CARING FOR THE PATIENT
WITH ASTHMA
Horace Williams (MScN)
Hyacinth Chen School of Nursing
NCU
Objectives
At the end of the interactive period, students
will be able to:
• Define the term Asthma according to Smelzter,
Bare, Hinkle and Cheever, (2010)
• Explain the Etiology/Risk
factors/Pathophysiology for Asthma as stated by
Smelzter et al (2010)
• Describe the manifestation of Asthma as cited by
Pellico (2013)
• State the diagnostic test/Lab test used in the
diagnosis of Asthma according to Chernecky,
(2013); Berger (2013) and (NHLB), (2013)
• Describe the general management for clients
with Asthma as explained by Pellico and Berger
(2013)
• Discuss the nursing management for
clients with Asthma utilizing the nursing
process
What is Asthma?
• A common, complex disease of the airways
characterized by recurring and variable
symptom, airflow obstruction and bronchial
hyper-responsiveness
(Pellico, 2013)
Etiology, Risk factor and
Pathophysiology of Asthma,
what are those?
• Asthma’s pathophysiology is characterized by a
reversible and diffusive airway limitation.
• Acute inflammation leads to airflow limitation and
changes in the airways.
• Broncho-constriction, which is constriction of
smooth muscles of the airway, occurs in
response to a variety of allergens and irritants
Smeltzer et al., 2010)
• The airways become hyper-responsive (respond
to stimuli in an exaggerated way).
• Airway edema (swelling of the membranes that
line the airway) becomes more progressive as
severity increases
• Mucus hyper-secretion and plug occurs
• In some cases remodeling can occur
• (permanent narrowing (changes) in the airway
structure) causing fibrosis and scarring (resulting in
irreversible CAL)
• Cellular elements such as mast cells, neutrophils,
eosinophils, and lymphocytes are implicated. They
release chemical mediators such as histamine,
bradykinnin, prostaglandin and leucotrienes
• Leaks into airway, attract WBC-constriction
(Smeltzer et al.,203)
Risk Factors-
• Atopy – the genetic predisposition for the
development of IgE-mediated response to
allergens, is the most common identifiable risk
factor.
• Allergens can be seasonal (grass, tree and flower
pollen) or perennial (mold, dust, animal feaces)
• Asthma has as a genetic component, which is
not clear.
• Exposure to environmental factors such as
airborne allergens, viral respiratory infections are
associated with increased incidents
• Exposure to smoke, air pollution and diet
(cheese, chocolate)
• Exercise, stress, emotions, menses, pregnancies
and thyroid disease could also trigger attacks
(Pellico, 2013)
Does Asthma have specific
signs and symptoms?
• The most common symptoms are: cough,
dyspnea, and wheezing
• Generally occurs at nights or early morning due
to circadian variation that influence airway
receptor thresholds
• Usually begins abrupt, with cough with or without
mucus production (when present it is thick and
viscous and cannot be coughed up).
• Chest tightness and dyspnea then occurs.
Expiration requires effort and become prolonged
• As this progress diaphoresis, tachycardia and
widened pulse pressure may occur with
hypoxemia and central cyanosis (late sign of
poor oxygenation)
• This is followed by wheezing on expiration and
possibly inspiration
Diagnostic Tests, what are
those?
Family and Medical History:
• The doctor/nurse may ask about family history of
asthma allergies, triggers, symptoms and when and
how often they occur
(NHLB, 2013).
Physical Exam:
• The doctor will listen to the client’s breathing and
look for signs of asthma or allergies. These
signs include wheezing, a runny nose or swollen
nasal passages, and allergic skin conditions
(such as eczema)
(NHLB, 2013)
DIAGNOSTIC TESTS
Lung Function Test:
• Spirometry - used to check how your lungs are
working. This test measures how much air you
can breathe in and out. It also measures how
fast you can blow air out.
• If the result is poor, the client may be given
medication and then retest to see whether the
results have improved.
• If the test results are lower than normal and
improve with the medication, and if the medical
history shows a pattern of asthma symptoms,
the doctor will likely diagnose the client with
asthma
(Chernecky et al., 2013 & NHLB, 2013)
Other Tests:
Other tests may include:
• A test to measure how sensitive the airways are.
This is called a broncho-provocation test.
• Using Spirometry, this test repeatedly measures
lung function during physical activity or after you
receive increasing doses of cold air or a special
chemical to breathe in.
(Chernecky, 2013)
• A test to show whether the clients have another
condition with symptoms similar to asthma, such
as reflux disease, vocal cord dysfunction, or
sleep apnea (NHLB, 2013).
• A Chest x ray or an EKG (electrocardiogram).
These tests will help find out whether a foreign
object in the airways or another disease might
be causing the client’s symptoms (Chernecky, 2013)
•
General Management of
Asthma what
does it involve?
Goal
• To prevent chronic troublesome symptoms
• Maintain near normal pulmonary function
• Maintain normal activity
• Prevent recurrent exacerbations
• To meet patient’s and families’ expectation of
care
(Pellico, 2013).
PHARMACOLOGICAL MANAGEMENT
• Short-Acting B2 Agonists – Albuterol –
interacts with B2 receptors in bronchial smooth
muscles resulting in relaxation of bronchial
smooth muscles thus reducing bronchospasm
and airway resistance
• Long –Acting B2 Agonist – Salmeterol – acts
similar to Albuterol, has slower onset and longer
duration
• Anticholinergic – Atrovent/Atropine – used for
maintenance (drying secretions)
• Methylxanthines – Theophilline, Aminiphilline –
prevention and treatment of asthma (especially status
asthmaticus)
• Corticosteroids – Prednisone – reduce edema and
inflammation
(McKenry et al., 2006)
Nursing Management of
Asthma entails?
• Mrs. Jones is brought to the UHWI’s Emergency
room with SOB, Dyspnea, and use of accessory
muscles, thick viscous secretions crackling
cough and frightened look on her face. She
complained of being unable to sleep . Her vital
signs revealed: T 37. 2 C; P100bpm; R32bpm;
B/P100/65..She is diagnosed with an acute
asthmatic attack. You are asked to outline the
Nursing Management for her under the
following needs:
• -Oxygenation (12 marks)
• -Psychosocial (10 marks)
EVALUATION
Questions
• Define the term Asthma
• Explain one risk factor for asthma
• Describe three (3) manifestations of Asthma
• Name three (3) classes of medications used to
manage Asthma
• Give two diagnosis and two interventions with
rationales
Answers
• Defined as a common, complex disease of the
airways characterized by recurring and variable
symptom, airflow obstruction and bronchial
hyper-responsiveness
• Allergens can be seasonal (grass, tree and
flower pollen) or perennial (mold, dust, animal
feaces).
• Atopy – the genetic predisposition for the
development of IgE- (immunoglobulin E)
mediated response to allergens, is the most
common identifiable risk factor.
• Asthma has as a genetic component, which is
not clear.
• Exposure to environmental factors such as
airborne allergens, viral respiratory infections
are associated with increased incidents.
• Exposure to smoke, air pollution and diet
(cheese, chocolate).
• Exercise, stress, emotions, menses,
pregnancies and thyroid disease could also
trigger attacks
(Pellico, 2013)
• Cough, dyspnea, and wheezing, cough with or
without mucus production, Chest tightness,
dyspnea then occurs, diaphoresis,
tachycardia and widened pulse pressure may
occur with hypoxemia and central cyanosis
• Short-Acting B2 Agonists, Long –Acting B2
Agonist, Anticholinergic, Methylxanthines
• Ineffective Breathing Pattern/Ineffective Airway
Clearance (See Care Plan)
