Asthma is a chronic respiratory condition characterized by inflammation of the airways causing symptoms like coughing, wheezing, and shortness of breath. It can be triggered by allergens, infections, pollution, and other factors. There are two main types - intrinsic asthma which has no identifiable cause and extrinsic asthma triggered by allergies. Treatment involves bronchodilators to open airways, corticosteroids to reduce inflammation, oxygen therapy, and avoiding triggers. Nursing care focuses on maintaining a clear airway, administering medications, monitoring for complications, and providing education to patients and families.

1. ASTHMA
CHIPO JAMES MAINDA
Nurses Zone(documentary)

2. DEFINITION
• Asthma is a chronic lower respiratory condition affecting the bronchi
and bronchioles in which there is inflammation of the airways
resulting in hyperresponsiveness (bronchospasms) , mucosal edema
and excessive mucus production mainly caused by allergies and
characterized by cough , dyspnea and wheezing.

3. PREDISPOSING FACTORS
• Family history of asthma
• Viral respiratory infection
• Allergens such as pollen , perfume , dust , smoke
• Emotional upsets
• Drugs such as NSAIDs like aspirin
• Air pollution
• Cold air
• Vigorous exercises

4. TYPES OF ASTHMA
INTRINSIC/CRYPTOGENIC ASTHMA
• Attacks tend to increase in severity causing irreversible lung damage.
• No history of asthma in the family
• May occur secondary to other respiratory tract infections
• No causative agent can be identified
• Often starts in middle age
• This type of asthma is not triggered by allergens
• Usually there is no history of childhood allergies.

5. TYPES OF ASTHMA
EXTRINSIC/ATOPIC ASTHMA
• It occurs in childhood and young adults
• There is usually family history of asthma
• Attacks tend to be less severe
• It is triggered by allergens like dust , feathers , perfume
• A definitive external cause is identified

6. PATHOPHYSIOLOGY
• During inhalation , air enters the lungs by travelling down the trachea.
Then it continues to the bronchi and bronchioles and ends up in the
alveoli.
• The alveoli are tiny air sacs surrounded by small blood vessels
(capillaries) and this is where gaseous exchange takes place.
• Normally the bronchi and bronchioles are flexible , springy or expand
when the inhaled air is warm , moist and free of irritants and allergens
causing substances.
• But when the patient inhales a substance to which he/she is
hypersensitive , allergens will interact with the immune globulin IgE on
the mast cells normally found in the bronchi and bronchioles.

7. PATHOPHYSIOLOGY
• This causes the mast cells to rupture releasing chemicals such as
prostaglandins , histamine , bradykinin.
• These mediators causes inflammation lead to bronchoconstriction ,
edema and hyper secretion of mucus inside the bronchi.
• Mucosal thickening , swelling and production of mucus interferes with
airflow hence the patient will present with dyspnea , wheezing.
• With increasing severity and chronicity of disease, permanent
structural changes can occur in the airway these are associated with a
progressive loss of lung function that is not prevented by or fully
reversible by current therapy (status asthmaticus)

8. SIGNS AND SYMPTOMS
• Cough due to clogged mucus in the bronchi and bronchioles
• Dyspnea due to constriction of the airway
• Wheezing due to narrowed airway by mucus
• Cyanosis due to obstruction of the airway leading to low oxygen
perfusion
• Sweating due to labored breathing
• Nasal flaring due to hyperventilation
• Headache due to cerebral hypoxia
• Chest tightness due to bronchial constriction

9. INVESTIGATIONS
• History taking , will reveal exposure to allergens
• Physical examination , will show dyspnea
• Pulse oximetry , will show low oxygen saturation
• Skin test , will reveal the specific allegens
• Pulmonary function test , will show airway obstruction
• Chest X-ray , will show complications of asthma like pneumothorax

10. TREATMENT
• Drugs used include rapid acting bronchodilators such as ;
• Salbutamol - this is the fastest and most effective, hence remain the
drug of choice. It is given through a nebulizer or orally 2gm TDS.
• Action – selectively stimulate beta receptors producing
bronchodilatation.
• Side effects – tachycardia, Bp changes, nervousness, palpitation, muscle
tremors, nausea, vomiting, insomnia, dry mouth, headache.
• Aminophylline 5mg/kg given intravenously.
• Action – relaxation of bronchial smooth muscle and improve contractility
of fatigued diaphragm.

11. TREATMENT
• Side effects – tachycardia, Bp changes, arrhythmias, anorexia, nausea and
vomiting, nervousness, irritability, headache, muscle twitching.
• Prednisolone 40-50mg given orally.
• Action- it has anti-inflammatory and immunosuppressive effects.
Decrease edema in bronchial airway thus decreasing mucus secretion.
• Side effects- skin changes, osteoporosis, increased appetite, obesity,
immunosupression, catabolism, muscle weakness.
• Oxygen therapy
• Antibiotics
• Intravenous fluids

12. NURSING CARE
AIMS
• To maintain a clear airway
• Restore normal or best possible lung function
• Reduce the risk of severe attacks
• To give psychological care
• This is a medical emergency condition!

13. RESUSCITATION
AIRWAY
• Quickly I will assess the nose for any blockages and remove them to
maintain a clear airway . I will feel for the respiration by putting my palm
on the nostrils of the patient to ensure a clear airway . I will assess for
any blockages in the mouth and remove them to maintain a clear airway
. I will remove the dentures if any because they can also obstruct the
airway . I will suction for any secretions in the mouth to maintain a
patent airway . I will put the head of the patient in lateral position in
order to promote free flow of secretions and prevent the tongue from
obstructing the airway . I will encourage to cough so as to remove the
clogged mucus in the airway.

14. RESUSCITATION
BREATHING
• I will quickly assess for the breathing pattern to obtain the baseline
data . Then I will position the patient in semi fowlers to promote lung
expansion . I will loosen any tighten clothing on the chest to promote
lung expansion . I will do cardiopulmonary resuscitation (CPR) to
promote cardiopulmonary function . I will give oxygen therapy 4-6ml/l
via a mask to promote oxygen perfusion . I will intubate and put the
patient on mechanical ventilation to promote good tissue perfusion.

15. RESUSCITATION
CIRCULATION
• I will quickly insert a large bore cannula for drug administration . I will
put a pulse oximeter on the thumb of the patient to monitor the
oxygen saturation . I will monitor for the blood pressure and if low I’ll
commence normal saline to stabilize it . I will insert a urinary catheter
for monitoring fluid intake and fluid output . I will collect blood for Hb
and arterial blood gas analysis.

16. MEDICATION
• I will give short acting bronchodilators like salbutamol to enlarge the
airway . I will administer corticosteroids such as prednisolone to
reduce the inflammatory process . I will give oxygen therapy via nasal
prongs 4-5l/m to improve tissue perfusion . I will give intravenous
fluids to maintain hydration . I will monitor for the side effects of
medication.

17. ENVIRONMENT
• Environment should be safe for the patient.
• Nurse patient in a quiet, clean environment near to nurse’s bay for
close observations. The room should be well ventilated and free
from dust. It should contain all resuscitative equipment such as
oxygen cylinder; suctioning machine etc
POSITION
• Place the patient in the semi fowler’s position for maximum lung
expansion and encourage diaphragmatic breathing to allow
enough air intakes

18. PSYCHOLOGICAL CARE
• Create a therapeutic relationship with the patient so that the patient
can have confidence in you.
• Reassure the patient and family during an asthmatic attack to allay
anxiety. Provide comfort by being with the patient.
• Explain the disease process, the cause of the wheezing and labored
respiration to the mother to allay anxiety.
• Allow the patient to verbalize his fears to allay anxiety if the child is old
enough.
• Explain every procedure and machines that are being used to the
patient to promote cooperation.

19. I.E.C
• Teach the patient how to use an oral inhaler and caution him about
the possible adverse reactions associated with the medications he is
receiving.
• Show patient how to breathe deeply. Instruct him how to cough
secretions accumulated overnight.
• Teach the patient and the family to avoid known allergens and
irritants such as smocking, dust perfumes, fur and cold weather etc.
• Emphasize the importance of taking only prescribed drugs as certain
drugs such as aspirin may precipitate an asthmatic attack.

20. I.E.C
• Encourage the patient to have well balanced diet to prevent
respiratory infection and fatigue.
• Explain the importance of review dates so that the patient can be
monitored.
• Teach the mother signs and symptoms of an impending asthmatic
attack and encourage them to seek medical attention as soon as
possible

21. COMPLICATIONS
• Status asthmaticus- This is a severe asthmatic attack which cannot be
controlled with usual medications . This arises when impaired gas exchange
and heightened airway resistance increase the work of breathing.
• Respiratory failure- This is the impairment of the lung’s ability to maintain
balance between oxygen and carbon dioxide.
• Cardiac arrest- Occurs secondary to respiratory failure
• Emphysema – irreversible accumulation of air in the alveolar spaces due to
repeated asthmatic attacks which results in decrease in total breathing
capacity.
• Atelectasis- lung collapse due to accumulation of air in the alveoli.

22. THE END!
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