Asthma is a chronic condition affecting the lungs. When in contact with a trigger, the muscles around the airways constrict and inflammation and mucus in the airways make breathing difficult, known as an asthma attack. There is no cure for asthma, and untreated asthma attacks can be life-threatening, but there are many effective treatments that help manage and control this condition.
Asthma is the most common chronic condition among children. Children with asthma are extra sensitive to triggers as their smaller airways are easily affected by swelling and mucus. Approximately 50% of children “outgrow” asthma once they reach adolescence, though it may return in adulthood.
The Nursing Process
Nurses can expect to have frequent contact with patients who have asthma. Asthma can present as an acute exacerbation requiring prompt treatment and close observation or as a chronic condition in the patient’s history. Nurses can support patients in the management of their disease by providing education on symptoms, triggers, and medications.
Nursing Care Plans Related to Asthma
Activity Intolerance Care Plan
Symptoms such as dyspnea and fatigue during an asthma exacerbation deplete energy and prevent the ability to carry out tasks.
Nursing Diagnosis: Activity Intolerance
- Airway constriction
- Imbalance between oxygen supply and demand
As evidenced by:
- Dyspnea on exertion
- Chest tightness
- Inability to play, eat, or complete tasks
- Poor sleep due to dyspnea or coughing
- Patient will complete ADLs without dyspnea or wheezing
- Child will participate in play without shortness of breath or coughing
Activity Intolerance Assessment
1. Assess for activity triggers.
Exercise-induced asthma causes a narrowing of the airways due to strenuous exercise. The nurse can assess for activities or sports the patient engages in that may be contributing to their asthma exacerbations.
2. Assess the level of limitation.
Observe the patient completing tasks, or simply transferring or ambulating. Note the level of limitation in comparison to the patient’s usual activity or their perceived degree of deficit.
3. Monitor for emotional factors affecting activity.
Asthma flare-ups can be frightening. Assess if the patient is fearful of partaking in exercise or activities for fear of an asthma attack. The nurse can help with forming a balance between appropriate exercise and necessary rest.
Activity Intolerance Interventions
1. Encourage progressive activity.
Exercise is necessary for health. Encourage activities such as walking or yoga which are generally safe for asthmatics. The patient should limit their sedentary time and alternate between rest and activity to improve their tolerance.
2. Educate on triggers.
Educate patients to consider the elements before engaging in outdoor activity. Allergens, smoke, humidity, and cold temperatures can trigger asthma attacks.
3. Offer other activities.
Children who are not able to participate in high-endurance activities such as soccer or running can instead play games, crafts, or sports such as gymnastics or golf.
4. Plan for exercise.
Exercise-induced asthma requires preparation to prevent attacks. Medication should be taken before engaging in exercise, a thorough warm-up prepares the lungs for vigorous exercise, and the patient should monitor their respiratory status closely and know when to stop or reduce their effort.
Ineffective Breathing Pattern Care Plan
Narrowing of the airways results in inadequate pulmonary ventilation and an ineffective breathing pattern.
Nursing Diagnosis: Ineffective Breathing Pattern
- Inflammation and swelling to the lungs
- Airway spasming
- Increased mucus
As evidenced by:
- Nasal flaring
- Accessory muscle use
- Patient will display an effective breathing pattern evidenced by a respiratory rate and rhythm within normal limits without wheezing or coughing
- Patient will verbalize potential triggers of asthma exacerbations
- Patient will demonstrate the appropriate use of a peak flow meter
Ineffective Breathing Pattern Assessment
1. Auscultate lung fileds.
Wheezing is a common finding with asthma as the airways are constricted from inflammation. Other adventitious sounds such as rales or rhonchi can signal possible infections which require further treatment.
2. Monitor respiratory status.
Monitor closely for changes in respiratory status in order to intervene quickly. Increased respiratory rates and decreasing oxygen saturation levels signal respiratory distress.
3. Monitor ABGs.
Respiratory alkalosis can develop from hyperventilation. Respiratory acidosis occurs from severe asthma and can develop into respiratory failure if prolonged.
Ineffective Breathing Pattern Interventions
1. Administer bronchodilators and corticosteroids.
Bronchodilators such as Albuterol help relax the muscles around the airways. Inhaled corticosteroids reduce inflammation and mucus. Corticosteroids should be given after bronchodilators.
2. Instruct on peak flow meters.
Peak flow meters can be used daily to monitor how well air is moving in and out of the lungs. Peak flow meters can often detect changes in the airway before symptoms occur and can signal to the patient to take their medication to prevent an attack.
3. Help the patient identify their triggers.
Each individual will have their own asthma triggers. Common triggers include dust, pet hair, pollen, mold, pollution, infections, high humidity, and even stress. Identifying triggers helps prevent asthma exacerbations.
4. Promote calm, relaxed breathing.
The nurse should remain with the patient when experiencing an asthma exacerbation. Keep them supported in an upright position, reassure them, and assist with even, controlled, diaphragmatic breathing.
Readiness for Enhanced Therapeutic Regimen Management Care Plan
Children may take an interest in managing their asthma and making their own decisions. Even toddlers can learn how to use inhalers and spacers. Parents and healthcare professionals can support children in managing their treatment.
Nursing Diagnosis: Readiness for Enhanced Therapeutic Regimen Management
- To be developed
As evidenced by:
- Expressed desire to learn about asthma
- Interest in inhalers and medical devices
- Displays adherence to medication regimen
- Verbalizes correct information regarding disease
- Child correctly states symptoms of an asthma attack and when to seek help
- Child correctly uses inhalers at prescribed intervals
- Child remains free of asthma attacks
Readiness for Enhanced Therapeutic Regimen Management Assessment
1. Assess for readiness to learn and make decisions.
A child may display obvious signs of readiness such as asking questions or taking the initiative to take their medication. Assess the child’s decision-making ability as well as responsibility in managing their asthma.
2. Assess for a dependable support system.
A child will only be successful if they are supported by their parents, caregivers, and teachers. It is a collaborative team effort to support a child in their independence.
3. Assess the child’s understanding of the disease.
Ensure the child understands generally how asthma affects their lungs and when they need to seek help. Inquire about their medication regimens and assess their knowledge on when and how to take medications.
Readiness for Enhanced Therapeutic Regimen Management Interventions
1. Provide games and videos to promote learning.
Children often learn best with interactive learning. Provide videos appropriate to their educational level about asthma symptoms, triggers, and medications.
2. Make tracking symptoms fun.
Help a child keep track of their asthma symptoms with a planner or calendar. They can draw or use stickers to feel involved in managing their disease while also learning about how symptoms correlate with triggers.
3. Observe for proper use of inhalers and devices.
Children should become familiar with their inhalers from a young age and should not be afraid of them. Have the child demonstrate proper use, cleaning, and storage of inhalers, spaces, and nebulizers.
4. Create an action plan.
Parents, healthcare providers, and teachers should collaborate on an action plan. The child should have a copy of the action plan to share with adults when needed and also understand when to seek help from a school nurse and feel confident discussing their needs with teachers or guardians.
References and Sources
- Asthma and Children Fact Sheet. (2020, October 23). American Lung Association. Retrieved March 8, 2022, from https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/asthma-children-facts-sheet
- Asthma in Infants and Young Children |. (n.d.). Asthma and Allergy Foundation. Retrieved March 8, 2022, from https://asthmaandallergies.org/asthma-allergies/asthma-in-infants-and-young-children/
- Asthma Medication and Treatment. (n.d.). Allergy & Asthma Network. Retrieved March 8, 2022, from https://allergyasthmanetwork.org/what-is-asthma/how-is-asthma-treated/
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Help your child manage their own asthma | Asthma + Lung UK. (2019, June). Asthma UK. Retrieved March 8, 2022, from https://www.asthma.org.uk/advice/child/manage/help/
- Using a Peak Flow Meter to Manage Asthma | AAFA.org. (2017, December). Asthma and Allergy Foundation of America | AAFA. Retrieved March 8, 2022, from https://www.aafa.org/asthma/asthma-diagnosis/lung-function-tests/peak-flow-meters.aspx
- Vasileiadis, I., Alevrakis, E., Ampelioti, S., Vagionas, D., Rovina, N., & Koutsoukou, A. (2019). Acid-Base Disturbances in Patients with Asthma: A Literature Review and Comments on Their Pathophysiology. Journal of clinical medicine, 8(4), 563. https://doi.org/10.3390/jcm8040563
- What Is Exercise Induced Asthma? | AAFA.org. (2015, October). Asthma and Allergy Foundation of America | AAFA. Retrieved March 8, 2022, from https://www.aafa.org/exercise-induced-asthma/