bronchial asthma with nursing management for nursing students

1. UTTAR PRADESH UNIVERSITY OF MEDICAL
SCIENCES
SAIFAI (Etawah)
Course – G.N.M.
Year - II YEAR
Subject - MEDICAL SURGICAL NURSING-I
Unit - 7
Tutorial Title – BRONCHIAL ASTHMA
Presented by – P.K. PANWAR (Author/ Nursing Officer)

2. DEFINITION
Asthma is a chronic inflammatory disease of airway caused
by allergic response of bronchi resulting in reversible
narrowing of airway due to bronchoconstriction (spasm),
congestion and thickening of walls of bronchi and
accumulation of mucous. (Recurrent attack of Dyspnoea and
wheezing.)

4. AETIOLOGY
There are some factors which are responsible for Asthma.
1. Environmental factors
• Change in temperature mostly cold air.
• Change in humidity – dry air.
2. Atmospheric pollutants
• Cigarette, industrial smoke, ozone, sulphur dioxide, formaldehyde.
3. Allergen inhalation
• Food treated with sulphate, beer, wine etc.
4. Stress/Emotional upset
5. Medication
• NSAIDs, β-blockers

6. RISK FACTORS
• Family history
• History of allergen
• Passive smoking
• Obesity
• Urban living
• Low birth weight
• Regular use of NSAIDs

7. SIGN & SYMPTOMS
• Shortness of breath
• Tightness of chest
• Wheezing
• Excessive coughing or a cough that keeps awake at night

8. TYPE OF ASTHMA
It is of two types:
1. Extrinsic (Allergic): Commonly occur in childhood.
2. Intrinsic (Non-allergic): Commonly occur about 35 yrs. age.

9. DIAGNOSTIC EVALUATION
• Physical examination.
• History collection.
• Spirometry.
• ABG (Atrial blood gas analysis)—Hypoxemia, Increased
respiratory acidosis.
• Chest X-ray (for hyperinflation of lung).
• Auscultation of breath sound (Wheezing sound).Wheezing

10. COMPLICATIONS
• Respiratory failure
• Status Asthmaticus
• Pneumonia
• Atelectasis
• Cardiac arrest

11. MEDICAL MANAGEMENT
1. Bronchodilator (Beta-agonist): They causes widening of
the airway by relaxing bronchial smooth muscle by stimulate
beta-receptors.
Example- Salbutamol, Albuterol, Formoterol.
2. Xanthine derivatives: They have a diuretic effect and
relaxes smooth muscles, especially of bronchi
Example-Theophylline, Aminophylline, Deriphylline

12. Cont…..
3. Anticholinergic: The actions of these drugs include
relaxation of smooth muscle, and decreased secretion of
mucus (antispasmodic action).
Example- Ipratropium, Atropine sulphate (Nebulizer).
4. Corticosteroids: Anti-inflammatory and anti-allergic.
Example- Methylprednisolone,Prednisolone,Betamethasone

13. Cont…..
5. Leukotriene receptor antagonist: They prevent the
action of leukotriene by blocking their receptors on cell
membranes (leukotrienes have a key role in inflammation).
Example- Montelukast, Zafirlukast.
6. Mast cell stabilizers: They stop the activities of mast cells.
Example- Cromolyn sodium.

15. NURSING MANAGEMENT

16. NURSING DIAGNOSIS & INTERVENTION
1.Ineffective breathing pattern related to anxiety or due to airway spasm or oedema.
INTERVENTION
• Assess respiratory rate and breath pattern and depth.
• Monitor ABG.
• To give Fowler position to the patient.
• Administration of oxygen as prescription.
• Provides bronchodilator and steroids..

17. 2. Defective airway clearance related to increase secretion
production and bronchospasm
INTERVENTION
• Suctioning may be given if airway obstruct.
• Monitor sputum for colour and consistency.
• To encourage for liquid diet for thin secretion (sputum).
• Increase humidity of room slowly.
• To give oral hygiene in every 2-4 hours.

18. 3. Impaired gas exchange due to air trapping.
Nursing Intervention
• Assess lung sounds in every hours to determine
gas exchange.
• Assess colour of mucous membrane or skin for
detection of cyanosis.
• Administration of O2.

19. 4. Knowledge deficit due to disease condition
Nursing Intervention
• Provide knowledge about disease to the patient.
• Provide psychological support to the patient.
• Advice the patient to be far away from the items
from which he is having allergy.
• Give comfortable position also give feedback to
patient

20. HEALTH EDUCATION
Health education should be based on 5 A’s:
1. Avoid allergens
2. Avoid extreme cold weather
3. Avoid mouth breathing
4. Avoid contact with viral infectious people
5. Avoid smoking (active/passive).