Asthma: Risk Factors, Treatment And Nursing Diagnosis
Asthma affects about three hundred billion people worldwide; it has no cure but there are effective and established ways to manage the disease and to prevent worsening symptoms. Asthma is an obstructive pulmonary disease and is described as the swelling and narrowing of the airways in the lungs, resulting in difficulty breathing. The clinical manifestations are listed as expiratory wheezing, prolonged expiration, shortness of breath, swollen nasal passages, tightness of the chest, runny nose and coughing that is either dry or productive. Asthma is mostly triggered by inhalation of allergens, pollutants, drugs, exercise, weather changes and stress (physical or emotional).
The risk factors for asthma are obesity, genetics (asthma has a component that could be inherited), job-related exposure to irritants/chemicals, respiratory tract infections, sinus problems and gastroesophageal reflux disease (GERD).
Treatments for asthma include anti-inflammatory drugs such as corticosteroids, anti-IgE (omalizumab), anti-Interleukin 5 (mepolizumab, reslizumab) and leukotriene modifiers (zafirlukast, montelukast, zileuton). Another treatment used is the bronchodilators such as ß2-adrenergic agonist drugs (SABAs which are also known as rescue medications and LABAs), anticholinergic drugs and methylxanthines. These drugs of choice can be inhaled using inhalers or nebulizers and some are in tablet form to be taken by mouth. Asthma complications include status asthmaticus (when asthma no longer responds to treatment), respiratory failure, collapsed lung(s) and pneumonia
Inter-professional areas involved with collaborative care include a primary care physician or an allergy/asthma specialist and are involved in medical diagnoses and treatment recommendations, a nurse/school nurse or an asthma specialist nurse who is going to be involved with patient and family teaching (what is asthma and how the prescribed medications work), peak flow checks, enforces medication compliance, provides referrals to social or medical needs regarding asthma care, and a pharmacist who is involved with filling prescriptions and checking drug interactions.
Nursing diagnoses for asthma include but are not limited to ineffective breathing pattern and ineffective airway clearance. The nursing interventions for the nursing diagnoses ineffective breathing pattern include assessing the patient’s vital signs (blood pressure, heart rate, and respiration rate), auscultation of breath sounds (wheezing, respiration depth and rhythm), monitor for the presence of pulsus paradoxes that is greater than or equal to 12 mmHg as this could be a sign of severe airflow obstruction, assessing the arterial blood gasses (ABGs), providing frequent rest between activities to prevent fatigue and lower oxygen demands, monitoring oxygen saturation and intervening when oxygen saturation falls below 95%, elevating the patient’s head of bed (HOB) to promote lung expansion and improve breathing, and administering ordered medications and monitoring adverse effects and assessing the effectiveness of the medications ordered.
The nursing interventions for the nursing diagnoses ineffective airway clearance include reducing the patient’s anxiety to prevent asthma attack occurrence, monitoring laboratory results such as white blood cell count, potassium levels on patients on ß2-adrenergic agonist drugs (as these medications can cause potassium to shift into the cells and cause hypokalemia), and theophylline levels if the patient is on theophylline therapy, assessing the patient’s secretions and noting the amount, color, and odor, and assessing/monitoring for color changes to the nail beds and lips which could indicate cyanosis.
