Asthma: What are the Nursing Interventions?

Asthma Nursing Interventions

Implement and monitor care for asthmatic clients

Asthma affects the airways causing muscles to tighten and the lining to swell. When someone is exposed to a trigger, their lungs will immediately become inflamed, leading to bronchospasm and other asthmatic symptoms. The inflammation process can cause people to have recurrent episodes of asthma symptoms. These may include coughing, difficulty breathing, wheezing, and increased mucus production.

The common triggers for asthma symptoms include pollen, exercise, and catching a cold or flu. The triggers for asthma symptoms can vary from person to person. Some common triggers include;

• Allergic triggers: House dust, mites, pollens, pets, molds, wood dust, and chemicals.
• Upper respiratory tract infections,
• History of Asthma in the family
• Viral infections – for example, colds and flu, hay fever or eczema
• Cigarette smoke, cold air, or changes in the weather.
• Some drugs, and exercises.
• Foods to which a child is allergic.

Pathophysiology

The pathophysiology of Asthma helps you understand how the condition is diagnosed and treated. Asthma involves many processes, including inflammation of the bronchi and constriction and airway resistance, which manifests as cough episodes, shortness of breath, and wheezing. Asthma can affect the trachea, bronchi, and bronchioles. Inflammation can exist even though obvious signs and symptoms of Asthma may not always occur. Bronchoconstriction can be caused by edema, epithelial and muscle damage, excessive mucus, and bronchospasms. Bronchospasms and edema from the microvascular leakage contribute to the airway narrowing. Airway capillaries may dilate and leak, increasing secretions, which in turn causes edema and impairs mucus clearance.

What are the three types of Asthma?

The common types of Asthma include:

Childhood asthma

Childhood asthma is a common health issue that affects children. It is an inflammation of the airways that leads to wheezing, coughing, shortness of breath, chest tightness, and other symptoms. Many different factors can lead to childhood asthma, including genetics, environmental factors, and lifestyle choices. Asthma is one of the leading causes of hospitalization among children. In some cases, Asthma may subside as the child grows. For many children, however, it is a lifelong condition.

Adult-onset Asthma

Adult-onset asthma is a type of Asthma that develops after the age of 18. It is considered the most common type of Asthma among adults, and it affects both men and women. Adult-onset asthma can be challenging to diagnose because symptoms may not appear until the disease has progressed. In addition, patients may not experience any symptoms for years before their diagnosis.

Occupational Asthma

Occupational Asthma is a type of Asthma triggered by a person’s work environment. It affects people who work in jobs with high dust levels, chemicals, and other irritants. It can be triggered by minor things such as a single exposure to an irritant. Some symptoms may be present only when the person is exposed to certain chemicals or substances. Some other symptoms may appear without any exposure to the substance. Exposure to particular substances can also trigger an attack that does not happen when the person is not exposed to them.

Signs and symptoms 

Asthma affects over 300 million people worldwide, but there are still no effective treatments for this condition. It,s important to understand what adult-onset asthma is and how it will progress to manage your symptoms better and reduce your risk for complications. The most common symptoms of Asthma include shortness of breath, coughing, chest tightness or pain, and a wheezing or whistling sound while breathing.

What are the causes of Asthma?

The causes of Asthma are a combination of environmental and genetic factors. The common causes include:

Allergies: Allergies are the leading cause of Asthma. When allergic individuals come into contact with an allergen, the immune system responds by releasing histamine. Histamine causes the airways to swell and the muscles around them to contract. This causes difficult airflow in and out of the lungs, which results in the symptoms of Asthma.

Environmental factors: Asthma is a common lung disease that affects people of all ages. It is caused by environmental factors, such as air pollution, allergens, and smoke.

Genetics: Genetic factors increase your risk of developing Asthma. Some of these genes are involved in the immune system, while others are involved in the development of the lungs. For people with a family history of Asthma, it is essential to be aware of the risk and see a doctor if you start to experience any symptoms.

Respiratory infections: A respiratory infection is an infection of the nose, throat, or lungs. It can be viral or bacterial. Respiratory infections are a common cause of Asthma in children. Viral respiratory infections, such as the common cold and the flu, are the most common causes of asthma flares. Bacteria can also cause respiratory infections and asthma flares.

How is Asthma classified?

The severity of the symptoms is used to classify Asthma. The main classifications are;

Mild Intermittent Asthma: Symptoms are mild and occur less than twice a week. Symptoms at night occur less than twice a month. You experience a few asthmatic attacks.

Mild Persistent Asthma: Asthmatic symptoms occur three to six times a week. Symptoms at night occur three to four times a month. Asthmatic attacks might affect daily activities.

Moderate Persistent Asthma: Asthmatic symptoms occur daily. You experience nighttime attacks five or more times in a month. The symptoms may affect daily activities.

Severe Persistent Asthma: Symptoms are persistent and occur both during the day and at night. You are limited to performing your daily activities.

How do you know if your Asthma is getting worse? When you have asthmatic symptoms that occur more frequently and lead to interference in your daily life, when you struggle to breathe well( this is measured using a peak flow meter) and when you often need to use a quick-relief inhaler.

Difference between an Asthmatic attack and Status Asthmaticus

Status Asthmaticus

Status asthmaticus, also known as severe acute Asthma, is a potentially life-threatening respiratory emergency characterized by severe difficulty breathing, as evidenced by rapid and deep inhalations, marked wheezing, and a prolonged expiratory phase. This clinical state is most often associated with Asthma. However, it can also be caused by other respiratory system disorders, such as chronic obstructive pulmonary disease (COPD) or pneumonia. Treatment typically involves the rapid delivery of oxygen and bronchodilators through an inhaler or nebulizer, with supplemental intravenous constrictors or sedatives. The condition is chronic for adults as it is hard for symptoms to remit. For some children who develop Asthma, recurrence is rare after management. Avoiding triggers and taking medication prevents complications.

Asthmatic attack

An asthmatic attack is an episode in which bands of muscle around the airways are triggered to tighten. When you have an asthma attack, three things can happen; Bronchospasms – The airway narrows due to constriction of surrounding muscles. When they tighten, the air can not flow freely through the airway. Inflammation – The lining of your airways becomes swollen. Swollen airways do not let as much air in or out of your lungs. Mucus production – The body produces more mucus during the attack, which clogs the airway. When your airways constrict, you make wheezing sounds when you breathe ( a whistling noise your airways make when you breathe out). 

Asthma is a chronic lung disease that inflames and narrows the airways. This can cause coughing, wheezing, and shortness of breath. Symptoms of Asthma can vary from person to person and even from day to day for the same person. An asthma attack is a sudden episode of difficulty breathing, chest tightness, and coughing. An attack can be mild, moderate, or severe. Status asthmaticus is a severe asthma attack that does not respond to treatment with standard asthma medications. This can lead to life-threatening respiratory failure. Symptoms of an asthma attack include coughing ( may be accompanied by mucus production), tight feeling in the chest, wheezing – whistling noise when breathing both on inspiration and expiration, shortness of breath, prolonged expiration – requires more effort, swollen and inflamed airway -begins abruptly, rapid heart rate, profuse sweating may occur and blue fingernails or lips (cyanosis). 

How is Asthma diagnosed?

Sometimes, Asthma can contribute to psychological effects, including the severity of the illness, the extent to which the disease limits activities, the quality of support available to the person, the age when the person discovered the illness, the patient’s way of copying, and skills and overall personality. Most asthmatic people feel uncomfortable with being different from the rest – A good example is using an inhaler, having frequent asthmatic attack episodes, or being too careful about avoiding triggers. This makes them feel left out in society. This also leads to changes in family schedules as the members have to spend most of their time taking care of asthmatic patients. For children, it is hard as their participation is confined. They may feel rejected or bullied if they do not participate in physical activities like the rest. The condition can prompt weariness, underperformance, absenteeism from school because of clinical arrangements or hospitalization, and mental issues including pressure, uneasiness, and sorrow.

Asthma is a respiratory disease that inflames and narrows the airways. Asthma is diagnosed based on a person’s symptoms and a physical examination. A doctor will ask about a person’s symptoms and medical history. The doctor will also do a physical examination, including checking a person’s lungs and breathing. If the doctor thinks Asthma is likely or in the acute stages, he or she may order tests, such as a chest X-ray or pulmonary function test, to confirm the diagnosis.

Nursing management

The severity of symptoms will determine the immediate nursing care for asthmatic patients. Anxiety is expressed by individuals and family members due to difficulty breathing. The most important aspect of care is the approach. Monitor the severity of symptoms, vital signs, and breath sounds to assess the client’s respiratory status. Before prescribing medications, obtain a history of any allergic reactions to medicine. Administer medication according to the prescription and monitor how well the patient responds. In case of dehydration, administer fluids. The nursing care plan’s main aim is to control allergens, maintain a patent airway, prevent hypersensitive reactions, and prevent complications. Here are some of the asthma patients’ nursing care plans:

Nursing Diagnosis for Asthma

1. Ineffective breathing pattern related to swelling and spasm of bronchial tubes secondary to inhaled irritants, allergies, or infections.
2. Ineffective airway clearance related to bronchospasms, mucosal edema, and increased secretions as evidenced by dyspnea and chest tightness.
3. Deficient knowledge related to lack of information as evidenced by ineffective self-care and absence of questions.
4. Anxiety related to change in environment secondary to restlessness.
5. Activity intolerance related to fatigue as evidenced by prolonged dyspnea.

Ineffective breathing pattern related to swelling and spasm of bronchial tubes secondary to inhaled irritants, allergies, or infections.

Desired Outcomes

• The patient will maintain optimal breathing patterns as evidenced by regular respiratory rate, absence of dyspnea, and relaxed breathing.
• The patient will verbalize an understanding of how to maintain a patent airway.

Nursing Interventions

• Monitor vital signs in the duration of distress. Rationale – To help in an accurate diagnosis and monitor the effectiveness of the medication.
• Monitor the respiratory rate, depth, and rhythm. Rationale – To detect any signs of respiratory distress.
• Assess the patient’s level of anxiety. Rationale – To rule out the inability to breathe properly.
• Assess adventitious sounds (wheezing and stridor) and breath sounds. Rationale – Adventitious signs may indicate developing complications like pneumonia. Wheezing occurs due to bronchospasms.
• Elevate the head of the bed and assist the patient in assuming Semi Fowler’s position. Rationale – To assist breathing and promote the expansion of the lungs.
• Asses for fatigue. Rationale – Fatigue indicates increased work of breathing/distress – Can lead to respiratory failure.

Ineffective airway clearance related to bronchospasms, mucosal edema, and increased secretions as evidenced by dyspnea and chest tightness.

Desired Outcomes

• The patient will maintain a patent airway without secretions, as evidenced by the ability to cough out secretions, normal respiratory rate, and improved oxygen exchange.
• The patient will verbalize understanding of the triggers and the management regimen.

Nursing Interventions

• Manage the airway by suctioning and monitoring the respiratory rate. Rationale -To check airway obstructions and clear secretions the client is unable to expectorate.
• Auscultate lungs for abnormal sounds. Rationale – Wheezing indicates resistance or partial obstruction.
• Assess secretions (viscosity, odor, color, amount). Rationale – Thick secretions cause airway resistance. Normal secretions are clear/gray and minimal.
• Use pulse oximetry to monitor the saturation of oxygen. Rationale – Oxygen levels below 90 indicate oxygenation problems.
• Monitor and record fluid input and output. Rationale – Dehydration can result in thick secretions and decreased airway clearance.
• Assess the effectiveness of cough and encourage deep breaths. Rationale – Ineffective cough indicates thick secretions, severe bronchospasms, and respiratory muscle fatigue.

Deficient knowledge related to lack of information as evidenced by ineffective self-care and absence of questions.

Desired Outcomes

• The patient will verbalize knowledge of asthma and the management and available resources to help cope with the condition.

Nursing Interventions

• Assess the patient’s knowledge of care for asthma and status asthmaticus. Rationale – Knowing how to handle asthmatic attacks saves time.
• Assess the patient’s response to past and present therapies. Rationale – Knowledge of what was effective in the past determines what is needed.
• Assess the patient’s knowledge of asthma triggers and medications. Rationale – Knowing asthma triggers makes it easier to avoid and control them. Slow deep inhalation when using an inhaler ensures the medication is effective.
• Explain details of the condition to the patient and significant others. Rationale – Knowledge of self-management reduces the need for hospitalization.

Anxiety related to change in environment secondary to restlessness.

Desired Outcomes

• The patient will verbalize reduced anxiety by being calm and cooperative
• The patient will apply an effective coping mechanism.

Nursing Interventions

• Assess for presenting signs of anxiety: Uneasiness, fear or panic, Restlessness, Sweaty or cold hands/feet. Rationale – When the signs are present, the breathing becomes rapid and shallow. This can worsen the condition.
• Monitor oxygen saturation. Rationale – Increased anxiety indicates an early sign of low oxygen levels.
• Stay with the patient and provide reassurance. Rationale – To provide a sense of security with a reliable person.
• Provide a calm environment accompanied by soft music. Rationale – To reduce work of breathing and oxygen consumption.

Activity intolerance related to fatigue as evidenced by prolonged dyspnea.

Desired Outcomes

• The patient will engage actively in desired activities.

Nursing Interventions

• Assess the patient’s daily activities and ask about any preferred activities. Rationale – To create a baseline and increase tolerance towards physical activities.  
• Encourage the patient to read or watch during rest. Rationale – To avoid energy depletion and changes in respiration.
• Provide a calm and well-ventilated environment. Rationale – To promote rest and allow oxygenation.

Complications

To manage asthmatic symptoms and avoid complications, most people with Asthma make specific lifestyle changes (like quitting smoking and maintaining a healthy weight) and use medications (like inhaled corticosteroids). Additional problems could be a result of poorly managed or poorly treated Asthma. Short-term complications include Severe asthma attacks, disruption of everyday activities, increased risk of pneumonia, and lung infections. Long-term complications include Permanent airway damage, mental health problems, weight gain, and increased risk of other chronic illnesses

Prevention

The reason why Asthma develops has not yet been established. The condition seems to develop from a mixture of genetic and environmental factors. An Asthmatic attack can be triggered by allergies, smoke, fumes, and exercise for some people. The best way to prevent an asthma attack is to avoid triggers. If you have Asthma, it is important to keep your asthma medications with you at all times. You should also carry an inhaler with you in case of an emergency. If you have an asthma attack, take your inhaler and seek medical help. There are several ways to prevent Asthma from developing, including Staying away from cigarette smoke, avoiding exposure to allergens, taking medications prescribed by a doctor, exercising regularly, keeping your home clean and free of dust and pet dander, staying indoors on days when air quality is poor, using an air filter in your home and washing your hands regularly to avoid respiratory infections.

Suppose you already have the condition and hope to prevent the asthmatic symptoms. In that case, several ways are effective in going about it: When avoiding asthmatic triggers and taking your medication, make sure you do it as instructed by the doctor. Getting vaccinated lowers the chances of developing Asthma through one of the triggers. It’s essential to get all your vaccinations as scheduled. Use your peak airflow meter to help you spot any impending flare-ups. This helps you monitor your condition and get you ready to handle it. You should have an idea about warning signs. A frequent inhaler or cough shows that a bad flare-up is coming. This will help you take the necessary measures to prevent an abrupt attack.

What should I do if I have a severe asthma attack?

In case of an asthmatic attack, seek medical care as soon as possible. First, you should use your rescue inhaler as prescribed by the doctor. The primary use of an inhaler is to open the airway. The rescue inhaler is used when symptoms are persistent. The maintenance inhaler is used daily, making it different from the rescue inhaler. Then stay calm and take deep breaths. If there is no improvement or not having your inhaler with you, go to the nearest pharmacy and get one. You can then head to the emergency department in case you have any of the following symptoms: Anxiety or panic, Cyanosis- Bluish lips or fingernails, Chest pain or pressure, Severe wheezing when you breathe, and a persistent cough, Difficulty in speaking, Pale, sweaty face and Rapid breathing. 

To control Asthma, it’s crucial to know self-management. All patients should be encouraged to take responsibility for their care. Controlling asthmatic symptoms improves the quality of life and lowers the risk of complications. Educating the patients also improves beyond the control of symptoms. This involves knowledge about Asthma, satisfaction, and self-control. This will help reduce absence from work or school and improve involvement in physical activities. The patient and family members can experience depression and anxiety. This results from the burden of living with the condition leading to compromise in controlling Asthma.

Summary

Asthma occurs when someone is exposed to a trigger e.g. pollen, exercise, dust, and catching a cold or flu. Their lungs will immediately become inflamed, leading to bronchospasm and other asthmatic symptoms. If your symptoms include wheezing, shortness of breath, chest tightness, or coughing more than three times a week, then you may have Asthma. You’ll need to see a healthcare provider to perform the diagnosis. Asthma can not be cured, but it can be managed. Children may outgrow Asthma as they grow older. One of the most common symptoms of Asthma is difficulty breathing, particularly at night. This is known as nocturnal Asthma.

There are many potential reasons why Asthma might worsen at night. One of the most common is that nighttime symptoms are caused by the body’s natural response to slower breathing during sleep. When you’re asleep, your muscles relax, and your airways tend to narrow, leading to difficulty breathing. Other possible causes of nighttime asthma symptoms include exposure to allergens or irritants in the bedroom, changes in the environment (temperature, humidity, etc.), and stress. If you’re experiencing worsening asthma symptoms at night, talk to your doctor about possible causes and treatment options.

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