Nursing Care Plan For Asthma Exacerbation

Asthma Nursing Care Plan For Hypotensive Patient In A Severe Attack

Administer oxygen by mask at 10L/min and prepare for intubation. Reassess the patient every 30 minutes until unstable vitals are stable.

Administer IV epinephrine 0.1 mcg/kg every 5 minutes as needed for systolic BP less than 90mmHg or diastolic less than 60 mmHg.

Administer Albuterol 2.5mg every 12 hours by nebulizer through a spacer. If wheezing persists, administer Albuterol every 5 minutes by nebulizer with the patient sitting position on bed rest.

Apply supplemental oxygen at 8L/min via nasal cannula and give IV fluids at a rate of 50mL/kg/hr.

Administer Diphenhydramine HCl every 4 to 6 hours PRN.

Administer IV magnesium sulfate with at least two additional drugs if significant tachycardia persists despite other interventions or if hypotension is present.

Current Model Of Care

Across Australia, current models of care for severe asthma are variable in different states and hospitals. Most primary care referrals for asthma will be managed in a general respiratory clinic, with selected tertiary centres providing a subspecialised severe asthma multidimensional service . Data from Alfred Health in Melbourne suggest that 13% of patients with asthma already seen in a general respiratory clinic would further benefit from subspecialised review for difficult-to-treat asthma.12

Asthma Nursing Care Plan For A Client In Status Asthmaticus:

1) Maintain patent airway, frequently assess for change in mental status.

2) Administer Albuterol 2.5mg every 12 hours by nebulizer through a spacer. If wheezing persists, administer Albuterol every 5 minutes by nebulizer with the client sitting position on bed rest.

3) Administer oxygen by nasal cannula at 8-10L/min or via facemask at 15L/ min.

4) Place an IV and infuse fluids at a rate of 50mL/kg/hr.

5) If the client is hypotensive, administer IV epinephrine 0.1 to 0.5 mcg/kg every 5 minutes as needed for systolic BP less than 90mmHg or diastolic less than 60mmHg.

6) Administer Diphenhydramine HCl every 4 to 6 hours PRN.

7) Consider IV magnesium sulfate with at least two additional drugs if significant tachycardia persists despite other interventions or if hypotension is present.

8. Auscultate breath sounds every 4 hours and reports dyspnea, rales, or crackles to a physician.

9) Assess vital signs hourly for changes and notify the physician if necessary.

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Primary Care Contribution To The Multidimensional Assessment And Management Of Severe Asthma

A multidimensional approach to severe asthma is not necessarily complex and provides a structured framework for assessment and management it is equally applicable to the management of milder forms of asthma. As such, some core elements of this approach could be delivered through primary care with help from available community or online resources .

Potential Use Of Electronic Records To Improve Asthma Care

General practices are increasingly adopting software systems that allow the use of reminders and facilitate preventive care. In a randomised controlled trial in a UK primary care setting, a novel approach using an electronic asthma risk registry was found to reduce asthma hospitalisations, ED presentation and unscheduled GP visits by 50%, 26% and 21%, respectively. There was also increased prescription of recommended preventive therapies, which was considered cost-effective.42 The at-risk registry identified potential patients with severe or difficult-to-control asthma based on the British asthma guidelines.42 Electronic alerts were added to the medical records of at-risk patients at participating primary care practices. This was coupled with practice-based training about the use of alerts to improve patient access and opportunistic management of asthma at every possible contact.

The increasing use of the MyHealth electronic health record may provide another means of streamlining the care of patients with severe asthma by allowing improved communication between primary and specialist care physicians.

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Role Of Primary Care In The Administration Of Biological Therapies For Asthma

Until recently, the primary choice of therapy for recurrent exacerbations was repeated or long term use of corticosteroids. New treatments such as omalizumab , mepolizumab and benralizumab dramatically improve symptom control and reduce exacerbations and oral corticosteroid use in patients with severe refractory asthma.10

Nursing Care Plans Concept Map Bronhial Asthma

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What Happens During An Asthma Attack

In Asthma, three processes occur. First is a hypersensitivity of the bronchial passages. Second is inflammation of the airway passages. Lastly is airway obstruction. Together, this produces an asthma attack. The patient will not be able to breathe properly.

Hypersensitivity occurs due to an exaggerated response from a variety of stimuli. This could be an allergic reaction, emotional response or a hormonal change . Inflammatory mediators or chemical substances are released such as histamines, prostaglandins, and leukotrienes as well as neutrophils, eosinophils and lymphocytes. The result is narrowing of the bronchial passages mucous is produced as well as inflammation in the trachea, bronchi, and the bronchioles. Additionally, the smooth muscles in the bronchial system spasm, and there is a thickening of the walls in the airway. The narrowed airway makes it difficult to breathe in air . Receptors in the lungs trigger hyperventilation or attempts at rapid breathing. The exchange of air and oxygen in the alveoli becomes erratic. Hypoxemia or low oxygen level in the blood occurs, and carbon dioxide levels rise as it can no longer escape through exhaling. If the asthma attack continues without treatment respiratory failure can occur .

Nursing Care Plan For Asthma 3

Nursing Diagnosis: Ineffective Breathing Pattern related to inadequate pulmonary ventilation, secondary to asthma, as evidenced by shortness of breath, coughing, cyanosis, nasal flaring, changes in the depth of breathing, excessive use of accessory muscles, presence of respiratory noise, and tachypnea.

Desired Outcomes:

• The patients abnormal breathing pattern will be corrected, as evidenced by a normal respiratory pattern, with no evidence of dyspnea noted.
• The nurse will note that the use of diaphragmatic compression is evident, ABG values are within the prescribed ranges, and there is evidence of comfortable breathing, either vocally or by the patients conduct.

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Therefore A Calm Approach Is An Important Aspect Of Care

Nursing care plan for anxiety related to asthma. Intake of nutrients insufficient to meet metabolic needs. In this plan, a person is set free from anxiety attacks and panic attacks. With those goals in mind you can now care for your patient holistically.

The nursing care plan for asthma patient concentrates on preventing the hypersensitivity response, controlling the pollutants, keeping airway patency and preventing the incidence of reversible complications. Improve oxygen intake and gas exchange Weakness of muscles required for swallowing or mastication

The muscles of the bronchial tree become tight and the lining of the air passages become swollen, reducing airflow and producing the wheezing sound. Asthma can also be genetic, environmental, triggered by exercise or from allergies. If asthma symptoms are controlled, the patient should have fewer exacerbations, a higher quality of life, lower costs, slower progression of airway from inflammation, less morbidity, and lower risk of death from asthma.

Part b nursing care plan If asthma symptoms are controlled, the patient should have fewer exacerbations, a higher quality of life, lower costs, slower progression of airway from inflammation, less morbidity, and lower risk of death from asthma. The patient and family are often frightened and anxious because of the patients dyspnea.

Teach deep breathing exercises and relaxation techniques. Nursing care plan of asthma 1. Asthma is a chronic disease of the airways.

Nursing Care Plan For Copd 4

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of COPD as evidenced by patients verbalization of I want to know more about my new diagnosis and care

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of COPD and its management.

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Pearls And Other Issues

Disposition

If the patient requires nebulized salbutamol and is not ordinarily on home nebulizers, he or she should be admitted. Anyone who has presented with severe or life-threatening asthma should usually be monitored to ensure that the disease does not return when the medication has worn off.

Pitfalls

Issues include forgetting to remove the nebulizer mask once the nebulizer is done , not assessing inhaler technique, and neglecting to stress the importance of maintenance therapy with inhaled steroids even when the patient is well.

Is Inhaler Therapy Optimised

Guideline-recommended maintenance therapy

Best practice management of severe asthma starts in primary care with guideline-based therapies, including appropriate use of inhalers. In the United Kingdom, in the national review of asthma deaths that occurred between February 2012 and January 2013, expert panels identified multiple factors that could have contributed to these deaths.1 Suboptimal implementation of guidelines was observed in 46% of deaths there was excessive prescription of short-acting -agonist, and, most importantly, there was underprescription of maintenance therapy 80% patients were prescribed less than the recommended maintenance inhaler therapy in the previous year. There was also evidence of inappropriate prescription of LABA as monotherapy.

Managing non-adherence and poor inhaler technique

Appropriate use of inhaler therapy is fundamental to the treatment of asthma. A significant proportion of patients referred for severe asthma assessments have poor adherence,20,27 which can and should be managed in primary care. In some Australian reports, only 10% of patients were able to use their inhaler device correctly.3 Critical mistakes are common for all inhaler devices, ranging from 12% for metered dose inhalers, 35% for Diskus and HandiHaler , and 44% for Turbuhalers .28 Poor inhaler technique is associated with increased risk of hospitalisation and increased exacerbations requiring oral corticosteroids.28

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Nursing Care Plan For Copd 1

Ineffective Airway Clearance related to COPD and pneumonia as evidenced by shortness of breath, wheeze, SpO2 level of 85%, productive cough, difficulty to expectorate greenish phlegm

Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation between 88 to 92%, and verbalize ease of breathing.

Nursing Care Plan For Copd 7

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to decrease food intake due to fatigue and dyspnea as evidenced by weight loss, poor muscle tone and lack of appetite

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

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The Priority Asthma Nursing Care Plan For A Client With Stable Poorly Controlled Asthma:

1) Review all environmental exposures that may irritate or aggravate asthma, such as cold air drafts from windows, allergens, cigarette smoke, high pollen count, and pets.

2) Have the client use a peak flow meter daily to monitor his rate of airflow.

3) Use a spacer when administering medications for the treatment of asthma or have the patient take deep breaths using short puffs of air from their inhaler through pursed lips.

4) Encourage deep breathing

5) Educate client regarding the importance of good nutrition in maintaining overall health and wellness and its effect on asthma symptoms.

6) Assess the patients current health care provider and medication regimen, including dosage schedule, to determine if changes are needed.

Interventions Rationale For A Patient In Severe Acute Asthma With Increased Work Of Breathing

Assist the client with his coughing efforts by gently tapping him on the back, raising his head during expiration, and instructing him to take slow deep breaths. If the client develops a cough, the nurse can administer an antitussive via the IV to help ease breathing efforts. The nurse also should frequently check the clients pulse oximetry readings, blood pressure, heart rate, respiratory rate, and capillary refill time. If the pulse oximeter is unstable and exceeds 90%, then a clinician should be notified immediately.

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Asthma Nursing Care Plans For A Patient With Intermittent Asthma Are:

1) Emphasize symptoms of abdominal discomfort and pain with dyspnea, and have the patient notify you if these increase.

2) Monitor respiratory status closely by observing cyanosis, respiratory distress, shallow rapid respirations, orthopnea, and paroxysmal nocturnal dyspnea.

3) Administer Albuterol 2.5 mg every 12 hours by nebulizer through the spacer. The patient should take deep breaths using short puffs of air from their inhaler through pursed lips.

4) Perform peak flow monitoring at home, and have the patient record his results daily. If PEFR is less than 50% of standard value or greater than 80%, notify the physician.

5) Encourage deep breathing and coughing exercises

6) Have the client maintain a symptom diary and report all respiratory complaints about the review with pharmacologic management.

7) Assess the appropriateness of his home environment, paying particular attention to the use of humidifiers and smoking, and educate him regarding these factors as well as medication.

Is The Asthma Controlled

Assessment of asthma control is essential for the initiation and subsequent titration of maintenance inhaler therapy and should be completed at every opportunity. In a multinational survey, 90% of patients self-rated their asthma as well controlled, but of these only 18% were indeed controlled based on the definition in the Global Initiative for Asthma guideline.2 As per these guidelines, a patient with well controlled asthma should have no limitation of activities no nocturnal, early morning or daytime symptoms and minimal use of reliever therapy . It is therefore important to ask direct and specific details of symptom frequency and severity, exacerbation episodes, oral corticosteroid use and emergency department visits. The Asthma Control Questionnaires 3 and Asthma Control Test 3 are validated questionnaires that are accessible and easy for patients to complete. They provide a valuable objective framework that can be used to assess response to treatment over time.

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Nursing Care Plan Nursing Care Plan For Copd 2

Nursing Diagnosis: Ineffective Breathing Pattern related to COPD and pneumonia as evidenced by shortness of breath, SpO2 level of 85%, productive cough, and greenish phlegm

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation between 88 to 92%, and verbalize ease of breathing.

Effective Management Of Adult Patients With Asthma

Therese Marie Bidder Clinical nurse specialist, Department of Specialist Allergy and Clinical Immunology, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust, London, England

Why you should read this article:

• To enhance your understanding of the signs and symptoms of asthma and how the condition is diagnosed

• To be aware of the treatments available that can achieve asthma control and reduce the risk of acute exacerbations of asthma

• To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account

• To contribute towards your professional development and local registration renewal requirements

Asthma is a chronic respiratory condition that can affect people of all ages. Globally, asthma is one of the most common non-communicable diseases and is associated with significant personal, financial and societal costs. In some cases, asthma can be fatal, although many fatalities would have been preventable with appropriate management. People with asthma often underestimate the effects of their symptoms, and nurses should develop their knowledge and skills so that they can provide appropriate management advice. This article outlines the causes of asthma and its symptoms. It also explains the interventions used in the management of this condition, including medicines, patient education, appropriate lifestyle changes and referral to specialist services.

Peer reviewCorrespondence

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