Bronchial Asthma Nursing Management

BRONCHIAL  ASTHMA

It is an intermittent, reversible, obstructive airway disease, characterized by increased responsiveness of the trachea and bronchi to various stimuli

Etiology:

Hereditary

Allergens e.g.  Dust pollen, animals, food

Factors common cold, respiratory tract infection, exercise emotion, and Environmental pollutants.

Pharmacological agents eg. Aspirin

Pathophysiology

Asthma caused by

Contraction of muscles surrounding bronchi narrows airway

Swelling of membrane which lines bronchi (mucosal edema)

Filling bronchi with thick mucus (mucus production)

Also bronchial muscle enlargement, mucous gland enlargement, thick tenacious sputum and air trapping in alveoli

Infection, Irritants, allergens, cold, stress, exercise

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IgE mast cell-mediated response -

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Release of mediators from mast cells in bronchial epithelium

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Asthma attack-bronchospasm, mucosal edema and increased mucus production.

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Obstruction of large and small airways

Clinical Manifestations

Wheezing, cough, dyspnea, chest tightness, expirations may be prolonged Lack of Oz in the blood

Acute attack signs of hypoxemia restlessness, increased anxiety, inappropriate behaviour, increased pulse, respiration (More than 30/minute) and Blood pressure,

Diagnostic Investigations

1. Health history and physical examination.
2. Pulmonary function test
3. X-ray chest
4. ABG
5. Allergy Skin Test -
6. Sputum gram stain and culture Blood level eosinophils & IgE-

Medical Management:

1. Bronchodilators and steroids are administered.Oxygen Administration
2. Monitor for clinical manifestations-increasing anxiety, difficulty in breathing and tiring.
3. Sedation and in rare cases administration of paralytic agents necessary to blunt clients respiratory effort
4. After acute attack is over suppression from the medication.  steroids have to be tapered because of induced adrenal
5. Beta-adrenergic agonists- eg. Albuterol (Ventolin), metaproterenol (Alupent).
6. Environmental control - Avoid stuffed animals, smoking, smoked filled areas, outdoor activities when high pollen/pollutants are in the air.
7. Regular aerobic exercise should be encouraged. Use and inhaled ẞ-agonist taken 15-20 minutes before exercise will decrease induced bronchospasm

Nursing Management

1. Observe the patient and assess the rate, depth and character of respirations especially on expiration; observation for hyperinflation.
2. Assess for triggers of asthma allergens, respiratory infection, inhalation of irritating substances (dust, fumes, gases) environmental factors (weather, air pollution), exercise particularly in cold weather, aspirin and its derivatives, emotional factors.
3. Monitor vital signs, skin colour, and degree of restlessness, which may indicate hypoxia.
4. Provide nebulization and oxygen therapy as proscribed.
5. Encourage intake of fluids to liquefy secretions.
6. Instruct patient 'on positioning to facilitate breathing - sitting upright (leaning forward on a table).
7. Encourage patient to use adaptive breathing techniques (eg. Pursed lip breathing) to decrease the work of breathing.
8. Use chest-physiotherapy/postural drainage to mobilize secretions, if ordered.
9. Explain rationale for interventions to gain patient's co-operation, Provide case in prompt confident manner.