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Outline
Pathophysiology
Bronchoconstriction, inflammation, and increased mucus production narrows air passages and decreases the ability to bring air into the alveoli, decreasing the amount of oxygenation red blood cells are able to exchange. This can also lead to increased amounts of carbon dioxide (CO2) retention due to lack of ability to exhale the CO2.
Etiology
Swelling and mucus aggregated from an irritant or “trigger” cause difficulty in breathing, wheezing lung sounds and hypoxia. Triggers include dust, pollen, smoke, infection, etc. Asthma can also be genetic, environmental, triggered by exercise or from allergies.
Desired Outcome
Decreased work of breathing, adequate ventilation and oxygenation, and perfusion of oxygen-rich blood to tissues.
Asthma Nursing Care Plan
Subjective Data:
- “I can’t breathe”
- Chest Pressure
- Chest Pain
- Chest Tightness
- Reported Cough
Objective Data:
- Observed Cough
- Pursed lip breathing
- Low pulse oximetry (<90%)
- Blue lips/fingers
- Tachypnea
- Wheezing
- Tripod position
Nursing Interventions and Rationales
- Check pulse oximetryApply oxygen if O2 saturation is less than 90%, start at 2 liters nasal cannula (2L NC)
Get subjective data to determine if patient is receiving proper amounts of oxygen.
This is both a comfort measure as well as physiologically helpful. In other words, it can’t hurt the patient (at higher amounts and flows it could hurt the patient!). Eliminate hypoxia, move up by 1L if not improving after re-checking every few minutes, call respiratory therapy if they require more than 6L NC.
- Auscultate lung sounds
If wheezing they may need a bronchodilator.
If you hear crackles or rhonchi they may have pneumonia and potentially could use suctioning.
**Note – disappearing wheezes does not always mean improvement. It could mean the airway has closed tighter and therefore there isn’t even enough air for a wheeze. Check SpO2
- Educate about triggers.Make sure the patient’s room does not have any triggers
Dust is near impossible to completely get rid of, however, other triggers like pollen (no flowers), animal dander (no visiting puppies), etc. can be eliminated.
Make sure the patient knows about their asthma triggers and help them problem solve how to eliminate the trigger from their life.
- Positioning patient in an upright position
Opens lung bases and airway
- Have the patient perform a peak flow meter
Peak flow meters tell us how much air that patient can exhale. The smaller the number the less amount of air they are moving.
- Breathing treatments and medication therapy
- Beta-Agonists: Such as albuterol work as bronchodilators
- Anticholinergics: Such as Ipratropium work to relax bronchospasms
- Corticosteroids: Such as Fluticasone work as an anti-inflammatory
- If the patient is a child or the patient has been working very hard to breath for a long period of time and is getting worse, be prepared with an airway cart. And for the love of the airway, have your respiratory therapist aware of the patient
Safety! Plus you do not want to wait until the impending airway closure happens to try to secure their airway. Sometimes the patient will be sedated and intubated to try to correct any respiratory acidosis or alkalosis.
References
- http://www.lung.org
- http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/measuring-your-peak-flow-rate.html
- http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/asthma-symptoms-causes-risk-factors/what-causes-asthma.html
- https://www.uptodate.com/contents/management-of-acute-exacerbations-of-asthma-in-adults
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