Nursing Care Plans for Asthma Plus Diagnosis and Interventions with Examples

Introduction

Asthma is an inflammatory disease of the airways to the lungs. It makes breathing difficult and can make some physical activities challenging or even impossible.

According to the Centers for Disease Control and Prevention (CDC), about 25 million Americans   have asthma. It’s the most common chronic condition among American children: 1 child out of every 12 has asthma.

To understand asthma, it’s necessary to understand a little about what happens when you breathe. Normally, with every breath you take, air goes through your nose or mouth, down into your throat, and into your airways, eventually making it to your lungs.

This blog post discusses nursing care plans for asthma together with the diagnosis, causes, symptoms and interventions with elaborate examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Symptoms of Asthma

The most common symptom of asthma is wheezing. This is a squealing or whistling sound that occurs when you breathe.

Other asthma symptoms may include:

1. Coughing, especially at night, when laughing, or during exercise
2. Tightness in the chest
3. Shortness of breath
4. Difficulty talking
5. Anxiousness or panic
6. Fatigue
7. Chest pain
8. Rapid breathing
9. Frequent infections
10. Trouble sleeping

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Classification of Asthma

1. Extrinsic Asthma – called Atopic/allergic asthma. An “allergen” or an “antigen” is a foreign particle which enters the body. Our immune system over-reacts to these often harmless items, forming “antibodies” which are normally used to attack viruses or bacteria. Mast cells release these antibodies as well as other chemicals to defend the body.

Common irritants:

• Cockroach particles
• Cat hair and saliva
• Dog hair and saliva
• House dust mites
• Mold or yeast spores
• Metabisulfite, used as a preservative in many beverages and some foods
• Pollen

2. Intrinsic asthma – called non-allergic asthma, is not allergy-related, in fact it is caused by anything except an allergy. It may be caused by inhalation of chemicals such as cigarette smoke or cleaning agents, taking aspirin, a chest infection, stress, laughter, exercise, cold air, food preservatives or a myriad of other factors.

• Smoke
• Exercise
• Gas, wood, coal, and kerosene heating units
• Natural gas, propane, or kerosene used as cooking fuel
• Fumes
• Smog
• Viral respiratory infections
• Wood smoke
• Weather changes

Causes of Asthma

It isn’t clear why some people get asthma and others don’t, but it’s probably due to a combination of environmental and inherited (genetic) factors.

Asthma triggers

Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:

1. Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste
2. Respiratory infections, such as the common cold
3. Physical activity
4. Cold air
5. Air pollutants and irritants, such as smoke
6. Certain medications, including beta blockers, aspirin, and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve)
7. Strong emotions and stress
8. Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine
9. Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

Risk factors of Asthma

A number of factors are thought to increase your chances of developing asthma. They include:

1. Having a blood relative with asthma, such as a parent or sibling
2. Having another allergic condition, such as atopic dermatitis — which causes red, itchy skin — or hay fever — which causes a runny nose, congestion and itchy eyes
3. Being overweight
4. Being a smoker
5. Exposure to secondhand smoke
6. Exposure to exhaust fumes or other types of pollution
7. Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing

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Complications of Asthma

Asthma complications include:

• Signs and symptoms that interfere with sleep, work and other activities
• Sick days from work or school during asthma flare-ups
• A permanent narrowing of the tubes that carry air to and from your lungs (bronchial tubes), which affects how well you can breathe
• Emergency room visits and hospitalizations for severe asthma attacks
• Side effects from long-term use of some medications used to stabilize severe asthma
• Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Prevention of Asthma

While there’s no way to prevent asthma, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks.

Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life.

Get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-ups.

Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.

Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath.

But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter. A peak flow meter measures how hard you can breathe out. Your doctor can show you how to monitor your peak flow at home.

Identify and treat attacks early. If you act quickly, you’re less likely to have a severe attack. You also won’t need as much medication to control your symptoms.

When your peak flow measurements decrease and alert you to an oncoming attack, take your medication as instructed. Also, immediately stop any activity that may have triggered the attack. If your symptoms don’t improve, get medical help as directed in your action plan.

Take your medication as prescribed. Don’t change your medications without first talking to your doctor, even if your asthma seems to be improving. It’s a good idea to bring your medications with you to each doctor visit. Your doctor can make sure you’re using your medications correctly and taking the right dose.

Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma isn’t under control. See your doctor about adjusting your treatment.

Diagnosis of Asthma

There’s no single test or exam that will determine if you or your child has asthma. Instead, your doctor will use a variety of criteria to determine if the symptoms are the result of asthma.

The following can help diagnose asthma:

Health history. If you have family members with the breathing disorder, your risk is higher. Alert your doctor to this genetic connection.

Physical exam. Your doctor will listen to your breathing with a stethoscope. You may also be given a skin test to look for signs of an allergic reaction, such as hives or eczema. Allergies increase your risk for asthma.

Breathing tests. Pulmonary function tests (PFTs) measure airflow into and out of your lungs. For the most common test, spirometry, you blow into a device that measures the speed of the air.

Doctors don’t typically perform breathing tests in children under 5 years of age because it’s difficult to get an accurate reading.

Instead, they may prescribe asthma medications to your child and wait to see if symptoms improve. If they do, your child likely has asthma.

For adults, your doctor may prescribe a bronchodilator or other asthma medication if test results indicate asthma. If symptoms improve with the use of this medication, your doctor will continue to treat your condition as asthma.

Treatment of Asthma

To help treat asthma, the National Asthma Education and Prevention Program (NAEPP)   classifies the condition based on its severity before treatment.

Asthma classifications include:

Intermittent. Most people have this type of asthma, which doesn’t interfere with daily activities. Symptoms are mild, lasting fewer than 2 days per week or 2 nights per month.

Mild persistent. The symptoms occur more than twice a week — but not daily — and up to 4 nights per month.

Moderate persistent. The symptoms occur daily and at least 1 night every week, but not nightly. They may limit some daily activities.

Severe persistent. The symptoms occur several times every day and most nights. Daily activities are extremely limited.

Treatments for asthma fall into four primary categories:

1. Quick relief medications
2. Long-term control medications
3. A combination of quick relief and long-term control medications. The most current asthma clinical guidelines, released in 2020 by the NAEPP, recommend this treatment. However this treatment is not yet approved by the federal drug administration (FDA).
4. Biologics, which are given by injection or infusion usually only for severe forms of asthma

Nursing Diagnosis for Asthma

1. Ineffective Breathing Pattern
2. Ineffective Airway Clearance
3. Anxiety

Nursing Care Plans for Asthma Based on Nursing Diagnosis

Nursing Care Plan 1: Ineffective Breathing Pattern

Related Factors

Swelling and spasm of the bronchial tubes in response to inhaled irritants, infection, drugs, allergies or infection.

Defining Characteristics

The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

• Cough
• Cyanosis
• Dyspnea
• Loss of consciousness
• Nasal flaring
• Prolonged expiration
• Respiratory depth changes
• Tachypnea
• Use of accessory muscles

Desired Outcomes

Patient will maintain optimal breathing pattern, as evidenced by relaxed breathing, normal respiratory rate or pattern, and absence of dyspnea.

Nursing Interventions and Rationales

Here are the nursing assessment and interventions for this asthma nursing care plan.

Nursing Interventions	Rationale
Nursing Assessment
Assess the client’s vital signs as needed while in distress.	Increased BP, RR, and HR occur during the initial hypoxia and hypercapnia. And when it becomes severe, BP and HR drops and respiratory failure may result.
Assess the respiratory rate, depth, and rhythm.	Changes in the respiratory rate and rhythm may indicate an early sign of impending respiratory distress.
Assess the client’s level of anxiety.	Anxiety may result from the struggle of not being able to breathe properly.
Assess breath sounds and adventitious sounds such as wheezes and stridor.	Adventitious sounds may indicate a worsening condition or additional developing complications such as pneumonia. Wheezing happens as a result of bronchospasm. Diminishing wheezing and indistinct breath sounds are suggestive findings and indicate impending respiratory failure.
Assess the relationship of inspiration to expiration.	Reactive airways allow air to move into the lungs more easily than out of the lungs. If the client is gasping for air, instruction for effective breathing is needed.
Assess for signs of dyspnea (flaring of nostrils, chest retractions, and use of accessory muscle).	These indicate respiratory distress. Once the movement of air into and out of the lungs becomes challenging, the breathing pattern changes.
Assess for conversational dyspnea.	Dyspnea during a normal conversation is a sign of respiratory distress.
Assess for fatigue.	Fatigue may indicate distress, leading to respiratory failure.
Assess the presence of paradoxical pulse of 12 mm Hg or greater.	Paradoxical pulse is an abnormally large decrease in systolic blood pressure and pulses wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg. A paradoxical pulse of 12 mm Hg or greater indicates a severe airflow obstruction.
Monitor oxygen saturation.	Oxygen saturation is a term referring to the fraction of oxygen-saturated hemoglobin relative to the total hemoglobin in the blood. Normal oxygen saturation levels are considered 95-100%.
Monitor peaked expiratory flow rates and forced expiratory volume as taken by the respiratory therapist.	The severity of the exacerbation can be measured objectively by monitoring these values. The peak expiratory flow rate is the maximum flow rate that can be generated during a forced expiratory maneuver with fully inflated lungs. It is measured in liters per second and requires maximal effort. When done with good effort, it correlates well with forced expiratory volume in 1 second (FEV1) measured by spirometry and provides a simple, reproducible measure of airway obstruction.
Monitor arterial blood gasses (ABG).	During a mild to moderate asthma attack, clients may develop respiratory alkalosis. Hypoxemia leads to increased respiratory rate and depth, and carbon dioxide is blown off. An ominous finding is a respiratory acidosis, which usually indicates that respiratory failure is pending and that mechanical ventilation may be necessary.
Therapeutic Interventions
Plan for periods of rest between activities.	Fatigue is common with the increased work of breathing from the ineffective breathing pattern. Activity increases metabolic rate and oxygen requirements.
Maintain head of bed elevated.	This promotes maximum lung expansion and assists in breathing.
Encourage client to use pursed-lip breathing for exhalation.	Pursed lip breathing improves breathing patterns by moving old air out of the lungs and allowing for new air to enter the lungs.
Administer medication as ordered:
Short-acting beta-2-adrenergic agonist. Albuterol (Proventil, Ventolin). Levalbuterol (Xopenex). Terbutaline (Brethine).	Short-acting beta2-agonists are bronchodilators. They relax the muscles lining the airways that carry air to the lungs; treatment of choice for acute exacerbation of asthma.
Inhaled Corticosteroids. Budesonide (Pulmicort). Fluticasone (Flovent). Beclomethasone (Vancenase). Mometasone (Asmanex Twisthaler).	Corticosteroids reduce inflammation in the airways that carry air to the lungs and reduce the mucus made by the bronchial tubes. Inhaled steroids should be given after beta-2-adrenergic agonist.
Anticipate the need for alternative treatment if life-threatening bronchospasm continues:
General anesthesia.	General anesthesia is used when there is both dynamic hyperinflation and profound hypercapnia that cannot be corrected by increasing minute ventilation.
Magnesium sulfate.	Magnesium sulfate has bronchodilating and anti-inflammatory effects that are sometimes used in the treatment of moderate to severe asthma in children.
Heliox (a helium-oxygen mixture).	The use of helium (a less dense gas than nitrogen) causes decrease airway resistance thus lessens the work of breathing.

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Nursing Care Plan 2: Ineffective Airway Clearance

Related Factors

• Bronchospasms
• Increased pulmonary secretions
• Ineffective cough
• Mucosal edema

Defining Characteristics

The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

• Abnormal arterial blood gasses
• Adventitious lung sounds (Wheezes, Rhonchi)
• Changes in respiratory rate and rhythm
• Chest tightness
• Cough
• Cyanosis
• Dyspnea; orthopnea
• Retained secretions
•  

Desired Outcomes

Common goals and expected outcomes:

• Patient will verbalize understanding of cause and therapeutic management regimen.
• Patient will maintain airway patency as evidenced by clear breath sounds, improved oxygen exchange, normal rate and depth of respiration, and ability to effectively cough out secretions.

Nursing Interventions and Rationales

Here are the nursing assessment and interventions for this asthma nursing care plan.

Nursing Interventions	Rationale
Nursing Assessment
Assess respiratory rate, depth, and rhythm.	Changes in the respiratory rate and rhythm may indicate an early sign of impending respiratory distress.
Assess for color changes in the buccal mucosa, lips, and nail beds.	Cyanosis indicates low oxygenation and that breathing is ineffective to maintain adequate tissue oxygenation.
Auscultate lungs for adventitious breath sounds (wheezes and rhonchi).	Wheezes suggest partial obstruction or resistance. While rhonchi may indicate retained secretions in the lungs.
Assess the effectiveness of cough.	Coughing is a natural way to clear the throat and breathing passage of foreign particles, irritants, and mucus. Severe bronchospasm, thick secretions, and respiratory muscle fatigue are some of the causes of an ineffective cough.
Assess the amount, color, odor and viscosity of the secretions.	Normal secretion is clear or gray and minimal; abnormal sputum is green, yellow, or bloody; malodorous; often copious. Thick tenacious secretions increase airway resistance.
Monitor and record intake and output (I&O) adequately.	Provides information on the fluid balance of the patient. Dehydration can contribute in viscous secretions and may result to decrease airway clearance.
Monitor oxygen saturation using pulse oximetry.	Oxygen saturation of less than 90% indicates problems with oxygenation.
Monitor chest x-ray results.	A chest x-ray provides information regarding the presence of infiltrates, lung inflation, or the presence of barotrauma.
Monitor laboratory results as indicated:
White blood cell count	Increased WBC count indicates an infection.
Potassium	The use of beta-adrenergic agonists shift potassium into the cell and cause hypokalemia.
Theophylline level (if on theophylline therapy)	Therapeutic range of theophylline is between 10 to 20 mcg/mL. Signs of toxicity include hypotension, tachycardia, GI symptoms, and restlessness.
Monitor arterial blood gasses (ABGs).	Retention of carbon dioxide happens due to fatigue from labored breathing caused by bronchospasm. Once the client is mechanically ventilated, permissive hypercapnia may be utilized to prevent lung damage and maintain plateau pressure less than 30 to 35 cm H20.
Obtain peak expiratory flow rate (PEFR) or forced expiratory volume in 1 second (FEV1) before and after respiratory treatment.	Peak expiratory flow rate (PEFR) is the maximum flow rate generated during forceful exhalation. It should be improved with effective therapy. FEV1  is the volume exhaled during the first second of a forced expiratory maneuver started from the level of total lung capacity.
Therapeutic Interventions
Pace the client’s activities.	Break up activities into smaller parts and take rest breaks in between to avoid fatigue. increased effort in breathing properly.
Encourage deep breathing and coughing exercises.	Helps loosen and expectorate excess secretions and contribute in effective clearing mucus out of the lungs.
Encourage increased fluid intake of up to 3000 ml/day within cardiac or renal reserve.	Fluids help minimize mucosal drying and increases ciliary action to remove secretions.
Limit alcohol and caffeinated drinks.	When consumed in excess, it may contribute to dehydration making difficulty for secretions to be expectorated. In addition, it may also increased the risk of CNS and cardiovascular system side effects of medications.
Administer IV fluids and medication as ordered.	IV fluid therapy can be beneficial for clients with dehydration. Medications such as bronchodilators and inhaled corticosteroids may be prescribed.
Administer oxygen as ordered.	Oxygen therapy corrects hypoxemia, which can be caused by retained respiratory secretions.
Anticipate the need for intubation and mechanical ventilation.	Acute exacerbations of asthma can lead to respiratory failure requiring mechanical ventilation.

Nursing Care Plan 3: Anxiety

Related Factors

• Change in the environment
• Change in health status
• Loss of control
• Hypoxia
• Respiratory distress

Defining Characteristics

The common assessment cues that could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

• Apprehensiveness
• Dyspnea
• Frequent request for someone to be in the room
• Restlessness
• Tachycardia
• Tachypnea

Desired Outcomes

Common goals and expected outcomes:

• Patient will use an effective coping mechanism.
• Patient will verbalize a reduction in level of anxiety experienced.
• Patient will demonstrate reduced anxiety as evidenced by a calm demeanor and cooperative behavior.
•  

Nursing Interventions and Rationales

Here are the nursing assessment and interventions for this seizure nursing care plan.

Nursing Interventions	Rationale
Nursing Assessment
Assess for signs of anxiety: Feelings of panic, fear, and uneasiness. Tachycardia. Cold or sweaty hands or feet. Shortness of breath. Restlessness.	Asthma can become much worse with anxiety since it causes rapid, shallow breathing.
Assess theophylline levels.	Therapeutic range of theophylline is between 10 to 20 mcg/mL. Theophylline causes increases anxiety.
Monitor oxygen saturation.	Increase anxiety may indicate an early sign of hypoxia.
Therapeutic Interventions
Provide comfort measures: Calm, quiet environment. Soft music.	Maintaining calmness will reduce oxygen consumption and the work of breathing.
Explain every procedure to the client in a simple and concise manner.	Client’s anxiety will decrease as he or she can understand the treatment regimen.
Ensure to update the significant others of the client’s progress.	Family’s anxiety can be easily transferred to the client. Giving off information to them can help relieve apprehension.
Stay with the client, and encourage slow, deep breathing. Assure the client and significant others of close, consistent monitoring that will ensure prompt intervention.	The presence of a trusted reliable person may give the client a sense of security.
Encourage the use of relaxation techniques: Progressive muscle relaxation as indicated. Diaphragmatic and pursed lip breathing. Use of imagery, repetitive phrases (repeating a phrase that triggers a physical relaxation, such as “relax and let go”).	Relaxation techniques are an effective way of decreasing anxiety.

References

Ncbi.gov

Scholar.google.com