Nursing Care Plan for Bronchial Asthma

Bronchial Asthma

Bronchial asthma is a disease of the lungs in which an obstructive ventilation disturbance of the respiratory passages evokes a feeling of shortness of breath. The cause is a sharply elevated resistance to airflow in the airways. Despite its most strenuous efforts, the respiratory musculature is unable to provide sufficient gas exchange. The result is a characteristic asthma attack, with spasms of the bronchial musculature, edematous swelling of the bronchial wall and increased mucus secretion. In the initial stage, the patient can be totally symptom-free for long periods of time in the intervals between the attacks. As the disease progresses, increased mucus is secreted between attacks as well, which in part builds up in the airways and can then lead to secondary bacterial infections. Bronchial asthma is usually intrinsic (no cause can be demonstrated), but is occasionally caused by a specific allergy (such as allergy to mold, dander, dust). Although most individuals with asthma will have some positive allergy tests, the allergy is not necessarily the cause of the asthma symptoms.

Symptoms can occur spontaneously or can be triggered by respiratory infections, exercise, cold air, tobacco smoke or other pollutants, stress or anxiety, or by food allergies or drug allergies. The muscles of the bronchial tree become tight and the lining of the air passages become swollen, reducing airflow and producing the wheezing sound. Mucus production is increased.

Typically, the individual usually breathes relatively normally, and will have periodic attacks of wheezing. Asthma attacks can last minutes to days, and can become dangerous if the airflow becomes severely restricted. Asthma affects 1 in 20 of the overall population, but the incidence is 1 in 10 in children. Asthma can develop at any age, but some children seem to outgrow the illness. Risk factors include self or family history of eczema, allergies or family history of asthma. Bronchial asthma causes cough, shortness of breath, and wheezing. Bronchial asthma is an allergic condition, in which the airways (bronchi) are hyper-reactive and constrict abnormally when exposed to allergens, cold or exercise.


Nursing Care Plan for Bronchial Asthma

Nursing Assessment for Bronchial Asthma

1. Past medical history :
   • Assess personal or family history of previous lung disease.
   • Review the history of allergic reaction or sensitivity to the substances / environmental factors.
   • Assess the patient's employment history.
2. Activity
   • The inability to perform activities because of difficulty breathing.
   • The decline in the ability / improvement needs help doing daily activities.
   • Sleeping in a sitting position higher.
3. Respiratory
   • Dipsnea at rest or in response to activity or exercise.
   • Breath worsened when the patient lay supine in bed.
   • Using the drug ventilator, for example: raising the shoulders, widen the nose.
   • The existence of wheezing breath sounds.
   • The recurrent coughing.
4. Circulation
   • The increasing blood pressure.
   • There is an increasing frequency of heart.
   • The color of skin or mucous membranes normal / gray / cyanosis.
   • Redness or sweating.
5. Ego integrity
   • Anxiety
   • Fear
   • Be sensitive to stimuli
   • Restlessness
6. Nutrition
   • 
     
   • Inability to eat due to respiratory distress.
   • Weight loss due to anorexia.
7. Sosal Relations
   • 
     
   • The limited physical mobility.
   • Difficult to talk or stammering.
   • The existence of dependence on others.
8. Sexuality
   • Decrease in libido.

Nursing Diagnosis for Bronchial Asthma

1. Ineffective airway clearance related to the accumulation of mucus.
2. Ineffective breathing pattern related to decreased lung expansion.
3. Impaired nutrition less than body requirements related to inadequate intake.

Nursing Intervention for for Bronchial Asthma

1. Ineffective airway clearance related to the accumulation of mucus.

Goal :
The Way of breath effectively.

Result Criteria :

• Shortness reduced
• Coughing reduced
• Clients can issue a sputum
• Wheezing is reduced / lost.
• Vital signs within normal limits.

Nursing Intervention :

• Auscultation of breath sounds, record the sound of breath, for example: wheezing, erekeis, ronchi.
  Rational : Some degree of bronchial spasms occur with airway obstruction. Faint breath sounds with expiratory wheeze (empysema), no breathing function (severe asthma).
• Review / monitor respiratory frequency, record the ratio of inspiration and expiration.
  Rational : Tachypnoea usually found in some degree and can be found at the reception during the stress / the process of acute infection. Respiratory frequency can be slowed down and elongated than the expiration of inspiration.
• Assess the patient to a safe position, for example: elevation of the head does not sit on the backrest.
  Rational : Elevation head is not easier for respiratory function by using gravity.
• Observation of the characteristic cough, persistent, hacking cough, wet. Auxiliary actions to improve effectiveness cough efforts.
  Rational : The cough can be settled but is not effective, especially on elderly clients, acute pain / weakness.
• Give warm water.
  Rational : use of warm fluids can decrease bronchial spasms.
• Collaboration based drug Spiriva indikasi.Bronkodilator 1 × 1 (inhalation).
  Rational : Freeing airway spasm, wheezing and mucus production.

2. Ineffective breathing pattern related to decreased lung expansion.

Goal :
The pattern of effective breathing.

Result Criteria :

• effective breathing pattern
• The sound of normal breathing or net
• Vital signs within normal limits
• Coughing reduced.
• Expansion of the lungs inflate.

Nursing Intervention :

• Assess respiratory frequency and depth of chest expansion. Record the respiratory effort including the use of auxiliary respiratory muscles / nasal dilation.
  R / velocity usually reaches a depth of respiration varies depending on the degree of respiratory failure. Limited chest expansion associated with atelectasis and / or chest pain.
• Auscultation of breath sounds and record sounds like crekels breath, wheezing.
  R / rhonchi and wheezing accompanying airway obstruction / respiratory failure.
• Elevate the head and help change the position.
  R/ Sitting high enable lung expansion and eases breathing.
• Observation of the pattern of coughing and secretions character.
  R / alveolar congestion often result in cough / irritation.
• Encourage / assist the patient in breathing and coughing exercises.
  R / Can increase / number of sputum where the interference plus the lack of comfortable ventilation and breathing effort.
• Collaboration
  • Provide supplemental oxygen.
  • Provide additional humidifikasi eg nebulizer.
  R / Maximize breath breathe and reduce labor, provide moisture to the mucous membranes and helps thinning secretions.

Source :
http://respiratory-lung.health-cares.net/bronchial-asthma.php