive hypercapnia may be utilized to prevent lung
damage and maintain plateau pressure less than 30 to 35 cm H20.
n Peak expiratory flow rate (PEFR) is the maximum flow rate generated
during forceful exhalation. It should be improved with effective therapy.
FEV1 is the volume exhaled during the first second of a forced
expiratory maneuver started from the level of total lung capacity.
c Interventions
Break up activities into smaller parts and take rest breaks in between
to avoid fatigue. increased effort in breathing properly.
Helps loosen and expectorate excess secretions and contribute in
effective clearing mucus out of the lungs.
Fluids help minimize mucosal drying and increases ciliary action to
remove secretions.
When consumed in excess, it may contribute to dehydration making
difficulty for secretions to be expectorated. In addition, it may also
increased the risk of CNS and cardiovascular system side effects of
medications.
IV fluid therapy can be beneficial for clients with dehydration.
Medications such as bronchodilators and inhaled corticosteroids may
be prescribed.
Oxygen therapy corrects hypoxemia, which can be caused by retained
respiratory secretions.
Acute exacerbations of asthma can lead to respiratory failure requiring
mechanical ventilation.

17

Nursing Diagnosis : Deficient Knowledge
Related Factors
Common related factors for this nursing diagnosis:

• Chronicity of disease
• Lack of information sources
• Long-term medical management

Defining Characteristics
The common assessment cues that could serve as defining characterist

• Absence of questions
• Ineffective self-care
• Inability to answer properly

Desired Outcomes
• Patient and significant others will verbalize knowledge of the dise
client in coping with chronic disease.

tics or part of your “as evidenced by” in your diagnostic statement.
ease and its management and community resource available to help the

18

Nursing Interventions and Rationales
Here are the nursing assessment and interventions for this asthma nursi

Nursing Interventions

Nursing

Assess the client’s knowledge of care for status asthmaticus, as K
appropriate.
K
Assess past and present therapies, including the client’s response in
to them.

Assess the client’s knowledge of asthma triggers and asthma Id
medications: C
in
• Treatment for status asthmaticus. M
• Correct use of metered-dose inhaler (MDI) and space.
• Use of spacers with an MDI.
• Ability to distinguish between rescue medications and

controllers.

Assess the client’s tobacco use. A
d
Therapeutic Interventions s
Evaluate self-care activities: preventive care and home
management of an acute attack. S
d
Explain the disease to the client and significant others.
A
m
m

ing care plan.

Rationale

g Assessment

Knowledge of how to handle care can save time.

Knowledge of what has been effective in the past determines the appropriate
ntervention needed.

dentifying the asthma triggers will make the client know how to control them;
Correct use of spacers by slow, deep inhalation and breath-holding after
nhalation will ensure the effectiveness of the medication. Improper use of an
MDI will lead in the medications not getting deep enough to affect the airway.

Assessment of tobacco use is important for clients suffering from lung
disease. If the client is a tobacco user, cessation of smoking should be
stressed.

Since it is a chronic disease, the client must be able to self-manage the
disease.

A misconception regarding asthma attack is that it can be managed without
medication through self-control and discipline. Knowledge on asthma self-
management reduces the need for frequent hospitalizations.

19

Instruct the client how to avoid asthma triggers: E
• Smoke. a
• Exercise
• Air pollution. A
• Allergens. w
th
Educate the client about the warning signs and symptoms of an
asthma attack and the importance of early treatment of an S
impending attack. Provide a written copy of daily exacerbation re
management. 2
th
Review all medications with the client including a discussion of th
short versus long-acting medications, a review of zones, and the y
dosage of each medication in each zone. w
th
Reinforce the need for taking controller medications as indicated. a

Teach how to administer nebulizer treatments, Diskus, MDIs A
spacers, or dry powder capsules with the correct technique. o
re

P
a

Environmental trigger control can lessen the frequency of asthma attacks
and improve the client’s quality of life.

A written treatment plan is needed by the client to reinforce information that
was already taught. Early treatment within 6 hours of an attack may lessen
he chance of hospitalization.
Short-acting beta-agonists are the first line medication of choice since they
elieve acute asthma attacks very quickly compared to the long-acting. Beta-
2-adrenergic agonist should be used before inhaled steroids since they open
he airways and allow the anti-inflammatory medication to reach deeper into
he lung fields. Rinsing the mouth after using an inhaled steroids prevents
yeast infection. Anti-inflammatory medications, such as inhaled steroids,
work by reducing swelling and mucus production in the airways. As a result,
he airways are less sensitive and less likely to respond to asthma triggers
and cause asthma symptoms.
Asthma is a chronic condition that is present even when attacks are not
occurring. Medications such as bronchodilators and anti-inflammatory agents
educe the incidence of attacks.

Providing return demonstrations on techniques are needed to ensure
appropriate delivery of the medication.

20

Instruct in the use of peak flow meters and develop an U
b
individualized plan on how to adjust medications and when to seek m
medical advice. Establish the client’s personal best peak h
th
expiratory flow rate (PEFR).

Discuss the importance of pneumococcal pneumonia vaccine R
and influenza vaccine yearly.

Reinforce what to do in an asthma attack (Home management and In
prevention, and when to seek urgent hospitalization). c
s

Address long-term management issues. C
a
Discuss the use of a medical alert bracelet or other identification. h
Instruct the client to keep emergency phone numbers readily
available. T
o
Refer to support groups, as appropriate.
T

A
n
c

Use the zone system individualized to the client. Personal best is established
by having the client take and document peak flow each morning before
medication use and in the late afternoon for 2 weeks. Personal best is the
highest peak flow reading regularly blown, which is then used to calculate
he client’s zone.

• Green Zone: 80 to 100% of the usual or “normal” peak flow rate
signals all clear.

• Yellow Zone: 50 to 80% of the usual or “normal” peak flow rate
signals caution. A temporary increase in medication may be needed.

• Red Zone: Less than 50% of the usual or “normal” peak flow rate
signals a Medical Alert. A beta-adrenergic agonist is usually taken,
and if there is no improvement in PEFR to yellow or green zones, the
physician is notified.

Regular immunizations reduce the chance of acquiring these diseases.

nformation enables the client to take control and reduce life-threatening
complications. Hospitalization is required for severe exacerbations, the
severity of the condition and poor response to treatment.

Control of allergens, avoidance of precipitators, environmental control,
avoidance of air pollutants such as perfumes, aerosol sprays, powder, and
health habits prevents the occurrence of asthma attacks.

These identification alert others to an asthma history to facilitate the delivery
of safe, effective medical care.

These will help in seeking immediate medical attention.

Asthma support groups offer an environment in which the client can learn
new ways of dealing with the illness and appropriate health behavior
changes such as smoking cessation.

21

2. Nursing Diagnosis : Anxiety
Related Factors
Common related factors for this nursing diagnosis:

• Change in the environment
• Change in health status
• Loss of control
• Hypoxia
• Respiratory distress

Defining Characteristics
The common assessment cues that could serve as defining characterist

• Apprehensiveness
• Dyspnea
• Frequent request for someone to be in the room
• Restlessness
• Tachycardia
• Tachypnea

tics or part of your “as evidenced by” in your diagnostic statement.
22

Nursing Interventions

Nursing

Assess for signs of anxiety:

• Feelings of panic, fear, and uneasiness.
• Tachycardia.
• Cold or sweaty hands or feet.
• Shortness of breath.
• Restlessness.

Assess theophylline levels.

Monitor oxygen saturation. Therapeut
Provide comfort measures:

• Calm, quiet environment.
• Soft music.

Explain every procedure to the client in a simple and concise manner.

Ensure to update the significant others of the client’s progress.

Stay with the client, and encourage slow, deep breathing. Assure the c
significant others of close, consistent monitoring that will ensure promp

Encourage the use of relaxation techniques:

• Progressive muscle relaxation as indicated.
• Diaphragmatic and pursed lip breathing.
• Use of imagery, repetitive phrases (repeating a phrase that t

physical relaxation, such as “relax and let go”).

Rationale

g Assessment

Asthma can become much worse with anxiety since it
causes rapid, shallow breathing.

Therapeutic range of theophylline is between 10 to 20
mcg/mL. Theophylline causes increases anxiety.

Increase anxiety may indicate an early sign of hypoxia.

tic Interventions

Maintaining calmness will reduce oxygen consumption
and the work of breathing.

client and Client’s anxiety will decrease as he or she can understand
pt intervention. the treatment regimen.

Family’s anxiety can be easily transferred to the client.
Giving off information to them can help relieve
apprehension.

The presence of a trusted reliable person may give the
client a sense of security.

triggers a

23

Desired Outcomes
Common goals and expected outcomes:

• Patient will use an effective coping mechanism.
• Patient will verbalize a reduction in level of anxiety experience
• Patient will demonstrate reduced anxiety as evidenced by a c

Nursing Interventions and Rationales
Here are the nursing assessment and interventions for this seizure nursi

Nursing Diagnosis : Activity Intolerance
Related Factors
Common related factors for this nursing diagnosis:

• Fatigue
• Airway problem

Defining Characteristics
The common assessment cues that could serve as defining characterist

• Tired appearance
• Lethargy
• Prolonged dyspnea due to an asthma attack
• Inability to speak, eat, play

Desired Outcomes
Common goals and expected outcomes:

• Child will engage in normal activities with absence of fatigue.

ed.
calm demeanor and cooperative behavior.
ing care plan.

tics or part of your “as evidenced by” in your diagnostic statement.

24

Nursing Interventions and Rationales
Here are the nursing assessment and interventions for this asthma nursi

Nursing Interventions

Nursing

Assess the presence of weakness and
fatigue caused by airway problem.

Therapeut

Encourage activities such as quiet play, reading, watching movies, gam
during rest.

Disturb only when necessary, perform all care at one time instead of sp
over a long period of time, avoid doing any care or procedures during a
attack.

Schedule and provide rest periods in a calm peaceful environment.

Explain the reason for the need to conserve energy and avoid fatigue t
parents and child.

Assist in planning a schedule for bathing, feeding, rest that will save en
and prevent an attack or promote resolution of an attack.

Reinforce activity or exercise limitations
if these trigger attack; advise physician approved activities (aerobics, w
swimming).

Nursing Diagnosis: Health-Seeking Behaviors
Related Factors
Common related factors for this nursing diagnosis:

ing care plan.

Rationale

g Assessment

Provides information about energy reserves as dyspnea and work
of breathing over a period of time wears out these reserves.

tic Interventions

mes Avoids change in respiratory status and energy depletion due to
excessive
preading activity.
an
Conserves energy and limits interruption in rest.

o Promotes adequate rest and decreases stimuli.
nergy
Promotes understanding of the effect of activity on breathing and
the need for rest to prevent fatigue.

Provides care while promoting activities of daily care.

walking, Provides preventive measures to offset possible attack.

25

• Longing for information about preventive measures and beha

Defining Characteristics
The common assessment cues that could serve as defining characterist

• Expressed desire for increased control of health practices and
status

• Increased frequency of attacks

Desired Outcomes
Common goals and expected outcomes:

• Parents (and child if age-appropriate) will verbalize understan

avior changes
tics or part of your “as evidenced by” in your diagnostic statement.
d effect of current environmental conditions and behaviors on health
nding of triggering agents and prevention measures for asthma attacks.

26

Nursing Interventions and Rationales
Here are the nursing assessment and interventions for this asthma nursi

Nursing Interventions

Nursing As

Assess client history such as triggering factors, incidence of Prov
as r
respiratory infections and interventions taken to support the
child’s health.

Assess family’s history of allergies, what does or does not Rev
trigger an attack, and what behaviors result from the attack. of e

Assess for use of over-the-counter Dete
medications, type used and effects. resp
with

Therapeutic In

Instruct child to avoid exposure to persons with respiratory Prev
infections, how to cover mouth and nose when coughing or
sneezing, and to dispose of tissues.

Instruct the child to refrain from stressful situations and Prov
strenuous physical exercise. atta

ing care plan.

Rationale

ssessment

vides a basis for information required for maintaining the health,
respiratory changes or infection can precipitate an asthma attack.

veals familial tendency to airway reactive disease or history
eczema, allergic rhinitis, urticaria.

ermines whether products readily accessible for treatment of
piratory infection should or should not be used, as they may interact
h prescribed medications, causing a more severe attack.

nterventions

vents transmission of microorganisms by airborne droplets.

vides information on how to prevent situations that may provoke an
ack.

27

Instruct parents to modify the home environment to reduce dust,

exposure to pets and indoor plants, foods (peanut, egg), Limi

changing of filters.

Educate parents/child about proper techniques Avo
in handwashing and allow time for return demonstration. touc

Encourage breathing exercises and Prev
controlled breathing and relaxation.

Educate parents and child about the disease condition, signs Prov
and symptoms and possible triggering factors influencing an prev
attack.

Discuss with parents and child the signs and symptoms Tea
indicating the onset of an attack (shortness of breath, wheezing, the
chest pain).

Educate parents about the effect of allergens and how to limit Red
exposure to external factors (cold air, pollen, dust mites, air
pollutants).

Inform parents of skin testing for Iden
sensitivities to allergens.
Prom
Teach parents and child about medication main
administration as ordered and how to manage method of
administration;
advise avoiding over-the-counter drugs without physician
advice.

its exposure to factors that can trigger an attack.

oids transfer of microorganisms from touching or handling supplies,
ching the face of the child by parents or child without handwash.
vents attack before it begins and increases ventilation.
vides information that will improve the performance of
ventive measures and compliance with the medical regimen.
ach actions to be taken to prevent a severe attack and when to notify
physician.

duces exposure to factors that precipitate an attack.

ntifies allergies for hypersensitization regimen.

motes compliance in order to prevent an attack and
ntain wellness.

28

Provide contact with community agencies for information and Offe
support.

ers support to families with the child suffering from asthma.
29

Nursing Diagnosis : Interrupted Family Processes
Related Factors
Common related factors for this nursing diagnosis:

• Sick child
• Emergent hospitalization
Defining Characteristics
The common assessment cues that could serve as defining characterist

• Alterations in the parent-child relationship which may hinder a
development potential

• Parental stress, which may result in parental dysfunction
• Stress may be manifested by excessive worry, withdrawal, de

Desired Outcomes
Common goals and expected outcomes:

• Parent will verbalize feelings and concerns related to the impl
• Family will demonstrate acceptance, adjustment, and coping b

tics or part of your “as evidenced by” in your diagnostic statement.
adjustment and decrease parent’s ability to maximize child’s growth and
enial, difficulty in making child-rearing decisions, overprotectiveness
lications of the disease on the entire family.
behaviors related to the symptoms and effects of asthma.

30