Nursing Care Plan for Asthma / Childhood Asthma

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Pathophysiology

Asthma is the chronic inflammation of the airways that causes difficulty breathing in about 6 million children across the United States. When the lining of the lungs becomes irritated and inflamed, tightening of the smooth muscles around the airways (bronchospasms) causes the airway to become narrow making it harder to get oxygen in and carbon dioxide out. An asthma attack (exacerbation) is considered a medical emergency.

Etiology

While the exact cause of asthma is unknown, it is believed to be somewhat hereditary. Certain triggers can cause the exacerbation of symptoms, known as “asthma attacks”.  Allergies are one of the most common triggers for asthma including dust, pollen, pet dander and mold. Other triggers and lung irritants include smoke and perfume. Exercising, breathing cold air or having a respiratory infection can also cause attacks.

Desired Outcome

Patient will have adequate air exchange and respiratory status; patient and caregivers will demonstrate ability to effectively use rescue medications; patient will have well-managed disease with symptoms occurring less than 2 days per week

Asthma / Childhood Asthma Nursing Care Plan

Subjective Data:

  • Tightness or pain in the chest
  • Symptoms that are worse at night
  • Frequent headaches
  • Feeling weak or tired (especially later into an asthma attack)

Objective Data:

  • Wheezing
  • Cough
  • Bronchospasms
  • Tachypnea
  • Tachycardia
  • Retractions
  • Dark circles under the eyes
  • Tripod positioning

Nursing Interventions and Rationales

  • Assess respiratory status

 

Get a baseline to determine effectiveness of interventions and course of treatment.

During attacks, patient will have tachypnea, wheezing and labored breathing, nasal flaring and/or retractions

 

  • Monitor peak flow rates in children over 5 years old. Pulmonary function testing

 

In asthma, patients can inhale, but it is more difficult to exhale the air taken in.  A peak flow meter measures the lungs’ ability to expel air and regular use can help recognize the signs of an attack before symptoms begin.

Peak flow testing can help determine if treatment is working.

Routine pulmonary function testing helps determine the course and progression of the disease

 

  • Assess patient’s level of anxiety and provide relaxation techniques

 

Being unable to breathe causes anxiety which, in turn,  causes even more constriction of the airways. Help the patient to learn coping and relaxation techniques to control the breathing and help reduce the severity of the attack.

 

  • Position upright

 

Patients will need to sit upright to promote lung expansion and make air flow easier. Patients may often be found in the tripod position.

 

  • Administer medications via nebulizer

 

Bronchodilators and corticosteroids can be helpful in reducing inflammation and swelling that makes breathing difficult. A nebulizer works well to deliver an adequate amount of medication into the lungs.

 

  • Educate patient and parents / caregivers on how and when to use medications and rescue inhalers (age appropriate)

 

Depending on the child’s age, an inhaler may be required for acute symptoms and before and after exercise. Demonstrate use of inhaler with spacer for children over 5 years old.

 

  • Assist parents and providers in creation of Asthma Action Plan for school or daycare

 

An asthma action plan helps the parents, school and daycare providers to understand and control asthma in children.

 

This plan outlines the patient’s known triggers and how to manage symptoms that arise. If the patient is required to take maintenance or rescue medications during school hours, this plan outlines the importance of that treatment and how to administer those medications.

 

  • Provide education for patient / parents regarding use of maintenance medications and how to recognize and avoid triggers

 

  • Depending on the child’s age, patient may use oral maintenance medications or daily inhalers. Proper use of these devices helps maximize effectiveness of treatment.
  • Help patient to understand what triggers asthma attacks and how to avoid those situations.
  • Help parents understand that lifestyle and environmental changes may be made, including pets in the home and exposure to cigarette smoke. Wash patient’s sheets / linens weekly to kill and prevent dust mites.
  • Encourage routine immunizations to help prevent diseases that may make asthma worse.

 


References

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