STATUS ASTHMATICUS
It is a severe attack of asthma. Unresponsive to conventional therapy and lasts longer than 24 hours.
Occurs as a result of infection, anxiety, overuse of tranquilizers, nebuliser abuse, dehydration and non-specific irritants.
Acute episode is precipitated by hypersensitivity to aspirin.
Causes
- Infection
- Inhalation of air pollutants and allergens to which sensitize..
- Non-compliance in taking medication, including over use of bronchodilators.
- Injection of aspirin or related drugs in aspirin sensitive patient.
- Aspiration of gastric acid.
Pathophysiology
1. Constriction of bronchial smooth muscle, swelling of bronchial mucosa and thickened secretion.
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Decreases the diameter of bronchi
2. Ventilation perfusion abnormality results from hypoxemia and respiratory acidosis/alkalosis.
Clinical Manifestations
- Tachypnea, laboured respiration with increased effort or exhalation, decreased ability to speak in phrases/sentences, anxiety, irritability, fatigue, headache, impaired mental functioning
- Muscle twitching, somnolence, diaphoresis from continued CO₂ retention
- Tachycardia, elevated BP
- Heart failure and death from suffocation
Management and Nursing Interventions
1. Monitor respiratory rate and oxygen saturation, continuously; ABG, BP & ECG.
2. Administer repeated aerosol treatments with ẞ agonist bronchodilators such as albuterol as prescribed.
3. Monitor, IV therapy.
a. When intravenous fluids are administered, aminophylline may be prescribed and administered slowly by constant infusion, inform doctor of signs of theophylline toxicity (tachycardia, nausea, vomiting, restlessness, dizziness). b. Corticosteroids-treatment of inflammation of airways
c. Fluids are given to treat dehydration and loosen secretions.
4. Provide continuous humidified Oxygen via nasal cannula as prescribed.
5. Initiate mechanical ventilation if necessary
6. Assist with mobilization of obstrueting bronchial mucůs
a. Perform chest physiotherapy (chest wall percussion and vibration).
. Administer expectorant and mucolytic drugs as prescribed. b
c. Remove secretion by suctioning or prepare for bronchoscopy if needed.
7. Provide adequate hydration,
8. Obtain portable chest x-ray and administer antibiotics as prescribed - treatment of respiratory infection.
9. Alleviate the patient's anxiety and fear by acting calmly and reassuring the patient during an attack. Stay with the patient until the attack subsides.
