What is Asthma?

This a condition where the airway becomes inflamed, causing them to be overly responsive, secreting excessive mucus and leading to mucosal edema. The inflammation further results in recurrent symptoms like chest tightness, difficulties in breathing, wheezing, and coughing. Childhood Asthma is the most prevalent chronic disease in the US.

Different factors increase the risk of getting Asthma, such as allergies, family history of the illness, exposure to allergens like dust, mold, pollens from weeds and glass, and animal dancer. Triggers like stress, respiratory infections, exercise, certain medications, and gastroesophageal reflux can worsen the symptoms of Asthma.

The pathological process of Asthma begins with inhaling allergens or irritants that trigger an inflammatory response in the windpipes, resulting in mucus secretion and windpipe resistance. This resistance is most experienced when exhaling, making it difficult to breathe. If the problem is left untreated, increased mucus production can impact inhaled medication’s efficiency.

Nursing Care Plans for Asthma

The goals of the Asthma nursing care plan include the following:

• Prevention of hypertensive reaction,
• Managing potential allergens,
• Keep the airway clean and,
• Avoid the development of reversible complications.

The following are Nursing Care Plans and Nursing Diagnoses for Asthma

1. Activity Intolerance
2. Anxiety
3. Deficient Knowledge
4. Fatigue
5. Impaired Gas Exchange
6. Ineffective Airway Clearance
7. Ineffective Breathing Pattern
8. Interrupted Family Processes
9. Readiness for Enhanced Health Management

1.Activity Intolerance

This is a medical condition in which a patient’s ability to perform physical activities is reduced due to exposure to dry or cold air, bronchoconstriction, and environmental pollutants. Exercise-induced Asthma is a type of bronchoconstriction occurring in patients with increased airway reactivity after or during robust physical activity. Signs of activity intolerance include weakness or exhaustion, exertional dyspnea, lethargy, inability to eat, play or speak, and tachycardia. This type of Asthma is usually overlooked, and most people who have it may not know they have an underlying condition until they exercise. Thus, the ability of the patient to exercise and their response to medication is generally reduced by their condition.

Nursing Diagnosis

• Activity Intolerance

It may be associated with the following:

• Environmental pollutants
• Exposure to dry or cold air
• Intense physical activity
• Constriction

May be indicated by

• Lethargy
• Increased heart rate
• Verbal reports of weakness or tiredness
• Difficulty breathing during exercise
• Inability to eat, play or speak

Possible outcome

• The patient’s vital symptoms will remain within an optimum healthy range.
• The patient is expected to participate in everyday activities without feeling fatigued.
• The patient is expected to engage in physical exercise without experiencing dyspnea.

Nursing Assessment and Rationales

Nursing Assessment	Rationales
Evaluate the patient’s response to physical activities	It helps to determine the patient energy levels and evaluate for signs of exercise-induced Asthma. Respiration and dyspnea can deplete these reserves with time, and bronchoconstriction can occur in patients with exercise-induced Asthma after some minutes of finishing the exercise. This is caused by abnormal heat and water fluxes in the bronchial tree.
Evaluate the patient’s level of fatigue and look for other causes.	Bronchoconstriction after physical activities may occur in patients’ normal spirometry findings but with conditions like allergic rhinitis, atopy, or cyst fibrosis. Other cause of exercise-induced asthma symptoms includes environmental pollutants, duration and intensity of exercises, cold and dry air, level of bronchial hyperreactivity, and coexisting respiratory infection.
Monitor the patient’s vital signs after and during the activity. Record adverse responses to increased activity like tachypnea, increased BP, and tachycardia.	Changes in vital signs after an activity indicate attempts by the lungs to provide sufficient oxygen to the tissue. The evaluation and diagnosis of exercise-induced bronchoconstriction are made more regularly in children and young adults than older adults and are associated with increased physical activity levels.

Nursing Interventions and Rationales

Nursing Interventions	Rationales
During rest, encourage quiet activities like watching movies, playing games, and reading.	These activities prevent changes in respiratory status and depletion of energy. There are no recommended limitations for Asthmatic patients. However, they should avoid exposure to agents that may trigger Asthma.
Limit disturbance, perform all care at once and avoid spreading them over a long period, avoid providing procedure or care during an attack	Clustering activities help conserve the patient’s energy and reduce interruptions in rest. Elevated respiration, oxygen consumption, and cardiac output may result in metabolic acidosis.
Help the patient to find a comfortable position for sleep or rest.	The patient may prefer an elevated head of the bed, use a pillow for support, or sleep in a chair,
Use energy-saving methods like sitting when working and shower chairs.	This encourages the patient to do what they can while preventing fatigue and saving energy.
Provide scheduled rest periods in a calm environment.	A peaceful environment with limited visitors helps reduce stress and conserve patients’ energy.
Explain to the patient the significance of maintaining body warmth and environmental temperature as prescribed.	This is significant in balancing the patient’s need for warmth and avoiding asthma triggers.
Educate parents and children about the need to avoid fatigue and conserve energy.	This is vital in developing awareness of the impacts of activities on respiration and the need to reduce fatigue. Resting reduces oxygen requirements and helps conserve the energy required for healing.
Encourage exercise or activity limitations if Asthma triggers an attack and recommend prescribed activities (swimming, walking, aerobics).	Encourage physical activity to enhance mental and physical well-being regardless of age.
Help the patient to plan a schedule for feeding, rest, and bathing that will conserve energy and limit the chances of attack.	This helps in reducing exhaustion and balancing the supply and demand for oxygen. If the patient cannot do self-care activities independently, the nurse should assist where necessary.

2.Anxiety

Anxiety is a powerful predictor of breathlessness in Asthmatic people and is more strongly related to Asthma-linked health problems than lung function. Anxiety can increase symptoms awareness and negatively impact cognition and coping abilities.

Nursing Diagnosis

• Anxiety

It may be associated to

• Environmental changes
• Changes in health status.
• Hypoxia
• Loss of control
• Respiratory distress

Possibly evidenced by

• Dyspnea
• Apprehension
• Restlessness
• Tachypnea
• Tachycardia
• Regular request a companion in the room

Desired outcome

• The patient is expected to demonstrate low anxiety levels, indicated by cooperative behavior and a calm demeanor.
• The patient is expected to articulate a decrease in anxiety levels.
• The patient will demonstrate effective coping strategies.
• The patient will discuss and acknowledge their concerns and fears.

Nursing Assessment and Rationale

Nursing Assessment	Rationale
Check for anxiety indications	Anxiety can exacerbate the sign of Asthma by causing rapid and shallow breathing. Tools like the BAI (Beck Anxiety Inventory) can be used to provide precise anxiety data. BAI is a self-reported assessment that evaluates signs like dizziness, nervousness, and inability to relax, focusing on somatic anxiety symptoms.
Assess the patient and the family’s understanding of the diagnosis.	The patient and family are learning new information, such as changes in lifestyle and self-image. Understanding their perspective aids in personalized care and the option for appropriate interventions.
Observe oxygen saturation	Elevated anxiety may signify initial signs of hypoxia, which cause cardiovascular and respiratory responses. Acute hypoxia can result in mental effects.
Monitor the patient’s comments and response that indicates effective coping strategies.	Patients who acknowledge and deal positively with their condition may experience reduced anxiety and fear, indicating their preparedness to participate in their recovery process.

Nursing interventions and Rationale

Nursing Assessment	Rationale
Provide comfortable strategies.	Minimizing physical discomfort can reduce oxygen requirement and the work of breathing, enabling the patient to address emotional problems more efficiently.
Consider the patient’s realities and concerns.	Supporting patients can help them face diagnosis and treatment, allowing them to express and explore their concerns.
Explain treatment and diagnosis procedures precisely and in simple terms.	Proper communication of treatment plans to the patient can prevent anxiety and enhance trust with healthcare providers, minimizing misperceptions and misinterpretations of information.
Involve the patient and significant others in the care plan and provide progress updates to them.	Including significant others in the care plan and providing updates can reduce anxiety and empower patients to take control of their treatment.
Ensure close monitoring and timely intervention and avoid excessive reassurance.	A reliable presence gives the patient a sense of security without reducing emotional impact. However, the anxiety of the family members can intensify the patient’s emotions.
Identify the patient’s coping abilities and strength	Recalling previous coping strengths and strategies can help the client to focus on their capabilities, enhancing their sense of control.
Encourage relaxing techniques.	Relation techniques such as deep breathing and guided imagery can lower anxiety and help the patient feel more in control of the situation. Music therapy and biofeedback are effective ways of providing relaxation. This method encourages active management of the problem and lowers feelings of helplessness.

3.Deficient Knowledge

Inequality in educational opportunities has been associated with a lack of investment in early education and low-quality early education perpetuated by lower property values and increased poverty. According to the Centers for Disease Control and Prevention, personal health literacy refers to the extent of the individual’s ability to understand, find and use services and information to make health-associated actions and decisions for themselves and others.

Nursing Diagnosis

• Deficient Knowledge

It may be associated to

• Cognitive limitation or lack of recall.
• Limited sources of information
• Misinterpretation of information
• Chronicity of illness
• Long-term medical management.

Possibly evidenced by

• Ineffective self-care
• Absence of questions
• Inability to provide answers properly
• Inaccurate execution of instructions
• Growth of preventable complications.

Desired Outcomes

• With the help of SO, the patient is expected to initiate lifestyle adjustments and participate in the treatment program.
• The patient is expected to recognize the link between their present signs and disease progression.
• The patient is expected to use community resources to manage their long-term conditions.
• The patient and SO are expected to demonstrate an understanding of the illness and how to handle the situation.

Nursing Assessment and Rationale

Nursing Assessment	Rationale
Evaluate the educational achievement and cognitive ability of the patient.	Limited health literacy is attributed to low educational achievement, directly affecting health.
Evaluate the appropriate patient’s knowledge of asthma care and status asthmaticus.	Patient knowledge in handling care can significantly save time.
Evaluate current and past therapies such as response to them.	This assessment helps identify the past effective measures and determine the most effective interventions. Acute severe or status asthmaticus resistant to outpatient therapy is a medical emergency requiring aggressive medical management.
Evaluate the patient’s knowledge about asthma triggers.	Irritants and environmental exposures play a significant role in symptoms worsening. Thus, it is essential to use in vitro or skin testing in patients with persistent Asthma to evaluate their response to perennial indoor allergens.
Evaluate the tobacco use of the patient.	This assessment is significant for individuals suffering from a lung illness. Emphasis on cessation of smoking if the patient is a tobacco user. For an individual diagnosed with Asthma, education on the avoidance of either secondhand or firsthand smoke is essential.
Evaluate the patient’s ability and knowledge to use asthma drugs.	Handling inhalers is a significant issue. Thus, the patients should be educated on the proper handling techniques of inhalers.

Nursing Interventions and Rational

Nursing Interventions	Rationale
Assess self-care activities like home management and preventive care of an acute attack.	Asthma is a chronic illness, and the patient should be able to self-manage it. They should be able to carry out behaviors that prevent and monitor asthma symptoms like evading triggers and effectively communicate about Asthma with family.
Educate the patient and the SO about the disease.	Knowledge about self-care management of Asthma minimizes the need for regular hospitalization. Besides, it reduces anxiety leading to enhanced participation in the treatment regimen.
Educate the patient on how to evade asthma triggers.	Controlling environmental triggers can reduce the frequency of attacks and enhance the quality of life. Avoiding asthma triggers like ecological temperature extremes, allergens, fumes, and chemical products is essential in self-care management and preventing acute worsening.
Provide the client with information about the signs of an asthma attack and the significance of prompt treatment. Provide the patient with a written daily aggravation management copy.	An individualized written daily self-management plan is essential to reinforce patient information. Timely treatment of Asthma may reduce cases of hospitalization.
Analyze medication with the patient, such as long and short-acting medications, zones, and dosage of every drug in every zone	The first-line treatment for acute asthma attacks is a short-acting beta-agonist due to faster efficiency than long-acting. It is advisable to use beta-2-adrenergic agonists before inhaling steroids to open the airway and enable deep penetration of anti-inflammatory medication into the lungs.
Emphasis on taking controller medication and educating the patient about their impacts.	Asthma is a chronic illness that may be present without attacks. The incidences of asthma attacks can be minimized by the use of anti-inflammatory agents and bronchodilators
Educate the patient about nebulizer treatment administration techniques, MDIs spacers, Diskus, or dry powder capsules.	To ensure appropriate medication administration, it is essential to demonstrate the methods involved. For instance, present the proper way of using MDI, including instructions about how to hold it and clean the inhaler, pausing 2 to 5 minutes between puffs.
Develop a personalized plan for adjusting medication, when to seek medical attention, and instruct on using peak flow meters. Develop the patient’s individual appropriate peak expiratory flow rate.	Use a personalized zone system for patients. · Green zone · Yellow zone · Red zone
Emphasis on the significance of influenza and pneumococcal pneumonia vaccine annually.	Routine immunization is essential in the reduction of instances of getting these diseases.
Emphasis on the significance of avoiding active respiratory infection patients.	This helps reduce the patient’s exposure and likelihood of contracting severe upper respiratory infections.
Deal with long-term asthma management problems.	To reduce the likelihood of asthma attacks, taking appropriate measures like managing allergens, controlling the environment, and avoiding triggers and air pollutants like aerosol sprays, perfumes, and powder is critical.
Analyze effective coughing methods, breathing exercises, and general conditioning exercises.	Pursed-lip and Abdominal or diaphragmatic breathing exercises strengthen respiratory muscles, minimize the likelihood of small airway collapse and help to control dyspnea.
Refer to the patient support groups.	The support groups for Asthma provide an environment where a patient learns new ways to handle the situation and lifestyle changes like avoiding smoking.
Emphasis on using medical alert bracelets and keeping emergency phone numbers available.	Patients need to get timely assistance when necessary.

4.Fatigue

Apart from other common respiratory symptoms, patients diagnosed with Asthma usually experience a lack of energy, daytime sleepiness, and tiredness. Thus, fatigue, defined as an individual perception of exhaustion or tiredness, maybe a clinically common and significant sign in patients diagnosed with Asthma.

Nursing Diagnosis

• Fatigue

Fatigue may be associated with

• Respiratory distress
• Hypoxia
• Elevated breathing
• High energy requirements in performing tasks.

Fatigue may be evidenced by

• Apprehensiveness
• Tachypnea
• Tachycardia
• Restlessness
• Dyspnea
• Regular request for a companion
• Unable to uphold everyday routines
• Increased physical complaints

Possible outcome

The patient is expected to identify personal actions impacting fatigue and risk factors.

The patient is expected to identify alternatives that enhance activity levels.

The patient is expected to show reduced fatigue, indicated by less restlessness and irritability, the ability to perform ordinary tasks, and enhanced sleeping patterns.

Nursing Assessment and Rational

Nursing Assessment	Rationale
Accept and record the presence of fatigue	The most frequently reported signs of fatigue are persistent fatigue which studies indicate can occur with little energy use and is more frequent than acute normal fatigue.
Determine factors impacting capacity to be active.	This helps in developing effective techniques for enhancing and upholding mobility.
Observe vital signs after every 4 hours. Observe the frequency of breathing work.	Identifying and informing about alterations enables prompt action to address the problem and reduce incidences of fatigue.
Evaluate for symptoms of hypoxia-like shortness of breath, irritability, restlessness, fatigue, and tachycardia.	This is essential in enabling timely management and reduces the likelihood of fatigue.

Nursing Interventions and Rationale

Nursing Interventions	Rationale
Accept when the patient is not to do tasks.	Intolerance of activities differs from time to time, and nonjudgmental acceptance promotes self-esteem and independence,
Encourage quiet, age-appropriate, and simple tasks as the patient’s condition improve.	Emotional and physical comfort positively impacts the patient’s general well-being, reduces oxygen consumption, encourages relaxation, and reduces fatigue.
Place the patient in a position they feel comfortable.	Children with Asthma are comfortable when standing or sitting rather than lying down when asthma attacks and should be allowed to stay in their position of comfort.
Emphasis on stopping activity or exercises before fatigue worsens.	Exceeding one’s physical limits leads to prolonged or excessive discouragement and fatigue.
During care, allow the presence of the patient or SO.	This is essential in reducing fear and anxiety, thus decreasing oxygen utilization and fatigue.
Plan and integrate nursing care to enable undisturbed sleep and rest periods. Provide a peaceful and quiet environment.	These measures encourage rest and minimize oxygen consumption, stress, and fatigue.

5.Impaired Gas Exchange

The impaired gas exchange usually occurs in asthmatic patients because of inadequate oxygen at the alveolar-capillary membrane. This results from airway narrowing and increased production of mucous, which further blocks the airway and exacerbates airflow obstruction. This airway obstruction causes airflow resistance, making it difficult to exhale.

Nursing Diagnosis

• Impaired Gas Exchange

Impaired Gas Exchange may be associated to

• Alveoli
• Bronchospasm
• Airway obstruction by secretions

Impaired Gas Exchange is evidenced by

• Hypoxia
• Dyspnea
• Confusion
• Hypercapnia
• Alterations in vital signs
• Unable to mobilize secretions

Possible nursing care outcome

• The patient is expected to participate in the treatment plan.
• The patient is expected to indicate enhanced ventilation and enough tissue oxygenation by normal ABGs.
• The patient is expected to demonstrate reduced signs of breathing distress.

Nursing Assessment and Rationale

Nursing Assessment	Rationale
Evaluate the breathing rate of the patient, depth, and rhythm.	This is essential in assessing the extent of breathing distress and the chronicity of the illness process.
Observe changes in the mucous membrane or skin color.	Cyanosis can be seen around the lips and nail beds. Central cyanosis and duskiness show progressive hypoxemia that needs medical attention.
Listen to breath sounds and record abnormal sounds in particular areas.	Reduced airflow may cause faint breath sounds, and the presences of wheezes indict secretions and bronchospasm. Bronchial hyperresponsiveness, which may result in wheezing and other typical signs, is usually associated with chronic airway inflammation.
Gently touch the chest to detect the presence of fremitus.	Palpation aims to identify any abnormal or unusual lumps or bony crepitus. Reduction in vibration tremors may be an indicator of air trapping.
Track the client’s vital signs and oxygen saturation levels.	The presence of systemic hypoxemia may result in fluctuations and tachycardia.
Track the patient’s Arterial Blood Gas (ABG).	The levels of ABG may indicate dangerous levels of high carbon dioxide or low oxygen caused by respiratory acidosis and breathing too slowly.

Nursing Interventions and Rationale

Nursing Interventions	Rationale
Raise the bed head and help the patient stay in a position that eases respiration.	The upright position is ideal for oxygen delivery. The lung has different volumes when the patient is sitting, standing, or supine. In addition, position affects respiratory muscles’ activity and length, resulting in changes in maximum air exchange.
Encourage the patient to do breathing exercises and observation of peak flow.	The patient can perform different breathing techniques like low, pursed-lip, or deep breathing as tolerated and necessary. This is crucial in dyspnea of breath, airway collapse, and efforts needed in respiration.
Promote expectoration of sputum or use suction if necessary.	The presence of tenacious, copious, or thick secretions can significantly block the exchange of gases in the small airway. Deep suctioning may be essential if coughing does not bring up the secretions.
Promote a quiet and calm environment. Encourage patient relaxation with a limited number of activities.	Care activities with a rest schedule are critical to the patient’s treatment plan. Lower the noise levels from staff and equipment and conserve patient’s energy.
Emphasis on the gradual resume of activities and increase as tolerated.	Fitness programs aim to enhance the body’s ability to do aerobics and functional performance, build endurance and strength and promote wellness while evading dyspnea.
Emphasis on limiting or avoiding stimulants like caffeine.	External factors like tea or caffeine consumption may impede relaxation and the patient’s ability to utilize their limited energy.
Provide additional oxygen as required.	Oxygen therapy may be significant in averting and correcting the worsening of hypoxemia. However, additional oxygen is provided only when the situation is worse or like long-term therapy.
Help the patient with mechanical breathing or the insertion of the breathing tube.	Treatment of severe Asthma via mechanical ventilation provides unique difficulties like the possibility of reduced systemic blood pressure due to high pressure and less frequent but potentially severe complications like pneumomediastinum, pneumothorax, or barotrauma.

6.Ineffective Airway Clearance

Asthma is an airway condition indicated by hyperreactivity and airway inflammation. Hyperreactivity results in airway obstruction due to the severe onset of muscle spasms leading to a narrowed lumen. In addition, there is inflammation of the mucosa resulting in edema. The airway obstruction is due to the secretion of thick mucus by goblet cells into the airway.

Nursing Diagnosis

• Ineffective Airway Clearance

Ineffective Airway Clearance is associated with

• Mucosal edema
• Bronchospasms
• Ineffective cough
• Elevated pulmonary secretions

Ineffective Airway Clearance is evidenced by

• Chest tightness
• Dyspnea; orthopnea
• cough
• Wheeze and rhonchi
• cyanosis
• Altered in breathing rhythm and rate
• Retained secretions
• Unusual arterial blood gases

Possible nursing care outcome

• The patient is expected to demonstrate comprehension of the cause and treatment plan.
• The patient is expected to express behaviors in enhancing airway clearing.
• The patient will show clear breathing sound, regular breathing depth and rate, better oxygen intake, and ability secret, indicating an open airway.

Nursing Assessment and Rationale

Nursing Assessment	Rationale
Examine breathing depth, rhythm, and rate	Changes in breathing rhythm and rate indicate early signs of respiratory distress.
Examine for color changes in nail beds, buccal mucosa, and lips.	Cyanosis signifies low oxygenation and ineffective breathing in upholding enough tissue oxygenation.
Listen to the sounds for adventurous respiration sounds.	The most common sign is the wheezing, high-pitched, musical, and whistling sound produced due to turbulence airflow. Wheezing is an end-expiratory in the mildest form.
Examine how effective is a patient cough.	Thick secretion, acute bronchospasm, and fatigue of breathing muscles cause ineffective coughing. Cough can be associated with Asthma in cases of nocturnal or exercise-induced Asthma.
Examine the color, viscosity, odor, and amount of the secretions.	The color of normal secretion is grey or clear and minimal. At the same time, abnormal sputum is either bloody, yellow, or green malodorous and usually copious.
Observe oxygen saturation.	Oxygen saturation below 90% signifies issues with oxygenation. Pulse oximetry is significant in tracking asthma deterioration or attack severity.
Observe chest X-ray results.	The chest x-ray provides information about lung inflation, infiltrates, or barotrauma. It is an essential assessment for patients with a history of possible infection or risk for possible foreign bodies.
Observe laboratory results as required	If the patient has a repeat salbutamol or high dose, it is recommended to check the level of electrolytes and urea. Salbutamol’s side effect temporarily shifts potassium into intrasellar space, resulting in unintentional and temporary hypokalemia.
Observe the patient’s Arterial Blood Gas (ABG).	Measurement of ABG provides significant information about severe Asthma. This test is vital in indicating dangerous levels of hypercarbia or hypoxemia secondary to hypoventilation resulting in acidosis.
Collect the measurement of FEV1 in one second prior to and after receiving PEFR	Practical and repeated measurements of FEV1 and PEFR can help assess the effectiveness of therapy and whether the patient will be admitted or discharged from the hospital.

Nursing Interventions and Rationale

Nursing Interventions	Rationale
Help the patient pace their activities.	Break patient activities into small parts with rest breaks in between to prevent fatigue and difficulties in breathing.
Limit the use of alcohol and caffeine.	This drink increases gastric acid secretion, significantly increasing reactivity and airway resistance.
Emphasis on coughing and deep breathing exercises.	This is significant in clearing and loosening excess secretions from the lungs. Besides, the exercises help the patient to cope with dyspnea and minimize air trapping.
Assist the patient in staying in a comfortable position for breathing.	Raise the head of the bed and emphasize leaning over a table to facilitate respiratory function using gravity. Support legs and arms with pillows to minimize muscle fatigue and help chest expansion.
Minimize environmental pollution from sources like smoke, feather pillows, and dust.	Effective environmental measures can help minimize indoor allergens and exposure to pollutants associated with enhanced Asthma.
Emphasis on higher fluid intake of up to 300 ml per day within the renal or cardiac reserve	Fluid is essential in lowering mucosal drying and maximizing ciliary actions to remove secretions. Hydration reduces the viscosity of secretions and facilitates expectoration.
Provide prescribed medication	· Inhaled corticosteroids · Long-acting beta2 agonists · Leukotriene receptor antagonists.
Provide the prescribed high-flow nasal cannula (HFNA) oxygen treatment.	HFNA oxygen treatment can significantly raise PO2 in acute bronchial asthma patients.
Help with respiratory treatment like chest physiotherapy and spirometry.	Help in exercise to enhance breathing, and use a nebulizer or aerosol medication to minimize bronchospasm and clear mucus. Tapping and positioning strategies improve the removal of excessive secretions and airflow to the lower lung segments.
Be ready for the possibility of mechanical ventilation and intubation.	During acute asthma attacks, intubation may be critical to aid breathing. However, it might cause high blood pressure and other complications like pneumothorax, barotrauma, or pneumomediastinum.

7.Ineffective Breathing Pattern

Hyperventilation and bronchial are the primary factors linked to ineffective breathing patterns. This mainly happens when the airway diameter narrows because of mucosal edema, inflammation, and increased secretions resulting in varying degrees of obstruction. Airway obstruction leads to increased levels of hydrogen and carbon dioxide in the blood, causing hyperventilation characterized by infective breathing patterns.

Nursing Diagnosis

• Ineffective Breathing Pattern

Ineffective Breathing Pattern is related to

• Bronchial secretions
• Infective mobilization and expel secretions
• Spasms and swelling of bronchial tubes as a result of inhaled infection, allergens, drugs, or irritants

Ineffective Breathing Pattern

• Tachypnea
• Nasal flaring
• Cough
• Dyspnea
• Changes in respiratory depth
• Cyanosis
• Utilization of accessory muscles
• Prolonged expiration
• Loss of consciousness

Possible nursing care outcome

• The patient’s breathing is expected to be optimally shown by relaxed breathing, reduced breathing difficulties, and average breathing rate and pattern.
• The patient is expected to experience reduced respiratory complications or issues.
• The patient is expected to show typical arterial blood gas results and be hypoxia-free.

Nursing Assessment and Rationale

Nursing Assessment	Rationale
Evaluate the patient’s vital signs as required.	Vasoconstriction may lead to hypoxia because of perfusion/ventilation mismatch resulting in elevated respiration, tachycardia, and hypotension.
Observe the breathing depth, rhythm, and rate.	Changes in breathing rate, rhythm, and rate signify early symptoms of respiratory distress.
Measure the patient’s weight and BMI.	Obesity which is a BMI of 30 kg/m2 is a potential risk factor and illness modifier of Asthma in adults and children. Obese adults have higher chances of acute Asthma than lean adults, with an increased risk of hospitalization.
Evaluate the levels of patient anxiety.	In an unfamiliar environment or in emergencies, the symptoms of Asthma worsen, especially for patients experiencing the condition for the first time.
Evaluate the patient’s adventurous sounds, and breath sounds like stridor and wheezes	Adventurous sounds signify a deteriorating condition or developing complications like pneumonia. Wheezing is a usual sign of Asthma resulting from airflow turbulence.
Determine the relationship between expiration and inspiration.	Reactive airways allow air to enter the lungs more easily than to exit the lungs. The patients need instruction on adequate respirations.
Evaluate for dyspnea signs like chest retraction, flaring of nostrils, and accessory muscle utilization.	Dyspnea signifies respiratory distress. When air movement in and out of the lungs becomes difficult, breathing patterns change.
Evaluate for conversational dyspnea.	Dyspnea in a regular conversation shows respiratory distress. Breathlessness impacts the client’s speaking ability, resulting from airflow limitation and the development of hypercapnia or hypoxemia that leads to respiratory failure.
Evaluate for stress and fatigue.	Fatigue indicates stress leading to breathing failure.
Evaluate the patient for the existence of a paradoxical pulse that measures 12 mm Hg or more.	A paradoxical pulse of 12 mm Hg or more signifies acute airflow obstruction. In acute Asthma, pulsus paradoxus can reach 40 mm Hg.
Track oxygen saturation	It is critical to track the amount of oxygen-saturated hemoglobin in blood in relation to the total amount of hemoglobin. ·  The optimal range is between 91% to 100% ·  In severe cases is less than 91% ·  In moderate acute cases, ranges between 91% to 95% ·  In mild cases, it remains above 95%.
Track the ABG	The presence of acidosis indicates respiratory failure, and mechanical ventilation is necessary.

Nursing Interventions and Rationale

Nursing Interventions	Rationale
Schedule rest periods between activities.	Physical activities increase oxygen needs and metabolic rates, which might be reduced by the patient’s exercise, tolerance, and response to medication.
Raise the head of the bed and assist the patient in staying in a comfortable position, depending on their breathing effort.	This intervention prevents aspiration of vomitus or secretions, improves ventilation to lower lobes, and reduces pressure on the diaphragm.
Emphasis on breathing exercises.	These exercises are used to correct dysfunctional breathing.
Emphasis on weight loss for obese patients.	Obesity is a risk factor for Asthma. Obese patients have reduced asthma control, and losing 5% of their weight is recommended for significant improvement for adults.
Emphasis on appropriate nutritional intake is necessary for weight and allergen avoidance.	High sugars beverages and diets low in vegetables and grains and rich in dairy products and sweets are considered risk factors for Asthma.
Emphasis the importance of environmental control and avoiding allergens to prevent symptoms from worsening.	Encourage the patient to avoid exposure to known allergens, especially at home, where they spend most of their time. Regular dusting, cleaning, and using quality air filters can prevent dust mites.
Reduce indoor pets that may cause allergies.	Removing animals from home, especially from the bedroom, can prevent indoor airborne allergens.
Emphasis on smoking cessation and avoiding secondhand smoke.	Avoiding secondhand and firsthand tobacco smoke is essential for patients diagnosed with Asthma.
Provide asthma medication as prescribed.	· Anticholinergic agents · Inhaled corticosteroids · Short-acting beta-2 adrenergic agonist agents · Oral corticosteroids
Help in tubulation as recommended.	Some patients may require endotracheal intubation despite the best efforts of medical providers.

8.Interrupted Family Processes

More than 9 million children and families in the United States face difficulties managing childhood asthma. Asthma guidelines recommend avoiding allergens, monitoring the environment, and having a self-management plan at home. Little children between 5 and 12 years need their families’ help managing asthma.

Nursing Diagnosis

• Interrupted Family Processes

Interrupted Family Processes are related to

• Uncertainty about results
• Sick child
• Emergent medical attention

Interrupted Family Processes are possibly evidenced by

• Alterations of family dynamics impede adjustment and reduce the patient’s ability to increase the child’s growth and development.
• Parental stress and dysfunction
• Challenges in receiving or accepting assistance appropriate.
• Withdrawal, excessive worry, denial, overprotectiveness, and difficulty deciding about child-rearing.

Possible nurse care outcome

• The patient is expected to communicate concerns and feelings associated with the effects of the situation to the entire family.
• The patient and SO are expected to identify externa and internal resources to assist them in managing the situation.
• The patient and SO are expected to demonstrate adjustment, coping behaviors, and acceptance of Asthma and its implications.

Nursing Assessment and Rationale

Nursing Assessment	Rationale
Evaluate the family’s available resources and coping abilities.	To promote the development of coping techniques, reinforce the family’s strength, and identify their capability to manage the situation.
Evaluate the interpersonal relationships in the family and support system, particularly emphasizing the child’s diagnosed with asthma relation with family.	Timely identification of interpersonal issues, especially among caregivers (primarily mothers), is essential to manage the challenges of caring for a child with Asthma.
Evaluate peers and siblings at intervals as necessary and provide time for discussion and questions, and feelings. Assist the family in accommodating the needs of everyone in the family.	This assessment helps promote positive relationships among siblings and peers that could be affected by the condition necessitating parental attention.
Determine the family’s concerns about the child’s condition.	During history-taking, open discussion is critical in identifying family-associated psychological stress. Early identification of psychological stress helps in focusing preventive care to promote adaptations.
Assess and discuss family objectives and expectations.	Address unrealistic beliefs about home management and recovery from severe attacks.

Nursing Interventions and Rationale

Nursing Interventions	Rationale
Allow the family to cope with the disease and acknowledge their typical reaction to losing the pre-diseased person.	Depending on the acuteness, these reactions are expected in the early adjustment stage following illness diagnosis.
Assist the family in evaluating particular feelings regarding anger, fear, irritation, guilt, and disappointment.	These intervention helps in reducing stress and promotes positive coping skills.
Encourage the use of relaxation measures and stress management techniques.	This intervention includes visualization, breathing exercise, and music therapy, significantly reducing stress and enhancing coping skills.
Discuss with the patient about their fears regarding their child’s Asthma, such as death, coping with anxiety, treatment, complications, and the child feeling different from friends.	Continuous education is essential in helping families identify triggers, manage medication effectively, and reduce exposure, increasing evidence in the control and management of Asthma.
Assist the family in differentiating between unrealistic and realistic fears associated with Asthma.	Studies show that high levels of asthma-associated anxiety are related to individuals taking asthma symptoms very seriously, visiting hospitals frequently, and taking preventive measures to manage asthma symptoms effectively.
Encourage positive family relationships and attitudes towards the asthmatic child.	This intervention helps to promote the family’s ability to adjust to the situation positively.
Identify individual roles and anticipate changes in family roles due to the condition.	It is essential to recognize that family members may take different roles and responsibilities, which impacts family coping.

9.Readiness for Enhanced Health Management

Nursing Diagnosis

• Readiness for Enhanced Health Management

It may be associated with

• Readiness to handle personal needs
• Fundamental needs are adequately satisfied, and adaptive activities are addressed effectively.
• Desire to knowledge about ways to modify and prevent the behavior.

Possibly evidenced by

• Frequent attacks
• The patient is expected to demonstrate the desire to elevate control over health practices and better understand how their current behavior and environment influence their health.

Possible nursing care outcome.

• The patient and SO are expected to demonstrate their comprehension of risk factors and preventive measures.
• The patient and SO are expected to demonstrate their readiness to take necessary measures for effective change.
• The patient and SO are expected to express a sense of self-confidence and contentment with the advancements made.

Nursing Assessment and Rationale

Nursing Assessment	Rationale
Evaluate the health beliefs of the patient and caregivers.	Health beliefs for caregivers and patients have been identified as the contributing factors to ineffective asthma management and non-compliance to recommended therapies.
Evaluate the readiness of the patient in managing their health condition.	Transferring asthma management responsibilities to young children prematurely is associated with suboptimal self-management and adverse health outcomes.
Evaluate the utilization of non-prescribed medications, the medication used, and its impacts.	This assessment helps evaluate whether available drugs for treating breathing infections may or may not be used since they may interfere with prescribed medication and worsen the situation.
Evaluate for family history of allergies, including respiratory infections, triggers, and treatment used to support the child’s health.	This information is critical in upholding patient health since breathing changes or infection can result in an asthma attack.

Nursing Interventions and Rationale

Nursing Interventions	Rationale
Instruct the patient to avoid people with breathing infections, cover their mouth when coughing or sneezing, and dispose of tissues.	This intervention helps prevent the spread of microorganisms via airborne droplets, which can result in Asthma, particularly in children.
Advise children to avoid stressful situations and strenuous exercises.	This measure helps avert triggering an asthma attack, especially if the patient has exercise-induced bronchoconstriction.
Educate both children and parents about proper handwashing.	These methods are essential in preventing the transfer of microorganisms responsible for a viral illness, which is a significant factor in worsening Asthma.
Encourage respiration exercises and relaxation strategies.	Pursed-lip and abdominal breathing help strengthen respiration muscles, avert small airway collapse, and manage dyspnea.
Educate the children and the parents about the disease process, symptoms, and possible triggers.	This is essential in enhancing compliance with the medical regimen and preventive measures.
Instruct the child and parent on proper ways of administering medication as prescribed. Discourage the use of over-the-counter medicines without a doctor’s prescription.	This is vital in ensuring compliance with the treatment regimen and averting asthma attacks.
Emphasis on the significance of allergy skin testing to determine sensitivity.	Positive results should be examined in the context of the patient’s medical history.
Discuss with children and parents about the signs of asthma attacks like wheezing, chest pain, and shortness of breath.	This helps in preventing severe attacks and promotes timely medical intervention.