Asthma is a chronic inflammatory lung disease that causes airway hyperresponsiveness, mucus production, and

mucosal edema resulting in reversible airflow obstruction. Allergens, air pollutants, cold weather, physical exertion,
strong odors, and medications are common predisposing factors for asthma. When an individual is exposed to a
trigger, an immediate inflammatory response with bronchospasm happens. This inflammatory process leads to
recurrent episodes of asthmatic symptoms such as cough, dyspnea, wheezing, and increased mucus production.

Status asthmaticus is severe and persistent asthma that does not respond to usual therapy; attacks can occur with
little or no warning and can progress rapidly to asphyxiation.

Nursing Care Plans

The nursing care plan focuses on preventing the hypersensitivity reaction, controlling the allergens, maintaining airway
patency and preventing the occurrence of reversible complications.

Here are four (4) nursing care plans (NCP) for bronchial asthma:

1. Ineffective Breathing Pattern

2. Ineffective Airway Clearance
3. Deficient Knowledge
1.4. Anxiety

Ineffective Breathing Pattern

Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation

May be related to

Swelling and spasm of the bronchial tubes in response to inhaled irritants, infection, drugs, allergies
or infection.

Possibly evidenced by

Cough.
Cyanosis.
Dyspnea.
Loss of consciousness.
Nasal flaring.
Prolonged expiration.
Respiratory depth changes.
Tachypnea.
Use of accessory muscles.

Desired Outcomes
 Client will maintain optimal breathing pattern, as evidenced by relaxed breathing, normal respiratory rate or
pattern, and absence of dyspnea.
Nursing Interventions
Assess clients vital signs as
needed while in distress.
Assess the respiratory rate,
depth, and rhythm.
Assess clients level of anxiety.
Assess breath sounds and
adventitious sounds such as
wheezes and stridor.
Assess the relationship of
inspiration to expiration.
Assess for signs of dyspnea
(flaring of nostrils, chest
retractions, and use of
accessory muscle).
Assess for conversational
dyspnea.
Rationale
Increased BP, RR, and HR
happens during the initial
hypoxia and hypercapnia. And
when it becomes severe, BP
and HR drops and respiratory
failure may result.
Changes in the respiratory rate
and rhythm may indicate an
early sign of impending
respiratory distress.
Anxiety may result from the
struggle of not being able to
breathe properly.
Adventitious sounds may
indicate a worsening condition
or additional developing
complications such
as pneumonia. Wheezing
happens as a result of
bronchospasm. Diminishing
wheezing and indistinct breath
sounds are suggestive findings
and indicate impending
respiratory failure.
Reactive airways allow air to
move into the lungs more
easily than out of the lungs. If
the client is gasping for air,
instruction for effective
breathing is needed.
These indicate respiratory
distress. Once the movement
of air into and out of
the lungs becomes challenging,
the breathing pattern changes.
Dyspnea during a normal
conversation is a sign of
respiratory distress.

Assess for fatigue.
Assess the presence of
paradoxical pulse of 12 mm Hg
or greater.
Monitor oxygen saturation.
Monitor peaked expiratory flow
rates and forced expiratory
volume as taken by the
respiratory therapist.
Monitor arterial blood gasses
(ABG).
Fatigue may indicate distress,
leading to respiratory failure.
Paradoxical pulse is an
abnormally large decrease in
systolic bloodpressure and
pulses wave amplitude during
inspiration. The normal fall in
pressure is less than 10 mm
Hg. A paradoxical pulse of 12
mm Hg or greater indicates a
severe airflow obstruction.
Oxygen saturation is a term
referring to the fraction of
oxygen-
saturated hemoglobin relative
to the total hemoglobin in
the blood. Normal oxygen
saturation levels are
considered 95-100%.
The severity of the
exacerbation can be measured
objectively by monitoring
these values. The peak
expiratory flow rate is the
maximum flow rate that can be
generated during a forced
expiratory maneuver with fully
inflated lungs. It is measured
in liters per second and
requires maximal effort. When
done with good effort, it
correlates well with forced
expiratory volume in 1 second
(FEV ) measured by
1
spirometry and provides a
simple, reproducible measure
of airway obstruction.
During a mild to
moderate asthmaattack, clients
may develop respiratory
alkalosis. Hypoxemia leads to
increased respiratory rate and
depth, and carbon dioxide is
blown off. An ominous finding
is a respiratory acidosis, which
usually indicates that

Plan for periods of rest between
activities.
Maintain head of bed elevated.
Encourage client to use pursed-
lip breathing for exhalation.
Administer medication as ordered:
Short-acting beta-2-adrenergic
agonist.
Albuterol (Proventil, Ventolin).
Levalbuterol (Xopenex).
Terbutaline (Brethine).
Inhaled Corticosteroids.
Budesonide (Pulmicort).
Fluticasone (Flovent).
Beclomethasone (Vancenase).
Mometasone (Asmanex Twisthaler). steroids should be given after
Anticipate the need for alternative treatment if life-threatening
bronchospasm continues:
General anesthesia.
Magnesium sulfate.
respiratory failure is pending
and that mechanical
ventilation may be necessary.
Fatigue is common with the
increased work of breathing
from the ineffective breathing
pattern. Activity increases
metabolic rate and oxygen
requirements.
This promotes maximum lung
expansion and assists in
breathing.
Pursed lip breathing improves
breathing patterns by moving
old air out of the lungs and
allowing for new air to enter
the lungs.
Short-acting beta2-agonists are
bronchodilators. They relax the
muscles lining the airways that
carry air to the lungs;
treatment of choice for acute
exacerbation of asthma.
Corticosteroids reduce
inflammation in the airways
that carry air to the lungs and
reduce the mucus made by the
bronchial tubes. Inhaled
beta-2-adrenergic agonist.
General anesthesia is used
when there is both dynamic
hyperinflation and profound
hypercapnia that cannot be
corrected by increasing minute
ventilation.
Magnesium sulfate has
bronchodilating and anti-
inflammatory effects that are
sometimes used in the

Heliox (a helium-oxygen mixture).
treatment of moderate to
severe asthma in children.
The use of helium (a less dense
gas than nitrogen) causes
decrease airway resistance thus
lessens the work of breathing.