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mucosal edema resulting in reversible airflow obstruction. Allergens, air pollutants, cold weather, physical exertion,
strong odors, and medications are common predisposing factors for asthma. When an individual is exposed to a
trigger, an immediate inflammatory response with bronchospasm happens. This inflammatory process leads to
recurrent episodes of asthmatic symptoms such as cough, dyspnea, wheezing, and increased mucus production.
Status asthmaticus is severe and persistent asthma that does not respond to usual therapy; attacks can occur with
little or no warning and can progress rapidly to asphyxiation.
The nursing care plan focuses on preventing the hypersensitivity reaction, controlling the allergens, maintaining airway
patency and preventing the occurrence of reversible complications.
Here are four (4) nursing care plans (NCP) for bronchial asthma:
Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation
May be related to
Swelling and spasm of the bronchial tubes in response to inhaled irritants, infection, drugs, allergies
or infection.
Possibly evidenced by
Cough.
Cyanosis.
Dyspnea.
Loss of consciousness.
Nasal flaring.
Prolonged expiration.
Respiratory depth changes.
Tachypnea.
Use of accessory muscles.
Desired Outcomes
Client will maintain optimal breathing pattern, as evidenced by relaxed breathing, normal respiratory rate or
pattern, and absence of dyspnea.
Paradoxical pulse is an
abnormally large decrease in
systolic bloodpressure and
Assess the presence of pulses wave amplitude during
paradoxical pulse of 12 mm Hg inspiration. The normal fall in
or greater. pressure is less than 10 mm
Hg. A paradoxical pulse of 12
mm Hg or greater indicates a
severe airflow obstruction.
During a mild to
moderate asthmaattack, clients
may develop respiratory
Monitor arterial blood gasses alkalosis. Hypoxemia leads to
(ABG). increased respiratory rate and
depth, and carbon dioxide is
blown off. An ominous finding
is a respiratory acidosis, which
usually indicates that
respiratory failure is pending
and that mechanical
ventilation may be necessary.
Short-acting beta-2-adrenergic
Short-acting beta2-agonists are
agonist.
bronchodilators. They relax the
muscles lining the airways that
Albuterol (Proventil, Ventolin).
carry air to the lungs;
Levalbuterol (Xopenex).
treatment of choice for acute
Terbutaline (Brethine).
exacerbation of asthma.
Inhaled Corticosteroids. Corticosteroids reduce
inflammation in the airways
Budesonide (Pulmicort). that carry air to the lungs and
Fluticasone (Flovent). reduce the mucus made by the
Beclomethasone (Vancenase). bronchial tubes. Inhaled
Mometasone (Asmanex Twisthaler). steroids should be given after
beta-2-adrenergic agonist.
Anticipate the need for alternative treatment if life-threatening
bronchospasm continues:
General anesthesia is used
when there is both dynamic
General anesthesia. hyperinflation and profound
hypercapnia that cannot be
corrected by increasing minute
ventilation.
Magnesium sulfate has
Magnesium sulfate. bronchodilating and anti-
inflammatory effects that are
sometimes used in the
treatment of moderate to
severe asthma in children.
The use of helium (a less dense
Heliox (a helium-oxygen mixture). gas than nitrogen) causes
decrease airway resistance thus
lessens the work of breathing.