ASSIGNMENT

Topic: Asthma
Subject: ADULT HEALTH NURSING
Faculty: Miss Sehrish
GROUP MEMBERS
Nida Ali
Bushra Sadiq
Sonam Parvez
Samkey Rasheed
Busmenn Khan
Waqas Ahmad
Abida Jamal
Um-e-Kalsoom
Ihsan
Year I, Semester I
DATE: 5th December, 2019

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OBJECTIVES
Respiratory System Overview
Define Asthma
Prevalence of Asthma
Etiology and Risk Factors of Asthma
Pathophysiology of Asthma
Clinical Manifestations of Asthma
Complication of Asthma
Prevention of Asthma
Diagnostic study and Evaluation for Asthma
Medical Management of Asthma
Nursing Diagnosis of Asthma
Nursing Interventions of Asthma

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RESPIRATORY SYSTEM
Overview
Cells in the body require oxygen to survive. Vital functions of the body are carried out as the
body is continuously supplied with oxygen. Without the respiratory system exchange of gases
in the alveoli will not be made possible and systemic distribution of oxygen will not be made
possible. The transportation of oxygen in the different parts of the body is accomplished by the
blood of the cardiovascular system. However, it is the respiratory system that carries in oxygen
to the body and transports oxygen from the tissue cells to the blood. Thus, cardiovascular
system and respiratory system works hand in hand with each other. A problem in the
cardiovascular system would affect the other and vice versa.

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DEFINITION
Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways.
Asthma causes recurring periods of wheezing (a whistling sound), chest tightness, shortness of
breath, and coughing. The coughing often occurs at night or early in the morning.
Asthma is a chronic inflammatory disease of the airways that causes airway hyper-
responsiveness, mucosal edema, and mucus production.
Inflammation ultimately leads to recurrent episodes of asthma symptoms.
Patients with asthma may experience symptom-free periods alternating with acute
exacerbations that last from minutes to hours or days.
Asthma, the most common chronic disease of childhood, can begin at any age.

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STATISTICS AND EPIDEMIOLOGY
Asthma is considered as the most common chronic disease of childhood, and is a disruptive
disease that affects school and work attendance.
Asthma affects more than 22 million people in the United States.
Asthma accounts for more than 497, 000 hospitalizations annually.
The total economic cost of asthma exceeds $27.6 billion.

TYPES OF ASTHMA
1. Extrinsic or Atopic Asthma
Usually in the first twenty years of life & most common type.
Extrinsic asthma results from an inflammatory response of the airway caused by mast cell
activation, eosinophil infiltration and epithelial sloughing. An attack is triggered by
environmental allergens (dust, pollens etc).
Encounter with an allergen stimulates plasma cells to produce antigen-specific IgE,
antibodies that bind mast cell in the airways. When exposed to the allergen IgE antigen
binding causing causes mast cells degranulation and release of inflammatory mediators.
The result is an intense inflammatory response in the airways.
Type 1 hypersensitivity reaction and to extrinsic antigen.
It occurs in atopic individual. IgE former to some things like dust.
Serum IgE level increases.
2. Intrinsic or Non-Atopic Asthma
In adults, External allergens play no part, these things can trigger bronchospasm such as
pulmonary viral infection, aspirin, psychological stress and exercise.

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 Serum IgE level is normal.
No involvement of type 1 hypersensitivity

GRADES/STAGES ACCORDING TO SEVERITY

Asthma can be divided into four stages. Grading is based on how frequently symptoms occur,
how severe they are when they occur, and your overall health.
The four stages of asthma are:
1. Mild intermittent asthma. Mild symptoms of asthma occur no more than two days per
week or two times per month.
2. Mild persistent asthma. Mild symptoms occur more often than twice per week.
3. Moderate persistent asthma. Increasingly severe symptoms of asthma occur daily and at
least one night each week. Flare-ups also last several days.
4. Severe persistent asthma. At this stage, symptoms occur several times per day almost
every day. You may also experience symptoms many nights each week. This stage of
asthma may not respond well to treatment.
Moderate persistent asthma isn’t as common as mild intermittent or mild persistent asthma.
The least common type of asthma is severe persistent asthma.

PATHOPHYSIOLOGY
The underlying pathophysiology in asthma is reversible and diffuse airway inflammation that
leads to airway narrowing.
Activation: When the mast cells are activated, it releases several chemicals
called mediators.
Perpetuation: These chemicals perpetuate the inflammatory response, causing
increased blood flow, vasoconstriction,, fluid leak from the vasculature, attraction of
white blood cells to the area, and bronchoconstriction.
Bronchoconstriction: Acute bronchoconstriction due to allergens results from a release
of mediators from mast cells that directly contract the airway.
Progression: As asthma becomes more persistent, the inflammation progresses and other
factors may be involved in the airflow limitation.

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“OR”

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RISK FACTORS
A number of factors are thought to increase chance of developing asthma. These includes:
Having a blood relative such as a parent or sibling with asthma
Being overweight
Having an allergic condition such as atopic dermatitis or hay fever
Being a smoker
Having a mother who smoked while pregnant
Low birth weight

CAUSES
Despite increased knowledge on the pathology of asthma and the development of improved
medications and management plans, the death rate from the disease continues to rise. Here
are some of the factors that influence the development of asthma.
Allergy: Allergy is the strongest predisposing factor for asthma.
Chronic exposure to airway irritants: Irritants can be seasonal (grass, tree, and weed
pollens) or perennial (mold, dust, roaches, animal dander).
Exercise: Too much exercise can also cause asthma.
Stress/ Emotional upset: This can trigger constriction of the airway leading to asthma.
Medications: Certain medications can trigger asthma.
Allergens or triggers: Common asthma triggers include:
o Animals (pet hair or dander)
o Dust
Pollen Changes in weather (cold weather)
Respiratory infections(common cold) Chemicals in the air or in food
Strong emotions (stress) Exercise
Tobacco smoke Mold

CLINICAL MANIFESTATIONS
The signs and symptoms of asthma can be easily identified:
Most common symptoms of asthma are cough (with or without mucus production),
dyspnea, and wheezing (first on expiration, then possibly during inspiration as well).
Cough: There are instances that cough is the only symptom.
Dyspnea: General tightness may occur which leads to dyspnea.

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Wheezing: There may be wheezing, first on expiration, and then possibly during
inspiration as well.
Shortness of breath and Chest tightness
Asthma attacks frequently occur at night or in the early morning.
As exacerbation progresses, central cyanosis secondary to severe hypoxia may occur.
Additional symptoms, such as diaphoresis, tachycardia, and a widened pulse pressure,
may occur.
Exercise-induced asthma: maximal symptoms during exercise, absence of nocturnal
symptoms, and sometimes only a description of a “choking” sensation during exercise.

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PREVENTION
Patients with recurrent asthma should undergo tests to identify the substances that precipitate
the symptoms.
Allergens: Allergens, either seasonal or perennial, can be prevented through avoiding
contact with them whenever possible.
Get vaccinated for influenza and pneumonia: Staying current with vaccinations can
prevent flu and pneumonia from triggering asthma flare-ups.
Knowledge: Knowledge is the key to quality asthma care.
Evaluation: Evaluation of impairment and risk are key in the control.

COMPLICATIONS
Complications for asthma include the following:
Status asthmaticus: Airway obstruction in status asthmaticus often results in hypoxemia.
Respiratory failure: Asthma, if left untreated, progresses to respiratory failure.
Pneumonia: Mucus that pools in the lungs and becomes infected can lead to the
development of pneumonia.

DIAGNOSTIC STUDY AND EVALUATION

To determine the diagnosis of asthma, the clinician must determine that episodic symptoms
of airway obstruction are present.
Allergy testing: may be helpful to identify allergens in people with persistent asthma.
The doctor or nurse will use a stethoscope to listen to the lungs. Wheezing or other asthma-
related sounds may be heard. However, lung sounds are usually normal between asthma
episodes.
Positive family history: Asthma is a hereditary disease, and can be possibly acquired by
any member of the family who has asthma within their clan.
Environmental factors: Seasonal changes, high pollen counts, mold, pet dander, climate
changes, and air pollution are primarily associated with asthma.
Arterial blood gas
Blood tests to measure eosinophil count (a type of white blood cell) and IgE
Chest x-ray
Lung function tests

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MEDICAL MANAGEMENT
Immediate intervention may be necessary, because continuing and progressive dyspnea leads
to increased anxiety, aggravating the situation.
Short acting beta-agonists: Albuterol (Ventolin)
Corticosteroids: Prednisone, Beclomethasone for short term therapy
Anticholinergic agents: Atrovent
Mast-cell inhibitors: (Cromolyn)
Leukotriene modifiers: montelukast (Singulair)
Inhaled steroids: ( Advair, Pulmocort, Azmacort)
Theophylline

PEAK FLOW MONITORING

Peak flow meters: Peak flow meters measure the highest airflow during a forced
expiration.
Daily peak flow monitoring: This is recommended for patients who meet one or more of
the following criteria: have moderate or severe persistent asthma, have poor perception of
changes in airflow or worsening symptoms, have unexplained response to environmental
or occupational exposures, or at the discretion of the clinician or patient.
Function: If peak flow monitoring is used, it helps measure asthma severity and, when
added to symptom monitoring, indicates the current degree of asthma control.

NURSING MANAGEMENT
Nursing Diagnosis:
Ineffective airway clearance related to airway spasm, secretion retention, amount of
mucus.
Ineffective breathing pattern related to spasm of the airway, respiratory muscle fatigue.
Impaired gas exchange related to bronchospasm, damage to the alveoli.
Activity intolerance related to imbalance of oxygen supplied to the needs

NURSING INTERVENTIONS
The nurse generally performs the following interventions:
Assess history: Obtain a history of allergic reactions to medications before administering
medications.
Assess respiratory status: Assess the patient’s respiratory status by monitoring
the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.

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Assess medications: Identify medications that the patient is currently taking. Administer
medications as prescribed and monitor the patient’s responses to those medications;
medications may include an antibiotic if the patient has an underlying
respiratory infection.

Pharmacologic therapy: Administer medications as prescribed and monitor patient’s

responses to medications.

Fluid therapy: Administer fluids if the patient is dehydrated.

Assess respiratory status every hour during acute phase: lung sounds, respiratory rate and
depth, presence and severity of wheezing, breathing pattern, use of accessory muscles.
Assist patient to assume to comfortable position, i.e. elevate head of bed, have client lean
on overbed table or sit on the edge of bed.
Keep environmental pollution to a minimum according to individual situation.
Encourage and assist abdominal and pursed – lip breathing exercises.
Increase fluid intake to 3000ml/ day within cardiac tolerance.
Provide warm liquids and recommend intake of fluids between meals, instead of during
meals.
Administer medications as indicated.
Monitor side effects of bronchodilator (tremors/ tachycardia).
Provide supplemental humidification, e.g., neutralizer in respiratory treatments.
Monitor ABGs, pulse oximetry, chest x- ray.
Assist parents in eliminating allergens or other stimuli that trigger attack.
Meal planning to eliminate allergic food.
Removal of pets.
Modification of environment (allergy proof) home especially no smoking in home. Avoid
extremes of environmental temperature.

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REFERENCES

https://en.wikipedia.org/wiki/Asthma
www.webmd.com/asthma
www.mayoclinic.com
https://www.youtube.com/watch?v=4aK76DoxKGk
https://nurseslabs.com/asthma/#Description
https://nurseslabs.com/asthma/#Nursing-Management

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