Learning about Asthma for nursing students
As a nurse who also personally suffers from asthma, I will say that having access to a rescue inhaler (bronchodilator) like Albuterol can oftentimes provide quick relief when an attack begins. Luckily, I have never been hospitalized for my asthma, but I have been treated for it.
I also treat patients post-operatively with a history of asthma and many times the anesthesia providers will order a breathing treatment to be completed by respiratory therapy in the PACU.
The provider will often request that supplemental oxygen such as a nasal cannula at 2L be kept on for a minimum of one hour as well to support oxygen exchange and reduce the chance of an asthma-related flare-up.
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Overview on Asthma
1. Inflammatory disorder of airways
2. Stimulated by triggers (infection, allergens,exercise, irritants)
3. Status Asthmaticus – a life-threatening condition→ Asthma unresponsive to treatment
Nursing Assessment for Asthma
1. Symptoms
a. Narrowed airways→ Wheezing/crackles
b. ↓ gas exchange→ Restless/anxious
c. Inflammation of airways→ Diminished breath sounds and tachypnea
2. Diagnostics
a. Peak Flow Rate
i. The volume of expired air
ii. Stable = 80-100% baseline
iii. Caution = 50-80% baseline
iv. Danger = <50% baseline
b. Pulmonary Function Tests
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Therapeutic Management for Asthma
1. High-Fowler’s or position of comfort
2. Administer O2
3. Medications
a. Bronchodilators
b. Corticosteroids
c. Leukotriene Modulators (Montelukast/Singulair)
Nursing Case Study for Asthma
The parents of 10-year-old patient L.F. bring her into urgent care for an exacerbation of asthma. They state she was playing outside in a grassy area with friends and suddenly had trouble breathing. They administered 1 dose of her bronchodilator inhaler and noticed little improvement. Upon arrival she is tachypneic with a RR of 30, O2 sat of 86%, lung sounds present wheezing, she appears anxious and is having trouble speaking.
As L.F.’s nurse, what do you do first? Remember ABC’s. The airway is inflamed and oxygen exchange is compromised. How will you maintain the compromised airway?
As L.F.’s nurse, the immediate priority should be to address her compromised airway and ensure proper oxygen exchange. Remembering the ABC’s (Airway, Breathing, Circulation) is crucial in this situation. Here’s what you should do first:
Airway Management:
Given the severity of the situation, the first priority is to ensure a patent airway. Follow these steps:
Positioning: Sit L.F. upright, leaning slightly forward, to help alleviate the work of breathing and maximize air exchange.
Administer Oxygen: Provide supplemental oxygen using a mask or nasal cannula to improve her oxygen saturation. This will help address her low oxygen saturation level (86%) and reduce the risk of hypoxia.
Monitor Oxygen Saturation: Continuously monitor L.F.’s oxygen saturation, heart rate, and respiratory rate to assess her response to interventions.
Administer Bronchodilator: Administer another dose of her bronchodilator inhaler to help relax and open up her airways.
Prepare for Advanced Interventions: If her condition does not improve with initial interventions, be prepared to escalate care by notifying the healthcare provider and preparing for potential administration of systemic medications or other advanced airway interventions.
*NCLEX tip: The NCLEX loves to give a good priority question!
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Happy Nursing!
