What is the priority nursing intervention for a patient in status asthmaticus most severe asthma episodes )?

Asthma is a chronic condition affecting the lungs. When in contact with a trigger, the muscles around the airways constrict and inflammation and mucus in the airways make breathing difficult, known as an asthma attack. There is no cure for asthma, and untreated asthma attacks can be life-threatening, but there are many effective treatments that help manage and control this condition.

Asthma is the most common chronic condition among children. Children with asthma are extra sensitive to triggers as their smaller airways are easily affected by swelling and mucus. Approximately 50% of children “outgrow” asthma once they reach adolescence, though it may return in adulthood.

The Nursing Process

Nurses can expect to have frequent contact with patients who have asthma. Asthma can present as an acute exacerbation requiring prompt treatment and close observation or as a chronic condition in the patient’s history. Nurses can support patients in the management of their disease by providing education on symptoms, triggers, and medications.

Nursing Care Plans Related to Asthma

Activity Intolerance Care Plan

Symptoms such as dyspnea and fatigue during an asthma exacerbation deplete energy and prevent the ability to carry out tasks.

Nursing Diagnosis: Activity Intolerance

Related to: 

• Airway constriction 
• Imbalance between oxygen supply and demand 

As evidenced by: 

• Dyspnea on exertion 
• Chest tightness 
• Fatigue 
• Inability to play, eat, or complete tasks 
• Poor sleep due to dyspnea or coughing 

Expected Outcomes: 

• Patient will complete ADLs without dyspnea or wheezing 
• Child will participate in play without shortness of breath or coughing 

Activity Intolerance Assessment

1. Assess for activity triggers.
Exercise-induced asthma causes a narrowing of the airways due to strenuous exercise. The nurse can assess for activities or sports the patient engages in that may be contributing to their asthma exacerbations.

2. Assess the level of limitation.
Observe the patient completing tasks, or simply transferring or ambulating. Note the level of limitation in comparison to the patient’s usual activity or their perceived degree of deficit.

3. Monitor for emotional factors affecting activity.
Asthma flare-ups can be frightening. Assess if the patient is fearful of partaking in exercise or activities for fear of an asthma attack. The nurse can help with forming a balance between appropriate exercise and necessary rest.

Activity Intolerance Interventions

1. Encourage progressive activity.
Exercise is necessary for health. Encourage activities such as walking or yoga which are generally safe for asthmatics. The patient should limit their sedentary time and alternate between rest and activity to improve their tolerance.

2. Educate on triggers.
Educate patients to consider the elements before engaging in outdoor activity. Allergens, smoke, humidity, and cold temperatures can trigger asthma attacks.

3. Offer other activities.
Children who are not able to participate in high-endurance activities such as soccer or running can instead play games, crafts, or sports such as gymnastics or golf.

4. Plan for exercise.
Exercise-induced asthma requires preparation to prevent attacks. Medication should be taken before engaging in exercise, a thorough warm-up prepares the lungs for vigorous exercise, and the patient should monitor their respiratory status closely and know when to stop or reduce their effort.

Ineffective Breathing Pattern Care Plan

Narrowing of the airways results in inadequate pulmonary ventilation and an ineffective breathing pattern.

Nursing Diagnosis: Ineffective Breathing Pattern

Related to: 

• Inflammation and swelling to the lungs 
• Airway spasming 
• Increased mucus 

As evidenced by: 

• Dyspnea 
• Coughing 
• Cyanosis 
• Nasal flaring 
• Accessory muscle use 
• Wheezing 
• Tachypnea 

Expected Outcomes: 

• Patient will display an effective breathing pattern evidenced by a respiratory rate and rhythm within normal limits without wheezing or coughing 
• Patient will verbalize potential triggers of asthma exacerbations 
• Patient will demonstrate the appropriate use of a peak flow meter 

Ineffective Breathing Pattern Assessment

1. Auscultate lung fileds.
Wheezing is a common finding with asthma as the airways are constricted from inflammation. Other adventitious sounds such as rales or rhonchi can signal possible infections which require further treatment.

2. Monitor respiratory status.
Monitor closely for changes in respiratory status in order to intervene quickly. Increased respiratory rates and decreasing oxygen saturation levels signal respiratory distress.

3. Monitor ABGs.
Respiratory alkalosis can develop from hyperventilation. Respiratory acidosis occurs from severe asthma and can develop into respiratory failure if prolonged.

Ineffective Breathing Pattern Interventions

1. Administer bronchodilators and corticosteroids.
Bronchodilators such as Albuterol help relax the muscles around the airways. Inhaled corticosteroids reduce inflammation and mucus. Corticosteroids should be given after bronchodilators.

2. Instruct on peak flow meters.
Peak flow meters can be used daily to monitor how well air is moving in and out of the lungs. Peak flow meters can often detect changes in the airway before symptoms occur and can signal to the patient to take their medication to prevent an attack.

3. Help the patient identify their triggers.
Each individual will have their own asthma triggers. Common triggers include dust, pet hair, pollen, mold, pollution, infections, high humidity, and even stress. Identifying triggers helps prevent asthma exacerbations.

4. Promote calm, relaxed breathing.
The nurse should remain with the patient when experiencing an asthma exacerbation. Keep them supported in an upright position, reassure them, and assist with even, controlled, diaphragmatic breathing.

Readiness for Enhanced Therapeutic Regimen Management Care Plan

Children may take an interest in managing their asthma and making their own decisions. Even toddlers can learn how to use inhalers and spacers. Parents and healthcare professionals can support children in managing their treatment.

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