Bronchial Asthma

MEDICAL SURGICAL NURSING
MRS.SHINCY GEORGE,MSN,RN,AUTHOR
www.nursingmanthra.com
SHINCY GEORGE,MSN,RN,AUTHOR
www.nursingmanthra.com 1
INTRODUCTION
 Asthma is a chronic lung-disease that inflames and
narrows the airways (tubes that bring air into and out
of an individual’s lungs).
 Asthma is the most common chronic disease among

children.
DEFINITION
 A chronic inflammatory disorder of the airways in
which many cells and cellular elements play a role. The
chronic inflammation causes recurrent episodes of
wheezing, breathlessness,chest tightness, and
coughing, particularly at night and in the early
morning. These episodes are usually associated with
widespread but variable airflow obstruction that is
often reversible either spontaneously or with
treatment.
Risk Factors for Asthma
Host factors:
 predispose individuals to, or protect them from,
developing asthma
Environmental factors:
 Influence susceptibility to development of asthma in
predisposed individuals, precipitate asthma
exacerbations, and/or cause symptoms to persist
Factors that Exacerbate Asthma
 Allergens
 Respiratory infections
 Exercise and hyperventilation
 Weather changes
 Sulfur dioxide
 Food, additives, drugs
Factors that Influence Asthma
Development and Expression
Host Factors:
 Genetic - Atopy - Airway hyperresponsiveness
 Gender
 Obesity
Environmental :
 Indoor allergens
 Outdoor allergens
 Occupational sensitizers
 Tobacco smoke
 Air Pollution
 Respiratory Infections
 Diet
PATHOPHYSIOLOGY OF ASTHMA
PATHOPHYSIOLOGY
 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.
DIAGNOSIS:
 History and patterns of symptoms
 Measurements of lung function - Spirometry - Peak
expiratory flow
 Measurement of airway responsiveness
 Measurements of allergic status to identify risk factors
 Extra measures may be required to diagnose asthma
in children 5 years and younger and the elderly
CLINICAL MANIFESTATIONS
 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.
Management and Prevention
Program
Goals of Long-term Management:
 ■ Achieve and maintain control of symptoms
 ■ Maintain normal activity levels, including exercise
 ■ Maintain pulmonary function as close to normal
levels as possible
 ■ Prevent asthma exacerbations
 ■ Avoid adverse effects from asthma medications
 ■ Prevent asthma mortality
Component 1: Develop
Patient/Doctor Partnership
 ■ Educate continually
 ■ Include the family
 ■ Provide information about asthma
 ■ Provide training on self-management skills
 ■ Emphasize a partnership among health care
providers, the patient, and the patient’s family
Component 2:Identify and Reduce
Exposure to Risk Factors
 ▪Measures to prevent the development of asthma, and
asthma exacerbations by avoiding or reducing
exposure to risk factors should be implemented
wherever possible.
 ▪Asthma exacerbations may be caused by a variety of
risk factors – allergens, viral infections, pollutants and
drugs.
 ▪Reducing exposure to some categories of risk factors
improves the control of asthma and reduces
medications needs.
 ■ Reduce exposure to indoor allergens
 ■ Avoid tobacco smoke
 ■ Avoid vehicle emission
 ■ Identify irritants in the workplace
 ■ Explore role of infections on asthma development,
especially in children and young infants
Influenza Vaccination :
 ▪ Influenza vaccination should be provided to patients

with asthma when vaccination of the general
population is advised
 However, routine influenza vaccination of children
and adults with asthma does not appear to protect
them from asthma exacerbations or improve asthma
control
Component 3: Assess, Treat and
Monitor Asthma
 ▪ Depending on level of asthma control, the patient is
assigned to one of five treatment steps
 Treatment is adjusted in a continuous cycle driven by
changes in asthma control status.
 The cycle involves: - Assessing Asthma Control -
Treating to Achieve Control - Monitoring to Maintain
Control
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.
Peak Flow Monitoring
 Peak flow meters. Peak flow meters measure the

highest airflow during a forced expiration.
 Daily peak flow monitoring. This is recommended
for patients who meet one or more of the following
criteria: have moderate or severe persistent asthma,
have poor perception of changes in airflow or
worsening symptoms, have unexplained response to
environmental or occupational exposures, or at the
discretion of the clinician or patient.
Peak flow monitoring..cont…
 Function. If peak flow monitoring is used, it helps
measure asthma severity and, when added to symptom
monitoring, indicates the current degree of asthma
control.
Component 4: Asthma
Management and Prevention
Program
 Allergen-specific Immunotherapy
 Greatest benefit of specific immunotherapy using
allergen extracts has been obtained in the treatment of
allergic rhinitis
 The role of specific immunotherapy in asthma is
limited
 Specific immunotherapy should be considered only
after strict environmental avoidance and
pharmacologic intervention, including inhaled
glucocorticosteroids, have failed to control asthma
 Perform only by trained physician
Nursing assessment
 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
 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.
Goals :
 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:
 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 antibioticif 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:
 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.
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.
Clinical manifestation
 Tachypnea, labored respirations, with increased effort on
exhalation.
 Suprasternal retractions, use of accessory muscles of
respiration.
 Diminished breath sounds, decreased ability to speak in
phrases or sentences
 Anxiety, irritability, fatigue, headache, impaired mental
functioning.
 Muscle twitching, somnolence, diaphoresis—from
continued carbon dioxide retention
 Tachycardia, elevated BP.
 Heart failure and death from suffocation.
MANAGEMENT AND NURSING
INTERVENTIONS
 Monitor respiratory rate and oxygen saturation
continuously;
 Frequently monitor arterial blood gas levels, BP,
electrocardiogram.
 Administer repeated aerosol treatments with beta2-
agonist bronchodilators, such as albuterol or levalbuterol
 Add anticholinergic ipratropium as prescribed
 Administer with caution until the metabolic and
respiratory acidosis and hypoxemia have been corrected
 Monitor I.V. therapy.
 Corticosteroids are given to treat inflammation of airways;
because these act slowly, their beneficial effects may not be
apparent for several hours.
 Fluids are given to treat dehydration and loosen secretions.
 Provide continuous humidified oxygen via nasal cannula
as prescribed.
 Patients with associated chronic obstructive pulmonary
disease or emphysema are at risk for depressed hypoxemic
ventilatory drive, thus compounding respiratory
insufficiency, so use oxygen cautiously
 Initiate mechanical ventilation, if necessary.
 Assist with mobilization of obstructing bronchial mucus.
Perform chest physiotherapy (chest wall percussion and
vibration).
 Administer expectorant and mucolytic drugs as prescribed.
 Remove secretions by suctioning, or prepare for
bronchoscopy if needed.
 Provide adequate hydration.
 Obtain portable chest X-ray and administer antibiotic,
as prescribed, to treat any underlying respiratory
infection.
 Alleviate the patients anxiety and fear by acting
calmly and by reassuring the patient during an attack
 Stay with the patient until the attack subsides.

Bronchial Asthma

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Bronchial Asthma

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MEDICAL SURGICAL NURSING

 Asthma is the most common chronic disease among

 ▪ Influenza vaccination should be provided to patients

 Peak flow meters. Peak flow meters measure the

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