Nursing Care Plan for Asthma

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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

Transcript

Hey guys, in this care plan, we will explore asthma. 

 

So, in this asthma care plan, we will talk about the desired outcome, the subjective and objective data, along with the nursing interventions and rationales. 

 

So, asthma consists of bronchoconstriction. We’re going to draw our lungs here. So, we have our bronchioles. So, bronchoconstriction inflammation and increased mucus production, which is going to narrow the passageways for that air to get through and decreases the ability to bring air into the alveoli, which decreases the amount of oxygenation that the red blood cells are able to exchange. So, swelling and mucus aggregated from irritants or triggers are what causes this difficulty in breathing, wheezing, and hypoxia. So triggers include dust, pollen, smoke, infections. Asthma can also be genetic, environmental, triggered by exercise, or even because of allergies. So, our desired outcome is we want this patient to have a decreased work in their breathing, adequate ventilation and oxygenation and perfusion of oxygen rich blood to the tissues. 

 

So, let’s take a look at our care plan for asthma, starting with the subject of data. So, our patient might feel really short of breath because of that lack of oxygen. They might experience some chest pain or tightness because of those bronchioles constricting and from all the coughing.  

 

Then let’s look at our objective data. So, you might observe your patient coughing because of those bronchial spasms. They might be breathing really fast or have that pursed lip breathing, or even kind of sit in like a tripod position where they’re trying to open up their lungs more. The bronchial constrictions can cause wheezing and you might even hear it without even using your stethoscope. It might be super loud. The patient’s pulse-ox will probably be low because of that lack of oxygen. 

 

Now, let’s take a look at the nursing interventions for asthma. So, you should check the patient’s pulse oximetry to determine if the patient is receiving enough oxygen. You might want to put them on a continuous puls-ox device, so you can monitor the oxygen levels continuously. If the oxygen level is less than 90%, go ahead and put them on two liters of oxygen on the nasal cannula. You might have to increase as appropriate, but keeping the patient at higher levels can be harmful to the patient if they don’t really need it. So, next you want to listen to the patient’s lung sounds. This is so that you can listen for any signs of needing an intervention, Um, for example, if they’re having some wheezing, they might need a bronco dilator. If you’re hearing some crackles or rhonchi, they might have pneumonia and they could use some suctioning.  Something important to remember is that, just because that wheeze goes away, doesn’t necessarily mean that the patient’s getting better. It could mean that that airway has gotten even tighter, meaning that no air is really getting through there and that’s why you’re not hearing the wheeze. So, just make sure you always check the pulse-ox. Next, you want to make sure you educate your patient about triggers. Remember, there’s many things that can be triggering this asthma. So just try to figure out what they are and help them decide how they can avoid these triggers, especially in their homes and their lives. 

 

So, it’s super helpful to position your patient upright. It just helps to open up their lung bases and airway so that they can breathe better. Have your patient perform a peak flow monitor. This is going to help to show how much air the patient can exhale. The smaller the number, the less air that the patient’s moving. You’ll administer breathing treatments and medications as appropriate to help to dilate the bronchioles and decrease inflammation. So beta agonists such as albuterol are used to help open up those lungs. Anticholinergics such as Ipratropium is going to help to relax those bronchospasms. Corticosteroids such as Flucotasone are going to help to decrease the inflammation in the lungs. 

 

Guys, make sure you keep communication open between you and that respiratory therapist okay? They have a big part in this too, right, especially when your patient starts to go downhill and struggle with their breathing, which hopefully doesn’t happen. Make sure that the crash cart is nearby if things take a negative turn so that you’re prepared. If the patient does stop breathing or the airway closes, they may need to be intubated. 

 

We love you guys. Now, go out and be your best self today and as always, happy nursing!