Nursing Care Plan (NCP) for Asthma / Childhood Asthma
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Lesson Objective for Nursing Care Plan (NCP) for Asthma / Childhood Asthma
What is Asthma?
Asthma is a condition where a person’s airways (the tubes that carry air in and out of the lungs) get inflamed and narrow. It’s like a straw that gets squeezed, making it hard to blow air through. This makes it difficult to breathe.
Childhood Asthma:
It’s the same as adult asthma but in kids. Kids might find it hard to play or do sports because of their asthma. It’s important to know what triggers a child’s asthma so they can avoid it.
Triggers:
Things like pollen, dust, smoke, or even cold air can trigger asthma. It’s like these triggers make the airways even more squeezed and irritated.
Symptoms:
Wheezing (a whistling sound when breathing), coughing, and feeling short of breath. Sometimes the chest may feel tight, like it’s hard to get air in.
Upon completion of this care plan, nursing students will be able to:
- Understand the pathophysiology of Childhood Asthma, including the inflammatory processes and airway hyperresponsiveness involved.
- Conduct a thorough nursing assessment of a child with asthma, identifying triggers, symptoms, and risk factors.
- Formulate and prioritize nursing diagnoses tailored to address acute exacerbations, long-term management, and preventive measures for childhood asthma.
- Develop evidence-based nursing interventions to manage acute asthma episodes, promote medication adherence, and educate children and caregivers on asthma self-management.
- Implement pediatric-focused assessment skills, such as monitoring respiratory status, assessing inhaler technique, and recognizing signs of respiratory distress in children.
Pathophysiology of Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Childhood asthma is a chronic inflammatory disorder of the airways that involves complex interactions between genetic, environmental, and immune factors. Here’s a simplified breakdown:
- Airway Inflammation:
- Triggers: Exposure to allergens or irritants, such as pollen, pet dander, or tobacco smoke, initiates an immune response in the airways.
- Inflammatory Cells: Inflammatory cells, particularly mast cells and eosinophils, become activated, releasing inflammatory mediators.
- Bronchoconstriction:
- Smooth Muscle Constriction: Inflammatory mediators cause smooth muscle constriction in the bronchioles, leading to the narrowing of the airways.
- Airway Hyperresponsiveness: The airways become overly sensitive, reacting to various stimuli with increased bronchoconstriction.
- Mucus Production:
- Goblet Cell Activation: In response to inflammation, goblet cells in the airways produce excess mucus.
- Airway Obstruction: Increased mucus and bronchoconstriction contribute to airway obstruction.
- Airway Remodeling:
- Chronic Inflammation: Persistent inflammation over time can lead to structural changes in the airways, known as airway remodeling.
- Submucosal Gland Hypertrophy: Increased size and number of submucosal glands contribute to long-term airway changes.
- Triggers and Exacerbations:
- Environmental Triggers: Exposure to environmental triggers, such as respiratory infections, exercise, or stress, can exacerbate asthma symptoms.
- Acute Exacerbations: The combination of inflammation, bronchoconstriction, and mucus production can result in acute exacerbations or asthma attacks.
Etiology for Nursing Care Plan (NCP) for Asthma / Childhood Asthma
While the exact cause of asthma is unknown, it is believed to be somewhat hereditary. Certain triggers can cause the worsening of symptoms, known as “asthma attacks”. Allergies are one of the most common triggers for asthma including dust, pollen, pet dander, and mold. Other triggers and lung irritants include smoke and perfume. Exercising, breathing cold air, or having a respiratory infection can also cause attacks.
Desired Outcome for Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Desired Outcomes:
- Asthma Symptom Control:
- Short-Term Goal: Achieve immediate relief and control of acute asthma symptoms.
- Interventions: Administer bronchodilators and anti-inflammatory medications as prescribed. Monitor respiratory status regularly.
- Reduced Frequency of Asthma Exacerbations:
- Intermediate-Term Goal: Decrease the frequency and severity of asthma exacerbations.
- Interventions: Develop and implement an asthma action plan with the child and caregivers. Provide education on trigger avoidance.
- Optimized Respiratory Function:
- Short-Term and Long-Term Goals: Improve and maintain optimal respiratory function.
- Interventions: Monitor peak flow measurements regularly. Educate on proper inhaler technique and encourage adherence to prescribed medications.
- Enhanced Medication Adherence:
- Intermediate-Term Goal: Ensure consistent adherence to prescribed asthma medications.
- Interventions: Provide education on the importance of medication adherence. Collaborate with the child and caregivers to address barriers to adherence.
- Effective Asthma Management Skills:
- Long-Term Goal: Develop and demonstrate effective asthma management skills.
- Interventions: Conduct regular education sessions on recognizing early signs of asthma exacerbations, proper inhaler use, and self-management strategies.
Asthma / Childhood Asthma Nursing Care Plan
Subjective Data:
- Tightness or pain in the chest
- Symptoms that are worse at night
- Frequent headaches
- Feeling weak or tired (especially later into an asthma attack)
Objective Data:
- Wheezing
- Cough
- Bronchospasms
- Tachypnea
- Tachycardia
- Retractions
- Dark circles under the eyes
- Tripod positioning
Nursing Assessment for Asthma / Childhood Asthma
- Respiratory Assessment
- Observe the child’s breathing pattern. Look for signs of difficulty breathing, like fast breathing (tachypnea), use of accessory muscles (muscles in the neck or between the ribs working hard to breathe), or wheezing sounds when breathing out.
- Listen to Lung Sounds
- Use a stethoscope to listen to the lungs. Wheezing (a high-pitched whistling sound), especially on exhalation, is a common finding in asthma.
- Check for Coughing
- Note if the child has a persistent cough, which may worsen at night or during exercise. The cough can be dry or may produce mucus.
- Observe for Chest Tightness
- Ask the child if they feel any tightness or pressure in their chest, which is a common symptom of asthma.
- Assess for Shortness of Breath
- Look for signs that the child is having trouble breathing or feels short of breath, especially after physical activity or during certain times (like at night).
- Identify Triggers
- Determine if there are any specific triggers that seem to worsen the child’s asthma, such as allergens (dust, pollen), irritants (smoke, strong odors), cold air, or exercise.
- Review Past Medical History
- Check if there is a history of asthma or allergies in the family. Also, review the child’s past medical history for any previous asthma attacks or hospitalizations.
- Assess Medication Use
- Inquire about any asthma medications the child is taking, such as quick-relief inhalers (like albuterol) or long-term control medications. Check how often they are using these medications and if they are using them correctly.
- Note Any Allergic Reactions
- Look for signs of allergies (like runny nose, itchy eyes, skin rashes) that can be associated with asthma.
- Monitor Peak Flow Readings
- If the child uses a peak flow meter (a device that measures how well air moves out of the lungs), review their readings. A lower reading than usual can indicate worsening asthma.
- Evaluate Activity Tolerance
- Assess if the child’s asthma is affecting their ability to participate in normal activities or play.
Nursing Interventions and Rationales Nursing Care Plan (NCP) for Asthma / Childhood Asthma
- Assess respiratory status
- Get a baseline to determine the effectiveness of interventions and course of treatment.
- During attacks, the patient will have tachypnea, wheezing and labored breathing, nasal flaring, and/or retractions
- Monitor peak flow rates in children over 5 years old. Pulmonary function testing
- In asthma, patients can inhale, but it is more difficult to exhale the air taken in. A peak flow meter measures the lungs’ ability to expel air and regular use can help recognize the signs of an attack before symptoms begin.
- Peak flow testing can help determine if treatment is working.
- Routine pulmonary function testing helps determine the course and progression of the disease
- Assess the patient’s level of anxiety and provide relaxation techniques
- Being unable to breathe causes anxiety which, in turn, causes even more constriction of the airways. Help the patient to learn coping and relaxation techniques to control breathing and help reduce the severity of the attack.
- Position upright
- Patients will need to sit upright to promote lung expansion and make air flow easier. Patients may often be found in the tripod position.
- Administer medications via nebulizer
- Bronchodilators and corticosteroids can help reduce inflammation and swelling which makes breathing difficult. A nebulizer works well to deliver an adequate amount of medication into the lungs.
- Educate patient and parents/caregivers on how and when to use medications and rescue inhalers (age-appropriate)
- Depending on the child’s age, an inhaler may be required for acute symptoms and before and after exercise. Demonstrate use of inhaler with spacer for children over 5 years old.
- Assist parents and providers in the creation of an Asthma Action Plan for school or daycare
- An asthma action plan helps the parents, school, and daycare providers to understand and control asthma in children.
- This plan outlines the patient’s known triggers and how to manage symptoms that arise. If the patient must take maintenance or rescue medications during school hours, this plan outlines the importance of that treatment and how to administer those medications.
- Provide education for patients/parents regarding the use of maintenance medications and how to recognize and avoid triggers
- Depending on the child’s age, the patient may use oral maintenance medications or daily inhalers. Proper use of these devices helps maximize the effectiveness of treatment.
- Help the patient to understand what triggers asthma attacks and how to avoid those situations.
- Help parents understand that lifestyle and environmental changes may be made, including pets in the home and exposure to cigarette smoke. Wash patient’s sheets/linens weekly to kill and prevent dust mites.
- Encourage routine immunizations to help prevent diseases that may make asthma worse.
Evaluation for Nursing Care Plan (NCP) for Asthma / Childhood Asthma
- Asthma Symptom Control:
- Expected Outcome: Immediate relief and control of acute asthma symptoms.
- Evaluation Criteria: Compare pre- and post-treatment respiratory assessments. Assess the child’s ability to articulate symptom improvement.
- Frequency of Asthma Exacerbations:
- Expected Outcome: Decreased frequency and severity of asthma exacerbations.
- Evaluation Criteria: Review asthma action plan documentation. Analyze the number and severity of exacerbations over time.
- Optimized Respiratory Function:
- Expected Outcome: Improved and maintained optimal respiratory function.
- Evaluation Criteria: Monitor peak flow measurements regularly. Compare current measurements with baseline values. Evaluate the child’s ability to perform daily activities without respiratory distress.
- Medication Adherence:
- Expected Outcome: Consistent adherence to prescribed asthma medications.
- Evaluation Criteria: Use medication logs and self-reports to assess adherence. Address any identified barriers to adherence.
- Effective Asthma Management Skills:
- Expected Outcome: Demonstration of effective asthma management skills.
- Evaluation Criteria: Observe the child and caregivers performing proper inhaler techniques. Conduct knowledge assessments to measure understanding of asthma management principles.
- Normal Physical Activity and Play:
- Expected Outcome: Ability to engage in normal physical activities and play.
- Evaluation Criteria: Assess the child’s participation in physical activities. Interview the child and caregivers about any perceived limitations.
- Regular Pediatric Check-ups:
- Expected Outcome: Regular follow-up pediatric appointments.
- Evaluation Criteria: Review attendance records for pediatric check-ups. Assess any adjustments made to the care plan based on evolving needs.
References
- https://www.webmd.com/asthma/children-asthma#1
- https://www.mayoclinic.org/diseases-conditions/childhood-asthma/in-depth/asthma-in-children/art-20044376
- https://kidshealth.org/en/parents/asthma-mgmt.html
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Transcript
We are going to create a care plan focusing on childhood asthma. Some of the patho behind childhood asthma, asthma is a chronic inflammation of the airways and it causes difficulty in breathing in about 6 million children across the country. The lining of the lungs gets inflamed, It starts to tighten, the smooth muscles contract, and air is not easily passed. Some of the things we want to consider as nurses is we want to do a good assessment of the respiratory status. We want to monitor those vital signs, focusing primarily on the heart rate and the oxygen saturation. We want to assess anxiety levels, administer some respiratory medications, such as steroids and inhalers, and we want to make sure we educate the parents and the patient on the proper use of rescue inhalers. Our desired outcome is for the patient to have adequate, uh, air exchange in the good respiratory status. The patients and the caregiver should be able to demonstrate how to use a nebulizer or an inhaler, and to manage the disease at home.
So, when you have a patient that comes in and presents with asthma, there are a few things that they’re going to say. One of the things that they are going to complain of is chest tightness. So, their chest is going to be really tight. They’re going to have some symptoms that typically are worse at night. Uh, they’re going to have a lot of headaches and they are also going to feel very weak and tired, especially, uh, as the asthma attack, uh, progresses. What we’re going to hear when we walk in and see the patient is we’re going to hear wheezing. We’re going to hear a lot of wheezing. Uh, the patient’s going to cough. We’re going to assess maybe some Bronchospasms.
Again, the breathing rate is going to be way up. So they’re going to have a respiratory rate well over a 20, they’re going to have tachycardia. You may see some retractions. They’re going to have some dark circles under eye, and they’re going to also get into the tripod positioning to kind of assist them with breathing a little better. So, some things that we can focus on as nurses, the first thing we want to do is we want to assess, remember assessment. We can get a lot of good information, so we’re going to assess and we’re going to get their baseline. So, when we do our assessment, we’re going to really focus on those lung sounds. Uh, again, the patient can have tachypnea, uh, wheezing, so, we want to make sure that we are able to see that and document that as, as it is. We want to make sure that we position this patient upright. Positioning is something that can really help open those lungs, expand those lungs and get that air moving.
Uh, patients again, tend to tripod when they are having some difficulty breathing, so if we position them upright, we can definitely keep that airflow going. We want to administer any medications that are ordered. So Bronchodilators, such as albuterol. It just helps reduce that inflammation kind of open up that airway and relax those contracted bronchial passageways. Um, we want to make sure that we use the nebulizer to deliver that medication into the lungs. The next thing we want to do is we want to assess the patient’s level of anxiety. When a person can’t breathe, they are anxious and that will drive up the respiratory rate. So, it’ll make the respiratory rate even higher and it will just make it more difficult to bring air into the lungs. We can kind of help them with some relaxing coping techniques, just calming their mind, some guided relaxation techniques. Okay. And finally, we want to make sure that we educate the parents. Education is key here. We want to educate the parents on the proper use of inhalers because any child that’s five years or older, we want to make sure that we use a spacer. I, so that way we can get all of the inhaler medication, uh, into the lungs properly.
Okay. So the key points for childhood asthma, remember it is a chronic inflammation of the airways and it makes it very difficult to breathe. Uh, some things that the patient is going to complain about is tightness of the chest, headaches, weakness. What we’re going to notice is we’re going to notice some objective data. We’re going to notice some wheezing, uh, increased heart rate, increased respiratory rate. They may have a cough as well as, uh, they may tripod. Asthma in school, the most important thing for parents to do, is to have a respiratory asthma action plan. This includes making sure that they have, uh, adequate inhalers at the school and what to do in case of an asthma attack outside of the home. It’s often exacerbated by activity, so, uh, kids playing at the playground tend to have asthma attacks. The next thing that we really want to focus on is we want to make sure we get a good respiratory assessment. Respiratory assessment frequently is going to ensure that we catch something that can go wrong. Remember, when the patient no longer wheezes, that’s an ominous sign because that just indicates that there’s no respiratory airflow, and that’s a respiratory emergency.
We love you guys. Go out and be your best self today and that’s always, happy nursing.
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