Asthma is a prevalent chronic respiratory condition characterized by airway constriction, inflammation, and mucus production, leading to breathing difficulties. This condition, while uncurable, is manageable with effective treatments. Asthma attacks can be life-threatening if left untreated, highlighting the importance of proper nursing care and management. It is particularly common in children due to their smaller airways being more susceptible to swelling and mucus, although approximately half of childhood asthma cases resolve by adolescence.
Nurses frequently encounter patients with asthma, in both acute exacerbations and as a chronic condition. Their role is crucial in patient management, focusing on education about symptoms, triggers, and medications. This guide provides a detailed Asthma Nursing Diagnosis Care Plan to support nurses in delivering optimal patient care.
Nursing Process in Asthma Management
The nursing process is fundamental in asthma care, guiding nurses through assessment, diagnosis, planning, implementation, and evaluation. This systematic approach ensures comprehensive and patient-centered care.
Comprehensive Nursing Assessment for Asthma
The initial step in asthma nursing care is a thorough assessment. This involves gathering subjective and objective data encompassing the patient’s physical, psychosocial, emotional, and diagnostic aspects.
Detailed Review of Health History
A comprehensive health history is vital to understand the patient’s asthma and related factors.
1. Evaluating General Asthma Symptoms: Identify common symptoms such as:
- Persistent Cough
- Wheezing (audible whistling sound during breathing)
- Shortness of Breath (dyspnea)
- Chest Tightness
2. Pinpointing Asthma Triggers: Determine factors that exacerbate symptoms. Common triggers include:
- Weather Changes
- Common Cold
- Dust
- Smoke
- Pollen (grass, tree)
- Animal Dander (fur, feathers)
- Cockroaches
- Strong Scents (soaps, perfumes)
- Fumes (gasoline)
- Exercise
- Medications
- Strong Emotions
- Cold, Dry Air
3. Comorbid Health Conditions: Assess for co-existing conditions that can worsen asthma:
- Obstructive Sleep Apnea
- Chronic Obstructive Pulmonary Disease (COPD)
- Food Allergies
- Gastroesophageal Reflux Disease (GERD)
- Nasal Polyps
- Pregnancy
- Respiratory Infections
4. Identifying Risk Factors: Note early life events that may contribute to asthma development:
- Low Birth Weight
- Prematurity
- Exposure to Tobacco Smoke
- Air Pollution Exposure
- Viral Respiratory Infections
5. Medication Review: Certain medications can trigger asthma exacerbations:
- Beta-blockers
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Aspirin
6. Family History of Asthma: A family history significantly increases asthma risk. If both parents have asthma, the probability for the child is 50%.
7. Allergy Assessment: Asthma and allergies often coexist. Identify allergic conditions:
- Eczema
- Rhinitis
- Sinusitis
- Hives
- Nasal Polyps
8. Environmental Factors: Urbanization increases asthma prevalence due to environmental allergens and irritants:
- Mold
- Dust Mites
- Air Pollution
- Fumes
- Dust
- Wood Fires
- Occupational Exposure to Toxic Chemicals
9. Body Mass Index (BMI): Obesity and overweight are linked to increased asthma risk and symptom severity.
10. Social History: Socioeconomic status can reveal factors impacting asthma management:
- Living Conditions
- Smoking Habits
- Workplace/School Environment
- Employment Setting
- Social Support
- Illegal Drug Use
- Financial Constraints
- Medication Adherence
11. Exacerbation History: Detail past asthma attacks to understand patterns:
- Initial Symptoms
- Onset (sudden or gradual)
- Triggers
- Frequency in the past year
- Emergency Department visits, hospitalizations, intubations
- Impact on daily activities
- Absences from work or school
12. Asthma Knowledge Assessment: Evaluate patient and caregiver understanding of:
- Asthma Triggers
- Medication Use
- Coping Techniques
- Family Support
- Financial Resources
Physical Examination for Asthma
Physical assessment provides objective data on the patient’s current condition.
1. Vital Signs Monitoring: Assess vital signs to determine exacerbation severity:
Mild Exacerbation:
- Elevated Respiratory Rate
- Heart Rate < 100 bpm
- No Pulsus Paradoxus
- SpO2 > 95%
Moderate Exacerbation:
- Increased Respiratory Rate
- Heart Rate 100-120 bpm
- Pulsus Paradoxus Present
- SpO2 91-95%
Severe Exacerbation:
- Respiratory Rate > 30 breaths per minute
- Heart Rate > 120 bpm
- SpO2 < 90%
2. Physical Assessment Findings: Observe physical signs based on exacerbation severity:
Mild Exacerbation:
- Breathlessness after Activity
- Able to speak in full sentences and lie down
Moderate Exacerbation:
- Breathless while Talking
- Accessory Muscle Use
- Retractions, Nasal Flaring, Abdominal Breathing (children)
- Poor Feeding, Softer Cry (infants)
Severe Exacerbation:
- Breathless at Rest
- Tripod Positioning
- Accessory Muscle Use
- Chest Retractions
- Agitation
- Speaks only in words
3. Recognizing Respiratory Failure Signs: Identify signs of impending respiratory failure:
- Drowsiness, Confusion (children)
- Absent Wheezing (severe airway constriction)
- Severe Hypoxemia with Bradycardia
- Diaphoresis, Bradypnea, Confusion, Agitation
- Pulling at Oxygen, Complaining of Inability to Breathe
4. Lung Sounds Auscultation: Auscultate for characteristic lung sounds:
- Bilateral, Expiratory Wheezing (mild to moderate)
- Wheezing During Inspiration (severe exacerbations)
- Absent Lung Sounds (life-threatening asthma)
5. Cough Pattern Observation: Note the nature of cough:
- Nocturnal Cough (primary sign of nocturnal asthma)
- Cough frequency, especially at night/early morning
6. Exercise-Induced Symptoms: Monitor symptoms related to exercise:
- Typical asthma exacerbation symptoms
- Sore Throat, Gastrointestinal Upset (some patients)
Diagnostic Procedures for Asthma
Diagnostic tests confirm asthma diagnosis and assess severity.
1. Peak Flow Meter Use: Utilize peak flow meters to monitor lung function:
- Portable, easy-to-use devices
- Evaluate symptoms against baseline function
- Measurements related to acute attack severity
- Expressed as percentage of predicted peak flow
2. Arterial Blood Gases (ABGs): Analyze ABGs for oxygen and carbon dioxide levels and blood pH:
- Detect Respiratory Alkalosis and Hypoxemia
3. Electrocardiogram (ECG): Perform ECG for patients with severe symptoms.
4. Chest X-ray: Employ chest X-ray to rule out other pulmonary diseases and for acute scenarios. Chest CT scans are recommended for persistent symptoms post-treatment.
5. Spirometry: The preferred diagnostic test for asthma:
- Reveals obstructive pattern, reversible with bronchodilators (salbutamol)
- Gauges disease severity before treatment initiation
6. Allergy Testing: Consider allergy testing to identify triggers:
- Skin tests, blood radioallergosorbent tests
- Detect common allergens (dust mites, pet dander, pollen)
Essential Nursing Interventions for Asthma
Nursing interventions are crucial for managing acute symptoms and preventing future exacerbations.
Managing Acute Asthma Symptoms
Prompt intervention is needed during acute exacerbations.
1. Albuterol Administration: Administer inhaled beta2 agonists like albuterol immediately for acute attacks. Repeat doses as needed (up to three times initially, then every 1-4 hours).
2. Oxygen Therapy: Administer supplemental oxygen as prescribed, based on severity of hypoxia, via nasal cannula or face mask.
3. Steroid Administration: Administer corticosteroids (oral or IV) to alleviate airway obstruction and prevent late-phase responses. Oral steroids are as effective as IV.
4. Hospitalization Preparedness: Prepare for potential hospitalization based on:
- Symptom Severity and Duration
- History of Severe Exacerbations
- Medication Adherence Ability at Home
- Adequacy of Home Support System
ICU Admission is necessary if:
- Condition Worsens Despite Treatment
- Mental Status Changes
- Respiratory Arrest Occurs
- Intubation is Required
5. Alternative Therapies Consideration: Offer alternative treatment options:
- Allergen Immunotherapy (allergy shots) for specific allergen triggers when medications are insufficient.
- Monoclonal Antibody Treatment for moderate to severe allergic asthma, reducing IgE levels and histamine release.
- Bronchial Thermoplasty to limit airway constriction using thermal energy via bronchoscopy.
Preventing Future Asthma Exacerbations
Education and environmental control are key to prevention.
1. Medication Adherence Education: Educate on long-term control and short-term (rescue) medications.
-
Long-Term Control Medications (daily/scheduled):
- Inhaled Corticosteroids
- Leukotriene Modifiers
- Combination Inhalers
- Theophylline
-
Short-Term (Rescue) Medications (symptom relief):
- Short-Acting Beta Agonists
- Anticholinergics
- Oral and Intravenous Corticosteroids
2. Environmental Control Promotion: Advise on reducing allergen exposure at home:
- Regular cleaning and dusting
- Face mask during vacuuming
- Cockroach control
- Smoke avoidance
- Waterproof mattress and pillow covers
- Hot water washing of bedding
- Clothing storage in closets and drawers
- Humidity reduction
- Staying indoors during high pollen counts
- Mask when mowing lawn
- Regular pet grooming, keep pets out of bedrooms
3. Lifestyle and Occupational Modifications Encouragement: Promote healthy habits:
- Self-monitoring of symptoms
- Weight Loss (if overweight/obese)
- Smoking Cessation
- Pollution Exposure Limitation
4. Long-Term Monitoring Education: Provide asthma action plan and educate on when to seek medical help.
- Demonstrate peak flow meter usage
- Refer to pulmonologist
- Counsel on follow-up spirometry
5. Vaccination Recommendations: Advise on influenza, pneumococcal, and other recommended vaccinations to prevent respiratory infections that can trigger asthma.
Asthma Nursing Care Plans: Examples and Applications
Nursing care plans prioritize diagnoses, assessments, and interventions for short-term and long-term asthma management goals.
Nursing Care Plan for Activity Intolerance
Asthma symptoms like dyspnea and fatigue can severely limit activity.
Nursing Diagnosis: Activity Intolerance
Related to:
- Airway Constriction
- Imbalance Between Oxygen Supply and Demand
As evidenced by:
- Dyspnea on Exertion
- Chest Tightness
- Fatigue
- Inability to Perform Activities of Daily Living (ADLs), Play, or Complete Tasks
- Poor Sleep Due to Dyspnea or Coughing
Expected Outcomes:
- Patient will perform ADLs without dyspnea or wheezing.
- Child will participate in play without shortness of breath or coughing.
Assessments:
1. Identify Activity Triggers: Assess activities, especially exercise, that trigger asthma.
2. Determine Limitation Level: Observe patient during activities to gauge limitations compared to usual activity levels.
3. Monitor Emotional Factors: Assess fear of activity-induced asthma attacks and help balance activity and rest.
Interventions:
1. Encourage Progressive Activity: Recommend safe activities like walking or yoga. Alternate rest and activity to improve tolerance.
2. Educate on Trigger Avoidance: Advise considering environmental factors (allergens, smoke, humidity, cold) before outdoor activities.
3. Suggest Alternative Activities: Recommend less strenuous activities like games, crafts, gymnastics, or golf for children.
4. Plan for Exercise: Educate on pre-exercise medication, warm-up routines, and monitoring respiratory status during exercise.
Nursing Care Plan for Impaired Gas Exchange
Airway narrowing and mucus lead to impaired gas exchange in asthma.
Nursing Diagnosis: Impaired Gas Exchange
Related to:
- Bronchospasm
- Airway Obstruction
- Respiratory Fatigue
- Inflammation
As evidenced by:
- Dyspnea
- Changes in Mental Status
- Abnormal Vital Signs
- Hypoxia
- Hypercapnia
- Cyanosis
- Agitation
Expected Outcomes:
- Patient will show improved ventilation and oxygenation (ABGs within normal limits).
- Patient will be free from respiratory distress signs.
- Patient will verbalize symptoms requiring medical notification.
Assessments:
1. Respiratory Status Assessment: Monitor for tachypnea, bradypnea, SpO2, breathlessness, and accessory muscle use.
2. Mental Status Changes Assessment: Assess for confusion, agitation, restlessness, or drowsiness as signs of worsening gas exchange.
3. Heart Rate and Rhythm Monitoring: Monitor for tachycardia, which may result from hypoxemia.
Interventions:
1. Oxygen Administration: Apply supplemental oxygen for hypoxia.
2. ABG Monitoring: Monitor ABGs for severe attacks to guide treatment (hypoxemia, hypercarbia, alkalosis/acidosis).
3. Medication Administration: Administer bronchodilators (albuterol) and corticosteroids as prescribed.
4. Intubation Preparation: Prepare for intubation if patient condition deteriorates, mental status changes, or ABGs indicate impending respiratory arrest.
Nursing Care Plan for Ineffective Airway Clearance
Inflammation, hyperresponsiveness, and mucus cause ineffective airway clearance.
Nursing Diagnosis: Ineffective Airway Clearance
Related to:
- Airway Edema
- Mucus Secretion
- Bronchoconstriction
- Respiratory Infections
- Trigger Exposure
As evidenced by:
- Abnormal Respiratory Rate and Rhythm
- Abnormal Breath Sounds
- Dyspnea
- Cough
- Restlessness
Expected Outcomes:
- Patient will maintain a patent airway.
- Patient will effectively expectorate secretions.
- Patient will exhibit clear breath sounds.
Assessments:
1. Respiratory Status Monitoring: Observe breathing patterns, accessory muscle use, retractions, and cough.
2. Lung Fields Auscultation: Assess for abnormal breath sounds like rhonchi or crackles indicating fluid accumulation.
3. Infection Signs Assessment: Check for fever, chills, or changes in sputum color, suggesting respiratory infections.
Interventions:
1. Head of Bed Elevation: Elevate the head of the bed to ease breathing and promote secretion drainage.
2. Anticholinergic Administration: Administer anticholinergics (ipratropium bromide) to reduce mucus secretion.
3. Allergen Exposure Reduction: Minimize exposure to dust mites, pollen, smoke, mold, and animal dander.
4. Nebulizer/MDI Education: Educate and assist in proper use of metered-dose inhalers (MDIs) or nebulizers for medication delivery.
Nursing Care Plan for Ineffective Breathing Pattern
Airway narrowing results in ineffective breathing patterns.
Nursing Diagnosis: Ineffective Breathing Pattern
Related to:
- Lung Inflammation and Swelling
- Airway Spasming
- Increased Mucus
As evidenced by:
- Dyspnea
- Coughing
- Cyanosis
- Nasal Flaring
- Accessory Muscle Use
- Wheezing
- Tachypnea
Expected Outcomes:
- Patient will demonstrate effective breathing pattern (normal respiratory rate/rhythm, no wheezing/coughing).
- Patient will verbalize potential asthma triggers.
- Patient will demonstrate proper peak flow meter use.
Assessments:
1. Lung Fields Auscultation: Auscultate for wheezing and other adventitious sounds.
2. Respiratory Status Monitoring: Closely monitor respiratory rate and oxygen saturation levels.
3. ABG Monitoring: Monitor for respiratory alkalosis or acidosis.
Interventions:
1. Bronchodilator and Corticosteroid Administration: Administer bronchodilators (albuterol) and inhaled corticosteroids. Administer corticosteroids after bronchodilators.
2. Peak Flow Meter Instruction: Instruct on daily peak flow meter use for monitoring lung function and early detection of changes.
3. Trigger Identification Assistance: Help patients identify personal asthma triggers.
4. Calm, Relaxed Breathing Promotion: Provide reassurance, maintain upright position, and guide diaphragmatic breathing during exacerbations.
Nursing Care Plan for Readiness for Enhanced Therapeutic Regimen Management
This plan focuses on empowering children to manage their asthma.
Nursing Diagnosis: Readiness for Enhanced Therapeutic Regimen Management
Related to:
- To be developed (intrinsic motivation, support system)
As evidenced by:
- Expressed Desire to Learn About Asthma
- Interest in Inhalers and Medical Devices
- Adherence to Medication Regimen
- Verbalizes Correct Disease Information
Expected Outcomes:
- Child accurately states asthma attack symptoms and when to seek help.
- Child correctly uses inhalers at prescribed intervals.
- Child remains free of asthma attacks.
Assessments:
1. Readiness to Learn Assessment: Assess child’s interest, questions, and initiative in medication management.
2. Support System Assessment: Evaluate support from parents, caregivers, and teachers.
3. Disease Understanding Assessment: Ensure child understands asthma basics, medication regimens, and when to seek help.
Interventions:
1. Interactive Learning Tools: Use games and videos to educate about asthma.
2. Symptom Tracking Engagement: Make symptom tracking fun with planners or stickers.
3. Inhaler/Device Use Observation: Observe and teach proper inhaler, spacer, and nebulizer use.
4. Action Plan Development: Create a collaborative asthma action plan with parents, healthcare providers, and teachers.
