Bronchial Asthma – Nursing Diagnosis and Nursing Care Plan

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• Asthma is an immediate hypersensitivity response.

• Severe bronchoconstriction can be induced by cold air and irritating odors or inhalation of an allergen.

Types of Bronchial asthma

• Intrinsic : No immunologic cause for clinical symptoms.

• Extrinsic: Due to allergens.

– pollen

– Molds

– House dust

– food

Pathophysiology  of Bronchial Asthma

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Respiratory failure in Bronchial asthma

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Assessment of Bronchial asthma

• Wheezing

• Coughing

• Dyspnea

• Expectoration of sputum

• Shortness of breath

• Tight feeling in the chest

• Increased respiratory rate

• Pallor

• Apprehension

• Irritability

• Nasal flaring

• Subcostal and intercostal retractions

• Cyanosis

• Drooping shoulder

 

Nursing care plan for a child with bronchial asthma

Nursing Intervention

Nurse in fowler or semi-fowler position
Administer humidified oxygen
Administer nebulizer of ventolin / normal saline
Observe for: cyanosis, breath sound, wheezing, respiratory rate apical pulse, blood pressure, pea expiratory flow.
Administer prescribed drugs: I.V Theophyllin (bolus) then in I.V pump.

Nursing Diagnosis

Ineffective airway

clearance related

To bronchospasm

and increased

pulmonary secretion

Assessment

Wheezing
Coughing
Dysnea
Expectoration of sputum
shortness of breath
Tight feeling in chest
Increase respiration
Apprehension

Administer I.V fluid to

prevent dehydration
secondary to ventilation
& perspiration.
Give small frequent oral fluids.
Provide rest and quiet
environment
Play and activity when condition Improves

Dehydration secondary to hyperventilation and perspiration

irritability

nasal flaring
subcostal and
intercostal retraction
cyanosis
shoulder forward in
attempt to use

accessory muscles of respiration

Nursing Intervention

Establish a trust

 relationship

Encourage them to express the concerns.
Explain pathophysiology of Asthma and possible causes e.g. smoking, perfume
Explain all procedures
Encourage them to participate care of the child.
Explain effect of medication

Parental fear and

anxiety related to

child’s breathlessness.

OR

Knowledge deficit

due to insufficient

information on child’s

condition

Parental Anxiety

 

Nursing responsibilities of the following drugs

A. Methvlxanthines (Bronchodilators)

Examples of drugs:

1. Aminophyline injection.

2.Theophylline tablets or syrup.

Side -effect: Tachycardia, hypertension, arrhythmias.

Nursing responsibility:

1. monitor vital signs especially respiratory rate

2. support client

3. monitor blood level for Theophylline

 

B. Sympathomimetics (Bronchodilators)

Examples of drugs :

1. Ventolin (Salbutamol) by puff or nebulizer with N/S.

2. Alupent (inhaler).

3. Isuprel (inhaler), iv. Epinephrine 1: 1000 subcutaneously

Side effects: dizziness, headache, tremors, nervousness, insomnia, hypertension

Nursing responsibility:

1. Observe as for above

2. Teach client correct technique for inhalation.

 

C. Corticosteroids (reduce inflammation and relax bronchial smooth muscle)

Examples of drugs :

1. Methyl-prednisolone I /v

2. Solu- Medrol I / v

3. Prednisolone tablets

Side effects: Fluid retention (cushingnoid body changes) ,Gastric irritation & Peptic ulcer /bleeding

Nursing responsibilities:

1. Observe for side effects

2. Monitor vital signs.

3. Administer with food or milk.

 

Administration of Oxygen Therapy:

1. by face mask with humidifier

2. by nasal cannulla with humidifier

3. oxygen tent with mist

4. oxygen hood with humidifier

Nursing responsibility:

1. regulate oxygen flow according to order

2. observe out come & provide oral hygiene

 

Teaching plan for a family with a child having Bronchial Asthma based on the assessment

Content

1. Teach how to provide a dust free

    environment for the child.

2. If the child is allergic to animal dander,

3. Remove pets from home.

4. Keep child out of smoke filled

environment.

1. Teach parents how to administer medication according to prescribed dosage and schedule.
2. Teach them how to observe for side effects.

Objectives

1. Environmental Control

2. Administration of medication

Teach parents how to use play activities like blowing bubbles to practice pursed-lip & diaphragmatic

3. Breathing exercise

1. Encourage activities & play with peer groups.
2. Provide consistency in discipline Provide opportunity for child to feel success & achievement.

4. Support for growth & development

Keep appointments for health care

5. Health Maintenance

Management for Bronchial Asthma

• Bronchodilators

• Corticosteroids

• Oxygen therapy

• Increase fluid intake

• Environmental control

 

Nursing Diagnoses for Bronchial Asthma

1. Ineffective airway clearance R/T allergenic response and inflammation in the bronchial tree.

2. Activity intolerance R/T imbalance between O2 supply and demand.

3. Interrupted family process R/T having a child with a chronic illness.

4. Risk for deficient fluid volume R/T difficulty in taking fluids, insensible fluid losses from tachypnea and diaphoresis

5. Risk for suffocation R/T interaction between individual and allergens, bronchospasm, mucus secretions and edema.

6. Risk for injury (respiratory acidosis, electrolyte imbalance) R/T hypoventilation, dehydration.

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