General Nursing©

ASTHMA

Asthma is a disease, which affects the respiratory system. The airways become narrowed, or blocked, making breathing difficult. Characterized by bronchial spasm, mucosal edema, and increased secretions.

The severity and frequency of attacks varies, but generally, mild to moderate asthma can be controlled with appropriate treatment.
In some cases, the symptoms can reverse, or disappear altogether, without the need for any medication.

Nursing cares to patient with asthma:

1. Obtain history of recent medication use, particularly theophylline preparations, steroids and inhalers.
2. Obtain baseline data on respiratory function, using spirometry or a peak flow meter, listen to breath sounds.
3. Oxygen via prongs.
4. Epinephrine 1:1000 in dose of 0.3 to 0.5 mg (0.01 mg/kg) subcutaneously unless the person has a pulse greater than 140, diastolic BP greater than 100, a history of hypertension or cardiac problems, and unless epinephrine has not been effective in the past or epinephrine or Isuprel-containing inhaler has been used prior to arrival. Epinephrine may be given every 20 minutes for a maximum of three doses. Listen to breath sounds to see if breathing has improved (i.e., wheezes are gone) before giving subsequent injections. NOTE: the timing of epinephrine doses is critical; delays in administration of subsequent doses impede the effectiveness of this therapy.
5. Terbutaline may be used instead of epinephrine.
6. Aminophylline is used if epinephrine is not indicated. Initial dose is usually 250 to 500 mg IV (approximately 5.6 mg/kg) given either IV push slowly or IV drip in 50 to 100 ml 5% D/W, for an individual who has not been taking theophylline before coming to the ED. If wheezing continues, 0.6 to 0.9 mg/kg of IV drip aminophylline may be administered. Caution: Only a fine line exists between therapeutic and toxic levels of aminophylline. Cardiac arrhythmias may occur without other signs of toxicity. Thus, cardiac monitoring is indicated when IV aminophylline is administered.
7. Reassurance; hydration with oral fluids.
8. IIPB or mist inhalation with normal saline, bronchodilators and so forth
9. Check results of diagnostic procedures.
10. Costecosteroids if not responding to standard treatments or if person routinely takes steroids daily. If steroids are required, hospital admission is usually indicated. Atropine by inhalation is sometimes used for bronchospasm.
11. Assess vital signs every 15 to 30 minutes in initial treatment period; retake temperature at least once; observe for changes in level of consciousness (e.g., depression due to hypoxemia or excitation due to aminophylline and/ or epinephrine).

1 2 3 4 5 Pages