Asthma

1. Definition of Asthma

Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to symptoms such as wheezing, shortness of breath, chest tightness, and coughing. These symptoms typically occur intermittently and can vary in severity, ranging from mild to severe attacks. Asthma is often triggered by exposure to allergens, irritants, exercise, infections, or changes in weather conditions.

2. Clinical Features of Asthma

•    Wheezing: A whistling or squeaky sound produced during breathing due to narrowed airways.

•    Shortness of breath: Difficulty breathing or feeling of tightness in the chest.

•    Chest tightness: Sensation of pressure or discomfort in the chest.

•    Coughing: Often worse at night or early morning, may be dry or produce mucus.

•    Increased respiratory rate: Rapid breathing to compensate for decreased airflow.

•    Use of accessory muscles: Visible use of neck and chest muscles to aid breathing.

•    Prolonged expiration: Difficulty exhaling fully due to narrowed airways.

3. Types of Asthma

• Atopic Asthma: Also known as allergic asthma, this type of asthma is triggered by exposure to allergens such as pollen, dust mites, pet dander, or mold. It typically presents with symptoms of allergic rhinitis (hay fever) and often runs in families with a history of allergies.

• Non-Atopic Asthma: Non-atopic asthma is not triggered by allergens but may be caused by other factors such as respiratory infections, exercise, cold air, smoke, or stress. It tends to develop later in life and may be associated with other respiratory conditions such as chronic obstructive pulmonary disease (COPD).

• Combined Asthma: Some individuals may have features of both atopic and non-atopic asthma, where allergic triggers can exacerbate underlying non-allergic inflammation of the airways.

4. Drugs Used in Managing Asthma:

• Short-acting beta-agonists (SABAs): e.g., albuterol, terbutaline - used for quick relief of acute asthma symptoms by relaxing the airway muscles.

• Long-acting beta-agonists (LABAs): e.g., salmeterol, formoterol - used as maintenance therapy to control asthma symptoms and prevent exacerbations.

• Inhaled corticosteroids (ICS): e.g., fluticasone, budesonide - reduce airway inflammation and help prevent asthma attacks when used regularly.

• Leukotriene modifiers: e.g., montelukast, zafirlukast - block the action of leukotrienes, substances that contribute to inflammation and bronchoconstriction in asthma.

• Combination inhalers: Contain both an ICS and a LABA in a single device for convenience and improved adherence.

• Biologic therapies: e.g., omalizumab, mepolizumab - targeted therapies that block specific immune pathways involved in asthma inflammation, recommended for severe, uncontrolled asthma.

5. Nursing Care of a Patient with Asthma:

Nursing care of asthmatic patients in admission focuses on clients needs

1. Continuous Monitoring.

   • Assess respiratory rate, oxygen saturation, lung sounds, and peak flow readings at regular intervals as per hospital protocol.

   • Document findings accurately in the client's medical record.

   • Notify the healthcare provider promptly of any significant changes or deterioration in the client's respiratory status.

2. Oxygen Therapy

   •  Administer supplemental oxygen via nasal cannula, face mask, or other appropriate delivery devices as prescribed.

   • Monitor oxygen saturation continuously and adjust oxygen flow rate as needed to maintain target saturation levels (typically 92-96%).

   • Ensure humidification of oxygen to prevent drying of mucous membranes and discomfort.

3. Medication Administration

   • Administer bronchodilators (e.g., albuterol) via metered-dose inhaler (MDI) or nebulizer as prescribed to relieve bronchospasm.

   • Administer corticosteroids (e.g., prednisone) orally or intravenously as prescribed to reduce airway inflammation.

   • Educate the client on the purpose, dosage, and potential side effects of medications.

4. Assessment for Triggers

   • Conduct a thorough assessment to identify potential triggers of asthma exacerbation, including environmental allergens, irritants, and respiratory infections.

   • Implement measures to minimize exposure to identified triggers, such as removing allergens from the client's environment and promoting hand hygiene practices.

5. Hydration

   •  Encourage the client to drink adequate fluids, preferably water, to maintain hydration and help thin respiratory secretions.

   •  Provide oral hygiene care to prevent dry mouth and promote comfort.

6. Positioning

   • Assist the client in assuming a comfortable position that optimizes breathing, such as sitting upright or in a high Fowler's position.

   • Provide pillows or cushions for support and comfort as needed.

7. Education

   • Provide comprehensive education to the client and family members about asthma management, including medication administration, inhaler technique, and symptom recognition.

   • Review the client's asthma action plan and ensure understanding of when to seek medical assistance.

8. Emotional Support

   • Provide emotional support and reassurance to alleviate anxiety and promote relaxation.

   • Use therapeutic communication techniques to address the client's concerns and fears.

9. Collaboration with Healthcare Team

   • Collaborate with physicians, respiratory therapists, and other members of the healthcare team to ensure coordinated care and effective management of the client's asthma exacerbation.

   • Participate in interdisciplinary rounds and communicate relevant information about the client's condition and response to treatment.

10. Discharge Planning

    • Initiate discharge planning early in the admission process, involving the client and family members in the development of a comprehensive asthma action plan.

    • Provide written instructions for home care, including medication regimen, follow-up appointments, and contact information for healthcare providers.

    • Coordinate referrals to community resources or support services as needed for ongoing management and support.

These nursing interventions aim to address the identified needs of an asthmatic client during admission, promote effective management of asthma exacerbation, and facilitate the client's recovery and transition to home care.