Asthma

Asthma
Def:
Asthma is a chronic inflammatory disease of the
airways that causes airway hyper responsiveness,
mucosal edema, and mucus production.
Pathophysiology
The underlying pathology in asthma is reversible.

The inflammation leads to obstruction from the
following:
 Mucosal edema.
 Contraction of the bronchial smooth muscle that
encircles the airways (bronchospasm), further
narrowing; and increased mucus production,
diminishes airway size and may entirely plug the bronchi.
Clinical Manifestations
The three most common symptoms of asthma

are:
1. Cough; my be the only symptom with or without
mucus production.
2. Dyspnea.
3. Wheezing; generalized wheezing first on expiration
and then possibly during inspiration.
Cont…
An asthma exacerbation may begin abruptly
but most frequently is preceded by increasing
symptoms over the previous few days.
As the exacerbation progresses:
 Diaphoresis.
 Tachycardia.
Central cyanosis (a late sign of poor
oxygenation).
Common triggers for asthma symptoms and
exacerbations in patients with asthma
Airway irritants (e.g., air pollutants, cold, heat, weather

changes, strong odors or perfumes, smoke).
 Exercise.
 Stress or emotional upsets.
 Sinusitis.
 Respiratory tract infections.
 Gastro- esophageal reflux.
Cont…
Common allergens can be seasonal (e.g. grass or tree)

or constant (e.g. dust or animal dander).
About 40% of cases are related to an allergic response.
May be seasonal depending on exposure to allergen.
Classification of Asthma
Asthma is categorized according to "Symptoms

Mild persistent.
Moderate persistent.
Severe persistent.
Assessment and Diagnostic Findings
Essential to establish the diagnosis:

A complete family history (A positive family history).
 Environmental history includes seasonal changes,
climate changes (particularly cold air), and air pollution.
Occupational history associated with a variety of
occupation (wood and vegetable dust).
ABGA is important
Chest x-ray.
Prevention
Patients with recurrent asthma should identify the

substances that precipitate the symptoms.
The patient is instructed to avoid the causative
agents whenever possible.
Knowledge is the key to quality asthma care.
Complications
Status asthmaticus.
Respiratory failure.
Pneumonia.
Atelectasis.
Airway obstruction.
Hypoxemia (Particularly during acute asthmatic
episodes).
Medical Management
Immediate intervention is necessary because the

continuing and progressive dyspnea leads to:
1. Increased anxiety.
2. Aggravating the situation.
Cont…
Corticosteroids:
Are the most potent and effective anti-inflammatory
medications currently available. They are:
 Broadly effective in alleviating symptoms.
 Improving airway function.
Cont…
It is either: inhaler or systematic.

The inhaled form is used initially
A spacer should be used with inhaled corticosteroids
and the patient should rinse the mouth after
administration to prevent thrush common
complication of inhaled corticosteroid use.
Cont…
A systemic Corticosteroids preparation may be used

to:
 Gain rapid control of the disease.
 Manage severe, persistent asthma.
 Treat moderate to severe exacerbations.
 Accelerate recovery.
 Prevent recurrence .
Cont…
 Methylxanthines (theophylline ) are mild to moderate

bronchodilators usually used in addition to inhaled
corticosteroids.
Nursing management
Assessment
• General condition.
• Vital sign.
• Cardiac disease.
• Risk factors.
• Ability of pt to mange asthma.
Nursing Management
The immediate nursing care of the patient with asthma
depends on the severity of the symptoms.
The patient may be treated successfully as an outpatient
if asthma symptoms are relatively mild, or he or she
may require hospitalization and intensive care for acute
and severe asthma.
The patient and family are often anxious because of the
patient’s dyspnea. Thus, an important aspect of care is a
calm approach.
Cont…
 The nurse assesses the patient’s respiratory status by monitoring

the severity of symptoms, pulse oximetry, and vital signs.
 The nurse obtains a history of allergic reactions to
medications and identifies the patient’s current use of
medications.
 The nurse administers medications as prescribed and
monitors the patient’s responses to those medications.
Cont…
Fluids may be administered if the patient is
dehydrated, and antibiotic agents may be prescribed
if the patient has an underlying respiratory infection.
If the patient requires intubation the nurse assists
with the intubation procedure, continues close
monitoring of the patient, and keeps the patient and
family informed about procedures.
Cont…
The nurse who has contact with the patient in the

hospital, clinic, school, or office uses the opportunity to
assess the patient’s:
 Respiratory status.
 Ability to manage self-care to prevent serious
exacerbations.
The nurse emphasizes adherence to the prescribed
therapy.
Cont…
Preventive measures and the need to keep follow-up

appointments with the primary health care provider.
A home visit to assess the home environment for
allergens may be indicated for the patient with recurrent
exacerbations.
The nurse refers the patient to community support
groups.
The nurse reminds the patient and family about the
importance of health promotion strategies and
recommended health screening.
Nursing diagnosis
Ineffective breathing Pattern related to impair

exhalation & anxiety evidence by dyspnea.
Ineffective air way clearance related to increased
mucous production & broncho spasm evidence by
synosis, low oxygen saturation.
Anxiety related to dyspnea & fear of death evidence by
questions.
 Risk for collaprtive problem ( status asthmatus).

Asthma

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Asthma

The underlying pathology in asthma is reversible.

The three most common symptoms of asthma

Airway irritants (e.g., air pollutants, cold, heat, weather

Common allergens can be seasonal (e.g. grass or tree)

Asthma is categorized according to "Symptoms

Essential to establish the diagnosis:

Patients with recurrent asthma should identify the

Immediate intervention is necessary because the

It is either: inhaler or systematic.

A systemic Corticosteroids preparation may be used

 Methylxanthines (theophylline ) are mild to moderate

 The nurse assesses the patient’s respiratory status by monitoring

The nurse who has contact with the patient in the

Preventive measures and the need to keep follow-up

Ineffective breathing Pattern related to impair

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