Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways. Bronchial asthma is the more correct name for the common form of asthma.
Nursing Care Plans
This post contains 5 bronchial asthma nursing care plans.
1. Ineffective Airway Clearance
The presence of a foreign microorganism triggers the B lymphocyte to produce antibodies that are specific to that antigen. These antibodies then attach to mast cells in the lungs. The mast cells with the antibody attaches to the antigen and begins to degranulate. This degranulation causes the release of certain chemical mediators, namely, histamine, bradykinin, prostaglandin, and leukotriene. These chemical mediators cause bronchospasm leading to bronchoconstriction, increased vascular permeability leading to fluid leakage from the lung vasculature and increased mucus production. These lead to swelling of the bronchi, mucus buildup that plugs the airway and decreased bronchial diameter. This causes an increased airway resistance and a constricted pathway for air. Air cannot pass effectively and this manifests as a whistling sound. Coughing is a way to expel the obstruction (mucus plug) while dyspnea is a manifestation of the increased airway resistance.
Patient may manifest
- Difficulty breathing
- Changes in depth and rate of respiration
- Use of respiratory accessory muscles
- Persistent ineffective cough with or without sputum production
- Wheezing upon inspiration and expiration
- Tachypnea, prolonged expiration
- Chest tightness
- Suprasternal retraction
- Loss of consciousness
- Ineffective airway clearance RT bronchoconstriction, increased mucus production, and respiratory infection AEB wheezing, dyspnea, and cough
May be related to
- Increased production or retainment of pulmonary secretions
- Decreased energy
- Patient will maintain/improve airway clearance AEB absence of signs of respiratory distress
- Patient will verbalize understanding that allergens like dust, fumes, animal dander, pollen, and extremes of temperature and humidity are irritants or factors that can contribute to ineffective airway clearance and should be avoided.
- Patient will demonstrate behaviors that would prevent the recurrence of the problem.
|Keep the patient adequately hydrated.||Systemic hydration keeps secretion moist and easier to expectorate.|
|Teach and encourage the use of diaphragmatic breathing and coughing exercises.||These techniques help to improve ventilation and mobilize secretions without causing breathlessness and fatigue.|
|Instruct patient to avoid bronchial irritants such as cigarette smoke, aerosols, extremes of temperature, and fumes.||Bronchial irritants cause bronchoconstriction and increased mucus production, which then interfere with airway clearance.|
|Teach early signs of infection that are to be reported to the clinician immediately.||Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of an asthmatic person. Early recognition is crucial.|
|Assist and prepare patient for postural drainage.||Uses gravity to help raise secretions so they can be more easily expectorated.|
|Administer nebulization as ordered.||This ensures adequate delivery of medications to the airways.|
|Administer medications as ordered.||Antibiotics may be prescribed to treat the infection.|
2. Ineffective Breathing Pattern
Presence of secretions in the bronchi will result into a blockage of air that will enter the body and thus producing insufficient air needed by the body. And inability to maintain clear airway. This obstruction is further heightened by bronchospasm due to the contraction of the smooth muscles in the bronchi. This is caused by parasympathetic stimulation of the muscarinic m2 receptors as well as by chemical mediators released in response to the presence of allergens.
Patient may manifest:
- wheezing upon inspiration and expiration
- chest tightness
- suprasternal retraction
- loss of consciousness
- Ineffective breathing pattern r/t presence of secretions AEB productive cough and dyspnea
- Patient will demonstrate pursed-lip breathing and diaphragmatic breathing.
- Patient will manifest signs of decreased respiratory effort AEB absence of dyspnea
- Patient will verbalize understanding of causative factors and demonstrate behaviors that would improve breathing pattern
|Assess patient’s respiratory rate, depth, and rhythm. Obtain pulse oximetry.||To obtain baseline data|
|Monitor and record vital signs.||Increase in respiratory rate could mean worsening condition.|
|Auscultate breath sounds and assess airway pattern||to check for the presence of adventitious breath sounds|
|Elevate head of the bed and change position of the pt. every 2 hours.||To minimize difficulty in breathing|
|Encourage deep breathing and coughing exercises.||To maximize effort for expectoration.|
|Demonstrate diaphragmatic and pursed-lip breathing.||To decrease air trapping and for efficient breathing.|
|Encourage increase in fluid intake||To prevent fatigue.|
|Encourage opportunities for rest and limit physical activities.||To prevent situations that will aggravate the condition|
|Reinforce low salt, low fat diet as ordered.||To mobilize secretions.|