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

Nursing Interventions and Rationales Nursing Care Plan (NCP) for Asthma / Childhood Asthma

• Assess respiratory status

• Monitor peak flow rates in children over 5 years old. Pulmonary function testing

• Assess the patient’s level of anxiety and provide relaxation techniques

• Position upright

• Administer medications via nebulizer

• Educate patient and parents/caregivers on how and when to use medications and rescue inhalers (age-appropriate)

• Assist parents and providers in the creation of an Asthma Action Plan for school or daycare

• Provide education for patients/parents regarding the use of maintenance medications and how to recognize and avoid triggers

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