Asthma is a chronical condition which is very common, in children especially. It is caused by chronical inflammation of the mucous membrane of the breathing organs, bronchoconstriction, which is a tightening of the smooth muscle, and a secretion of thick mucus which can clog the airway, making it hard to breathe.
Asthma can be seen in a lot of forms, from mild to more severe ones called asthmatic attacks which are life-threatening conditions where a person can have trouble breathing to the point that it endangers life. It can happen in the middle of the night, while laughing, eating chocolate. Some people can live with more mild ones where they can control their condition with an upfront learned behavior. Asthma is not treatable, but there were some cases where during puberty, the condition turned to milder forms.
Complications of an asthma attacks are:
- Status Asthmaticus where the attack is prolonged and it lasts more than 24 hours
- Respiratory failure
- Right heart disease or Cor pulmonale
What Does Nursing Diagnosis Stand For?
Nursing diagnosis is a bit different from medical diagnosis, where the nursing diagnosis is based on a patient’s condition and the potential complications during the disease. It is based on symptoms and how to provide the best outcome with further nurse interventions in their fields of competences.
This is caused by bronchospasm, which means constriction of the smooth muscles of the trachea and other, smaller airways. This is due to secretion of the leukotriene, which are an active component of the leucocytes. They play an important role in an asthma attack, where they trigger muscle constriction leading to heavy breathing and narrowing down the airway. This heavy breathing is usually heard like wheezing and it has characteristic sound especially in exhale part of the breath. Other important substances that play a key role in muscle contraction are eosinophils, which are mostly present in an atopic asthma attack, triggered with some allergic reaction. This kind of reaction can cause any respiratory substance like dust, mites, plumage and others.
Another thing that contributes to ineffective airway clearance is mucus synthesis, which can clog already narrowed airways, leading to more airway blockade.
- Breathing difficulty or dyspnea
- Cold sweat
- Respiratory depth and frequency change
- Chest tightness
- Altered consciousness
- Wheezing sound of breathing
- Using accessory muscles of the chest with intercostal indentation and nostril movement
- Show the patient postural drainage position where they lean forward which improves expectoration (semi-Fowler position)
- Persuade the patient to use his diaphragmatic breathing and show him some breathing exercises
- Give the patient proper medication and assist in using nebulizer if needed
- Teach the patient to recognize the signs of pre-asthma attack and list the things he should avoid (cigarette smoke, fume, irritating aerosols and other)
Ineffective Breathing Pattern
Due to the presence of the allergens or respiratory irritants, the bronchoconstriction and mucus production can cause breathing disorders which can lead to ineffective breathing pattern.
- Rapid breathing
- Shallow breathing
- Chest tightness
- Fast pulse
- Altered consciousness
- Putting the patient into a position with elevated head so he/she could breathe easier, use some pillows and elevate the hands too
- Limit patients activity and advise him/her to rest
- Auscultate the breathing sounds in search for wheezing and access his breathing pattern
- Use pulse oximetry for the monitoring of oxygenation
- Hydrate the patient and trace his vital signs
Compromised Gas Exchange
Due to mucus and constriction, a lot of respiratory surfaces is being compromised. Since this inhale/exhale irregularities, the blood vessels in the lungs don’t get to exchange enough oxygen for the body, so there is V/Q or ventilation/perfusion irregularity where perfusion is lower than normal and it leads to cyanosis. This can be diagnosed with spirometry and FEV1 parameter lower than 75%, and FEV1/FVC is less than 0.7.
- Short breath
- Fast and shallow breathing
- Blood gases change (hypoxaemia, hypercapnia)
- Fast pulse
- Change of consciousness
- Adapt the patient’s breathing depth, rhythm, and rate with oxygen therapy
- Auscultate breathing sounds for pathological wheezing
- Keep the patient lying down with elevated upper part of the body
- Hydrate enough
- Track the blood gasses through pulse oximetry
- Monitor vitals signs
- Give oxygen through a nasal or face mask canul
- The flow of 1-6 liters / minute oxygen concentration produces 24-44%
- The flow of 5-8 liters / minute oxygen concentration produces 40-60%
- The flow of 8-12 liters / min oxygen concentration produces 60-80%
- The flow of 8-12 liters / min oxygen concentration producing 90%
When using accessory muscles for breathing, it could end up in weakness if it prolonged.
- Inability for everyday routine
- Lack of energy
- Lack of verbal communication and concentration
- Talk to the patient about his physical activities and limit to his/hers ability
- Track the patients vitals signs
- Monitor the patient symptoms before and after activity
- Create the schedule for activity and rest
- Avoid upsetting the patient with unpleasant topics and create an environment for resting
Decreased Activity Tolerance
Lack of the oxygen in the body can lead to weakness in the muscles. This is a sign of a low perfusion inside the lungs where the lungs don’t produce enough gas exchange for body needs.
- General weakness
- Slower moves
- Painful inhale/exhale
- Quick tiring
- Free the airway (suction)
- Monitor breathing movement
- Monitor level of oxygen
- Auscultate the lung sounds
- Encourage the patient to rest and drink hot drinks
- Position the patient into semi-Fowler position for elevation
The patient can be scared of death and suffocation due to lack of oxygen, where he can be restless, and can further compromise breathing pattern.
- Talking and calming down the patient
- Explain each procedure for him to understand and to calm him down
- Instruct the patient to have accompanied of family or friends while asthma attack
- Turn his attention to other things
- Make some relaxing position for the patient
- Make a relaxed expression when talking, with a right posture and calming voice
- Explain to the patient that he/she should eat smaller and more frequent portions
- Create a calming atmosphere while eating
- Talk to nutrition about daily intake plan