SEMINAR

ON
BRONCHIAL ASTHMA

SUBMITTED BY:

SHABNA BEEGUM .A

SECOND YEAR MSC.NURSING

SSNMM COLLEGE OF NURSING,

VARKALA.
INTRODUCTION

In childhood asthma, the lungs and airways become easily inflamed when exposed to certain
triggers, such as inhaling pollen or catching a cold or other respiratory infection. Childhood
asthma can cause bothersome daily symptoms that interfere with play, sports, school and
sleep. In some children, unmanaged asthma can cause dangerous asthma attacks.

Childhood asthma isn't a different disease from asthma in adults, but children face unique
challenges. The condition is a leading cause of emergency department visits, hospitalizations
and missed school days.

Unfortunately, childhood asthma can't be cured, and symptoms can continue into adulthood.
But with the right treatment, you and your common chronic diseases of childhood, affecting
more than 6 million children. Asthma is a chronic inflammatory lung disease that can cause
repeated episodes of cough, wheezing and breathing difficulty. During an acute asthma
episode, the airway lining in the lungs becomes inflamed and swollen. In addition, mucus
production occurs in the airway and muscles surrounding the airway spasm. Combined, these
cause a reduction in air flow. t damage to growing lungs.

Asthma is the commonest chronic disease in childhood. Due to the various different
phenotypes of childhood asthma, it has been difficult to agree on a clear definition of the
condition and instead an operational description is used: ‘Asthma is a chronic inflammatory
disorder of the airways in which many cells and cellular elements play a role. The chronic
inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes
of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the
early morning. These episodes are usually associated with widespread, but variable, airflow
obstruction within the lung that is often reversible either spontaneously or with treatment.’
(Global Initiative for Asthma, 2012). However, in children <5 years of age, clinical
symptoms of asthma are variable and nonspecific, and a symptoms-only approach that
defines various wheezing phenotypes has been recommended.
 BRONCHIAL ASTHMA

Bronchial asthma is one of the most common chronic diseases of childhood.

DEFINITION

Bronchial asthma is defined a chronic inflammatory disorder of the lower airways

characterized by recurrent episodes of variable, reversible airflow obstruction and airway
hyper-responsiveness (AHR) manifested as recurrent wheeze and cough.

EPIDEMIOLOGY

The prevalence of asthma is increasing worldwide with an estimate of 1-8%. The

International Study of Asthma and Allergies in childhood estimated asthma prevalence in
India to be 6.2-6.8% in the 6-7 year olds and 6.4-6.7 % in 13-15 year olds, with more males
affected than females.

ETIOPATHOGENESIS

The etiological factors can be classified as biologicals and irritants

Aerobiologicals

Children develop sensitivity to indoor allergens as they grow older in the atmosphere they are
reared. The predominant indoor allergen is the house dust mite. It takes 100 mites/g of dust
to get sensitization and 500 dust mites/g of dust to produce wheezing. 50% of perennial
asthma is due to dust mites. The pollen and mould sensitivity is observed less frequently
whereas cockroach sensitivity is fairly common.

Viral infections

The precipitating factor for an asthma attack in 40% of the children is viral URTI. Most
children develop rhinitis with or without fever followed by cough. Respiratory syncytial
virus and rhinovirus are the predominant viruses triggering asthma.

Season

Seasonal variation of asthma attacks is experienced by 35% of children. Of these the

incidence during monsson, followed by winter and less common in summer. This is
attributed to increase in automobile emission and the bright sun converting the oxides of
nitrogen to O3 which aggravates the asthma sensitivity.

Food

The role of food allergy in asthma is difficult to prove in children. The most suspected food
items that may cause asthma are grapes, banana, guavas, citrus fruits, ice creams, fried foods.
Pets

Cats are more allergic than dogs. The saliva , urine and dander are the causes for allergy
sensitization.

Air pollution and asthma

Air pollution is both outdoor and indoor. The important outdoor pollutants are black smoke,
respirable suspended particulates, SO2 , NO, CO, O 3 and lead produced by combustion of
fossils fuels, factories, mines, paper pulp mills and automobiles exhaust. Nitrogen oxide
triggers asthma in 65% of patients and also sensitizes to dust mites allergy.

IMMUNOPATHOGENESIS

Asthma is influenced by an interaction between genetic and environmental factors which

leads to AHR with structural and functional changes in the airways. Genetically predisposed
individuals are shown to react to certain inducers such as:

Inducers

Dust mite (Dermatophagoides pteronyssinus),

Cockroach (Batella germanica),

Grass pollen (Parthenium hysterophorus),

Fungus ( Alternaria and Aspergillus)

Cat ( felis domestica)

Dog (canis familiaris)

Mouse (Mus Domesticus)

Rat (Rattus norwegicus)

Which generates an immune response , common genes associated with asthma included the
Interleukin-4(IL-4) gene on chromosome 5 (proinflammatory) , ADAM-33(metalloproteinase
family), IL-12 on chromosome 5q31, genes for prostanoid DP receptors and polymorphisms
in the beta-adrenergic receptors.

Th2 cytokine-mediated predominance is seen with a chronic activation of different

cell lines which include inflammatory cells like mast cells, eosinophills,lymphocytes,
macrophages, and dendritic cells and structural cells like epithelial cells and smooth muscle
cells. These stimulate he production of th2 mediators ,IgE, IgG4, and IgG1.

Enhancers known to aggravate this response with T helper cells, mast cells and eosinophils,
resulting in AHR. The role of anti-inflammatory therapy and immunotherapy is targeted at
this stage f pathogenesis.
The enhancers are;

Enhancers

Viral infections

Ozone

Sulfur dioxide

Particulate matter

Diesel particles

Endotoxins

Comorbid conditions: Rhinitis, Sinusitis, and gastro esophageal reflux

The agents that stimulate symptoms in a child predisposed to wheezing due to prior
sensitization with these inducers are triggers. This includes:

Triggers

Exercise

Cold and dry air environmental tobacco smoke

Pollution

Histamine/methacholine

Strong and noxious odors or fumes of perfumes and cleansing agents

Crying , laugher or hyper ventilation

PATHOPHYSIOLOGY

Bronchial asthma is caused by airway obstruction, inflammation and hyper-

responsiveness.

1. Airway obstruction: The inflammatory infiltrates like eosinophils, neutrophils,

T -lymphocytes can induce epithelial cell damage and desquamation into the lumen
causing excess mucous secretion. This along with bronchial smooth muscle spasm
leads to airway obstruction.
2. Airway inflammation and hyper-responsiveness:
 Early phase: During initial 10-30 min of exposure to specific antigen, activated mast
cells, T cells, eosinophils secret chemical substances like histamine, leukotrines,
cytokynins, and prostaglandins.This leads to broncho constriction, mucosal edema
and airway inflammation.
 Late phase: It happens 4-12 hours later. Due to airway inflammation, airway
resistance occurs during exhalation. Lungs become hyperinflatted leading to reduced
lung compliance. Ventilation perfusion mismatch results hypoxemia. In severe
obstruction, alveolar hypoventilation occurs leading to hypercarbia and respiratory
acidemia.
CLASSIFICATION OF ASTHMA

The severity of asthma is classified based on how often the symptoms occur and how bad

they are , including symptoms that happen at night, the characteristics of episodes and lung
function . these classification do not always work well in children because lung function is
difficult to measure for younger children. A child’s symptoms can be categorized into one
of four main categories of asthma each with different characterestics and requiring different
treatment approaches.

1. Mild intermittent asthma

Brief episodes of wheezing, coughing or shortness of breath that occur no more than
twice a week . children rarely have symptoms between episodes . mild asthma should
never be ignored because even between flares ,always airways are inflamed.

2. Mild persistent asthma

Episodes of wheezing .coughing or shortness of breath that occur more than twice a
week but less than once a day. Symptoms usually occur at least twice a month at
night and may affect normal physical activity.

3. Moderate persistent asthma

Symptoms occurring every day and requiring medication every day. Night
symptoms occur more than once a week. Episodes of wheezing, coughing or
shortness of breath occur more than twice a week and may last for several days.
These symptoms affect normal physical activity.

4. Severe persistent asthma

Children with severe persistent asthma have symptoms continuously. Episodes of

wheezing, coughing or shortness of breath are frequent and may require emergency
treatment and even hospitalization. Many children with severe persistent asthma have
frequent symptoms at night and can handle only limited physical activity.

OTHER CLASSIFICATION OF ASTHMA

Based on trigger factors:

Extrinsic asthma: It is caused by a type of immune system response to inhaled allergens

such as animal dander, or dust mite particles.
Intrinsic asthma: It is 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

Other classification:
 Atopic: IgE mediated, triggered by allergen.
Nonatopic: Non IgE-mediated triggered by infection.
Exercise or drug induced.

CLINICAL MANIFESTATIONS

The clinical features of asthma are variable. Symptoms vary from simple recurrent cough to
severe wheezing .Children may present with recurrent cough with or without wheezing. The
symptoms occur with change in season , aggravated by exercise and more in nights.

symptoms

Cough

Intermittent, chronic and a dry nature characterize the cough in asthma. Early morning
worsening of cough or following physical exertion is classical. Acute asthma usually begin
with a cold, or bouts of spasmodic coughing mores so at night. In early phase of the attack
cough is non-productive. The patient become dyspneic, with prolonged expiration and
wheezing.

Characteristics of cough in asthma

Hacking, paroxysmal, irritative, and non-productive becomes rattling and productive of

frothy, clear, gelatinous sputum.

wheeze

Wheezing is when the air flowing into the lungs makes a high pitched whistling sound.
Expiratory wheeze noted at night or following exercise characterizes asthma. Improvement
following bronchodilator use increases the possibility of asthma. Mild wheezing occurs at
the end of a breath when the child breathing out. More severe wheezing is heard during the
whole exhaled breath.

signs

Chest examination may be normal with an occasional expiratory wheeze or prolonged

expiratory phase elicited on deep breathing. Accessory muscle use ,intercostal retractions
and nasal flaring can be seen in severe cases with an acute exacerbation. Crackles can be
heard due to increased mucus and exudates in the large airways.

Other signs are;

 Shortness of breath
 Prolonged expiratory phase
 Audible wheeze
 Chest tightness
  May have a malar flush and red ears
 Lips deep, dark red color
 May progress to cyanosis of nail beds or circumoral cyanosis
 Restlessness
 Apprehension
 Prominent sweating as the attack progresses
 Older children sitting upright with shoulders in a hunched- over position, hands on the
bed or chair, and arms braced (tripod)
 Speaking with short, panting , broken phrases
Chest

 Hyper resonance on percussion

 Coarse, loud breath sounds
 Wheezes through out the lung fields
 Prolonged expiration
 Crackles
 Generalized inspiratory and expiratory wheezing; increasingly high pitched
With related episodes

 Barrel chest
 Elevated shoulders
 Use of accessory muscles of respiration
 Facial appearance- flattened malar bones, circles beneath the eyes, narrow nose, and
prominent upper teeth.

DIAGNOSTIC EVALUATION

Asthma is often difficult to diagnose in infants. However , in older children the disease can
often be diagnosed based on child’s medical history , symptoms and physical examination.

History collection

Includes the following

 History of breathing difficulty

 Family history of asthma , allergies, skin condition called eczema or other lung
disease. History of cough , wheezing , shortness of breath , chest pain or tightness- in
detail including when and how often these symptoms have been occurring.

Physical examination

Assess child for abnormal findings such as;

 cough, abnormal breath sounds. Respiratory rate, too breathless to talk or take feed, use of
accessory muscles of respiration, pulses paradoxes >15 mmHg, heart rate >140 beats /
minute.

Pulse oximetry

Oxygen saturation may be significantly decreased or normal during a mild exacerbation.

Blood routine examination

It shows eosinophilia

Chest x- ray

Usually reveals hyperinflation and also it shows bilateral and symmetric air trapping in
lungs. Also areas of atelectasis due to mucus plugs may be seen.

Blood gases

Might show carbon dioxide retention and hypoxemia.

Allergy test

Skin test or RAST can determine allergic triggers for the asthmatic child.

Pulmonary function test (P F T)

It represent an integral component of clinical management in school- aged children with

asthma, and are being increasingly used in pre-school children. Spirometry is the most
commonly applied lung function test and can be applied in a wide variety of locations and
across the ages. Spirometric indices commonly measured are forced vital capacity (FVC),
FEV1 and forced expiratory flow rate over 25-75% of FVC .FEV 1less than or equal to 80%
predicted for age, sex , and ethnicity is suggestive of airflow obstruction. While spirometry is
useful for determining the severity of asthma, monitoring and guiding treatment.

Bronchial provocation test

Airway hyper reactivity to methacholine, histamine or hypertonic saline in a child with

normal FEV1 can aid in the diagnosis of asthma. A 20% fall in the FEV 1induced by a
concentration of methacholine less than 4mg / ml is considered positive . however tests are
not routinely used in clinical practice, as airway stimulants should be carefully dosed and
monitored.

Exercise tolerance test

An exercise test such as running on a treadmill can be useful in diagnosing asthma in children
with a history suggestive of exercise induced bronchospasm.
Fractional Exhaled Nitric Oxide

Fractional Exhaled Nitric Oxide (FeNO) is a surrogate marker of eosinophilic airway

inflammation and a good predictor of corticosteroid response. It aids in the aasessment,
management and long term monitoring of asthma.

MANAGEMENT

There are a large number of guidelines on the management of asthma; however, the key
messages of them remain similar. The principal goal is disease control using least possible
medication.

Education of parents and caregivers

Asthma education is a continuous and dynamic process. Education should highlight chronic
nature of the disease , the recognition of asthma symtoms, different types of medication, need
for long term medication, importance of compliance and adherence and a demonstration of
use of inhalers and spacers.

Identification and avoidance of triggers

Avoidance of triggers may have a beneficial effect on disease activity. Reduction or

elimination of problematic environmental exposures is the key in asthma control. Efforts
need to be focused on avoiding perennial and indoor allergens which can potentially
decrease asthma symptoms, medication requirements, AHR and exacerbations. This however
requires avoidance of the offending agents for a sustained period of days to weeks.
Avoidance and control of the exposure to environmental tobacco smoke and other fumes has
shown to significantly control and reduce exacerbations in children with asthma. Prior to
advising avoidance of specific allergens, significant proof needs to be ascertained by a careful
clinical history, skin prick testing and/ or specific IgE measurement can help , particularly is
there are few identified or suspected triggers.

Following measures may help in decreasing the triggers;

 The bedroom of the child should be kept clean and as free from dust as possible. Wet
mopping of the floor should be done because dry dusting increases exposure of the
child to house dust.
 Heavy tapestry attracts dust and therefore light plain cloth sheets should be used as
curtains in the child’s room.
 Carpets, stuffed furniture, loose clothing, wall hangings, calendars and books attract
lot of dust and should be regularly cleaned at periodic intervals.
 The bed of the child should be made of light material and should be aired regularly.
 Keeping of animal pets should be discouraged, as the child may be sensitive to their
fur.
  Generally , it is not necessary to restrict the diet of the child because bronchial asthma
due to food allergy is unusual.
 Adolescent patients must be refrain from smoking.
 Exposure to strong or pungent odors such as wet paint, dissinfectants and smoke
should be minimized.
 The child should not got o attics or basements, especially if these were unoccupied
and kept closed for some days . These should be minimized.
 The child should be properly cleaned and aired for some time before the asthmatic
patent goes there.

Treating comorbid conditions

The most common causes of chronic coughing in children include rhinitis , sinusitis and GER
in addition to asthma. Effective management of these comorbid conditions is shown to
reduce medication requirement, disease severity and asthma symptoms.

Pharmacotherapy

The pharmacological therapy of bronchial asthma involves use of drugs that relax the smooth
muscles and dilate the airways and drugs that decrease inflammation and there by prevent
exacerbations. The medications used for long term treatment of asthma include
bronchodilators , steroids, mast cell stabilizers, leukotriene modifiers and theophylline.

 Bronchodilators
This group of drugs provides symptomatic relief. They may be short acting and long
acting. The commonly used short acting bronchodilators are adrenaline, terbutaline
and salbutamol. All of these have quick onset of action .adrenaline stimulates alpha
and both beta receptors; thus causes cardiac side effects. Terbutaline and salbutamol
are specific beta 2 agonist and hence have least cardiac side effects. Inhalation route is
preferred because of quick onset of action and least side effects.
Long acting beta agonists include salmetrol and formoterol. Both these drugs are
specific beta 2 agonist and have a longer duration of action of 12-24 hours.

 Corticosteroids
Asthma is a chronic inflammatory disease of airways. Corticosteroids being potent
anti-inflammatory agents, are the corner stone of long –term treatment of asthma.
Systemic glucocorticoids used early in the treatment of acute exacerbation can lessen
the need for visits to emergency department and hospitalization. The advantage of
inhaled corticosteroids is application of potent medication to the sites of where it is
specifically needed. This potentially reduces the risk for systemic adverse effect of
these medications.
The commonly used inhaled steroids include beclomethasone, budesonide and
fluticasone. Beclomethasone or budesonide has almost the same effect .
The newer inhalation steroid , fluticasone is considered to be superior to
Beclomethasone or budesonide.
  Mast cell stabilizers
In this group of drugs includes cromolyn sodium, nedocromil sodium and ketotifen.
Cromolyn sodium belongs to chromone group of chemicals. It reduces bronchial
reactivity and symptoms induced by irritants , antigens and exercise. Indications for
use of chromolyn includes mild to moderate persistent asthma and exercise induced
asthma.
Nedocromil is another nonsteroidal drug used for control of mild to moderate asthma.
Ketotifen is administered orally . significant clinical improvement may be evident
after 14 weeks of therapy.

 Leukotriene modifiers
Leukotriene inhibitors are new pharmacological agents for the treatment of mild to
moderate persistent asthma and exercise –induced asthma. Leukotriene inhibitors act
either by decreasing the synthesis of leukotriene or by antagonizing the receptors.
Monteleukast and zafirlukast have received approval for use in pediatric asthma
patients . Monteleukast can be used in children above one year of age while
zafrilukast above 6 year of age.

 Theophylline
Theophylline has concentration dependent bronchodilator effects . The bronchodilator
effect is exerted by inhibition of phosphodiesterace. In addition theophylline has anti-
inflammatory and immunomodulatory effects at therapeutic serum concentration that
appears to be distinct from its bronchodilator properties. It can also be used as
adjunctive therapy in moderate or severe persistent asthma.

 Immunotherapy
This consists of giving gradually increasing quantities of an allergen extract to a
clinically sensitive subject, so as to ameliorate the symptoms associated with
subsequent exposure to causative allergen. This is considered only occasionally in
highly selected children who are sensitive to a specific allergen such as grass pollen,
mites etc.

Medication for long-term treatment of asthma

Medication, route of Dose
administration

Bronchodilators
Salbutamol
100 µg/puff MDI 1-2 puff 4-6 hourly
Respirator solution 5
mg/ml Respules 2.5
mg/3 ml 0.15-0.2 mg/kg dose
Dry powder capsules nebulization
200µg/cap (rotacap)
1-2 puff 4-6 hourly
Terbutaline
250 µg puff MDI 1-2 puffs 12-24 hourly
Salmetrol 1 dry powder cap
25 µg/puff MDI inhalation 12-24 hourly.
Drypowder capsules 50 1-2 puffs 12-24 hourly Step wise treatment of asthma
µg /cap (rotacap) 1 dry powder cap
inhalation 12-24 hourly. After the assessment of severity
Formoterol appropriate anti-asthma drugs are
12 µg / puff MDI 5-15 mg/kg/day
Dry powder capsules
selected .
2 divided dose
12 µg /cap (rotacap)

Theophylline 5 mg/puff
100, 150, 200, 300 mg
tablets 1-2 puffs3-4 times a
Oral day
Mast cell stabilizers
Sodium, cromoglycate 1 mg twice a day
5mg /puff MDI
Nedocromil sodium 50-800 µg/day in 2-3
Inhalation divided dose
Ketotifen
1 mg tab and 1 mg /5ml 25-400 µg/day Long
in2 term prevention
Corticosteroids divided doses
Inhaled corticosteroids
Beclomethasone
50,100,200,250 µg/puff
Budesonide
50,100,200 µg/puff
MDI respules-0.5 and 1
mg /mi
Rotacaps 100/200/400
µg /cap
Fluticasone 2-5 years:4mg/day
25, 50, 125 µg /cap 5-12years:5mg/day
Respules:0.5 and 1 mg >12years:10mg/day
per ml
Monteleukast
4,5, 10 mg tabs
Step 4 Inhaled short acting beta agonist are
Severe persistent required + inhaled
corticosteroids
budesonide/beclomethasone,400 µg twice
daily may increase up to 1000 µg /day+ long
acting bronchodilator : long acting inhaled
beta 2 agonist and / or sustained release
theophylline + corticosteroids low dose
alternate day ) if no relief with above
treatment)
Step 3
Moderate persistent Inhaled short acting beta agonist as
required + inhaled corticosteroids
Budesonide / Beclomethasone , 200-400 µg
divided twice daily. If needed long acting
bronchodilator : long acting inhaled beta 2
agonist salmeterol 50 µg once/twice daily
and/ or sustained release theophylline.
Step 2
Mild persistent Inhaled short acting bête agonist as
required + inhaled corticosteroids
Budesonide/beclomethasone, 100-200 µg or
cromolyn or sustained release theophylline or
leukotriene modifiers.

Step 1
Intermittent Inhaled short acting beta agonist as required
for symptoms relief. If they are needed more
than 3 times a week move to step 2.

Home treatment of acute exacerbation

An important part of health education is instructing the parent on how to recognize and
manage acute exacerbation of asthma at home. A written action plan should be given to
them. Acute exacerbation can be identified by increase in cough, wheeze and breathlessness.
PEER, if measured, may be decreased by 15% from the baseline. For acute exacerbation
parents should administer short acting beta 2 agonists by MDI +_ spacer +_ facemask, one
puff at a time, repeated every 30-60 seconds up to maximum of 10 puffs with monitoring of
symptoms. If symptoms are relieved and PEFR is increased at the end of inhalation the child
can be continued on salbutamol/ terbutaline every 4-6 hour and a visit to treating physician is
planned, if any life threatening attack ,the child should be immediately transferred to a
hospital. Administration of single dose of prednisolone (1-2 mg/kg) before going to hospital
in a child who has symptoms of life threatening asthma or does not show satisfactory
improvement after inhalation therapy at home may be useful.
 NURSING MANAGEMENT
Nursing assessment

Assess for wheezing, coughing, dyspnea, expectoration of sputum, shortness of

breath, tight feeling in chest increase respiration, apprehension and subcostal and intercostal
retraction, cyanosis, shoulder forward in attempt to use accessory muscles of respiration.

Ineffective Breathing Pattern

Nursing Diagnosis

 Ineffective Breathing Pattern: Inspiration and/or expiration that does not

provide adequate ventilation
Related Factors

The following are the common related factors for the nursing diagnosis
Ineffective Breathing Pattern.

 Swelling and spasm of the bronchial tubes in response to inhaled

irritants, infection, drugs, allergies or infection.
Defining Characteristics

 Cough
 Cyanosis
 Dyspnea
 Loss of consciousness
 Nasal flaring
 Prolonged expiration
 Respiratory depth changes
 Tachypnea
 Use of accessory muscles
Desired Outcomes
Common goals and expected 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

Increased BP, RR, and HR occur during the

Assess the client’s vital signs as needed while in initial hypoxia and hypercapnia. And when it
distress. becomes severe, BP and HR drops and
respiratory failure may result.

Changes in the respiratory rate and rhythm

Assess the respiratory rate, depth, and rhythm. may indicate an early sign of impending
respiratory distress.

Anxiety may result from the struggle of not

Assess the client’s level of anxiety.
being able to breathe properly.

Adventitious sounds may indicate a

Assess breath sounds and adventitious sounds
such as wheezes and stridor.
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.
 Reactive airways allow air to move into the
Assess the relationship of inspiration to lungs more easily than out of the lungs. If
expiration. the client is gasping for air, instruction for
effective breathing is needed.

These indicate respiratory distress. Once the

Assess for signs of dyspnea (flaring of nostrils, movement of air into and out of the lungs
chest retractions, and use of accessory muscle). becomes challenging, the breathing pattern
changes.

Dyspnea during a normal conversation is a

Assess for conversational dyspnea.
sign of respiratory distress.

Fatigue may indicate distress, leading to

Assess for fatigue.
respiratory failure.

Paradoxical pulse is an abnormally large

decrease in systolic blood pressure and
pulses wave amplitude during inspiration.
Assess the presence of paradoxical pulse of 12
The normal fall in pressure is less than 10
mm Hg or greater.
mm Hg. A paradoxical pulse of 12 mm Hg
or greater indicates a severe airflow
obstruction.

Oxygen saturation is a term referring to the

fraction of oxygen-saturated hemoglobin
Monitor oxygen saturation. 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.
Monitor arterial blood gasses (ABG).
Therapeutic Interventions
Plan for periods of rest between activities.
Maintain head of bed elevated.
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.
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.
Fatigue is common with the increased work
of breathing from the ineffective breathing
pattern. Activity increases metabolic rate and
oxygen requirements.
This promotes maximum lung expansion and
assists in breathing.

Encourage client to use pursed-lip breathing for
exhalation.
Administer medication as ordered:
Short-acting beta-2-adrenergic agonist.
 Albuterol (Proventil, Ventolin).
 Levalbuterol (Xopenex).
 Terbutaline (Brethine).
Inhaled Corticosteroids.
 Budesonide (Pulmicort).
 Fluticasone (Flovent).
 Beclomethasone (Vancenase).
 Mometasone (Asmanex
Twisthaler).
Anticipate the need for alternative treatment if life-threatening bronchospasm continues:
 General anesthesia.
 Magnesium sulfate.
 Heliox (a helium-oxygen
mixture).
Pursed lip breathing improves breathing
patterns by moving old air out of the lungs
and allowing for new air to enter the lungs.
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.
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.
General anesthesia is used when there is
both dynamic hyperinflation and profound
hypercapnia that cannot be corrected by
increasing minute ventilation.
Magnesium sulfate has bronchodilating and
anti-inflammatory effects that are sometimes
used in the treatment of moderate to severe
asthma in children.
The use of helium (a less dense gas than
nitrogen) causes decrease airway resistance
thus lessens the work of breathing.
Ineffective Airway Clearance
Nursing Diagnosis

 Ineffective Airway Clearance: Inability to clear secretions or

obstructions from the respiratory tract to maintain a clear airway.
Related Factors

Common related factors for this nursing diagnosis:

 Bronchospasms
 Increased pulmonary secretions
 Ineffective cough
 Mucosal edema
Defining Characteristics

 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

Changes in the respiratory rate and rhythm

Assess respiratory rate, depth, and rhythm. may indicate an early sign of impending
respiratory distress.

Cyanosis indicates low oxygenation and that

Assess for color changes in the buccal mucosa,
breathing is ineffective to maintain adequate
lips, and nail beds.
tissue oxygenation.

Wheezes suggest partial obstruction or

Auscultate lungs for adventitious breath sounds
resistance. While rhonchi may indicate
(wheezes and rhonchi).
retained secretions in the lungs.

Coughing is a natural way to clear the throat

and breathing passage of foreign particles,
Assess the effectiveness of cough. irritants, and mucus. Severe bronchospasm,
thick secretions, and respiratory muscle fatigue
are some of the causes of an ineffective cough.

Normal secretion is clear or gray and minimal;

Assess the amount, color, odor and viscosity of abnormal sputum is green, yellow, or bloody;
the secretions. malodorous; often copious. Thick tenacious
secretions increase airway resistance.

Provides information on the fluid balance of

Monitor and record intake and output (I&O) the patient. Dehydration can contribute in
adequately. viscous secretions and may result to decrease
airway clearance.
Monitor oxygen saturation using pulse
oximetry.
Monitor chest x-ray results.
Monitor laboratory results as indicated:
 White blood cell count
 Potassium
 Theophylline level (if on
theophylline therapy)
Monitor arterial blood gasses (ABGs).
Obtain peak expiratory flow rate (PEFR) or
forced expiratory volume in 1 second (FEV1)
before and after respiratory treatment.
Therapeutic Interventions
Oxygen saturation of less than 90% indicates
problems with oxygenation.
A chest x-ray provides information regarding
the presence of infiltrates, lung inflation, or the
presence of barotrauma.
Increased WBC count indicates an infection.
The use of beta-adrenergic agonists shift
potassium into the cell and cause hypokalemia.
Therapeutic range of theophylline is between
10 to 20 mcg/mL. Signs of toxicity
include hypotension, tachycardia, GI
symptoms, and restlessness.
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.
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.
 Break up activities into smaller parts and take
Pace the client’s activities. rest breaks in between to avoid fatigue.
increased effort in breathing properly.

Helps loosen and expectorate excess secretions

Encourage deep breathing and coughing
and contribute in effective clearing mucus out
exercises.
of the lungs.

Encourage increased fluid intake of up to 3000 Fluids help minimize mucosal drying and
ml/day within cardiac or renal reserve. increases ciliary action to remove secretions.

When consumed in excess, it may contribute

to dehydration making difficulty for secretions
Limit alcohol and caffeinated drinks. to be expectorated. In addition, it may also
increased the risk of CNS and cardiovascular
system side effects of medications.

IV fluid therapy can be beneficial for clients

Administer IV fluids and medication as with dehydration. Medications such as
ordered. bronchodilators and inhaled corticosteroids
may be prescribed.

Oxygen therapy corrects hypoxemia, which

Administer oxygen as ordered. can be caused by retained respiratory
secretions.

Acute exacerbations of asthma can lead to

Anticipate the need for intubation and
respiratory failure requiring mechanical
mechanical ventilation.
ventilation.

Activity Intolerance
Nursing Diagnosis

 Activity Intolerance: Insufficient physiologic or physiological

energy to endure or complete required or desired activity.
Related Factors

Common related factors for this nursing diagnosis:

• Fatigue

• Airway problem

Defining Characteristics

• Tired appearance

• Lethargy

• Prolonged dyspnea due to an asthma attack

• Inability to speak, eat, play

Desired Outcomes

Common goals and expected outcomes:

• Child will engage in normal activities with absence of fatigue.

Nursing Interventions and Rationales

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

Nursing Interventions Rationale

Nursing Assessment

Provides information about energy reserves

Assess the presence of weakness and
as dyspnea and work of breathing over a
fatigue caused by airway problem.
period of time wears out these reserves.

Therapeutic Interventions

Encourage activities such as quiet play, reading, Avoids change in respiratory status and
 energy depletion due to excessive
watching movies, games during rest.
activity.

Disturb only when necessary, perform all care at

one time instead of spreading over a long period Conserves energy and limits interruption in
of time, avoid doing any care or procedures rest.
during an attack.

Schedule and provide rest periods in a calm Promotes adequate rest and decreases
peaceful environment. stimuli.

Promotes understanding of the effect of

Explain the reason for the need to conserve
activity on breathing and the need for rest to
energy and avoid fatigue to parents and child.
prevent fatigue.

Assist in planning a schedule for bathing,

Provides care while promoting activities of
feeding, rest that will save energy and prevent an
daily care.
attack or promote resolution of an attack.

Reinforce activity or exercise limitations

Provides preventive measures to offset
if these trigger attack; advise physician approved
possible attack.
activities (aerobics, walking, swimming).

Anxiety
Nursing Diagnosis

 Anxiety: Vague uneasy feeling of discomfort or dread

accompanied by an autonomic response.
Related Factors

Common related factors for this nursing diagnosis:

 Change in the environment

 Change in health status
 Loss of control
 Hypoxia
  Respiratory distress
Defining Characteristics

 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: Asthma can become much worse

with anxiety since it causes rapid,
 Feelings of panic, fear, and shallow breathing.
uneasiness.
 Tachycardia.
 Cold or sweaty hands or feet.
  Shortness of breath.
 Restlessness.
Therapeutic range of theophylline
is between 10 to 20 mcg/mL.
Assess theophylline levels.
Theophylline causes increases
anxiety.
Increase anxiety may indicate an
Monitor oxygen saturation.
early sign of hypoxia.
Therapeutic Interventions
Provide comfort measures:
Maintaining calmness will reduce
 Calm, quiet environment. oxygen consumption and the work
of breathing.
 Soft music.
Client’s anxiety will decrease as he
Explain every procedure to the client in a simple and
or she can understand the treatment
concise manner.
regimen.
Family’s anxiety can be easily
Ensure to update the significant others of the client’s transferred to the client. Giving off
progress. information to them can help
relieve apprehension.
Stay with the client, and encourage slow, deep breathing. The presence of a trusted reliable
Assure the client and significant others of close, consistent person may give the client a sense
monitoring that will ensure prompt intervention. of security.
Encourage the use of relaxation techniques:

 Progressive muscle relaxation as

indicated.
 Diaphragmatic and pursed lip Relaxation techniques are an
breathing. effective way of decreasing
anxiety.
 Use of imagery, repetitive phrases
(repeating a phrase that triggers a
physical relaxation, such as “relax and
let go”).

Interrupted Family Processes

Nursing Diagnosis
  Interrupted Family Processes: Change in family relationships
and/or functioning.
Related Factors

Common related factors for this nursing diagnosis:

 Sick child
 Emergent hospitalization
Defining Characteristics

 Alterations in the parent-child relationship which may hinder

adjustment and decrease parent’s ability to maximize child’s
growth and development potential
 Parental stress, which may result in parental dysfunction
 Stress may be manifested by excessive worry, withdrawal, denial,
difficulty in making child-rearing decisions, overprotectiveness
Desired Outcomes

Common goals and expected outcomes:

 Parent will verbalize feelings and concerns related to the

implications of the disease on the entire family.
 Family will demonstrate acceptance, adjustment, and coping
behaviors related to the symptoms and effects of asthma.
Nursing Interventions and Rationales

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

Nursing Interventions Rationale

Nursing Assessment
Assess available resources and coping skills of Promotes the reinforcement of positive coping
the family. skills.

Assess interpersonal relationships within the

family and support systems, with emphasis on
the family’s relationship with the Promotes early recognition of interpersonal
child diagnosed with asthma; intervene problems, especially within the parent-child
appropriately with evidence of relationship.
maladaptation; refer to counseling if
appropriate.

Promotes positive relationships between

Assess siblings and peers at intervals, as
siblings and peers, which can be affected by a
appropriate, providing time for questions and
chronic illness that needs increased parental
feelings.
attention, and so forth.

Open discussions during a history-taking can

Explore the family’s feelings regarding the identify family-related psychologic stress, if
child and the diagnosis. found early, can be the focus of preventive
services to promote adaptation.

Therapeutic Interventions

Provide an opportunity for the family to cope

Reaction may be expected in the early
up with the illness; anticipate the
adjustment phase, following the diagnosis of
normal grief reaction of “loss of the perfect
chronic disease, depending on the severity.
child.”

Assist the family to explore specific

feelings regarding guilt, anger,
disappointment, irritation, and fear;  speak with
parents about their fears:  coping with the
Validates the normalcy of their feelings which
child’s anxiety, fear of complications, fear of
promotes stress reduction and positive
death, fear of tests and procedures, fear of
coping skills.
treatments, and the child’s potential inability to
feel “normal” as compared to peers; help
family to identify realistic and unrealistic
fears.

Encourage positive family relationships;

Promotes the family’s ability to adjust in a
serve as a role model regarding attitudes and
positive manner.
behaviors towards the child.

Provide support to the family; assess Promotes positive adaptation within the

the family’s support systems and encourage family.
their appropriate use; refer to community
agencies and support groups, as applicable.

Provide clear and accurate information to the Promotes a sense of control and relieves stress;
family about the condition, treatments, and reinforcement and individualizing the
implications; reinforce all information given. approach fosters better understanding.

Provides for a maximum level of care at home;

Assist family in developing and implementing
parental participation in the plan of care may
a home care plan, employing age-appropriate
help to strengthen compliance and foster
goals consistent with activity tolerance.
positive adaptation.

Encourage child and family to perform good

health habits, such as a well-balanced diet,
Promotes the body’s own natural defenses.
sufficient rest, good hygiene, and follow-up
care.

Encourage family in methods to improve the

child’s physical, psychological, and cognitive Provides parents accurate knowledge on
development, based on the child’s current growth and development.
developmental level.

Explain to child/family the potential

Avoids possible asthma exacerbation when
advantages of hyposensitization therapy where
allergen-induced.
allergies cannot be avoided, as applicable.

Teach child and family accurate use of a

nebulizer, peak flow meter, and metered dose Prevents and/or minimizes exacerbation of
inhaler; stress understanding of equipment asthma by early recognition.
usage, cleaning, and strategies for compliance.

Teach child and family on preventive

treatment when applicable ( i.e., use of
Prevents and/or reduces asthma exacerbations.
bronchodilators as prophylaxis to prevent
exercise-induced asthma).

Reinforce measures to avoid infections such as

Prevention of infection may lessen asthma
good handwashing, cleaning and care of
exacerbations.
equipment used, and avoiding crowds.

Teach parents about the signs of Facilitates timely collaboration between parent
depression, particularly in the adolescent; and healthcare care team if a problem
suggest appropriate referrals as needed. develops.
Fatigue
Nursing Diagnosis

 Fatigue: An overwhelming, sustained sense of exhaustion and

decreased capacity for physical and mental work at usual level.
Related Factors

Common related factors for this nursing diagnosis:

 Increased work of breathing

 Hypoxia
 Respiratory distress
Defining Characteristics

• Apprehensiveness

• Dyspnea

• Frequent request for someone to be in the room

• Restlessness

• Tachycardia

• Tachypnea

Desired Outcomes

Common goals and expected outcomes:

• Patient will demonstrate decreased fatigue as evidenced by less

irritability and restlessness, improved sleeping pattern, and ability to
perform usual activities.

Nursing Interventions and Rationales

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

Nursing Interventions Rationale

Nursing Assessment

Identifying and notifying changes  allows

Monitor vital signs every 4 hours. Monitor
immediate action that find a solution to the
frequency of work of breathing.
problem and minimize the occurrence of fatigue.

Assess for signs of hypoxia such as change

of level of consciousness, shortness of Determining these symptoms immediately allows
breath, tachycardia, irritability, fatigue, timely management and minimize fatigue.
restlessness.

Therapeutic Interventions

Physical and emotional comfort has a positive

Encourage simple, quiet, age-appropriate
effect on the general well-being, encourages
play activities as the child’s condition
relaxation, and decrease oxygen consumption
improves.
and fatigue.

Schedule and integrate nursing care to allow

These interventions encourages rest and lessens
periods of uninterrupted rest and sleep.
stress, oxygen consumption, and fatigue.
Provide a quiet and peaceful environment

Allow the presence of a parent (if with with The presence of significant others minimizes
younger children) or significant others anxiety and fear hence it can lessen oxygen
during care. expenditure and fatigue.

Health-Seeking Behaviors: Prevention of Asthma

Attack
Nursing Diagnosis
  Health-seeking behaviors (specify): Active seeking (by an
individual in stable health) of ways to alter personal health habits
and/or environment to move toward a higher level of health.
Related Factors

Common related factors for this nursing diagnosis:

 Longing for information about preventive measures and behavior

changes
Defining Characteristics

 Expressed desire for increased control of health practices and

effect of current environmental conditions and behaviors on
health status
 Increased frequency of attacks
Desired Outcomes

Common goals and expected outcomes:

 Parents (and child if age-appropriate) will verbalize understanding

of triggering agents and prevention measures for asthma attacks.
Nursing Interventions and Rationales

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

Nursing Interventions Rationale

Nursing Assessment

Assess client history such as triggering

Provides a basis for information required for
factors, incidence of respiratory infections
maintaining the health, as respiratory changes or
and interventions taken to support the child’s
infection can precipitate an asthma attack.
health.

Assess family’s history of allergies, what Reveals familial tendency to airway reactive
does or does not trigger an attack, and disease or history of eczema, allergic rhinitis,
what behaviors result from the attack. urticaria.

Determines whether products readily accessible

for treatment of respiratory infection should or
Assess for use of over-the-counter
should not be used, as they may interact with
medications, type used and effects.
prescribed medications, causing a more severe
attack.

Therapeutic Interventions

Instruct child to avoid exposure to persons

with respiratory infections, how to cover Prevents transmission of microorganisms by
mouth and nose when coughing or sneezing, airborne droplets.
and to dispose of tissues.

Instruct the child to refrain from stressful Provides information on how to prevent
situations and strenuous physical exercise. situations that may provoke an attack.

Instruct parents to modify the home

environment to reduce dust, exposure to pets Limits exposure to factors that can trigger an
and indoor plants, foods (peanut, egg), attack.
changing of filters.

Avoids transfer of microorganisms from

Educate parents/child about proper
touching or handling supplies, touching the
techniques in handwashing and allow time
face of the child by parents or child without
for return demonstration.
handwash.

Encourage breathing exercises and Prevents attack before it begins and increases

controlled breathing and relaxation. ventilation.

Educate parents and child about the disease

Provides information that will improve the
condition, signs and symptoms and
performance of preventive measures and
possible triggering factors influencing an
compliance with the medical regimen.
attack.

Discuss with parents and child the signs and

Teach actions to be taken to prevent a severe
symptoms indicating the onset of an attack
attack and when to notify the physician.
(shortness of breath, wheezing, chest pain).

Educate parents about the effect of allergens

Reduces exposure to factors that precipitate an
and how to limit exposure to external factors
attack.
(cold air, pollen, dust mites, air pollutants).

Inform parents of skin testing for Identifies allergies for hypersensitization

sensitivities to allergens. regimen.

Teach parents and child about medication

administration as ordered and how to manage
Promotes compliance in order to prevent an
method of administration;
attack and maintain wellness.
advise avoiding over-the-counter drugs
without physician advice.

Provide contact with community agencies for Offers support to families with the child
information and support. suffering from asthma

Deficient Knowledge
Nursing Diagnosis

 Deficient Knowledge: Absence or deficiency of cognitive

information related to specific topic.
Related Factors

Common related factors for this nursing diagnosis:

 Chronicity of disease
 Lack of information sources
 Long-term medical management
Defining Characteristics

 Absence of questions
 Ineffective self-care
 Inability to answer properly
Desired Outcomes

 Patient and significant others will verbalize knowledge of the

disease and its management and community resource available
to help the client in coping with chronic disease.
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 knowledge of care for status Knowledge of how to handle care can save
asthmaticus, as appropriate. time.

Knowledge of what has been effective in the

Assess past and present therapies, including the
past determines the appropriate intervention
client’s response to them.
needed.

Assess the client’s knowledge of asthma

triggers and asthma medications:

 Treatment for status

asthmaticus.
 Correct use of metered-dose
inhaler (MDI) and space.
 Use of spacers with an MDI.
 Ability to distinguish between
rescue medications and
controllers.
Assess the client’s tobacco use.
Therapeutic Interventions
Evaluate self-care activities: preventive care
and home management of an acute attack.
Explain the disease to the client and significant
others.
Identifying the asthma triggers will make the
client know how to control them; Correct use
of spacers by slow, deep inhalation and
breath-holding after inhalation will ensure the
effectiveness of the medication. Improper use
of an MDI will lead in the medications not
getting deep enough to affect the airway.
Assessment of tobacco use is important for
clients suffering from lung disease. If the
client is a tobacco user, cessation
of smoking should be stressed.
Since it is a chronic disease, the client must be
able to self-manage the disease.
A misconception regarding asthma attack is
that it can be managed without medication
through self-control and discipline.
Knowledge on asthma self-management
reduces the need for frequent hospitalizations.
Instruct the client how to avoid asthma triggers:
 Smoke.
 Exercise
 Air pollution.
 Allergens.
Educate the client about the warning signs and
symptoms of an asthma attack and the
importance of early treatment of an impending
attack. Provide a written copy of daily
exacerbation management.
Review all medications with the client
including a discussion of short versus long-
acting medications, a review of zones, and the
dosage of each medication in each zone.
Reinforce the need for taking controller
medications as indicated.
Teach how to administer nebulizer treatments,
Diskus, MDIs spacers, or dry powder capsules
with the correct technique.
Instruct in the use of peak flow meters and
develop an individualized plan on how to adjust
medications and when to seek medical advice.
Establish the client’s personal best peak
expiratory flow rate (PEFR).
Environmental trigger control can lessen the
frequency of asthma attacks and improve the
client’s quality of life.
A written treatment plan is needed by the
client to reinforce information that was
already taught. Early treatment within 6 hours
of an attack may lessen the chance of
hospitalization.
Short-acting beta-agonists are the first line
medication of choice since they relieve acute
asthma attacks very quickly compared to the
long-acting. Beta-2-adrenergic agonist should
be used before inhaled steroids since they
open the airways and allow the anti-
inflammatory medication to reach deeper into
the lung fields. Rinsing the mouth after using
an inhaled steroids prevents yeast infection.
Anti-inflammatory medications, such as
inhaled steroids, work by reducing swelling
and mucus production in the airways. As a
result, the airways are less sensitive and less
likely to respond to asthma triggers and cause
asthma symptoms.
Asthma is a chronic condition that is present
even when attacks are not occurring.
Medications such as bronchodilators and anti-
inflammatory agents reduce the incidence of
attacks.
Providing return demonstrations on techniques
are needed to ensure appropriate delivery of
the medication.
Use the zone system individualized to the
client. Personal best is established by having
the client take and document peak flow each
morning before medication use and in the late
afternoon for 2 weeks. Personal best is the
highest peak flow reading regularly blown,
which is then used to calculate the client’s
zone.
 Green Zone: 80 to 100% of
the usual or “normal” peak

Discuss the importance of
pneumococcal pneumonia vaccine and
influenza vaccine yearly.
Reinforce what to do in an asthma attack
(Home management and prevention, and when
to seek urgent hospitalization).
Address long-term management issues.
Discuss the use of a medical alert bracelet or
other identification.
Instruct the client to keep emergency phone
numbers readily available.
flow rate signals all clear.
 Yellow Zone: 50 to 80% of
the usual or “normal” peak
flow rate signals caution. A
temporary increase in
medication may be needed.
 Red Zone: Less than 50% of
the usual or “normal” peak
flow rate signals a Medical
Alert. A beta-adrenergic
agonist is usually taken, and
if there is no improvement
in PEFR to yellow or green
zones, the physician is
notified.
Regular immunizations reduce the chance of
acquiring these diseases.
Information enables the client to take control
and reduce life-threatening complications.
Hospitalization is required for severe
exacerbations, the severity of the condition
and poor response to treatment.
Control of allergens, avoidance of
precipitators, environmental control,
avoidance of air pollutants such as perfumes,
aerosol sprays, powder, and health habits
prevents the occurrence of asthma attacks.
These identification alert others to an asthma
history to facilitate the delivery of safe,
effective medical care.
These will help in seeking immediate medical
attention.