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Asthma Nursing Guide

Content created/revised by: Rakesh Tripathi MBA, MPH, BSN, RN-CEN

Asthma Overview

This course is intended as a Quick Reference for Asthma and will cover an overview and nursing considerations utilizing the nursing process.

Asthma Etiology and Epidemiology

Asthma is characterized by the narrowing, swelling, and constriction of bronchial airways due to the inflammation of the bronchi and trachea. It is usually associated with an immunoglobulin E (IgE) mediated response and is triggered by factors including smoke, dust, pollen, or cold weather. The approximate number of U.S. emergency department visits caused by asthma is 1.6 million (CDC, 2021).

The risk factors for asthma include (American Lung Association, 2020):

  • Bacterial and viral infections
  • Environmental factors
    • Allergens
    • Air pollution
  • Exercise
  • Genetic predisposition
  • Illnesses or medications that cause bronchoconstriction
    • Beta blockers
    • Angiotensin- converting enzyme (ACE) inhibitors
  • Occupational exposure to external allergens
  • Gastroesophageal reflux disease (GERD)
  • Chronic rhinitis or sinusitis
  • Use of NSAIDs
  • Smoking
  • Stress

Asthma Diagnosis

The following diagnostic tests are routinely done in individuals with asthma:

  • Complete blood count (CBC)
  • Arterial blood gas levels
  • Blood and sputum eosinophil levels
  • Serum IgE levels
  • Chest X-ray
  • Chest CT scan if diagnosis is in doubt
  • Electrocardiogram (ECG)
  • Pulmonary function studies
  • Pulse oximetry measurements
  • Skin allergy testing
  • Spirometry
  • 24-hour pH monitoring if GERD is suspected as a cause

Management

  • Establish and maintain open airway with adequate oxygenation
  • Endotracheal (ET) intubation and mechanical ventilation for severe asthma
  • Administration of IV fluids, if required
  • Continuous nebulization with short-acting beta2 agonist (SABA)-salbutamol (Kirkland et al., 2017)
  • Anticholinergic agents, including the short-acting agent ipratropium (Kirkland et al., 2017)
  • Oral and IV corticosteroids, including prednisone (Deltasone®) and methylprednisolone (Solu-Medrol®)
  • IV magnesium sulfate: 2 g over 20 minutes for severe exacerbations of asthma (Griffiths & Kew, 2016)
  • Antibiotics to treat infections that can worsen asthma symptoms (e.g., sinusitis)
  • Heliox: helium-oxygen mixture (80/20 or 70/30), heliox-driven albuterol nebulizer

Asthma Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with asthma are listed below.

Assessment

  • History
    • Chest tightness
    • Hyperventilation
    • Increased mucus production
    • Nonproductive cough
    • Restlessness
    • Shortness of breath (SOB)
    • Signs and symptoms of a cold
  • Physical Examination
    • Dyspnea
    • Tachycardia
    • Tachypnea
    • Confusion
    • Cyanosis
    • Diaphoresis
    • Diminished breath sounds
    • Nasal flaring
    • Expiratory wheezing
    • Stridor
    • Hyperresonance
    • Increase in anterior-posterior thoracic diameter
    • Lethargy
    • Mild systolic hypertension
    • Nasal polyps
    • Peripheral edema
    • Prolonged expiratory phase
    • Dry skin, eczema (atopic dermatitis)
    • Use of accessory muscles

Nursing Diagnosis/Risk For

  • Impaired gas exchange related to mucosal swelling and spasm of bronchial tubes
  • Ineffective airway clearance related to altered gas exchange
  • Ineffective breathing pattern related to mucosal swelling and spasm of bronchial tubes
  • Deficient knowledge related in managing the condition
  • Activity intolerance related to altered gas exchange
  • Anxiety related to not being able to breath adequately

Interventions

  • Maintain open airway.
  • Perform chest percussion and suctioning, as needed, per order.
  • Prepare for intubation, if needed.
  • Provide humidified air.
  • Provide supplemental oxygen, as needed, per order.
  • Insert and maintain IV, per order.
  • Administer medications as ordered.
  • Have immediate access to code cart.
  • Continually educate and reassure individual about situation, tests, and treatments.
  • Draw lab test samples, per order.
  • Encourage family and caregiver communication.
  • Encourage individual to express feelings.
  • Maintain calm environment.
  • Remove source of allergen or trigger, if possible.
  • Monitor the individual’s:
    • Vital signs
    • Respiratory status
    • Intake and output
    • Lab test results
    • Level of consciousness
    • Oximetry values
    • Signs and symptoms of complications
    • Signs and symptoms of drug toxicity or adverse effects
    • Treatment response

Expected Outcomes

  • Maintain open airway and adequate ventilation
  • Maintain fluid volume balance
  • Decreased anxiety

Individual/Caregiver Education

  • Diagnosis and further treatment
  • Ability to recognize early signs and symptoms of an asthma attack and when to seek help
  • Medications and potential side effects
  • How to use inhaler and other medications properly and as directed
  • How to use peak flow meter properly and as directed
  • Need for medical alert bracelet in cases of moderate to severe asthma
  • Need for skin testing to confirm specific allergen that may trigger asthma attacks

Asthma Management

The goal of this course is to provide healthcare professionals in acute care settings with information about asthma treatment.

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

Course Contributors

The content for this course was created by Relias external nursing content writer and editor Rakesh Tripathi MBA, MPH, BSN, RN-CEN. He is a Certified Emergency Nurse (CEN) with extensive experience primarily in acute care settings. Mr. Tripathi has considerable experience in travel nursing, as well as more than decade of general nursing experience. He has conducted nursing research for the European governments and worked as a nursing lecturer for Glasgow Caledonian University (GCU) Scotland, affiliated colleges, and has practiced nursing in Asia, the UK, and the U.S.

Resources

References

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