MEDICINE

AND MEDICAL
NURSING
MANAGEMENT OF A
PATIENT WITH ASTHMA
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General objectives
At the end of the lecture/discussion the
students should demonstrate knowledge
and understanding of the management
of a patient with Asthma.

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SPECIFIC OBJECTIVES
At the end of the lecture/ discussion the
students should be able to:
1. Define Asthma
2. Outline the aetiology of asthma
3. Mention the classification of asthma

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Cont. Specific
objectives
4. Explain the pathophysiology of asthma
5. State the signs and symptoms of
asthma
6. List the investigations done in asthma
7. Describe the medical and nursing
management of asthma

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INTRODUCTION
 Asthma is a common inflammatory condition
affecting airways.
 The condition has no cure but can be
controlled
 The condition affects about 300million
people of all ages throughout the world.
 Though there is no much information on the
impact of asthma in Zambia, Asthma has still
been realised as a health problem globally.

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Cont. Introduction
 Itis a significant burden not only in
terms of health care costs, but also of
lost productivity and reduced peoples'
participation in family life.
 In most cases asthma is under-
diagnosed and under-treated, creating a
substantial burden and significant
impact on individuals, their families and
society.
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DEFINITION
1. It is a chronic inflammatory disorder of
the airways that is characterized by an
exaggerated narrowing of the air
passages to a wide variety of stimuli.
(Donovan etal, 2007)

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DEFINITION
2. This is an intermittent, reversible,
obstructive airway disease
characterized by increased
responsiveness of the trachea and
bronchi to various stimuli leading to
narrowing of airways, resulting in
dyspnoea, cough and wheezing

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AETIOLOGY
 The cause is idiopathic but there are a
number of predisposing factors
including:
 Environmental factors such as change in
temperature especially cold air.
 Atmospheric pollutants e.g. cigarette
and industrial fumes

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Cont. aetiology
 Allergens; hypersensitivity reaction to
certain substances such as drugs, foods,
dust and pollen.
 Stress or emotional upset: anxiety,
anger fear
 Infections such as RTI
 Heredity; tends to run in families

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CLASSIFICATION

 Asthma is classified depending on

 the severity of the attack i.e. mild,
moderate and severe
 the cause of the attack i.e. intrinsic and
extrinsic

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Intrinsic asthma (non allergic)

 This is seen in adulthood and there is no

history of childhood allergies.
 It is associated with chronic
inflammation such as chronic bronchitis.
 Attacks tend to increase in severity
causing irreversible lung damage.

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Extrinsic asthma (allergic)

 This type occurs in children and young

adults who are hypersensitive to foreign
particles or proteins such as; pollen,
dust, mites etc.
 There is usually a family history of
allergies and past medical history of
eczema or allergic rhinitis.
 Attacks tend to be less severe with age.

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PATHOPHYSIOLOGY

 When the allergy is inhaled and

absorbed in the bronchial mucosa,
production of immunoglobulin IgE
antibodies occurs.
 These antibodies are exaggerated in
asthmatic persons and are produced in
large amounts in response to antigens
and allergens.

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Cont. pathophysiology
 The IgE antibodies attach to the surface
of mast cells and basophils round the
bronchiole blood vessels.
 Re-exposure to the antigen results in the
antigen antibody reaction which will
cause release of mast cell products
(mediators) such as; histamine,
bradykinin and prostaglandins

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Pathophysiology cont.
 The mediators in the lung tissue affects the
smooth muscles and glands of the airway
causing bronchospasms, swelling of the
mucus membranes and excessive mucus
production.
 This will cause narrowing of the bronchioles
leading to a normal inspiration but only
partial and difficult expiration.

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Pathophysiology cont.
 There is use of accessory muscles.
 The lungs will be hyper inflated leading
to dyspnoea and wheezing. The duration
of an attack lasts for minutes to days.

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SIGNS AND SYMPTOMS

 An attack is usually sudden

 Wheezing – noisy (whistling) expiration
due to the air passing through the
narrowed airways.
 Dyspnoea due to impaired gas
exchange related to bronchiole
constriction and retained secretions

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Cont. Signs and

symptoms
 Cough - Act by the body to try clear away
the bronchial secretions causing blockage to
the airway
 Chest pains - Due to excessive use of
accessory muscles of the chest during
ventilation.
 Chest tightness includes any type of pain
or discomfort that occurs in the chest. This is
as a result of inflammation of the bronchiole
and smooth muscle spasms.
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Cont. signs and symptoms

 Tachypnoea - As a compensatory
mechanism by the body to increase
oxygen supply in the blood and tissues.
 Tachycardia - As a compensatory
mechanism by the body to increase
oxygen supply in the blood and tissues.
 Restless - Due to reduced oxygen
perfusion to the tissues.

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INVESTIGATIONS

 Diagnosis - clinical presentation by

looking at the classic symptoms of
wheezing, cough and shortness of
breath.
 A history of exposure to allergen
 Bronchoscopy – reveals the narrowed
bronchioles due to inflammation.

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Cont. Investigations

 Chest x-rays shows trapped air and

narrowed air passages (bronchioles). It
also helps rule out chest infections.
 Arterial blood gas analysis to identify
the levels of oxygen and carbon dioxide.

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TREATMENT

BRONCHO-DILATORS
1. Salbutamol 4mg TDS orally or
Salbutamol inhaler. Bronchodilator - It
offers immediate relief in mild cases.
2. Aminophylline tablet 100mg – 300mg
TDS orally, IV 250 – 500mg slow over
10 - 20 minutes.

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Cont. treatment
ANTIHISTAMINES
1. Adrenaline injection 0.2 – 0.5 mg
subcut slowly. Causes relief of
bronchospasm, reduced congestion
and oedema by inhibiting histamine
release. Side effects; tremor,
headache, fear, palpitations,
tachycardia and hypertension. Nursing
implication; monitor the BP, pulse.
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Cont. treatment
CORTICOSTEROIDS
 Hydrocortisone 200 mg IV stat is given if
the attack is very severe. This acts as
an anti-inflammatory. Side effects;
euphoria, insomnia, cataracts,
glaucoma, peptic ulceration and
delayed wound healing.

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Cont. treatment
 Oxygen 5- 8L per minute is
administered to increase tissue
oxygenation.

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NURSING CARE

Aims of management
 Relieve dyspnoea
 Prevent complications
 To improve activity tolerance
 To prevent recurrent symptoms

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Nursing care cont.

Environment
 Patient nursed in acute bay for easy
observation
  The room should be clean, warm, well
ventilated and quiet to prevent infection
and trigger an asthmatic attack.
 Oxygen cylinder should be available

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Nursing care cont.

Position
 Sitting position supported by a backrest
or pillows. This is to promote lung
expansion and relieve dyspnoea.
 Cardiac table should be placed for the
patient to lean forward since this
provides comfort

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Nursing care cont.

Rest
 Rest is important in the treatment of the
patient with asthma as it helps reduce
the oxygen demands
 Rest is promoted by restricting visitors,
carrying out procedures collectively

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Nursing care cont.

Observations
 Observe for cyanosis due to reduced O2
being inspired
 Check the degree of restlessness
 Check the other vitals thus; temperature
to rule out any infection, pulse and B/P
to assess the function of the heart

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Observations cont.
 Observe the breathing pattern for
dyspnoea
 Check for any sign of dehydration due to
increased insensible loss during the
laboured breathing

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Nursing care cont.

Psychological care
 Patients with asthma are frequently
anxious and apprehensive as their life,
job, family security and the whole future
becomes threatened.
 Explain the nature of the condition in a
honest manner as possible to the
patient, partner or significant others

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Nursing care cont.

Psychological care
 If the patient is stable, encourage the
significant others to stay with them to
relieve anxiety and let them if possible
participate in the nursing care to make
the patient feel she/he is cared for.
 When condition improves, provide
diversion therapy such as watching TV,
reading magazines or music if available.
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Nursing care cont.

 Maintaining a clear airway
 Suctioning PRN
 Teach and encourage to take deep
breathing exercises as they help in
expectoration and facilitates full lung
expansion.
 Oxygen is administered if patient is
dyspnoeac to aid in breathing and
overcome cyanosis.
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Nursing care cont.

Nutrition
 Sips of nutritious drinks to soothe the
patient to prevent choking and nausea
due to breathing difficulties.
 Normal diet will be established
depending on the condition.

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Nutrition cont.
 Avoid giving foods to the patient which
he/she is allergic to because it may
precipitate the attack
 Give a well balanced diet
 If patient is unable to feed, set up the IV
line and not NGT because this will
worsen the dyspnoea

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Nursing care cont.

 EXERCISES
 Deep breathing exercises are taught to
the patient to allow full lung expansion
 Exercises assist in prevention of chest
infections such as hypostatic pneumonia

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Nursing care cont.

 Medication
 IVinfusion set up for administration of
broncho-dilators
 Give prescribed drugs

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I.E.C
 Teach the patient and the relatives the
signs and symptoms of an attack such as
tightness in the chest, restlessness,
dyspnoea, wheezing and cough. Patient to
seek medical advice whenever they are in
an attack
 Advice patient to identify allergies and any
other triggering factors and avoid them.
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i.e.c cont.
 Breathing and postural exercises must
be taught to the patient to ensure they
carry them out even at home
 Continue medication at home as
prescribed.
 Importance of coming for reviews as
required
 Early treatment of respiratory tract
infections
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NURSING CARE PLAN

Problems identified
 Dyspnoea
 Activity intolerance
 Altered nutrition less than body requirements

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Problem Nursing diagnosis Objective Nursing intervention
45 Evaluation
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Dyspnoea Dyspnoea due to To relieve dyspnoea - Place patient in a propped up position Dyspnoea relieved after 1
impaired gas exchange within 30 – using pillows or a back rest supported by hour of nursing intervention
related to bronchiole 60minutes of pillows in order to promote lung as evidenced by patient’s
constriction and retained admission expansion. normal breathing pattern of
secretions evidenced by - Clear the airway by suctioning in order to 18- 20 breaths/minute.
laboured breathing. maintain a patent airway that promotes Also the patient verbalises
passage of air. that he can now breathe
- Administer oxygen to patient whenever properly.
necessary i.e. 5 litres per minute to
perfuse body tissues.
- Encourage the patient to be doing deep
breathing exercises to promote lung
expansion.
- Encourage the patient to avoid
suppressing a productive cough in order
to expectorate the accumulated secretions.

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Problem Nursing Objective Nursing intervention Evaluation
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diagnosis

Altered nutrition Altered nutrition To maintain - Do mouth wash and encourage oral hygiene to promote Patient’s appetite
less than body less than body adequate salivation as this increases appetite. improves as evidenced
requirements requirements nutrition - Encourage small frequent non-fatty meals that reduce by patient
related to reduced anorexia and promote appetite. verbalisation and
oral intake of food - Avoid gas forming foods as these may cause abdominal maintaining skin and
evidenced by fullness that may worsen the condition by compromising body integrity
verbalisation due the accessory organs of respiration.
to loss of appetite - Monitor intake and output as decreased urinary output or
as a result of concentrated urine is an indication of inadequate fluid
shortness of replacement.
breath and dry
mouth.

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Problem Nursing Objective Nursing intervention Evaluation
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diagnosis

Activity Activity To improve - Put up and maintain patient on bed rest to reduce Patient is now able to
intolerance intolerance related activity activity as this reduces oxygen needs of the body. tolerate exercises as
to dyspnoea tolerance. - Assist patient with activities of daily living as evidenced by his
evidenced by needed. Activity increases the metabolic demand and movements in bed and
inability to hence need for more oxygen hence worsening the tolerance of deep
perform activities dyspnoea. breathing exercises.
of daily living. - When a patient improves, the exercise schedule is
balanced with rest to avoid exhaustion and prevent
fatigue through good distribution of oxygen to vital
organs including the lungs.

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summary
1. Define Asthma
2. Outline the aetiology of asthma
3. Mention the classification of asthma
4. Explain the pathophysiology of asthma
5. State the signs and symptoms of
asthma
6. List the investigations done in asthma
7. Describe the medical and nursing
management of asthma asthma
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assignment
 Read
and write short notes on the
complications of asthma.

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references
 Cali-Ascani A.m., Cheever H.K., Evans G.N., et al,
Diseases, Springhouse Corporation, Pennsylvania
 Kumar P. and Clark M. (2005), Clinical Medicine, 6th
edition, Elsevier Saunders, London, UK
 Lewis M.S., Heitkemper M.M., and Dirksen R.S. (2004),
Medical-Surgical Nursing, Mosby Elsevier, USA
 Longmore M., Wilkinson B.I., and Rajagopalan R.S.
(2005), Oxford Handbook of Clinical Medicine, 6th
Edition, Oxford University Press, New York.
 Monahan etal (2007), Phipps’ Medical Surgical
Nursing, 8th edition, Mosby, Missouri.

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Thank you

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