Week No.

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PRIORITIZED NURSING PROBLEM FOR ASTHMA

Nursing Diagnosis Nursing Intervention Rationale
1. INEFFECTIVE Independent
BREATHING Place patient with proper body A sitting position permits
PATTERN alignment for maximum maximum lung excursion and
breathing pattern. chest expansion.
Encourage sustained deep These techniques promotes deep
breaths by: inspiration, which increases
- Using demonstration: oxygenation and prevents
highlighting slow inhalation, atelectasis. Controlled breathing
holding end inspiration for a methods may also aid slow
few seconds, and passive respirations in patients who are
exhalation tachypneic. Prolonged
- Utilizing incentive spirometer expiration prevents air trapping
- Requiring the patient to yawn This method relaxes muscles
Encourage diaphragmatic and increases the patient’s
breathing for patients with oxygen level.
chronic disease. This training improves
Evaluate the appropriateness of conscious control of respiratory
inspiratory muscle training. muscles and inspiratory muscle
Provide respiratory strength.
medications and oxygen, per Beta-adrenergic agonist
doctor’s orders. medications relax airway
Avoid high concentration of smooth muscles and cause
oxygen in patients with COPD. bronchodilation to open air
Maintain a clear airway by passages
encouraging patient to mobilize Hypoxia triggers the drive to
own secretions with successful breathe in the chronic CO2
coughing. retainer patient. When
Suction secretions, as administering oxygen, close
necessary. monitoring is very important to
Stay with the patient during avoid uncertain risings in the
acute episodes of respiratory patient’s PaO2, which could
distress. lead to apnea.
Ambulate patient as tolerated This facilitates adequate
with doctor’s order three times clearance of secretions.
daily This is to clear blockage in
Encourage frequent rest periods airway.
and teach patient to pace This will reduce the patient’s
activity. anxiety, thereby reducing
Consult dietitian for dietary oxygen demand.
modifications. Ambulation can further break up
Encourage small frequent and move secretions that block
meals. the airways.
Help patient with ADLs, as Extra activity can worsen
necessary. shortness of breath. Ensure the
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Avail a fan in the room. patient rests between strenuous

Encourage social interactions activities.
with others that have medical COPD may cause malnutrition
diagnoses of ineffective which can affect breathing
breathing pattern. pattern. Good nutrition can
Educate patient or significant strengthen the functionality of
other proper breathing, respiratory muscles.
coughing, and splinting This prevents crowding of the
methods diaphragm.
Educate patient about This conserves energy and
medications: indications, avoids overexertion and fatigue.
dosage, frequency, and possible Moving air can decrease
side effects. Incorporate review feelings of air hunger.
of metered-dose inhaler and Talking to others with similar
nebulizer treatments, as conditions can help to ease
needed. anxiety and increase coping
Teach patient about: skills.
- pursed-lip breathing These allow sufficient
- abdominal breathing mobilization of secretions.
- performing relaxation This information promotes safe
techniques and effective medication
- performing relaxation administration.
techniques These measures allow patient to
- taking prescribed medications participate in maintaining health
(ensuring accuracy of dose and status and improve ventilation.
frequency and monitoring Exercise promotes conditioning
adverse effects) of respiratory muscles and
- scheduling activities to avoid patient’s sense of well-being.
fatigue and provide for rest
periods
Refer patient for evaluation of
exercise potential and
development of individualized
exercise program.

2. INEFFECTIVE Teach the patient the proper

AIRWAY ways of coughing and The most convenient way to
CLEARANCE breathing. (e.g., take a deep remove most secretions is
breath, hold for 2 seconds, and coughing. So it is necessary to
cough two or three times in assist the patient during this
succession) activity. Deep breathing, on the
Educate the patient in the other hand, promotes
following: oxygenation before
- Optimal positioning (sitting The proper sitting position and
position) splinting of the abdomen
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- Use of pillow or hand splints promote effective coughing by

when coughing increasing abdominal pressure
- Use of abdominal muscles for and upward diaphragmatic
more forceful cough movement. Controlled coughing
- Use of quad and huff methods help mobilize
techniques secretions from smaller airways
- Use of incentive spirometry to larger airways because the
- Importance of ambulation and coughing is done at varying
frequent position changes times. Ambulation promotes
Position the patient upright if lung expansion, mobilizes
tolerated. Regularly check the secretions, and lessens
patient’s position to prevent atelectasis.
sliding down in bed. Upright position limits
Perform nasotracheal abdominal contents from
suctioning as necessary, pushing upward and inhibiting
especially if cough is lung expansion. This position
ineffective. promotes better lung expansion
Explain procedure to patient and improved air exchange.
Use well-lubricated soft Suctioning is needed when
catheters patients are unable to cough out
Use curved-tip catheters and secretions properly due to
head positioning (if not weakness, thick mucus plugs, or
contraindicated). excessive or tenacious mucus
Instruct the patient to take production.
several deep breaths before and This procedure can also
after nasotracheal suctioning stimulate a cough. Frequency of
procedure and use suctioning should be based on
supplemental oxygen, as patient’s present condition, not
appropriate. on preset routine, such as every
Stop suctioning and provide 2 hours. Over suctioning can
supplemental oxygen if the cause hypoxia and injury to
patient experiences bronchial and lung tissue.
bradycardia, an increase in Using well-lubricated catheters
ventricular ectopy, and/or reduces irritation and prevents
significant desaturation. trauma to mucous membranes.
- Use universal precautions: These facilitates secretion
gloves, goggles, and mask, as removal; from a specific side of
appropriate. the lung (left or right).
Maintain humidified oxygen as Hyperoxygenation before,
prescribed. during, and after suctioning
Encourage patient to increase prevents hypoxia.
fluid intake to 3 liters per day Oxygen therapy is
within the limits of cardiac recommended to improve
reserve and renal function. oxygen saturation and reduce
Coordinate with a respiratory possible complications
therapist for chest As protection against the blood-
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physiotherapy and nebulizer related modes of transmission,

management as indicated. health care workers should use
Provide postural drainage, universal precautions when
percussion, and vibration as coming in contact with the
ordered. blood of all patients, or bodily
Pace activities especially for fluids containing blood.
patients with reduced energy. Increasing humidity of inspired
Maintain planned rest periods. air will reduce thickness of
Promote energy-conservation secretions and aid their removal.
methods. Fluids help minimize mucosal
Educate patient on coughing, drying and maximize ciliary
deep breathing, and splinting action to move secretions
techniques. a variety of medications are
Provide patient understanding prepared to manage specific
about the proper use of problems. Most promote
prescribed medications and clearance of airway secretions
inhalers. and may reduce airway
Educate caregivers in resistance.
suctioning techniques. Provide hest physical therapy helps
opportunity for return mobilize bronchial secretions; it
demonstration. Modify should be used only when
techniques for home setting. prescribed because it can cause
harm if patient has underlying
conditions such as cardiac
disease or increased intracranial
pressure.
Oral care freshens the mouth
after respiratory secretions have
been expectorated.
Patient will understand the
underlying principle and proper
techniques to keep the airway
clear of secretions.
Understanding prescriptions
promote safe and effective
medication administration.
Hydration facilitates easy
elimination of secretions.
This promotes safe and effective
removal of secretions from the
airway.
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3. DEFICIENT Render physical comfort for Based on Maslow’s theory,

KNOWLEDGE the patient. basic physiological needs must
Grant a calm and peaceful be addressed before the patient
environment without education. Ensuring physical
interruption. comfort allows the patient to
Provide an atmosphere of concentrate on what is being
respect, openness, trust, and discussed or demonstrated.
collaboration. A calm environment allows the
Include the patient in creating patient to concentrate and focus
the teaching plan, beginning more completely.
with establishing objectives Conveying respect is especially
and goals for learning at the important when providing
beginning of the session. education to patients with
Consider what is important to different values and beliefs
the patient. about health and illness.
Involve patient in writing Goal setting allows the learner
specific outcomes for the to know what will be discussed
teaching session, such as and expected during the session.
identifying what is most Adults tend to focus on here-
important to learn from their and-now, problem-centered
viewpoint and lifestyle. education.
Explore reactions and feelings Allowing the patient to identify
about changes. the most significant content to
Support self-directed, self- be presented first is the most
designed learning. effective.
Help patient in integrating Patient involvement improves
information into daily life. compliance with health regimen
Give adequate time for and makes teaching and learning
integration that is in direct a partnership
conflict with existing values or Assessment assists the nurse in
beliefs. understanding how the learner
Provide clear, thorough, and may respond to the information
understandable explanations and possibly how successful the
and demonstrations. patient may be with the
Give information with the use expected changes.
of media. Use visual aids like Patients know what difficulties
diagrams, pictures, videotapes, will transpire in their own
audiotapes, and interactive environments, and they must be
Internet websites, encouraged to approach learning
Check the availability of activities from their priority
supplies and equipment. needs.
When presenting a material, This technique aids the learner
start with the basics or familiar, make adjustments in daily life
simple, and concrete that will result in the desired
information to less familiar, change in behavior.
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complex ones. Informatiom that is in direct

Focus teaching sessions on a conflict with what is already
single concept or idea. held to be true forces a
Pace the instruction and keep reevaluation of the old material
sessions short and is thus integrated more
When teaching, build on slowly
patient’s literacy skills. Patients are better able to ask
Identify patient’s questions when they have basic
understanding of common information about what to
medical terminology, such as expect.
“empty stomach,” “emesis,”
and “palpation.” Different people take in
Use the teach-back technique information in different ways.
to determine the patient’s Adequate preparation is
understanding of what was especially important when
taught: teaching in the home setting.
- The nurse gives information This method allows the patient
in a caring manner, using plain to understand new material in
language. relation to familiar material.
- Ask the patient to explain in Clearly focuses teaching allows
his or her own words. the learner to concentrate more
- Rephrase the information if completely on material being
unable to repeat it accurately. discussed.
- Again ask the patient to Learning requires energy, so
teach-back the information shorter, well-paced sessions
using his or her own words reduce fatigue and allow the
until the nurse is comfortable patient to absorb more
that is understood. completely.
- If the patient still does not In patients with low literacy
understand, consider other skills, materials should be short
strategies. and have culturally sensitive
Provide preadmission self- illustrations.
instruction materials to prepare Patients are expected to read
patient for postoperative and understand labels on
exercises. medicine containers,
Encourage questions appointment slips, and informed
Provide immediate feedback on consents.
performance. The teach-back technique
Allow repetition of the consists of specific steps in a
information or skill. repetitive order to evaluate the
Render positive, constructive recipient’s knowledge of the
reinforcement of learning content discussed. Patients who
Incorporate rewards into are not able to do this method
learning process after multiple cycles is
Note progress of teaching and considered cognitively
learning. impaired.
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Help patient identify Providing patients with

community resources for preadmission information about
continuing information and exercises has been shown to
support. increase positive feelings and
Approach individuals of color the ability to perform prescribed
with respect, warmth, and exercises.
professional courtesy. Questions facilitate open
communication between patient
and health care professionals
and allow verification of
understanding of given
information.
Immediate feedback allows the
learner to make corrections
rather than practicing the skill
wrongly.
Repeated practice allows patient
gain confidence in self-care
ability.
A positive approach by the
patient will help him or her feel
good about learning
accomplishments, gain
confidence, and maintain self-
esteem.
Rewards help to make learning
fun and exciting.
Documentation allows
additional teaching to be based
on what the learner has
completed
Learning occurs through
imitation, so persons who are
currently involved in lifestyle
changes can help the learner
anticipate adjustment issues.
Community resources can offer
financial and educational
support.
Instances of disrespect and lack
of caring have special
significance for individuals of
color.

References:
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