Nursing Diagnosis: Care for Individuals with Asthma

If you're a nurse, or nursing student, and want to follow a plan of care for an individual with asthma, you can take a look at some common nursing diagnosis to guide you. Today we'll summarize five and go into more depth with one of them. 

5 Nursing Diagnosis for Asthma: 

1.) Ineffective airway clearance (when one's actively experiencing an asthma attack)

2.) Ineffective breathing pattern (increased rate of breathing;may be due to fear or anxiety)

3.) Absence of knowledge related to asthma treatment (if a patient has not been educated on asthma and the medication they're prescribed) 

4.) Ineffective management of therapeutic regiment (if a patient is struggling with a medication schedule for example) 

5.) Impaired gas exchange (due to narrowing of airways not allowing adequate oxygen to enter the lungs) 

Now let's take a deeper look into the first diagnosis: Ineffective airway clearance. 

This nursing diagnosis would be an actual issue (it's not a risk for). 

Related to: inflammation in the airway and bronchospasms. 

Plan/Nursing interventions: Position patient so that they're sitting up. Assess patient's breath sounds with a stethescope, observe their breathing pattern, check their oxygen saturation. Administer medications (bronchodilators, metered dose inhalers, nebulizers, etc.). Educate patient and family on how to use medications. 

Outcome: The desired outcome would be for the patient's airway to be clear and the patient to breath easily again. 

For a guide to asthma care for nurses check out these websites that give a complete plan of action: http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick03.html

http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=130

Sources: 
EHS: Nursing Diagnosis Care Plans, 4/e - Airway Clearance, Ineffective. (n.d.). Retrieved February 27, 2015, from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick03.html

EHS: Nursing Care Planning Guides - Care Planner: Diagnosis: Impaired respiratory function. (n.d.). Retrieved February 27, 2015, from http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=130

Nursing Care for Asthma

This post will focus on nursing care for individuals with asthma. Whether or not you're a nurse, it still may be useful in understanding what to expect from your nursing care team if you, or someone you know has asthma. 

Let's start with a summary of the the nursing care for individuals with asthma by breaking it down into assessment, therapeutic interventions and education. Here are some examples under each category.  

Assessment: Monitoring breath sounds, respiration rate and rhythm, vital signs, and presence of a cough.

Therapeutic Interventions: Medication administration, suggesting the sitting position for most effective breathing, use of a pillow when coughing, use of incentive spirometry and ambulation to maintain lung expansion and to prevent mucus buildup (in a hospital setting), and use of humidifier if indicated.  

Education: Teaching techniques for medication administration including the use of a spacer, explaining side effects and dosing regiment, teaching what environmental factors may be asthma triggers and suggestions for how to record when symptoms are worse to narrow down specific triggers to the individual. 

In addition to assessment, interventions, and education the nurse may also play an important role in communicating with respiratory therapy, or a physician.  

As we've discussed in previous blogs, the use of medication can be critical in asthma care and is a big part of nursing support for patients with asthma. Here's a table that summarizes the asthma medications: 

For a complete guide to nursing care for individuals with asthma, check out this website: https://www.nasn.org/ToolsResources/Asthma

The website acts as a toolkit with links to other sites that share research on asthma, continued education opportunities and specifics for asthma in children for not only nurses, but schools and families as well. 

Resources: 

Asthma Medications Chart - Health Insurance Quotes. (n.d.). Retrieved February 21, 2015, from http://healthtipsinsurance.com/stories/24085/Asthma-Medications-Chart.html

EHS: Nursing Diagnosis Care Plans, 4/e - Airway Clearance, Ineffective. (n.d.). Retrieved February 21, 2015, from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick03.html

Asthma Online Tool Kit. (n.d.). Retrieved February 21, 2015, from https://www.nasn.org/ToolsResources/Asthma

Treating Asthma

The first step in treating asthma is to identify what triggers your asthma and work to eliminate or reduce them in your environment. This may mean limiting outdoor time during allergy season, or when a high smog index is in effect. Or having outdoor pets and setting up a air filters in your home. To get a complete guide on how to help reduce triggers, check out page 38 on this pdf. (Asthma Guidelines) and reference the table titled "How to Control Things That Make Your Asthma Worse".  If avoiding triggers doesn't help enough, your doctor may also recommend getting an allergy shot. 

Now let's talk about some of the medication options for asthma. The first line of defense is a fast acting inhaler to combat asthma attacks immediately. These are called bronchodilaters, or short-acting beta2-agonists. They dilate the bronchials, or airways, by relaxing the muscles that surround them. If you're needing to use the bronchodilators too frequently, your doctor will likely prescribe medication that you take daily to work consistently in lowering inflammation in your airways. The most common are inhaled corticosteroids that work to reduce the swelling and mucus secretion and cause airways to be less sensitive to triggers. Most people with asthma will need both bronchodilaters and inhaled corticosteroids and some medications are a combination of an inhaled corticosteroid and long acting bronchodilator. Here's a video that explains the difference between a rescue inhaler and a control inhaler: Asthma Medication: Control vs. Rescue 

Some common side effects of asthma medication include heart palpitations, a cough, or dry mouth. This chart breaks down specific side effects for each medication and when to discuss it with your doctor:Medication Side Effect Chart. A spacer is also recommended to allow more medication to be inhaled and reduce the effects an inhaler might cause in your mouth, or at the back of your throat. Here is a picture of a spacer and how it is used: 

For a more detailed explanation of asthma medications check out this awesome video: 

  

References: 

Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma - Summary Report 2007. (n.d.). Retrieved February 13, 2015, from http://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines/summary-report-2007

Asthma Facts Slideshow: Symptoms of Asthma, Causes, and Treatments. (n.d.). Retrieved February 13, 2015, from http://www.webmd.com/asthma/ss/slideshow-asthma-overview

Diseases & Conditions. (n.d.). Retrieved February 13, 2015, from http://my.clevelandclinic.org/health/diseases_conditions/hic_Asthma_An_Overview/hic_Medications_for_Treating_Asthma

Let me catch my breath....

There are four main signs and symptoms that are characteristic of asthma. They include coughing, wheezing, chest tightness and shortness of breath. Coughing with asthma often happens in the morning, or at night when lying down and while exercising. Wheezing is a hissing, or whistling sound that occurs during breathing. Chest tightness is a feeling like you can’t take a full breath, or as if someone were sitting on your chest. Lastly, shortness of breath is a feeling like you just can’t get enough air. Of course, having these signs and symptoms doesn’t mean you have asthma and you could have asthma without these signs and symptoms, or with just some, but these are the four most prevalent.

Here’s a fun video that explains symptoms in a kid friendly way:

And here’s another video that also explains symptoms and reminds us about why they may occur:

It’s difficult to find statistics on how many people with asthma experience each of these symptoms. Likely, this is because the symptoms can come and go with attacks and vary greatly between individuals with asthma. To help researchers and physicians move forward in finding correlations between triggers and the onset of symptoms, a medical doctor and researcher by the name of Sam Pejham has created an app for people to track their asthma. Gathering anonymous data about asthma symptoms, environmental factors, temperature change, etc. will hopefully help to advance the research of asthma. The app also helps the individual track his or her asthma, share the information with his or her physician and set-up handy things like alerts for taking medication. Here’s a link for this nifty app:  AsthmaMD



References:

What Are the Signs and Symptoms of Asthma? (n.d.). Retrieved February 5, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/signs

What are the symptoms of asthma? - for Kids with Asthma. (n.d.). Retrieved February 5, 2015, from https://www.youtube.com/watch?v=znHd7da_7z4

Introduction to Asthma and Asthma Symptoms - The Children's Hospital of Philadelphia (1 of 7). (n.d.). Retrieved February 5, 2015, from https://www.youtube.com/watch?v=ye9uxrjkTck

About | AsthmaMD. (n.d.). Retrieved February 5, 2015, from http://www.asthmamd.org/about/