This NCLEX review will discuss Asthma. Whether you are a nursing student or preparing for the next gen NCLEX, this review is all you need.
Normal Lung Function
When you breathe, air flows in through your mouth and nose and down your airways.
Inside your lungs, the airways end in clusters of air-filled sacs. These air sacs are surrounded by tiny blood vessels.
Here, oxygen from your lungs passes into your bloodstream to get to tissues throughout your body. Carbon dioxide is breathed out.
Pathophysiology of Asthma
Asthma is a chronic condition that affects the airways in the lungs. The airways are tubes that carry air down deep into the lungs.
When you have asthma, the walls of your airways become inflamed which makes the airway sensitive. The airways react strongly to certain irritating things you breathe in.
This reaction makes the airway muscles tighten and much less air flows to the lungs making it harder to breathe than normal.
People with asthma may experience wheezing, coughing, shortness of breath and chest tightness.
They may also wake up at night coughing and short of breath when the symptoms get worse. This is called an asthma attack. While asthma can’t be cured it can be managed.
NOTE these 3 problems with asthma– Airway inflammation, Bronchoconstriction, Increased mucus production, which results in recurrent attacks of coughing, wheezing
Risk Factors for Developing Asthma
Family history of allergies or asthma.
Specific allergens and irritants can cause or aggravate asthma symptoms
Note Common Triggers– Pollen, dust mites, pet dander, mold spores, smoke, air pollution, and respiratory illnesses
Certain workplace conditions (Occupational asthma)- exposure to chemicals, dust, or fumes.
Common Symptoms of Asthma
1. Wheezing: Wheezing is a typical asthmatic symptom that is characterized by a high-pitched whistling sound made during inhaling because of the constriction of the airways.
2. Shortness of Breath: People with asthma may experience shortness of breath, which makes it difficult to inhale deeply or fully exhale.
3. Chest Tightness: People with asthma frequently feel a tightness or pressure in their chest that is frequently compared to a heavy weight.
4. Coughing: Coughing due to asthma is typically worse at night or in the morning. It could be dry or come with mucous production.
How Asthma is Diagnosed
To diagnose asthma, healthcare professionals consider a combination of factors, including medical history, physical examination, lung function tests (such as spirometry), and sometimes additional tests such as allergy tests or imaging studies.
Accurate diagnosis is crucial to develop an appropriate treatment plan.
Nursing Assessment- History
- History of allergies, obtain a thorough description of the response to allergens or other irritants
The patient may describe a sudden onset of symptoms after exposure, with a sense of suffocation.
Symptoms include dyspnea, wheezing, and a cough (either dry or productive) and also chest tightness, restlessness, anxiety, and a prolonged expiratory phase.
2. The number of asthma attacks in the past year
3. The number of asthma attacks in the past year
4. The number of asthma attacks in the past year
5. The number of asthma attacks in the past year
Nursing Assessment- Physical Examination
- Wheezing
- Coughing
- Shortness of breath (dyspnea)
- Chest tightness
- Oxygen saturation levels
NOTE- In severe cases, they can hardly speak, use accessory muscles and are diaphoretic (sweaty). Wheezing may be absent because of severe reduction of airflow. Usually, the patient also has a prolonged expiratory phase of respiration. A rapid heart rate, mild systolic hypertension, and a paradoxic pulse may also be present.
Percussion of the lungs usually produces hyperresonance.
Palpation may reveal vocal fremitus.
Auscultation reveals high-pitched inspiratory and expiratory wheezes, but with a major airway obstruction, breath sounds may be diminished.
Nursing interventions for asthma- Medications
Primary goal is to prevent symptoms and reduce adverse events when acute episodes occur.
Administer Medications- manage airway obstruction
- Bronchodilators- Inhaled short-acting beta 2 adrenergic agonists (metered dose inhaler- MDI) e.g albuterol sulfate, pirbuterol acetate, levalbuterol
Epi-Pen Autoinjector- Onset (5–10 min) Peak ( 20 min) Duration (<1–4 hr)
Rationale- Reversal of airflow obstruction, relax bronchial smooth muscles
- 2. Systemic and inhaled corticosteroids– inhaled corticosteroids (ciclesonide, beclomethasone, fluticasone, budesonide, mometasone), Methylprednisolone IV; prednisone PO
Rationale– Decrease inflammatory response, speed recovery and limit symptoms
- 3. Leukotriene antagonists- Montelukast 10 mg PO daily; zafirlukast 20 mg PO daily
Rationale- prevents rather than reduces symptoms; used for long-term prevention
- 4. Theophylline – A bronchodilator used long-term control of reversible airway obstruction caused by asthma or COPD.
- 5. Low-flow oxygen therapy based on arterial blood gas results to treat hypoxemia
Nursing interventions for Asthma- Non- Pharmacological
Allergen Avoidance: One of the most important aspects of controlling asthma is recognizing and avoiding triggers, such as allergens or irritants, that exacerbate symptoms.
Asthma Action Plan: Patients should collaborate with their healthcare professionals to create an individual asthma action plan that outlines what they should do both daily to control their asthma and when they experience an exacerbation.
Lifestyle Changes: Living a healthy lifestyle will help you manage your asthma much better. People with asthma can benefit from regular exercise, a balanced diet, keeping a healthy weight, and not smoking.
Immunotherapy: To lessen sensitivity to particular allergens in people with allergic asthma, allergen immunotherapy (allergy shots or pills) may be advised.
Breathing Techniques: Practicing breathing exercises, such as diaphragmatic breathing, pursed lip breathing, and controlled breathing, can help improve lung function and reduce symptoms during asthma attacks.
Stress Management: Employing stress-reducing techniques like mindfulness, meditation, and relaxation exercises can help minimize stress-induced asthma exacerbations.
Client Education
Educate patients on how to control the environment, including how to prevent allergens, keep indoor air quality clean, and stop smoking.
Cold air and exercise may increase symptoms. Aspirin and NSAIDs can cause sudden, severe airway obstruction.
Instruct client to see their HCP if they develop any respiratory infection
Educate clients to carry an Epi-Pen auto injector and teach appropriate technique.
Appropriate medication usage, inhaler technique, and the significance of adhering to the recommended asthma action plan.
It is important that the patient uses the bronchodilator MDIs first and then uses the steroid inhalers. Explain to patients on steroid inhalers the need to rinse their mouths out after using them to avoid getting thrush.
To help patients manage symptoms and enhance lung function during asthma episodes, nurses educate patients on breathing strategies such as diaphragmatic breathing and pursed lip breathing.
To help patients and their families deal with the difficulties of having asthma, nurses provide them with emotional support, counseling, and direction.
Explain that any dyspnea unrelieved by medications and accompanied by wheezing and accessory muscle use needs prompt attention from a healthcare provider.
How to use an Epi-pen Auto injector
Remove gray safety cap, placing black tip on thigh at right angle to leg. Press hard into the thigh until auto-injector functions, hold in place for 10 sec, remove, and discard properly. Massage injected area for 10 sec.
Avoid IM administration in gluteal muscle. Administer into anterolateral thigh, through clothing if necessary for anaphylaxis.
Frequently Asked Questions (FAQs)
Does asthma have a cure?
Asthma has no known cure as of yet. Nevertheless, asthma can be effectively managed and treated, enabling people to lead regular, active lives.
Can asthma develop later in life?
Yes, asthma can develop at any age, including adulthood. It’s crucial to understand that adult new-onset asthma may have different triggers and underlying causes from childhood asthma.
Can asthma get better by itself?
As they get older, some asthmatic kids may see a decrease in their symptoms or even outgrow their condition. Adult-onset asthma, however, often needs continuing care and therapy.
Is asthma contagious?
No, asthma is not contagious. It is a non-communicable respiratory condition influenced by genetic and environmental factors.
Do asthma symptoms get worse under stress?
For some people, emotional stress and anxiety might exacerbate their asthma symptoms. To effectively treat asthma, a comprehensive plan must include strategies for coping with stress and managing anxiety.
Is it safe to exercise if you have asthma?
Yes, people with asthma are typically urged to exercise regularly. To create a personalized fitness plan and make sure that asthma symptoms are well-controlled when exercising, it is crucial to speak with a healthcare professional.
Are all asthma medications inhaled?
Although inhalers are the most popular type of asthma treatment, there are also oral pills and injections that can be used. The severity of asthma and personal preferences influence the treatment selection.
References:
Mayo Clinic. Asthma symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653
Asthma Canada. Understanding Asthma. Retrieved from https://asthma.ca/get-help/understanding-asthma
Unbound Medicine- Nursing Central. Asthma.
Respiratory Health Association. Understanding Asthma. Retrieved from https://resphealth.org/healthy-lungs/asthma/understanding-asthma
American Nurse. Understanding asthma pathophysiology, diagnosis, and management. Retrieved from https://www.myamericannurse.com/understanding-asthma-pathophysiology
Not studying for an exam, but my child has asthma and this is very informative. Thank you
I’m glad you found it informative, Ivanka.