• 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.
– House dust
Pathophysiology of Bronchial Asthma
Respiratory failure in Bronchial asthma
Assessment of Bronchial asthma
• Expectoration of sputum
• Shortness of breath
• Tight feeling in the chest
• Increased respiratory rate
• Nasal flaring
• Subcostal and intercostal retractions
• Drooping shoulder
Nursing care plan for a child with bronchial asthma
• 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.
• Expectoration of sputum
• shortness of breath
• Tight feeling in chest
• Increase respiration
• Administer I.V fluid to
• prevent dehydration
• secondary to ventilation
• & perspiration.
• Give small frequent oral fluids.
• Provide rest and quiet
• Play and activity when condition Improves
Dehydration secondary to hyperventilation and perspiration
• nasal flaring
• subcostal and
• intercostal retraction
• shoulder forward in
• attempt to use
accessory muscles of respiration
• Establish a trust
• 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
due to insufficient
information on child’s
• 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.
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
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
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
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
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
1. Teach parents how to administer medication according to prescribed dosage and schedule.
2. Teach them how to observe for side effects.
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
• 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.