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7 Asthma Nursing Care Plans
Asthma is a chronic inflammatory lung disease that causes airway hyperresponsiveness, mucus production, and mucosal edema resulting in reversible airflow obstruction. Allergens, air pollutants, cold weather, physical exertion, strong odors, and medications are common predisposing factors for asthma. When an individual is exposed to a trigger, an immediate inflammatory response with bronchospasm happens. This inflammatory process leads to recurrent episodes of asthmatic symptoms such as cough, dyspnea, wheezing, and increased mucus production.
Status asthmaticus is severe and persistent asthma that does not respond to usual therapy; attacks can occur with little or no warning and can progress rapidly to asphyxiation.
Nursing Care Plans
The nursing care plan (NCP) for ashtma focuses on preventing the hypersensitivity reaction, controlling the allergens, maintaining airway patency and preventing the occurrence of reversible complications.
Here are seven (7) nursing care plans (NCP) for bronchial asthma:
1. Ineffective Breathing Pattern
Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation
May be related to
- - Swelling and spasm of the bronchial tubes in response to inhaled irritants, infection, drugs, allergies or infection.
Possibly evidenced by
- - Cough.
- - Cyanosis.
- - Dyspnea.
- - Loss of consciousness.
- - Nasal flaring.
- - Prolonged expiration.
- - Respiratory depth changes.
- - Tachypnea.
- - Use of accessory muscles.
Desired Outcomes
- - Client will maintain optimal breathing pattern, as evidenced by relaxed breathing, normal respiratory rate or pattern, and absence of dyspnea.
| Nursing Interventions | Rationale |
|---|---|
| Assess client’s vital signs as needed while in distress. | Increased BP, RR, and HR happens during the initial hypoxia and hypercapnia. And when it becomes severe, BP and HR drops and respiratory failure may result. |
| Assess the respiratory rate, depth, and rhythm. | Changes in the respiratory rate and rhythm may indicate an early sign of impending respiratory distress. |
| Assess client’s level of anxiety. | Anxiety may result from the struggle of not being able to breathe properly. |
| Assess breath sounds and adventitious sounds such as wheezes and stridor. | Adventitious sounds may indicate a worsening condition or additional developing complications such as pneumonia. Wheezing happens as a result of bronchospasm. Diminishing wheezing and indistinct breath sounds are suggestive findings and indicate impending respiratory failure. |
| Assess the relationship of inspiration to expiration. | Reactive airways allow air to move into the lungs more easily than out of the lungs. If the client is gasping for air, instruction for effective breathing is needed. |
| Assess for signs of dyspnea (flaring of nostrils, chest retractions, and use of accessory muscle). | These indicate respiratory distress. Once the movement of air into and out of the lungs becomes challenging, the breathing pattern changes. |
| Assess for conversational dyspnea. | Dyspnea during a normal conversation is a sign of respiratory distress. |
| Assess for fatigue. | Fatigue may indicate distress, leading to respiratory failure. |
| Assess the presence of paradoxical pulse of 12 mm Hg or greater. | Paradoxical pulse is an abnormally large decrease in systolic blood pressure and pulses wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg. A paradoxical pulse of 12 mm Hg or greater indicates a severe airflow obstruction. |
| Monitor oxygen saturation. | Oxygen saturation is a term referring to the fraction of oxygen-saturated hemoglobin relative to the total hemoglobin in the blood. Normal oxygen saturation levels are considered 95-100%. |
| Monitor peaked expiratory flow rates and forced expiratory volume as taken by the respiratory therapist. | The severity of the exacerbation can be measured objectively by monitoring these values. The peak expiratory flow rate is the maximum flow rate that can be generated during a forced expiratory maneuver with fully inflated lungs. It is measured in liters per second and requires maximal effort. When done with good effort, it correlates well with forced expiratory volume in 1 second (FEV1) measured by spirometry and provides a simple, reproducible measure of airway obstruction. |
| Monitor arterial blood gasses (ABG). | During a mild to moderate asthma attack, clients may develop respiratory alkalosis. Hypoxemia leads to increased respiratory rate and depth, and carbon dioxide is blown off. An ominous finding is a respiratory acidosis, which usually indicates that respiratory failure is pending and that mechanical ventilation may be necessary. |
| Plan for periods of rest between activities. | Fatigue is common with the increased work of breathing from the ineffective breathing pattern. Activity increases metabolic rate and oxygen requirements. |
| Maintain head of bed elevated. | This promotes maximum lung expansion and assists in breathing. |
| Encourage client to use pursed-lip breathing for exhalation. | Pursed lip breathing improves breathing patterns by moving old air out of the lungs and allowing for new air to enter the lungs. |
| Administer medication as ordered: | |
Short-acting beta-2-adrenergic agonist.
| Short-acting beta2-agonists are bronchodilators. They relax the muscles lining the airways that carry air to the lungs; treatment of choice for acute exacerbation of asthma. |
Inhaled Corticosteroids.
| Corticosteroids reduce inflammation in the airways that carry air to the lungs and reduce the mucus made by the bronchial tubes. Inhaled steroids should be given after beta-2-adrenergic agonist. |
| Anticipate the need for alternative treatment if life-threatening bronchospasm continues: | |
| General anesthesia is used when there is both dynamic hyperinflation and profound hypercapnia that cannot be corrected by increasing minute ventilation. |
| Magnesium sulfate has bronchodilating and anti-inflammatory effects that are sometimes used in the treatment of moderate to severe asthma in children. |
| The use of helium (a less dense gas than nitrogen) causes decrease airway resistance thus lessens the work of breathing. |
2. Ineffective Airway Clearance
Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.
May be related to
- - Bronchospasms.
- - Increased pulmonary secretions.
- - Ineffective cough.
Possibly evidenced by
- - Abnormal arterial blood gasses.
- - Adventitious lung sounds (Wheezes, Rhonchi).
- - Changes in respiratory rate and rhythm.
- - Chest tightness.
- - Cough.
- - Cyanosis.
- - Dyspnea;orthopnea.
- - Retained secretions.
Desired Outcomes
- - Client will verbalize understanding of cause and therapeutic management regimen.
- - Client will maintain airway patency as evidenced by clear breath sounds, improved oxygen exchange, normal rate and depth of respirations, and ability to effectively cough out secretions.
| Nursing Interventions | Rationale |
|---|---|
| Assess respiratory rate, depth, and rhythm. | Changes in the respiratory rate and rhythm may indicate an early sign of impending respiratory distress. |
| Assess for color changes in the buccal mucosa, lips, and nail beds. | Cyanosis indicates low oxygenation and that breathing is ineffective to maintain adequate tissue oxygenation. |
| Auscultate lungs for adventitious breath sounds (wheezes and rhonchi). | Wheezes suggest partial obstruction or resistance. While rhonchi may indicate retained secretions in the lungs. |
| Assess the effectiveness of cough. | Coughing is a natural way to clear the throat and breathing passage of foreign particles, irritants, and mucus. Severe bronchospasm, thick secretions, and respiratory muscle fatigue are some of the causes of an ineffective cough. |
| Assess the amount, color, odor and viscosity of the secretions. | Normal secretion is clear or gray and minimal; abnormal sputum is green, yellow, or bloody; malodorous; often copious. Thick tenacious secretions increase airway resistance. |
| Monitor oxygen saturation using pulse oximetry. | An oxygen saturation of less than 90% indicates problems with oxygenation. |
| Monitor chest x-ray results. | Chest x-ray provides information regarding the presence of infiltrates, lung inflation, or the presence of barotrauma. |
| Monitor laboratory results as indicated: | |
| White blood cell count. | Increased WBC count indicates an infection. |
| Potassium. | The use of beta-adrenergic agonists shift potassium into the cell and cause hypokalemia. |
| Theophylline level (if on theophylline therapy). | Therapeutic range of theophylline is between 10 to 20 mcg/mL. Signs of toxicity includes hypotension, tachycardia, GI symptoms, and restlessness. |
| Monitor arterial blood gasses (ABGs). | Retention of carbon dioxide happens due to fatigue from labored breathing caused by bronchospasm. Once the client is mechanically ventilated, permissive hypercapnia may be utilized to prevent lung damage and maintain plateau pressure less than 30 to 35 cm H20. |
| Obtain peak expiratory flow rate (PEFR) or forced expiratory volume in 1 second (FEV1) before and after respiratory treatment. | Peak expiratory flow rate (PEFR) is the maximum flow rate generated during a forceful exhalation. It should be improved with effective therapy. FEV1 is the volume exhaled during the first second of a forced expiratory maneuver started from the level of total lung capacity. |
| Pace client’s activities. | e.g., Break up activities into smaller parts and take rest breaks in between to avoid fatigue. increased effort in breathing properly. |
| Reduce client’s anxiety. | Keeping the client calm will prevent the occurrence of an asthma attack. |
| Encourage increased fluid intake of up to 3000 ml/day within cardiac or renal reserve. | Fluids help minimize mucosal drying and increases ciliary action to remove secretions. |
| Administer IV fluids and medication as ordered. | IV fluid therapy can be beneficial for clients with dehydration. Medications such as bronchodilators and inhaled corticosteroids may be prescribed. |
| Administer oxygen as ordered. | Oxygen therapy corrects hypoxemia, which can be caused by retained respiratory secretions. |
| Anticipate the need for intubation and mechanical ventilation. | Acute exacerbations of asthma can lead to respiratory failure requiring mechanical ventilation. |
3. Deficient Knowledge
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- - Chronicity of disease.
- - Lack of information sources.
- - Long-term medical management.
Possibly evidenced by
- - Absence of questions.
- - Ineffective self-care.
- - Inability to answer properly.
Desired Outcomes
- - Client and significant others will verbalize knowledge of the disease and its management and community resource available to help the client in coping with chronic disease.
| Nursing Interventions | Rationale |
|---|---|
| Assess the client’s knowledge of care for status asthmaticus, as appropriate. | Knowledge on how to handle care can save time. |
| Assess past and present therapies, including client’s response to them. | Knowledge of what has been effective in the past determines the appropriate intervention needed. |
Assess the client’s knowledge of asthma triggers and asthma medications:
| Identifying the asthma triggers will make the client know how to control them; Correct use of spacers by slow, deep inhalation and breath-holding after inhalation will ensure the effectiveness of the medication. Improper use of an MDI will lead in the medications not getting deep enough to affect the airway. |
| Assess the client’s tobacco use. | Assessment of tobacco use is important for clients suffering from lung disease. If the client is a tobacco user, cessation of smoking should be stressed. |
| Evaluate self-care activities: preventive care and home management of an acute attack. | Since it is a chronic disease, the client must be able to self-manage the disease. |
| Explain the disease to the client and significant others. | A misconception regarding asthma attack is that it can be managed without medication through self-control and discipline. Knowledge on asthma self-management reduces the need for frequent hospitalizations. |
Instruct the client how to avoid asthma triggers:
| Environmental trigger control can lessen the frequency of asthma attacks and improve the client’s quality of life. |
| Educate the client about the warning signs and symptoms of an asthma attack and the importance of early treatment of an impending attack. Provide a written copy of daily exacerbation management. | Written treatment plan is needed by the client to reinforce information that was already taught. Early treatment within 6 hours of an attack may lessen the chance of hospitalization. |
| Review all medications with the client including a discussion of short versus long-acting medications, a review of zones, and the dosage of each medication in each zone. | Short-acting beta-agonist are the first line medication of choice since they relieve acute asthma attacks very quickly compared to the long-acting. Beta-2-adrenergic agonist should be used before inhaled steroids since they open the airways and allow the anti-inflammatory medication to reach deeper into the lung fields. Rinsing the mouth after using an inhaled steroids prevents yeast infection. Anti-inflammatory medications, such as inhaled steroids, work by reducing swelling and mucus production in the airways. As a result, the airways are less sensitive and less likely to respond to asthma triggers and cause asthma symptoms. |
| Reinforce the need for taking controller medications as indicated. | Asthma is a chronic condition that is present even when attacks are not occurring. Medications such as bronchodilators and anti-inflammatory agents reduce the incidence of attacks. |
| Teach how to administer nebulizer treatments, Diskus, MDIs spacers, or dry powder capsules with the correct technique. | Providing return demonstrations on techniques are needed to ensure appropriate delivery of the medication. |
| Instruct in the use of peak flow meters and develop an individualized plan on how to adjust medications and when to seek medical advice. Establish the client’s personal best peak expiratory flow rate (PEFR). | Use the zone system individualized to the client. Personal best is established by having the client take and document peak flow each morning before medication use and in the late afternoon for 2 weeks. Personal best is the highest peak flow reading regularly blown, which is then used to calculate the client’s zone.
|
| Discuss the importance of pneumococcal pneumonia vaccine and influenza vaccine yearly. | Regular immunizations reduce the chance of acquiring these diseases. |
| Reinforce what to do in an asthma attack (Home management and prevention ,and when to seek urgent hospitalization). | Information enables the client to take control and reduce life-threatening complications. Hospitalization is required for severe exacerbations, severity of the condition and poor response to treatment. |
| Address the long-term management issues. | Control of allergens, avoidance of precipitators, environmental control, avoidance of air pollutants such as perfumes, aerosol sprays, powder, and health habits prevents the occurrence of asthma attacks. |
| Discuss the use of a medical alert bracelet or other identification. | These identification alert others to an asthma history to facilitate the delivery of safe, effective medical care. |
| Instruct the client to keep emergency phone numbers readily available. | These will help in seeking immediate medical attention. |
| Refer to support groups, as appropriate. | Asthma support groups offer an environment in which client can learn new ways of dealing with the illness and appropriate health behavior changes such as smoking cessation. |
4. Anxiety
Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
May be related to
- - Change in environment.
- - Change in health status.
- - Hypoxia.
- - Respiratory distress.
Possibly evidenced by
- - Apprehensiveness.
- - Dyspnea.
- - Frequent request for someone to be in room.
- - Restlessness.
- - Tachycardia.
- - Tachypnea.
Desired Outcomes
- - Client will use an effective coping mechanism.
- - Client will verbalize a reduction in level of anxiety experienced.
- - Client will demonstrate reduced anxiety as evidenced by a calm demeanor and cooperative behavior.
| Nursing Interventions | Rationale |
|---|---|
Assess for signs of anxiety:
| Asthma can become much worse with anxiety since it causes rapid, shallow breathing. |
| Assess theophylline levels (if on theophylline). | Therapeutic range of theophylline is between 10 to 20 mcg/mL. Theophylline causes increases anxiety. |
| Monitor oxygen saturation. | Increase anxiety may indicate an early sign of hypoxia. |
Provide comfort measures:
| Maintaining calmness will reduce oxygen consumption and the work of breathing. |
| Explain every procedure to the client in a simple and concise manner. | Client’s anxiety will decrease as he or she can understand the treatment regimen. |
| Ensure to update the significant others of the client’s progress. | Family’s anxiety can be easily transferred to the client. Giving off information to them can help relieve apprehension. |
| Stay with the client, and encourage slow, deep breathing. Assure the client and significant others of close, consistent monitoring that will ensure prompt intervention. | The presence of a trusted reliable person may give the client a sense of security. |
Encourage the use of relaxation techniques:
| Relaxation techniques is an effective way in decreasing anxiety. |
5. Activity Intolerance
Activity Intolerance: Insufficient physiologic or physiological energy to endure or complete required or desired activity.
May be related to
- - Fatigue
- - Airway problem
Possibly evidenced by
- - Tired appearance
- - Lethargy
- - Prolonged dyspnea due to an asthma attack
- - Inability to speak, eat, play
Desired Outcomes
- - Child will engage in the normal activities with absence of fatigue.
| Nursing Interventions | Rationale |
|---|---|
| Assess the presence of weakness and fatigue caused by airway problem. | Provides information about energy reserves as dyspnea and work of breathing over a period of time wears out these reserves. |
| Encourage activities such as quiet play, reading, watching movies, games during rest. | Avoids change in respiratory status and energy depletion due to excessive activity. |
| Disturb only when necessary, perform all care at one time instead of spreading over a long period of time, avoid doing any care or procedures during an attack. | Conserves energy and limits interruption in rest. |
| Schedule and provide rest periods in a calm peaceful environment. | Promotes adequate rest and decreases stimuli. |
| Explain the reason for the need to conserve energy and avoid fatigue to parents and child. | Promotes understanding of the effect of activity on breathing and need for rest to prevent fatigue. |
| Assist in planning a schedule for bathing, feeding, rest that will save energy and prevent an attack or promote resolution of an attack. | Provides care while promoting activities of daily care. |
| Reinforce activity or exercise limitations if these trigger attack; advise physician approved activities (aerobics, walking, swimming). | Provides preventive measures to offset possible attack. |
6. Health-Seeking Behaviors: Prevention of Asthma Attack
Health-seeking behaviors (specify): Active seeking (by an individual in stable health) of ways to alter personal health habits and/or environment to move toward a higher level of health.
May be related to
- - Longing for information about preventive measures and behavior changes
Possibly evidenced by
- - Expressed desire for increased control of health practices and effect of current environmental conditions and behaviors on health status
- - Increased frequency of attacks
Desired Outcomes
- - Parents (and child if age-appropriate) will verbalize understanding of triggering agents and prevention measures for asthma attacks.
| Nursing Interventions | Rationale |
|---|---|
| Assess client history such as triggering factors, incidence of respiratory infections and interventions taken to support the child’s health. | Provides a basis for information required for maintaining the health, as respiratory changes or infection can precipitate an asthma attack. |
| Assess family’s history of allergies, what does or does not trigger an attack, and what behaviors result from the attack. | Reveals familial tendency to airway reactive disease or history of eczema, allergic rhinitis, urticaria. |
| Assess for use of over-the-counter medications, type used and effects. | Determines whether products readily accessible for treatment of respiratory infection should or should not be used, as they may interact with prescribed medications, causing a more severe attack. |
| Instruct child to avoid exposure to persons with respiratory infections, how to cover mouth and nose when coughing or sneezing, and to dispose of tissues. | Prevents transmission of microorganisms by airborne droplets. |
| Instruct the child to refrain from stressful situations and strenuous physical exercise. | Provides information on how to prevent situations that may provoke an attack. |
| Instruct parents to modify home environment to reduce dust, exposure to pets and indoor plants, foods (peanut, egg), changing of filters. | Limits exposure to factors that can trigger an attack. |
| Educate parents/child about proper techniques in handwashing and allot time for return demonstration. | Avoids transfer of microorganisms from touching or handling supplies, touching the face of the child by parents or child without handwash. |
| Encourage breathing exercises and controlled breathing and relaxation. | Prevents attack before it begins and increases ventilation. |
| Educate parents and child about the disease condition, signs and symptoms and possible triggering factors influencing an attack. | Provides information that will improve the performance of preventive measures and compliance with the medical regimen. |
| Discuss with parents and child the signs and symptoms indicating the onset of an attack (shortness of breath, wheezing, chest pain). | Teach actions to be taken to prevent a severe attack and when to notify the physician. |
| Educate parents about the effect of allergens and how to limit exposure to external factors (cold air, pollen, dust mites, air pollutants). | Reduces exposure to factors that precipitate an attack. |
| Inform parents of skin testing for sensitivities to allergens. | Identifies allergies for hypersensitization regimen. |
| Teach parents and child about medication administration as ordered and how to manage method of administration; advise avoiding over-the-counter drugs without physician advice. | Promotes compliance in order to prevent an attack and maintain wellness. |
| Provide contact with community agencies for information and support. | Offers support to families with the child suffering from asthma. |
7. Interrupted Family Processes
Interrupted Family Processes: Change in family relationships and/or functioning.
May be related to
- - Sick child
Possibly evidenced by
- - Alterations in the parent-child relationship which may hinder adjustment and decrease parent’s ability to maximize child’s growth and development potential
- - Parental stress, which may result in parental dysfunction
- - Stress may be manifested by excessive worry, withdrawal, denial, difficulty in making child-rearing decisions, overprotectiveness
Desired Outcomes
- - Parents will verbalize feelings and concerns related to the implications of the disease on the entire family.
- - Family will demonstrate acceptance, adjustment, and coping behaviors related to the symptoms and effects of asthma.
| Nursing Interventions | Rationale |
|---|---|
| Assess available resources and coping skills of the family. | Promotes reinforcement of positive coping skills. |
| Assess interpersonal relationships within the family and support systems, with emphasis on the family’s relationship with the child diagnosed with asthma; intervene appropriately with evidence of maladaptation; refer to counseling if appropriate. | Promotes early recognition of interpersonal problems, especially within the parent-child relationship. |
| Assess siblings and peers at intervals, as appropriate, providing time for questions and feelings. | Promotes positive relationships between siblings and peers, which can be affected by a chronic illness that needs increased parental attention, and so forth. |
| Explore the family’s feelings regarding the child and the diagnosis. | Open discussions during a history-taking can identify family-related psychologic stress, if found early, can be the focus of preventive services to promote adaptation. |
| Provide an opportunity for the family to cope up with the illness; anticipate the normal grief reaction of “loss of the perfect child.” | Reaction may be expected in the early adjustment phase, following the diagnosis of a chronic disease, depending on the severity. |
| Assist the family to explore specific feelings regarding guilt, anger, disappointment, irritation, and fear; speak with parents about their fears: coping with the child’s anxiety, fear of complications, fear of death, fear of tests and procedures, fear of treatments, and the child’s potential inability to feel “normal” as compared to peers; help family to identify realistic and unrealistic fears. | Validates the normalcy of their feelings which promotes stress reduction and positive coping skills. |
| Encourage positive family relationships; serve as a role model regarding attitudes and behaviors towards the child. | Promotes the family’s ability to adjust in a positive manner. |
| Provide support to the family; assess family’s support systems and encourage their appropriate use; refer to community agencies and support groups, as applicable. | Promotes positive adaptation within the family. |
| Provide clear and accurate information to the family about the condition, treatments, and implications; reinforce all information given. | Promotes a sense of control and relieves stress; reinforcement and individualizing the approach fosters better understanding. |
| Assist family in developing and implementing a home care plan, employing age-appropriate goals consistent with activity tolerance. | Provides for a maximum level of care at home; parental participation in the plan of care may help to strengthen compliance and foster positive adaptation. |
| Encourage child and family to perform good health habits, such as a well-balanced diet, sufficient rest, good hygiene, and follow-up care. | Promotes the body’s own natural defenses. |
| Encourage family in methods to improve the child’s physical, psychological, and cognitive development, based on the child’s current developmental level. | Provides parents accurate knowledge on growth and development. |
| Explain to child/family the potential advantages of hyposensitization therapy where allergies cannot be avoided, as applicable. | Avoids possible asthma exacerbation when allergen-induced. |
| Teach child and family accurate use of a nebulizer, peak flow meter, and metered dose inhaler; stress understanding of equipment usage, cleaning, and strategies for compliance. | Prevents and/or minimizes exacerbation of asthma by early recognition. |
| Teach child and family on preventive treatment when applicable ( i.e., use of bronchodilators as prophylaxis to prevent exercise-induced asthma). | Prevents and/or reduces asthma exacerbations. |
| Reinforce measures to avoid infections such as good handwashing, cleaning and care of equipment used, and avoiding crowds. | Prevention of infection may lessen asthma exacerbations. |
| Teach parents about the signs of depression, particularly in the adolescent; suggest appropriate referrals as needed. | Facilitates timely collaboration between parent and healthcare care team if a problem develops. |
References and Sources: nurse labes
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