Asthma is a serious and in some cases sustaining disorder of the bronchial airways characterized by bronchospastic periods. Asthma may be caused by a variety of reasons. Thus, according to the causes, experts divide this disease into such major subcategories: extrinsic (allergic) and intrinsic (non- allergic). Extrinsic asthma usually begins in childhood, therefore, the client may be allergic to pollen, dust, mold spores, insects, medications, smoke, and food. Intrinsic asthma, on the other hand, is commonly caused by internal health disorders (colds, respiratory infections, exercise etc). It occurs without any identified allergic reason over the age of 35.

Asthma is commonly considered to be an inherited disorder that interacts with negative environmental factors that may cause this disease. It involves airway inflammation and narrowing of airway lumina of a periodic character (hyperreactivity). Asthma may appear as a result of an individual response (alternative) to a great range of stimuli. Therefore, asthma often has an episodic nature, and it includes fluctuations or even worse exacerbation of its symptoms.

Asthma may have serious consequences, in case if no appropriate treatment is applied at the early stage of the disease development. People may suffer from asthma for many years, and symptoms may worsen. In such a case, it turns to a chronic character, when there may be observed the periods of getting better and those of worsening of the symptoms of asthma. In many cases, when asthma is diagnosed in children, treatment should be applied in a special way in order to get positive results as shortly as it possible. Sometimes parents do not realize the risks their children may be at, if asthma is not properly treated. In addition, new methods of treatment include the recent technological advances, like the following step-by-step guideline of how to manage this disease:

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1. Get an accurate diagnosis.

2. Work with a doctor to create an asthma action plan.

3. Monitor the peak flow rates daily taking adequate measures when symptoms reveal.

4. Keep a diary; this will enable you to track symptoms and use of all medications.

5. Avoid asthma triggers, such as outdoor aroma irritants, for example, flower blossoming or smog.

6. Seek for medical advice when asthma symptoms are worsening, such as allergic rhinitis, GERD, and sinusitis.

7. Do daily exercises to maximize aerobic fitness capabilities.

8. Attempt to prevent exercise-induced asthma symptoms by means of medicating treatment before exercising.

9. Consume nutritious foods maximizing immune defenses against bacterial and viral infections.

10. Try to stay in a normal weight.

11. Sleep normally, restfully.

12. Keep in touch with a health care provider, in case you notice some symptoms.

13. Check in with a health care provider to complete regular breathing tests to manage asthma effectively and make sure that medications work optimally for you.

However, theres no known natural way of asthma treatment; symptoms can be treated and controlled effectively with the help of asthma medications of several types.

Asthma Case Scenario

A 27-year old asthmatic lady has been having a bad cough for 2 weeks. She thinks it is a serious symptom, so she is ready to contact her healthcare provider in order to get information about treatment in order to relieve symptoms. As she contacts you by phone, the situation is quite unclear. However, she insists that the situation is serious, so she needs some treatment urgently. She states that her cough turns worse at night, so she turns breathless and can hardly get sleep. The situation turns worse, when she is walking with her dog outside. She can hardly complete sentences, as she speaks over the phone, and it turns clear she is wheezing badly. In this case, you have to appoint her meeting so that you can see her.

Diagnosis

Before completing a treatment, there is a need to check the patients medical history in order to find out the ways in which she was treated in the past, and how things with asthmatic symptoms went then. You have to follow the procedure:

1. Check her medication hx. As a result it was found out that she was cured with salbutamol inhaler, long acting salmeterol inhaler, and a steroid inhaler.

2. Check the medical records. As a result, it was found out that she had not used any inhaled salmeterol or inhaled steroid for three months. Two months ago, she defaulted from the asthma clinic, as everything was ok then.

3. As she arrives at a clinic, an audible wheeze can be heard. She informed that she had been using her inhalers, and she had no idea about what triggered off the symptoms.

4. The examination of the patient showed: pulse 120, sats 95%, respiratory rate 25, PEFR 200 (60% predictive) and wheeze throughout her chest. The patient`s temperature was 37.4 C and BP 120/80. The plan was to stabilize her so that she would have a good overnight sleep. I waited for some time hoping for some improvement of the situation. I kept chatting with her, but then noticed that she became quieter and blue. She was making feeble efforts to breathe. The patients pulse was rechecked, and at that moment it was just 56, and her sats had fallen to 92%. She was hardly managing PEFR of 150. Her chest breathing was almost silent. So I recognized that it was a life threatening case, and I rang the ambulance.

Treatment

According to BTS guideline (2008), admission is acceptable in this case. However, this guideline also supports a trial of corticosteroids in the community. For instance, if a patient had strived for previous admissions or had previously been on steroids, there is a stronger indication for admission. It is one of the safest options, if you are not quite sure about your asthma management skills, some other options should be applied in this case. The most severe asthma attacks may last up to several hours. During this period, it is better to proceed with ambulance treatment or hospital admission. As an effective and early intervention, it may prevent life threatening attacks and place the patient in a safer position. According to the guidelines, in case of acute asthma attacks, admission is the best way out, if any of acute severe asthma symptoms persist despite nebulised therapy.

The new guidelines distinguish between acute severe asthma case and life-threatening asthma case. For instance, life-threatening asthma is characterized by the following features: O2 saturation is below 92%; PEFR is less than 33% predicted; arterial partial pressure is O2 < 8 kPa; silent chest; feeble respiratory effort; cyanosis; arrhythmia; hypotension; confusion; exhaustion; bradycardia. These life-threatening symptoms may lead to coma, if no urgent ambulance help is provided. If any of these symptoms are present, immediate hospital admission is mandatory.

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2 Ways of Treatment

According to a health care web portal WebMD, there are several ways of asthma treatment in long perspective and when emergency occurs.

1. Steroids and other drugs of anti-inflammatory effect. For most people with asthma symptoms, the most important way of treatment is use of inhaled steroids. These lifesaving medications prevent asthma attacks and work by reducing swelling and mucus production in the airways (WebMD, 2014) to make them less sensitive and less likely to react to asthma triggers and cause asthma symptoms (WebMD, 2014).

2. Bronhodilators. This way of treatment can relieve symptoms of asthma by means of relaxing muscles that can tighten around the airways, opening them up and making breathing easier. Short-acting bronchodilator inhalers can relieve wheeze, cough, shortness of breath and chest tightness caused by asthma. Bronchodilators can be also used by people with exercise-induced asthma symptoms, prior to exercising. If a patient needs to use a short-acting rescue inhaler more than twice a week, than asthma is not optimally controlled, and a new way should be found out in order to improve asthma medication. As for long-acting bronchodilators, they are used in combination with inhaled steroids in order to control the ongoing asthma symptoms. The long-acting bronchodilators should never be used as the only way of asthma treatment, but combined with other ways of medical aid.

Asthma treatment is provided by using asthma inhalers and asthma nebulizers. Asthma inhalers are the most effective and most common way to get asthma drugs to a patients lungs. Inhalers are available in different types, therefore, require different techniques to use. Asthma nebulizers are an alternative way to deliver drugs to the a patient`s lungs. They are also known as breathing machines. They are produced in the form of a mask or mouthpiece to be used for infants, children, or older adults, - anyone who experience problems using inhalers. Nebulizers change asthma medications to a mist, instead of a liquid, so drugs are more easily inhaled into the lungs.

Asthma Nursing Care Plan(NCP)-Ineffective Airway Clearance

Nursing Diagnosis

Objectives

Nursing Interventions

Rationale

Evaluation

Ineffective Airway Clearance

Etiologies. This diagnosis is related to

Bronchospasm Increased production of secretions; retained secretions; viscous, thick secretions. Fatigue, decreased energy. It is characterized by such evidence: difficulty in breathing efforts; feelings of chest constriction. Some changes in depth/ rate of respiration may be observed;

Tachycardia. In addition, use of accessory muscles is observed, or marked respiratory efforts. Moreover,

abnormal breath sound, expiratory and inspiratory wheezing, persistent cough, prolonged expiration

without sputum production are observed in a patient.

 

Goals/ Objectives:

The short term goal:

Client should demonsrate signs of oxygen exchange and patent airway within the period of 3 days.

 

Long term goal:

Client should demonsrate some behaviors to maintain or improve airway clearance, identify complications and initiate adequate actions.

 

 

Nursing Actions

Assessing respiratory status every hour within the period of acute phase: respiratory rate/depth, lung sounds, assessing the severity of wheezing, breathing patterns, accessory muscles usage. It is obligatory to assist patients to assume to comfortable position, for example, elevate head of bed, make a patient lean on overbed table, or sit on the edge of bed.

The environmental pollution should be kept to a minimum, in accordance to individual situation.A patient should be encouraged and assisted to abdominal and lip breathing exercises. Intake of fluids should be increased to 3000ml/day, within cardiac tolerance. The warm liquids should be taken between meals, but not during meals.

The medications should be administered as indicated. Side effects of bronchodilator, such as tremors/ tachycardia should be monitored. The supplemental humidification, such as neutralizer in the context of respiratory treatments should be observed. Regular monitoring of ABGs, chest x- ray, pulse oximetry should be provided.

Rationale

Some degree in bronchospasm should be is present with obstruction in airways. It can be manifested with wheezing or absent breath sounds, in case of severe or life-threatening asthma. Tachypnea is commonly present to some degree and respiratory dysfunction is variable, depending on other processes, i.e. allergic reaction. If head of the bed is elevated, it facilitates breathing function by use of gravity. However, a distressed patient may seek the position that most eases breathing. Precipitators of allergic type of respiratory reactions may trigger or exacerbate onset of acute episode.

Some means to cope with or control dyspnea and reduce air trapping should be provided.

Hydration should help thin secretions facilitating expectoration using some warm liquids to decrease bronchospasm.

Fluids taken during meals may increase gastric distension and pressure on a patients diaphragm.

Anticholinergic medications can be the most appropriate drugs for patients with this condition.

Humidity must help to reduce viscosity of secretions that facilites expectoration. With the help of breathing exercises, it is possible to enhance diffusion. In their turn, nebulizer medications can reduce bronchospasm stimulating expectoration. The baseline to monitor progression/ regression of asthma process should be provided.

Outcome Criteria:

Patient should confirm verbally reduction or even absence of difficulty in breathing and feeling of chest constriction. Respiratory and cardiac rate should be within a normal range and inspiratory or expiratory wheezing should be absent or at least reduced. The patient should reveal the ability to resume normal activities. Patients should be able to detect potential allergens and avoidthem. Stimuli that trigger asthma should be handled or avoided. And if some asthma symptoms are recurred, patients should promptly contact their health care providers, checking up and bringing the prescribed medications, in caseasthma occurs.

         

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Conclusion

According to the Nurse Care Plan patients should be treated by commonly used ordinary medications, since there is no natural asthma treatment. Steroid inhalers and breathing machines should be alternatively used, in order to facilitate breathing and provide preventive actions against life-threatening asthma. The patient is a 27-year old young woman who can easily struggle with the disease, in case the proper treatment is provided.

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