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12a Asthma - Coggle Diagram
12a Asthma
Diagnostic Evaluations
(NPA) Nasopharyngeal aspirate
: test for viral panel (to detect causative factor)
Allergy test - skin prick test (Paediatric clinic)
: to confirm certain suspected allergens & avoiding it to prevent asthma attacks
Measurements of lung function
Spirometry, peak expiratory flow, Oscillometry, exhaled nitric oxide measurements
Capillaries blood gases
: to detect for acidosis/ hypoxia
History, physical examination & patterns of symptoms
diffuse wheezing during expiration
multiple episodes of coughing responsive to bronchodilator
chronic cough with no infection
Nursing Diagnosis
RISK FOR FLUID VOLUME DEFICIT
related to inability to meet body requirements & increased metabolic demand
Weight patient on admission.
(R) As a baseline weight/ to calculate level of dehydration & guide IV replacement therapy.
Assess mucuos membrane & evaluate skin turgor.
(R) Dry mucous membranes & decreased skin turgor provide observable evidence of dehydration.
Administered & monitor IV if ordered.
(R) Previous fluid loss may require immediate replacement to ensure adequate tissue hydration.
Monitor intake & output chart.
(R) Evaluate the effectiveness of replacement fluid.
ANXIETY (child and parents)
related to acute illness & inadequate knowledge on disease process
Encourage parents to express fears & ask questions; provide direct answers and discuss care, procedures, and condition changes.
(R) To reduce parents' anxiety & increase trust in nursing staff.
Incorporate parents in the child's care. Encourage parents to bring familiar objects from home.
(R) Familiar people, routines, and objects decrease the child's anxiety and increase parents' sense of control over unexpected, uncertain situation.
Explain symptoms, treatment, long term follow up care and action care plan of asthma.
(R) Provide sufficient information to assist parents to be prepared of recurrence for asthma.
INEFFECTIVE BREATHING PATTERN
related to increased work of breathing & decreased energy (fatigue)
Assess respiratory status a minimum of every 2-4 hourly or more often as indicated.
(R) Frequent assessment and monitoring provides objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Administer humidified oxygen via mask/ nasal prong as ordered.
(R) Oxygen will help to improve oxygenation associated with respiratory distress & hypoxia.
Note child's response to the prescribed medications (e.g. nebulizer treatments).
(R) To evaluate the effectiveness of medications as it act systemically & locally (on respiratory tissues) to improve oxygenation & decrease inflammation.
Position the child in high fowler's position.
(R) To maintain airway patency & facilitate lung expansion.
INEFFECTIVE AIRWAY CLEARANCE
related to bronchial edema & increased mucus production
Assess the child's respiratory rate & rhythm hourly.
(R) Frequent assessment and monitoring provides objective evidence of changes in the quality of respiratory effort, enabling prompt and effective intervention.
Give oxygen via face mask, nasal cannula, or hood as ordered.
(R) Humidified oxygen loosens secretions and helps maintain oxygenation status and decrease respiratory distress.
Observe child's response to ordered medications.
(R) Medications act systemically & locally (on respiratory tissue) to improve oxygenation & decrease inflammation.
Administer bronchodilator as directed.
(R) To relieve muscle spasms, and reduce bronchial edema.
Perform oral/ nasal suctioning as needed.
(R) Decrease airway resistance due to secretions & ensuring patent airway.
Encourage deep breathing and coughing.
(R) To remove secretions along the airway.
Clinical Manifestations
Wheezing
: a high-pitched whistling sound that occurs when a child breathes out
Cough
: troublesome at night / early in the morning
Medical Management
Bronchodilators (relievers)
: relax the muscles around the airway, relieving the obstruction to airflow rapidly, relieve from asthma symptoms within minutes, used during
acute asthma attack
e.g.(most common) Salbutamol (Ventolin)
Preventer / Controller Medications
: reduce the swelling of the airway lining & reduce mucus production, the first line treatment
Systemic corticosteroids (short term therapy) : e.g. (oral) Prednisone, Betamethasone; (IV) Hydrocortisone
Leukotriene modifiers: e.g. Montelukast (Singulair)
Inhalation corticosteroids: e.g. Budesonide (Pulmicort)
Definition: a recurrent & reversible obstruction of the airways
causing bronchospasm支气管痉挛(constriction), mucosal edema粘膜水肿, secretion & plugging by mucus
contributes to narrowing of the airways
impaired gas exchange
Triggers
allergens, vigorous exercise, cold air, infections, household products, drugs, emotional distress & excitement, occupational dusts & vapors, air pollution
Pathophysiology
bronchial constriction is abnormally severe, producing impaired respiratory function
the smooth muscle around the airway causes
narrowing
& shortening of airway -> increase airway resistance to airflow
causes force expiration through narrow lumen
volume of air trapped in the lung increases (
since airways are closed btwn alveoli & bronchi
)
the inspiration occurring at higher lung volume hyperinflates过度膨胀 the alveoli -> reduces the effectiveness of cough
severity of obstruction increases
-> reduced alveolar ventilation w/ CO2 retention, hypoxemia, respiratory acidosis & eventually
respiratory failure
Nursing Management (Acute Asthma care)
Monitor the effectiveness of the treatment
Monitor vital signs such as pulse oximetry, respiratory rate, heart rate
Observe work of breathing & monitor breath sound (auscultation)
Observe for signs of respiratory distress such as nasal flaring, tachypnea, chest retraction
Provide oral fluid intake adequately if able to take orally
Administer IV fluid replacement if NBM: to ensure adequate tissue hydration
Reassure the child / parents that the symptoms will be relieved