HOLY FAMILY NURSING AND MIDWIFERY TRAINING COLLEGE, TECHIMAN

ASTHMA

MEDICAL NURSING II

GROUP SIX
5/14/2015

DEFINITION, PATHOPHYSIOLOGY, CAUSES, SIGNS AND SYMPYOMS, DIAGNOSIS, MEDICAL AND

NURSING MANAGEMENT, COMPLICATIONS AND PREVENTIONS
Contents
DEFINITION OF ASTHMA....................................................................................2
CAUSES OF ASTHMA............................................................................................2
PATHOPHYSIOLOGY OF ASTHMA....................................................................2
CLINICAL FEATURES OF ASTHMA...................................................................3
DIAGNOSIS OF ASTHMA......................................................................................3
GOALS OF TREATMENT......................................................................................3
MEDICAL MANAGEMENT...................................................................................4
USING AN INHALER..............................................................................................4
NURSING MANAGEMENT...................................................................................4
Psychological care.................................................................................................4
Rest and Sleep........................................................................................................5
Observation............................................................................................................5
Nutrition.................................................................................................................6
Elimination.............................................................................................................6
Exercise..................................................................................................................6
Personal Hygiene...................................................................................................6
Medication..............................................................................................................7
COMPLICATIONS...................................................................................................7
PREVENTIONS OF ASTHMA................................................................................7
REFERENCES..........................................................................................................8

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DEFINITION OF ASTHMA
Asthma is a chronic inflammatory disease of the airways that causes airway
hyperresponsiveness, mucosal edema, and mucus production. Asthma can occur at any age and is
the most common chronic disease of childhood.

CAUSES OF ASTHMA
Asthma has no common cause but there are factors that can predispose individual to the
condition. These include;

 Allergy to pollens (Examples grass, tree and weed) or to perennial (Examples mold, dust,
roaches) and animal dander and antigen – antibody reaction.
 Infection such as viral respiratory heart infections.
 Airway irritant/Physical factors such as air pollution, cold, weather changes or sudden
change in temperature and barometric pressure, dust, chemicals (laundry detergents),
smoke, strong odour or perfumes.
 Exercise.
 Sinusitis with post nasal drip.

PATHOPHYSIOLOGY OF ASTHMA
The lungs of asthmatics are hypersensitive to stimuli that do not affect healthy lungs. Many
patients with asthma react to allergens such as pollen, dust mites, or animal dander, but colds,
viruses, and environmental irritants such as dust and pollution can also be triggers. During an
asthma attack, cells in the bronchial walls called mast cells release chemicals that force the
bronchial muscle to contract in spasms.

These chemicals, which include histamine, acetylcholine, and a group of substances called
leukotrienes, also bring white blood cells into the area, which is a key part of the inflammatory
response. This process also stimulates mucus formation. The entire process creates
bronchoconstriction. This inflammation ultimately leads to recurrent episodes of asthma
symptoms: cough, chest, tightness, wheezing, and dyspnea.

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CLINICAL FEATURES OF ASTHMA
 Episodes of coughing.
 Wheezing.
 Dyspnea.
 Feeling of chest tightness.
 Diaphoresis.
 Tachycardia.
 Hypoxemia and central cyanosis (a late sign of poor oxygenation).

DIAGNOSIS OF ASTHMA
 Peripheral blood test may disclose elevated eosinophils.
 Examination of nasal secretions and sputum.
 Pulmonary function studies may reveal diminished maximum breathing capacity, tidal
volume and forced expiratory volume.
 Arterial blood gas and PH analysis and pulse oximetry reveal hypoxemia during acute
phase.
 Chest X-ray may help to exclude other diseases.
 Signs and symptoms and physical examination may help in the diagnosis of the disease.

GOALS OF TREATMENT
 Prevent chronic and troublesome symptoms (eg, coughing or breathlessness in the night,
in the early morning, or after exertion)
 Maintain near-normal pulmonary function
 Maintain normal activity levels (including exercise and other physical activity)
 Prevent recurrent exacerbations of asthma and minimize the need for emergency
department visits or hospitalizations
 Provide optimal pharmacotherapy with minimal or no adverse effects.

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MEDICAL MANAGEMENT
 Administer methylxanthines like theophyllin. It may exert some anti-inflammatory effect,
and is especially helpful in controlling nighttime asthma
 Administer Beta-receptor agonists. These bronchodilators, such as albuterol, are the best
choice for relieving sudden attacks of asthma and for preventing attacks triggered by
exercise because they relax the smooth muscles in the lungs. It prevents bronchospasm.
 Prescribe steroids and corticosteroid to block inflammation and are extremely effective in
relieving asthma symptoms. When taken by inhalation for a long period, they reduce the
airways' sensitivity to allergens, and asthma attacks become less frequent.

USING AN INHALER
 Remove the inhaler’s cap.
 Holding the inhaler upright, shake it thoroughly for several seconds.
 Exhale as much air as possible, while tilting the head back slightly.
 Hold the inhaler in the position required by the manufacturer. Some should be held an
inch or two away from the mouth, others should be placed directly in the mouth.
 Press the inhaler to dispense the medication.
 Inhale slowly and deeply through the mouth only for several seconds.
 Hold the breath for at least 10 seconds; this allows the medication to penetrate into the
lungs. Take only one breath for each puff.
 Exhale.
 Wait a minute or so between puffs.
 This delay allows the second dose to get even farther into the airways

NURSING MANAGEMENT
Psychological care:

 The child and parents is reassured to gain their cooperation and lessen their anxiety
level about the condition.
 They should be reassured by the nurse to allay fear and anxiety.

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  The nurse then assures them of competent staff that will help with the management of
the condition.
 Provide diversional therapy in the form of jokes, watching of kids programmes on
television, listening to soft music or lullaby to her if the case of a child.

All these aimed at diverting child’s attention from the pain and worries.

Rest and Sleep

 Encourage child to rest to conserve energy.
 She should remain in bed to avoid over exertion and possible exacerbation of symptoms.
 Ensure noise-free environment and proper ventilation.
 Coordinate all nursing activities so as to avoid disturbing child’s sleep.
 To relieve respiratory distress and help in maximum lung expansion, place child in
fowler’s position with the head end of the bed raised.

Observation
 Observe the severity of the attack and degree of respiratory distress.
 Examples are rapid/shallow respiration and dyspnoea.
 Check and monitor vital signs such as temperature, pulse, respiration and blood pressure
and record them accurately.
 Tepid sponge child if temperature is above 38oC.
 Observe breathing pattern for expiratory dyspnoea nothing whether the child uses her
accessory muscles.
 The child should be observed for cyanosis and signs of air hunger.
 Child is observed for signs of dehydration like weight loss, loss of skin turgor, oliguria.
 Monitor intake and output chart if intravenous fluids are in situ to avoid fluids overload.
 Observe the site for swelling and also patency as well as flow rate. Sputum is observed
for blood stain, amount and colour.

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Nutrition
 Encourage intake of fluids at least two (2) litres per day.
 This is important because when respiratory rate increases, there is an increase fluid loss
during exhalation which can lead to dehydration.
 The child should be given semi-solid foods rich in protein, carbohydrates for proper
growth and repair of tissue.
 Normal diet can also be given if child can tolerate.
 Fluids also help to liquefy the secretions.

Elimination
 Child is assisted to void and empty bowel when the need arises.
 Encourage intake of fluids, roughages and fibre to promote easy bowel movement.
 Regular passive exercise and changing position is also encouraged to promote peristalsis.

Exercise
 Exercise improves circulation, prevent oedema and hypostatic pneumonia.
 Proper breathing pattern such as abdominal breathing, side expansion breathing forward
breathing and elbow arching can be done in the form of exercise.
 Passive exercise such as raising child’s limbs, assisting child to sit up in bed is
encouraged.

Personal Hygiene
 Because there is poor appetite, child’s oral toileting or mouth care is done before and
after meals.
 Mouth care is done on regular basis to avoid dryness and cracking that might result from
dehydration.
 The lips should be protected with Vaseline.
 Assist mother to bath patient if condition will allow.
 Bathing should be done at least two (2) times daily to improve the health of the child and
refresh her.
 Change child’s clothing, linens, napkin at regular interval and ensure free air circulation.
 Dress bed neatly and make sure is free from wrinkles and crumbs.

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  Keep child nails short since she gets irritated sometimes.
 Care for the hair to prevent infection and pediculosis.

Medication
 Serve prescribe medication as ordered.
 Observe the rules of drug administration such as the right patient, right drug, right time,
right dose, right route, right to know and refuse drug.
 Monitor desired effect and side effect of drugs and give necessary interventions
 Document and report any adverse effect for immediate action.

COMPLICATIONS
 Respiratory failure.
 Pneumonia
 Atelectasis.
 Hypoxemia.
 Fluid volume deficit.

PREVENTIONS OF ASTHMA
 Patient should be educated to minimize his or her psychological and physical stress.
 Example is, avoidance of strenuous exercise and activities, since emotional factors can
precipitate asthma.
 Educated patient on avoidance of exposure to allergens.
 Patient should be educated on the need to change his occupation or environment if some
triggering factors are there.
 Patient should be educated and encouraged on follow up to the hospital.
 Patient should be educated on the condition.

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REFERENCES
 Suzanne C. & O’Connell S. & Brenda G.B. (2010). Brunner & Suddarth’s Textbook of
Medical-Surgical Nursing (11th Ed.). Philadelphia, P.A.: Lippincott Williams & Wilkins.
 Kristine K. et al,. (2002). The Gale Encyclopedia of nursing and Allied Health. (8th Ed.).
New York: Gale Group.
 Sandra M., et al,. (2006). Lippincott Manual of Nursing Practice. (8th Ed.). Philadelphia,
Pa.: Lippincott Williams & Wilkins.

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