Introduction to Nursing Care Plan (NCP) for Asthma

Definition of Asthma

Asthma is a chronic respiratory condition characterized by bronchoconstriction, inflammation of airways, and increased mucus production. These factors collectively narrow the air passages, reducing the ability to bring air into the alveoli, and subsequently impairing the exchange of oxygen and carbon dioxide.

Asthma can lead to significant respiratory distress, hypoxia, and decreased overall quality of life. Understanding the pathophysiology, etiology, and appropriate nursing interventions for asthma is crucial for nurses in order to provide optimal care and support for individuals affected by this condition.

Triggers for Asthma

While asthma is not always preventable, identifying and managing its triggers can significantly improve a patient’s quality of life and reduce the frequency and severity of asthma attacks.

A helpful mnemonic for remembering common asthma triggers is:

ASTHMA

A – allergens (seasonal, animal, food)

One of the most well-known triggers for asthma is exposure to allergens. Allergens are substances that can stimulate an allergic reaction in some individuals, leading to airway inflammation and bronchoconstriction. Seasonal allergens, such as pollen from trees, grasses, and weeds, are notorious culprits, often causing “seasonal allergies” or allergic rhinitis. Additionally, allergens from animals, particularly pet dander, saliva, and urine, can trigger asthma symptoms. Foods can also be asthma triggers, with common culprits including peanuts, tree nuts, shellfish, and dairy products.

S – sports or smoking

Physical activity, particularly in cold or dry environments, can trigger asthma symptoms in some individuals. This phenomenon, known as exercise-induced bronchoconstriction (EIB) or exercise-induced asthma (EIA), occurs due to the loss of heat and moisture from the airways during heavy breathing. Smoking and exposure to secondhand smoke are well-established asthma triggers. Cigarette smoke contains numerous irritants that can worsen airway inflammation and lead to more severe asthma symptoms.

T – temperatures (change in season, cold air)

Cold air, in particular, is known to induce bronchoconstriction in individuals with sensitive airways. This is often exacerbated during the winter months when people spend more time indoors with indoor heating systems that can dry out the air.

H – hazards (chemicals)

Common indoor irritants include household cleaning products, perfumes, and strong odors. Outdoor air pollution, including particulate matter and ozone, can also be asthma triggers. Occupational exposures to specific chemicals or allergens in the workplace can lead to occupational asthma, a form of asthma that develops or worsens due to workplace conditions.

M – microbe (infection)

Respiratory infections, particularly viral infections like the common cold and influenza, are well-known asthma triggers. Infections can cause airway inflammation and increase mucus production, exacerbating asthma symptoms.

A – anxiety

Emotional factors, including anxiety and stress, can contribute to asthma symptoms. When a person experiences anxiety or heightened stress levels, their breathing pattern may change, leading to shallower and faster breathing. This altered breathing pattern can trigger or worsen asthma symptoms, emphasizing the mind-body connection in asthma management.

Pathophysiology For Asthma

Asthma’s pathophysiology revolves around three primary mechanisms: bronchoconstriction, inflammation, and increased mucus production. These processes collectively contribute to the narrowing of air passages, reducing the efficiency of oxygen exchange and causing difficulties in breathing.

Bronchoconstriction: In asthma, the smooth muscles surrounding the airways undergo spasms or contractions, leading to bronchoconstriction. This narrows the air passages and restricts the flow of air into the alveoli—the tiny air sacs in the lungs where oxygen is absorbed into the bloodstream.

Bronchoconstriction significantly reduces the patient’s ability to inhale adequate amounts of oxygen.

Inflammation: Chronic inflammation of the airways is a hallmark of asthma. In response to irritants or triggers, such as dust, pollen, smoke, or infection, the airway lining becomes inflamed. This inflammation further narrows the air passages and leads to the production of excess mucus. Inflammation can also make the airway walls thicker, increasing the resistance to airflow.

Increased Mucus Production: The inflammatory response in asthma prompts the airway epithelial cells to produce excessive mucus. This mucus accumulates within the airways, further obstructing airflow.

The combination of bronchoconstriction, inflammation, and mucus production creates a hostile environment for efficient gas exchange.

Etiology For Asthma

Asthma can have various etiological factors, including genetic, environmental, and trigger-related causes. Understanding these factors is essential for effective asthma management.

Genetic Factors for Asthma: Genetic predisposition plays a significant role in asthma development. Individuals with a family history of asthma are more likely to develop the condition themselves. Specific genetic markers and variations are associated with an increased susceptibility to asthma.

Environmental Factors Leading to Asthma: Environmental factors can also contribute to asthma. Exposure to allergens and irritants such as pollen, dust mites, smoke, or air pollution can trigger asthma symptoms in susceptible individuals. Additionally, indoor air quality, humidity levels, and exposure to secondhand smoke can impact asthma severity.

Triggers that lead to asthma: Asthma can be triggered by a wide range of factors, including respiratory infections, exercise, and allergies. Respiratory infections, such as viral or bacterial infections, can exacerbate asthma symptoms by increasing airway inflammation. Physical activity, while generally beneficial, can trigger exercise-induced bronchoconstriction in some individuals with asthma. Allergies to substances like pollen, animal dander, or certain foods can also provoke asthma attacks.

Desired Outcome For Asthma

The primary goal in managing asthma is to achieve a desired outcome that includes:

1. Decreased Work of Breathing: Patients should experience reduced respiratory distress, making breathing easier and less labored.
2. Adequate Ventilation and Oxygenation: Ensuring that patients can inhale and exhale effectively, facilitating sufficient oxygen intake, and the removal of carbon dioxide.
3. Perfusion of Oxygen-Rich Blood to Tissues: Optimizing oxygen saturation in the bloodstream, ensuring that vital organs and tissues receive an adequate supply of oxygen.

Asthma Nursing Care Plan (NCP)

To achieve the desired outcome for asthma management, nurses play a crucial role in assessing patients, implementing interventions, and providing education and support. The following nursing care plan outlines the essential elements of care for individuals with asthma.

Nursing Interventions and Rationales For Asthma

Check Pulse Oximetry:

Apply oxygen if O2 saturation is less than 90%, starting at 2 liters nasal cannula (2L NC).

Rationale: Monitoring oxygen saturation levels is critical to assess the patient’s oxygenation status. Applying supplemental oxygen helps alleviate hypoxia and ensures the patient receives adequate oxygen. Oxygen therapy is a safe and effective intervention, but it should be administered cautiously and adjusted as needed.

Auscultate Lung Sounds:

If wheezing is present, consider administering a bronchodilator. If crackles or rhonchi are heard, pneumonia may be suspected, and suctioning may be necessary.

Rationale: Auscultating lung sounds provide valuable information about the patient’s respiratory status. Wheezing indicates airway constriction, while crackles or rhonchi may suggest airway secretions or infection. Prompt intervention is essential to manage these issues effectively.

Educate About Triggers:

Ensure the patient’s environment is free from asthma triggers, such as dust, pollen, or smoke.

Rationale: Identifying and eliminating triggers is a fundamental aspect of asthma management. Educating patients about their specific triggers empowers them to take proactive measures to minimize exposure, thus reducing the risk of asthma exacerbations.

Positioning the Patient in an Upright Position:

Rationale: Placing the patient in an upright position helps open the lung bases and airway, making it easier for the patient to breathe. This position can alleviate respiratory distress and improve oxygenation.

Have the Patient Perform a Peak Flow Meter:

Rationale: Peak flow meters are valuable tools for monitoring asthma severity. They measure the patient’s ability to exhale air forcefully, providing an objective assessment of lung function. A decrease in peak flow readings may indicate worsening asthma, prompting the need for intervention.

Breathing Treatments and Medication Therapy:

• Beta-Agonists (e.g., albuterol) work as bronchodilators.
• Anticholinergics (e.g., Ipratropium) relax bronchospasm.
• Corticosteroids (e.g., Fluticasone) act as anti-inflammatories.

Rationale: Medications play a pivotal role in asthma management. Bronchodilators help relieve bronchoconstriction, while anti-inflammatories reduce airway inflammation. Administering the appropriate medications as prescribed is essential for symptom control and improved lung function.

Be Prepared with an Airway Cart for Critical Cases:

Rationale: In severe asthma aggravations, especially in pediatric patients or those who have been struggling to breathe intensely for an extended period, it is important to be prepared with an airway cart. This proactive approach ensures patient safety and allows for prompt intervention.

It is also important to involve respiratory therapists promptly, as they possess expertise in managing complex respiratory cases. Securing the airway should not be delayed, as an impending airway closure can lead to life-threatening situations. In certain instances, sedation and intubation may be necessary to address respiratory acidosis or alkalosis and stabilize the patient’s condition.

***Safety*** You do not want to wait until the impending airway closure happens to try to secure their airway. Sometimes the patient will be sedated and intubated to try to correct any respiratory acidosis or alkalosis.

Linchpin On Nursing Care Plan (NCP) For Asthma

Asthma is a multifaceted respiratory condition with complex pathophysiological mechanisms and various contributing factors. Effective management of asthma involves a comprehensive approach, encompassing a thorough understanding of its pathophysiology, identification of triggers, and the implementation of tailored nursing interventions.

By combining both subjective and objective data, you can provide patient-centered care that addresses the unique needs of individuals living with asthma. This comprehensive nursing care plan outlines essential interventions that aim to reduce respiratory distress, enhance oxygenation, and promote overall well-being.

Through a collaborative effort involving healthcare providers, patients, and their families, individuals with asthma can achieve improved clinical outcomes, increased comfort, and a higher quality of life. By adhering to evidence-based guidelines and tailoring care to each patient’s specific needs, nurses play a crucial role in helping individuals with asthma manage their condition effectively and live healthier lives.

References

• http://www.lung.org
• http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/measuring-your-peak-flow-rate.html
• http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/asthma-symptoms-causes-risk-factors/what-causes-asthma.html
• https://www.uptodate.com/contents/management-of-acute-exacerbations-of-asthma-in-adults