Asthma is the chronic inflammation of the airways that causes difficulty breathing in about 6 million children across the United States. When the lining of the lungs becomes irritated and inflamed, tightening of the smooth muscles around the airways (bronchospasms) causes the airway to become narrow making it harder to get oxygen in and carbon dioxide out. An asthma attack (exacerbation) is considered a medical emergency.
While the exact cause of asthma is unknown, it is believed to be somewhat hereditary. Certain triggers can cause the exacerbation of symptoms, known as “asthma attacks”. Allergies are one of the most common triggers for asthma including dust, pollen, pet dander and mold. Other triggers and lung irritants include smoke and perfume. Exercising, breathing cold air or having a respiratory infection can also cause attacks.
Patient will have adequate air exchange and respiratory status; patient and caregivers will demonstrate ability to effectively use rescue medications; patient will have well-managed disease with symptoms occurring less than 2 days per week
Asthma / Childhood Asthma Nursing Care Plan
- Tightness or pain in the chest
- Symptoms that are worse at night
- Frequent headaches
- Feeling weak or tired (especially later into an asthma attack)
- Dark circles under the eyes
- Tripod positioning
Nursing Interventions and Rationales
- Assess respiratory status
Get a baseline to determine effectiveness of interventions and course of treatment.
During attacks, patient will have tachypnea, wheezing and labored breathing, nasal flaring and/or retractions
- Monitor peak flow rates in children over 5 years old. Pulmonary function testing
In asthma, patients can inhale, but it is more difficult to exhale the air taken in. A peak flow meter measures the lungs’ ability to expel air and regular use can help recognize the signs of an attack before symptoms begin.
Peak flow testing can help determine if treatment is working.
Routine pulmonary function testing helps determine the course and progression of the disease
- Assess patient’s level of anxiety and provide relaxation techniques
Being unable to breathe causes anxiety which, in turn, causes even more constriction of the airways. Help the patient to learn coping and relaxation techniques to control the breathing and help reduce the severity of the attack.
- Position upright
Patients will need to sit upright to promote lung expansion and make air flow easier. Patients may often be found in the tripod position.
- Administer medications via nebulizer
Bronchodilators and corticosteroids can be helpful in reducing inflammation and swelling that makes breathing difficult. A nebulizer works well to deliver an adequate amount of medication into the lungs.
- Educate patient and parents / caregivers on how and when to use medications and rescue inhalers (age appropriate)
Depending on the child’s age, an inhaler may be required for acute symptoms and before and after exercise. Demonstrate use of inhaler with spacer for children over 5 years old.
- Assist parents and providers in creation of Asthma Action Plan for school or daycare
An asthma action plan helps the parents, school and daycare providers to understand and control asthma in children.
This plan outlines the patient’s known triggers and how to manage symptoms that arise. If the patient is required to take maintenance or rescue medications during school hours, this plan outlines the importance of that treatment and how to administer those medications.
- Provide education for patient / parents regarding use of maintenance medications and how to recognize and avoid triggers
- Depending on the child’s age, patient may use oral maintenance medications or daily inhalers. Proper use of these devices helps maximize effectiveness of treatment.
- Help patient to understand what triggers asthma attacks and how to avoid those situations.
- Help parents understand that lifestyle and environmental changes may be made, including pets in the home and exposure to cigarette smoke. Wash patient’s sheets / linens weekly to kill and prevent dust mites.
- Encourage routine immunizations to help prevent diseases that may make asthma worse.
We are going to create a care plan focusing on childhood asthma. Some of the patho behind childhood asthma, asthma is a chronic inflammation of the airways and it causes difficulty in breathing in about 6 million children across the country. The lining of the lungs gets inflamed, It starts to tighten, the smooth muscles contract, and air is not easily passed. Some of the things we want to consider as nurses is we want to do a good assessment of the respiratory status. We want to monitor those vital signs, focusing primarily on the heart rate and the oxygen saturation. We want to assess anxiety levels, administer some respiratory medications, such as steroids and inhalers, and we want to make sure we educate the parents and the patient on the proper use of rescue inhalers. Our desired outcome is for the patient to have adequate, uh, air exchange in the good respiratory status. The patients and the caregiver should be able to demonstrate how to use a nebulizer or an inhaler, and to manage the disease at home.
So, when you have a patient that comes in and presents with asthma, there are a few things that they’re going to say. One of the things that they are going to complain of is chest tightness. So, their chest is going to be really tight. They’re going to have some symptoms that typically are worse at night. Uh, they’re going to have a lot of headaches and they are also going to feel very weak and tired, especially, uh, as the asthma attack, uh, progresses. What we’re going to hear when we walk in and see the patient is we’re going to hear wheezing. We’re going to hear a lot of wheezing. Uh, the patient’s going to cough. We’re going to assess maybe some Bronchospasms.
Again, the breathing rate is going to be way up. So they’re going to have a respiratory rate well over a 20, they’re going to have tachycardia. You may see some retractions. They’re going to have some dark circles under eye, and they’re going to also get into the tripod positioning to kind of assist them with breathing a little better. So, some things that we can focus on as nurses, the first thing we want to do is we want to assess, remember assessment. We can get a lot of good information, so we’re going to assess and we’re going to get their baseline. So, when we do our assessment, we’re going to really focus on those lung sounds. Uh, again, the patient can have tachypnea, uh, wheezing, so, we want to make sure that we are able to see that and document that as, as it is. We want to make sure that we position this patient upright. Positioning is something that can really help open those lungs, expand those lungs and get that air moving.
Uh, patients again, tend to tripod when they are having some difficulty breathing, so if we position them upright, we can definitely keep that airflow going. We want to administer any medications that are ordered. So Bronchodilators, such as albuterol. It just helps reduce that inflammation kind of open up that airway and relax those contracted bronchial passageways. Um, we want to make sure that we use the nebulizer to deliver that medication into the lungs. The next thing we want to do is we want to assess the patient’s level of anxiety. When a person can’t breathe, they are anxious and that will drive up the respiratory rate. So, it’ll make the respiratory rate even higher and it will just make it more difficult to bring air into the lungs. We can kind of help them with some relaxing coping techniques, just calming their mind, some guided relaxation techniques. Okay. And finally, we want to make sure that we educate the parents. Education is key here. We want to educate the parents on the proper use of inhalers because any child that’s five years or older, we want to make sure that we use a spacer. I, so that way we can get all of the inhaler medication, uh, into the lungs properly.
Okay. So the key points for childhood asthma, remember it is a chronic inflammation of the airways and it makes it very difficult to breathe. Uh, some things that the patient is going to complain about is tightness of the chest, headaches, weakness. What we’re going to notice is we’re going to notice some objective data. We’re going to notice some wheezing, uh, increased heart rate, increased respiratory rate. They may have a cough as well as, uh, they may tripod. Asthma in school, the most important thing for parents to do, is to have a respiratory asthma action plan. This includes making sure that they have, uh, adequate inhalers at the school and what to do in case of an asthma attack outside of the home. It’s often exacerbated by activity, so, uh, kids playing at the playground tend to have asthma attacks. The next thing that we really want to focus on is we want to make sure we get a good respiratory assessment. Respiratory assessment frequently is going to ensure that we catch something that can go wrong. Remember, when the patient no longer wheezes, that’s an ominous sign because that just indicates that there’s no respiratory airflow, and that’s a respiratory emergency.
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