The document discusses asthma and status asthmaticus. It defines asthma as a chronic inflammatory disease of the airways characterized by airway hyperresponsiveness, mucosal edema, and mucus production. Status asthmaticus is described as a life-threatening emergency that occurs when bronchospasm does not respond to conventional therapy and can lead to worsening hypoxemia. The document covers the clinical manifestations, diagnostic findings, medical management including quick-relief medications and long-acting control medications, nursing management, and complications of both asthma and status asthmaticus.

1. Asthma
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner
and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.)
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2. Objective:

The student will be able to :
Define Asthma and status asthmaticus.
Discuss the clinical
manifestations, assessment, diagnostic
findings, complications, prevention, medica
l and nursing management of patients with
asthma and status asthmaticus.
S
2 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing (12th ed.)

3. Asthma
 Asthma
is a chronic inflammatory
disease of the airway hyper
responsiveness, mucosal edema, and
mucus production.
S
3 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing (12th ed.)

4. Facts
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The most common chronic disease of childhood,
asthma can occur at any age
Despite the development of knowledge and
treatment, the death rate from the disease
continues to rise.
Allergy is the strongest predisposing factor for
asthma.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing (12th ed.)

5. Asthma Triggers
Predisposing factors: Atopy, female gender
 Causal factors: a. Exposure to indoors allergens
such as Mold , Pet dander, Dust mites, Cockroach
droppings.
b. Exposure to outdoors allergens such
as
Pollen , Smoke, Pollution, Cold weather.
c. Occupational sensitizers.

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Contributing factors: Respiratory infections, Stress,
Strong emotions, Exercise. Food Allergens such
as Fish, Shellfish, Egg, Soy, peanuts…
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

6. Pathophysiology
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7. Clinical Manifestation
The three most common symptoms of
asthma are: Cough, dyspnea, and
wheezing.
chest tightness.
Description:
There is cough with or without mucus
production
Wheezing sound ( the sound of airflow
through narrowed airways)

S
7 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing (12th ed.)

8. Asthma classified as : mild
INTERMITTENT, moderate, or severe
PERSISTENT ASTHMA.
As Exacerbation progresses‘:
diaphoresis, tachycardia and a widened
pulse pressure may occur along with
hypoxemia and central cyanosis ( late sign
of poor oxygenation)
S
8 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing (12th ed.)

9. Assessment and diagnostic findings
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A positive family history and environmental factors
Occupation related to chemicals and compounds.
Other possible allergic reactions accompany with
asthma include eczema, rashes…
Sputum and blood tests ( elevated levels of
eosinophils)
Arterial blood gas analysis.
Pulse Oximetry reveal hypoxemia during acute
attack
Lung function is evaluated by spirometry
S
9 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing (12th ed.)

10. Cont…

Peak flow meters measure the highest volume of
air flow during a forced expiration (left). Volume
is measured in color-coded zones (right):
results….80%-100% (personal best), less than
60% patient should take appropriate action.
(Refer Pg. 629, chart 24-6)

Incentive spirometer : to examine the health of a
patient's lungs by measuring their inspiratory
volume.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

11. Prevention
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Patient with recurrent asthma should undergo test to
identify the substances that precipitate the
symptoms.
Patients are instructed to avoid the causative agents
whenever possible.
Knowledge is the key of quality asthma care
Evaluation of risk are the key in the control.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
11
Textbook of Medical Surgical Nursing (12th ed.)

12. Complication
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Status Asthmaticus
Respiratory failure
Pneumonia
Atelectasis
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

13. Medical management
Immediate intervention may be necessary, because
continuing and progressive dyspnea leads to anxiety
which increase the situation.
 Pharmacologic therapy
1. Quick- Relief Medication
 2. Long – Acting Control Medications

Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
13
Textbook of Medical Surgical Nursing (12th ed.)

14. 1. Quick- Relief Medications:
A. Short- acting beta2- adrenergic agonists…. Used to
relief acute symptoms and prevention of exerciseInduced asthma. Also to relax the smooth muscles
{ albuterol}
B. Anticholinergics…. Counteract
bronchoconstriction
Inhibit the mascarinic cholinergic receptors ,,,,used for
patient who do not tolerate short acting beta2adrenergic agonists. E.g (ipratropium bromide
(atrovent).
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

15. 2. Long – Acting Control Medications

1. Corticosteroids: most potent and effective
anti inflammatory medication. Improve the
airway function and decrease the peak
flow variability. E.g cromolyn sodium, it
used to stabilize mast cells and works as
prophylactic basis to prevent exercise induced asthma or unavoidable exposure
to known trigger.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
15
Textbook of Medical Surgical Nursing (12th ed.)

16. Long – Acting Control Medications

2. long- acting beta2- adrenergic agonists used
with anti-inflammatoy medications to control
asthma symptoms particularly those occur at
night. E.g theophylline.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

17. Management of Exacerbation
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Asthma exacerbation are best managed by early
treatment and education.
Quick – acting beta2 adrenergic agonist medication
are used first to relief of airflow obstruction
Systemic corticosteroids may be necessary to
decrease airway inflammation in patient who fail to
respond to inhaled beta-adrenergic medication.
Oxygen supplementation may be required to relieve
hypoxemia.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
17
Textbook of Medical Surgical Nursing (12th ed.)

18. Nursing management
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The immediate nursing care of patients with
asthma depends on the severity of symptoms.
Calm approach
The nurse assesses the patient’s respiratory
status by monitoring the severity of
symptoms, breath sounds, peak flow, pulse
oximetery and vital signs.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
18
Textbook of Medical Surgical Nursing (12th ed.)

19. Nursing Diagnoses
Ineffective Breathing Pattern r/t
bronchospasm
 Anxiety r/t fear of suffocating, difficulty in
breathing, death.

Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

20. Nursing Intervention:
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Obtains a history of allergic reactions to
medications before administering medications
Identifies medications the patient is currently
taking
Administers medications as prescribed and
monitors the patients responses to those
medications. These medications may include an
antibiotic if the patient has an underlying
respiratory infection.
Administers fluids if the patient is dehydrated as
prescribed.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
20
Textbook of Medical Surgical Nursing (12th ed.)

21. Status Asthmaticus :

Status Asthmaticus :
Status Asthmaticus Life-threatening emergency
Occurs when bronchospasm don’t respond to
conventional therapy Can lead to worsening
hypoxemia, acid-base imbalance, potential
respiratory arrest
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
21
Textbook of Medical Surgical Nursing (12th ed.)

22. Clinical Manifestation
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Same manifestation in sever asthma
Labored breathing, prolonged exhalation
Engorged neck veins
If the obstruction worsens, the wheezing may
disappear its sings of respiratory failure
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
22
Textbook of Medical Surgical Nursing (12th ed.)

23. Assessment and diagnostic findings
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Pulmonary function studies ( assessing acute airway
obstruction)
Arterial blood gas if the patient cannot perform
pulmonary function maneuvers because of sever
obstruction or fatigue.
Respiratory alkalosis (low paCO2) is the most
common finding in patient with asthma.
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

24. Medical management
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Close monitoring of the patient
Short acting beta adrenergic agonist
Systemic corticosteroids to decrease the airway
inflammation and swelling
Short acting inhaled bata2 adrenergic agonists for
rapid relief of bronchospasm
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

25. Cont…
IV fluids for hydration
 Oxygen to treat dyspnea, central cyanosis and
hypoxemia
( to maintain PO2 92 mmhg or Spo2 more than 95%)
Delivered by partial or non rebreather mask.
 Magnesium sulfate, a calcium antagonist, to induce
smooth muscle relaxant and hence cause
bronchodilation

(see the adverse effects Pg.630)
Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

26. Nursing management
Main focus of nursing management is to actively
assess the airway and the patients response to
treatment.
 Monitoring the patient for the fist 12 to 24 hours, until
the situation control.
 Assess the patient’s skin turgor for signs of
dehydration
( fluid intake is essential to combat dehydration, to
loosen secretions )
 Nurse administer IV fluid as prescribed.
 Vital signs to be monitored.
 Patient room should be free of respiratory irritants.

Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s
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Textbook of Medical Surgical Nursing (12th ed.)

27. Thank
you…Enjoy
learning and
Studying
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28. Reference

Smeltzer, S.C., Bare, B.G., Hinkle, J. L., &
Cheever, K. H. (2010). Brunner and Suddarth’s
Textbook of Medical Surgical Nursing (12th ed.).
Philadelphia, PA: J.B. Lippincott Williams & Wilkins.
Chapter 23 & 24, pp. 551-633
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29. 
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Mast cells Cells that synthesize & store histamine
Eosinophils Type of WBCs capable of releasing
chemical mediators that cause bronchoconstriction
IgE antibody attaches to mast cells in the respiratory
tract; contributes to allergic reactions
Hyper resonance Quality of sound heard on
percussion of a hollow structure
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30. Common Triggers for Asthma
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Extrinsic triggers: an allergic type reaction to antigen
( e.g air pollutants, cold, heat, weather
changes, strong odors or perfums, smoke)
Intrinsic triggers eg. Respiratory infection
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