Bondad, Shehada.

M
BSN-3A

CONCEPT MAP OF ASTHMA

Asthma:

 Asthma is a chronic inflammatory disease of the airways that causes airway

hyperresponsiveness, mucosal edema, and mucus production.
 Inflammation ultimately leads to recurrent episodes of asthma symptoms.
 Patients with asthma may experience symptom-free periods alternating with acute
exacerbations that last from minutes to hours or days.
 Asthma, the most common chronic disease of childhood, can begin at any age.

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Pathophysiology

The underlying pathophysiology in asthma is reversible and diffuse airway inflammation that leads to
airway narrowing.

 Activation. When the mast cells are activated, it releases several chemicals
called mediators.
 Perpetuation.These chemicals perpetuate the inflammatory response, causing
increased blood flow, vasoconstriction, fluid leak from the vasculature, attraction of white
blood cells to the area, and bronchoconstriction.
 Bronchoconstriction. Acute bronchoconstriction due to allergens results from a release of
mediators from mast cells that directly contract the airway.
 Progression. As asthma becomes more persistent, the inflammation progresses and other
factors may be involved in the airflow limitation.

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Clinical Manifestations

The signs and symptoms of asthma can be easily identified, so once the following symptoms are
observed, a visit to the physician is necessary.
  Most common symptoms of asthma are cough (with or without mucus production), dyspnea,
and wheezing (first on expiration, then possibly during inspiration as well).
 Cough. There are instances that cough is the only symptom.
 Dyspnea. General tightness may occur which leads to dyspnea.
 Wheezing. There may be wheezing, first on expiration, and then possibly during inspiration
as well.
 Asthma attacks frequently occur at night or in the early morning.
 An asthma exacerbation is frequently preceded by increasing symptoms over days, but it may
begin abruptly.
 Expiration requires effort and becomes prolonged.
 As exacerbation progresses, central cyanosis secondary to severe hypoxia may occur.
 Additional symptoms, such as diaphoresis, tachycardia, and a widened pulse pressure, may
occur.
 Exercise-induced asthma: maximal symptoms during exercise, absence of nocturnal
symptoms, and sometimes only a description of a “choking” sensation during exercise.
 A severe, continuous reaction, status asthmaticus, may occur. It is life-threatening.
 Eczema, rashes, and temporary edema are allergic reactions that may be noted with asthma.

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Causes

Despite increased knowledge on the pathology of asthma and the development of improved
medications and management plans, the death rate from the disease continues to rise. Here are some of
the factors that influence the development of asthma.

 Allergy. Allergy is the strongest predisposing factor for asthma.

 Chronic exposure to airway irritants. Irritants can be seasonal (grass, tree, and weed
pollens) or perennial (mold, dust, roaches, animal dander).
 Exercise. Too much exercise can also cause asthma.
 Stress/ Emotional upset. This can trigger constriction of the airway leading to asthma.
 Medications. Certain medications can trigger asthma.

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 Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the
symptoms.

 Allergens. Allergens, either seasonal or perennial, can be prevented through avoiding contact
with them whenever possible.
 Knowledge. Knowledge is the key to quality asthma care.
 Evaluation. Evaluation of impairment and risk are key in the control.

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Complications

 Status asthmaticus. Airway obstruction in status asthmaticus often results in hypoxemia.

 Respiratory failure. Asthma, if left untreated, progresses to respiratory failure.
 Pneumonia. Mucus that pools in the lungs and becomes infected can lead to the development
of pneumonia.

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Assessment and Diagnostic Findings
To determine the diagnosis of asthma, the clinician must determine that episodic symptoms of airway
obstruction are present.

 Positive family history. Asthma is a hereditary disease, and can be possibly acquired by any
member of the family who has asthma within their clan.
 Environmental factors. Seasonal changes, high pollen counts, mold, pet dander, climate
changes, and air pollution are primarily associated with asthma.
 Comorbid conditions. Comorbid conditions that may accompany asthma may include
gastroeasophageal reflux, drug-induced asthma, and allergic broncopulmonary aspergillosis.

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Medical Management

Immediate intervention may be necessary, because continuing and progressive dyspnea leads to
increased anxiety, aggravating the situation.

Pharmacologic Therapy

 Short-acting beta2 –adrenergic agonists. These are the medications of choice for relief of
acute symptoms and prevention of exercise-induced asthma.
 Anticholinergics. Anticholinergics inhibit muscarinic cholinergic receptors and reduce
intrinsic vagal tone of the airway.
 Corticosteroids. Corticosteroids are most effective in alleviating symptoms, improving
airway function, and decreasing peak flow variability.
 Leukotriene modifiers. Anti Leukotrienes are potent bronchoconstrictors that also dilate
blood vessels and alter permeability.
 Immunomodulators. Prevent binding of IgE to the high affinity receptors of basophils and
mast cells.

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Nursing Management

The immediate care of patients with asthma depend on the severity of the symptoms.

:Nursing Assessment

Assessment of a patient with asthma includes the following:

 Assess the patient’s respiratory status by monitoring the severity of the symptoms.
 Assess for breath sounds.
 Assess the patient’s peak flow.
 Assess the level of oxygen saturation through the pulse oximeter.
 Monitor the patient’s vital signs.
Nursing Diagnosis:

Based on the data gathered, the nursing diagnoses appropriate for the patient with asthma include:

 Ineffective airway clearance related to increased production of mucus and bronchospasm.

 Impaired gas exchange related to altered delivery of inspired O2.
 Anxiety related to perceived threat of death.

Nursing Care Planning & Goals

To achieve success in the treatment of a patient with asthma, the following goals should be applied:

 Maintenance of airway patency.

 Expectoration of secretions.
 Demonstration of absence/reduction of congestion with breath sounds clear, respirations
noiseless, improved oxygen exchange.
 Verbalization of understanding of causes and therapeutic management regimen.
 Demonstration of behaviors to improve or maintain clear airway.
 Identification of potential complications and how to initiate appropriate preventive or
corrective actions.

Nursing Interventions

The nurse generally performs the following interventions:

 Assess history. Obtain a history of allergic reactions to medications before administering

medications.
 Assess respiratory status. Assess the patient’s respiratory status by monitoring the severity
of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.
 Assess medications. Identify medications that the patient is currently taking. Administer
medications as prescribed and monitor the patient’s responses to those medications;
medications may include an antibiotic if the patient has an underlying respiratory infection.
 Pharmacologic therapy. Administer medications as prescribed and monitor patient’s
responses to medications.
 Fluid therapy. Administer fluids if the patient is dehydrated.
Evaluation

To determine the effectiveness of the plan of care, evaluation must be performed. The following must
be evaluated:

 Maintenance of airway patency.

 Expectoration or clearance of secretions.
 Absence /reduction of congestion with breath sound clear, noiseless respirations, and
improved oxygen exchange.
 Verbalized understanding of causes and therapeutic management regimen.
 Demonstrated behaviors to improve or maintain clear airway.
 Identified potential complications and how to initiate appropriate preventive or corrective
actions.

Documentation Guidelines

Documentation is a necessary part of the nursing care provided, and the following data must be
documented:

 Related factors for individual client.

 Breath sounds, presence and character of secretions, and use of accessory muscles for
breathing.
 Character of cough and sputum.
 Respiratory rate, pulse oximetry/o2 saturation, and vital signs.
 Plan of care and who is involved in planning.
 Teaching plan.
 Client’s response to interventions, teaching, and actions performed.
 Use of respiratory devices/airway adjuncts.
 Response to medications administered.
 Attainment or progress towards desired outcomes.
 Modifications to the plan of care.

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