BRONCHIAL ASTHMA

What is Bronchial Asthma?

- Bronchial asthma is a medical condition which causes the airway path of the lungs to
swell and narrow. Due to this swelling, the air path produces excess mucus making it
hard to breathe, which results in coughing, short breath, and wheezing.

EPIDEMIOLOGY

● Common disease with unacceptably high morbidity and mortality

● Commonly underdiagnosed and undertreated
● Only 36.1% of adult asthmatics ever had their peak flow measured
● Higher prevalence in rural (4.5%) than in urban areas (4%), lower educational status
(5.6%) and lower income
● Majority of patients (87.3%) had mild asthma: 9.9% had moderate asthma and 2.7% had
severe asthma
● Among severe asthmatics, only 19.4% were on inhaled corticosteroids

SYMPTOMS
Most childrens and adults with asthma may have times their breathing becomes more
difficult.
Some people with severe asthma may have breathing problems most of the time.

The most common symptoms of asthma are:

● Wheezing (a whistling sound when breathing)
● Breathlessness
● A tight chest - it may feel like a band is tightening around it
● Coughing

Many things can cause these symptoms, but they’re more likely to be asthma if they:
● Happen often and keep coming back
● Are worse at night and early in the morning
● Seem to happen in response to an asthma trigger like exercise or an allergy (such
as to pollen or animal fur)
Asthma Attacks
Asthma can sometimes get worse for a short time, this is known as an asthma attack. It
can happen suddenly, or gradually over a few days.

Signs of a severe asthma attacks include:

● Wheezing, coughing and chest tightness becoming severe and constant
● Being too breathless to eat, speak or sleep
● Breathing faster
● A fast heartbeat
● Drowsiness, confusion, exhaustion or dizziness
● Blue lips or fingers
● Fainting

DIAGNOSIS
A careful and detailed history as well as a clinical examination helps in diagnosis of
asthma. The doctor may conduct some tests to confirm the diagnosis and to exclude other lung
conditions.

1. Methacholine Test
- A methacholine challenge test is a type of bronchoprovocation test, which
measures lung function after exposure to factors that commonly trigger wheezing
and other asthma symptoms. A methacholine challenge test involves inhaling a
mist that contains methacholine, a substance that causes lung constriction in
people with asthma.
2. Pulmonary Function Test
- Pulmonary function tests are a group of procedures that measure the function of
the lungs, revealing problems in the way a patient breathes. The tests can
determine the cause of shortness of breath and may help confirm lung diseases,
such as asthma, bronchitis or emphysema.

3. Peak Flow
- A peak flow meter is a portable, easy-to-use device that measures how well your
lungs are able to expel air. By blowing hard through a mouthpiece on one end, the
peak flow meter can measure the force of air in liters per minute and give you a
reading on a built-in numbered scale.
4. X-ray
- X-rays are part of the electromagnetic spectrum, with wavelengths shorter than
visible light. Different applications use different parts of the X-ray spectrum. X-
ray image of human lungs. An X-ray, or X-radiation, is a penetrating form of
high-energy electromagnetic radiation.
PATHOPHYSIOLOGY

Normally we do this when breathing, whenever we inhale

air there is oxygen (O2) and whenever we exhale it the
build up of carbon dioxide (CO2).

We

breathe in the air in the upper airway and

down through the lower airway which is the trachea, into our bronchi and then the air goes down
even the smaller airway called the bronchioles. After the bronchioles are these little air sacs or
the alveoli sacs. Alveolar sac where the gas exchange happens.

What is going on when an Asthma Attack?

During an asthma attack, also called an asthma exacerbation, the airways become swollen and
inflamed. The muscle around the airways contract and the airways produce extra mucus, causing
the breathing (bronchial) tubes to narrow. During an attack, you may cough, wheeze and have
trouble breathing.
 Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATIO

N N

Subjective: N/A Ineffective After 12 hrs. 1. Position with -Proper Goal met. -
Airway of nursing the head of the positioning Patient
Objective: Clearance related intervention bed elevated, facilitates maintained a
the patient will
to accumulation head aligned effective patent airway
-(+)wheezing - be able to
Tachypnea of mucus. expel properly in passage of air and
bilateral by: thick, secretions straight position. through the demonstrated
effectively lungs and signs of
-(+) secretions 2. Change provides good reduction in
characterized After 3-5 days position aeration of respiratory
of nursing frequently. lung segments. secretions.
greenish in color, intervention
approx. amount the patient will
5-8ccq maintain clear 3. Keep the - Changing of -Displayed
airway patient 's position aids in decreasing
suctioning environment free mobilization of amount of
from sources of secretions that secretions.
-Frequent allergens, such may ease
dust, pow smoke. expectation of After 12 hrs. of
coughing
secretions. nursing
intervention the
-Precipitators patient will be
of allergic able to expel
types of secretions
respiratory effectively.
reactions that
can trigger or After 3-5 days
exacerbate of nursing
onset of acute intervention the
episode. patient will
maintain a clear
airway.

-Proper
positioning
facilitate
effective
passage of air
through the
lungs and
provide good
aeration of lung
segments.

- Changing of
position aids in
mobilization of
secretions that
may ease
expectoration
of secretions.

-Precipitators of
allergic types of
respiratory
reactions that
can trigger or
exacerbate
onset of acute
episodes.
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATIO
N N

Subjective: NA Impaired Gas After 12 hrs of 1.Provide -To decrease After 12 hrs of
Exchange nursing adequate rest. oxygen nursing
Objective: related to altered intervention the demand. intervention the
oxygen supply. patient will be 2.Keep an patient will be
-with slightly obstruction of free from environment free -To prevent free from
delayed capillary airways by episodes of of allergen. irritation of episodes of
refill (4 secs.) secretion, desaturation as bronchial walls. desaturation as
bronchospasm. manifested by 3.Administer manifested by
-episodes of oxygen oxygen as -To increase oxygen
frequent saturation of 95 ordered. the oxygen of saturation of 95
desaturation 100%. the patient.
approx. 2-4x/ shift 4. Nebulize the 100%. After 3-
After 3-5 days patient as -To promote 5 days of
-(+) clubbing of of nursing ordered. bronchodilation nursing
fingernails intervention the . intervention the
patient will 5. Administer patient will
demonstrate meds. As ordered -To promote demonstrate
improved curative aspect improved
ventilation and ventilation and
adequate adequate
oxygenation of oxygenation of
tissues as tissues as
evidenced by evidenced by
normal normal
respiratory rate respiratory rate
(20bpm), and (20bpm), and
good breathing good breathing
pattern. pattern

GOALMET.
Patient is free
from
desaturation
episodes as
manifested by
 02 sat. of 99%.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATIO

N N

Subjective: NA Ineffective After 12 hrs. of 1. Maintain a -Helps in

Breathing nursing clear airway. mobilization of GOALMET.
Objective: Pattern related to intervention the suction PRN, secretions.
airway patient will CPT as Demonstrated
-(+) dyspnea constriction demonstrate indicated. -Changing of normal
secondary to breathing at a position aids in breathing, no
-shortness of bronchial normal rate. 2. Elevate the mobilization of cyanosis and
breath asthma depth & head and help secretions that dyspnea, and
rhythm. change the may ease normal 02
-increased work position. expectoration of saturation.
of breathing. use After 3-5 days secretions.
of accessory of nursing 3.Nebulize with
muscles intervention the pulmicort + -Nebulization
patient will atrovent,
-(+) nasal flaring experience no administer may be used to
cyanosis, mucolytics as open constricted
-decrease O2 dyspnea and ordered airways &
sat. normal range liquefy
02 saturation. 4. Collaboration secretions as
-Provide well as the
supplemental mucolytics.
oxygen
-maximize
breath and
reduce labor

Discharge Instruction and Health Teaching

You have been diagnosed with an asthma attack. With the help of your healthcare provider, you
can keep your asthma under control and have less emergency department visits and stays in the
hospital.

Managing asthma
● Take your asthma medicines exactly as your provider tells you. Do this even if you feel
that your asthma is under control.

● Learn how to monitor your asthma. Some people watch for early changes of symptoms
getting worse. Some use a peak flow meter. Your healthcare provider may decide to give
you an asthma action plan.

● Be sure to always have a quick-relief inhaler with you. If you were given a prescription,
make sure you go to a pharmacy to get it filled as soon as possible.