TOPIC: Nursing Management of Br.Asthma المحاضر: فريدة محمد مصطفى (مشرفه التعليم الطبي بالتمريض) SPEAKER: Sr.Fareedah M. Mustafa ( Nursing Education Coordinator , MGH)

1. Asthma and NURSING
MANAGEMENTS
Fareeda Moh’d. Mustafa
CNE,MGH, MADINA

2. DEFINITION
Asthma :-
*Is the common chronic inflammatory disease of the
airways characterized by variable and recurring symptoms,
reversible airflow obstruction, and bronchospasm .

3. Anatomy

4. Causes:-
The cause of asthma is not known, but there is evidence
that many factors play a part
1-)Genetic factors
2-)Environmental factors:
3-)Dietary changes
4-)Lack of exercise
5-)Occupational exposure

5. Pathophysiology :-
Airway inflammation is the primary problem in asthma.
An initial event in asthma appears to be the release of
inflammatory mediators triggered. The mediators are
released from bronchial mast cells, alveolar
macrophages, and epithelial cells. Some mediators
directly cause acute
bronchoconstriction.” The inflammatory mediators also
direct the activation of eosinophils and neutrophils, and
their migration to the airways, where they cause injury.
called “late-phase asthmatic response” results in
epithelial damage, airway edema, mucus hyper
secretion and hyper responsiveness of bronchial
smooth muscle Varying airflow obstruction leads to
recurrent episodes of wheezing, breathlessness, chest
tightness and cough

7. Asthma triggers:-
A trigger is any thing or condition that causes
inflammation in the airways, which then leads to
asthma symptoms
*Infections such as colds, flu, or pneumonia
*Allergens such as food, pollen, mold, dust and pet
dander
*Exercise

8. Asthma triggers:-
*Air pollution and toxins
*Weather, especially extreme changes in
temperature
*Drugs (such as aspirin,)
*Emotional stress and anxiety
*Singing, laughing, or crying
*Smoking, perfumes, or sprays

9. Risk factors for asthma :-
1-)Genetics
2-)Allergies
3-)Medical Conditions
-Respiratory infections in childhood
-Low birth weight
-Obesity
-Congestive heart failure
-Pulmonary embolism
4-)Gender
5-) Ethnic Background
6-) Medications

10. Types of Asthma :-
1.) Child-Onset Asthma
2.) Adult-Onset Asthma
3.) Exercise-Induced Asthma
4.) Cough-Induced Asthma
5.) Occupational Asthma
6.) Nocturnal Asthma
7.) Steroid-Resistant Asthma (Severe Asthma)

11. Diagnosis :-
1-)Peak flow measurements
2-) spirometer
3-)Lung function tests
4-)Blood tests to measure eosinophil count (a type of white
blood cell) and IgE (a type of immune system protein
called an immunoglobulin)
5-)Arterial blood gas
6-)Chest x-ray

13. Spirometer
A spirometer is a diagnostic device that measures the amount of air
you're able to breathe in and out and the time it takes you to exhale
completely after you take a deep breath

14. Clinical manifestations :-
1-)Coughing, especially at night
2-)Wheezing
3-)Shortness of breath
4-)Chest tightness, pain, or pressure

15. Early warning signs:-
* Frequent cough, especially at night
*Losing your breath easily or shortness of breath
*Feeling very tired or weak when exercising
*Wheezing or coughing after exercise
*Feeling tired, easily upset
*Decreases or changes in a peak expiratory flow
*Signs of a cold,
*upper respiratory infection, or allergies
(sneezing, runny nose, cough, congestion, sore throat, and
headache)
*Trouble sleeping

16. Symptoms of worsening asthma:-
*Cough that won’t go away (day and night)
*Wheezing
*Tightness in the chest
*Shortness of breath
*Poor response to medicines (bronchodilators)

17. Late, severe symptoms:-
* Severe wheezing (both when breathing in and out)
*Coughing that won’t stop
*Very rapid breathing
*Inability to catch your breath
*Chest pain or pressure
*Tightened neck and chest muscles
*Difficulty talking
*Inability to fully exhale
*Feelings of anxiety or panic
*Pale, sweaty face
*Blue lips or fingernails

18. Managements:-
cannot be cured, but appropriate management can control the
disorder and enable people to enjoy a good quality of life
1.) The first step in asthma management is environmental
control by
* Clean the house at least once a week and wear a mask while
doing it
*Avoid pets with fur or feathers
*Wash the bedding (sheets, pillow cases, mattress pads) weekly
in hot water
*Encase the mattress, pillows and in dust-proof covers
*Replace bedding made of down, foam rubber
*Consider replacing carpeting with hardwood floors *Use the
air conditioner
*Keep the humidity in the house low

19. Managements:-
2.) The second step is to monitor lung function. *Asthmatics use a
peak flow meter to gauge their lung function
* listen to breath sounds
*pulse oxymetry ,and vital signs
3.) The third step in managing asthma involves the use of
medications. There are two major groups of medications used in
controlling asthma
* Anti inflammatory (corticosteroids) and bronchodilators.
*immunotherapy may help those there are not control symptoms
or used medications.

20. Nursing managements:-
*The goal of nursing care in a patient’s having an asthma attack is to make
sure there is adequate oxygen intake.
1-) Evaluate respiratory rate/depth and breath sounds
2-). Assist client to maintain a comfortable position
3-)Encourage/instruct in deep-breathing and directed coughing
exercises
4-)Obtain history of recent medication use, particularly theophylline
preparations, steroids and inhalers.
5-)Obtain baseline data on respiratory function, using a peak flow meter,
listen to breath sounds

21. *Nursing managements:-
6-) the nurse must following physician order to:-
-Administer inhaled rapid acting bronchodilators to open up the
airways.
-Administer corticosteroids such as prednisone to reduce
inflammation in the airways.
-Administer low flow humidified oxygen to prevent hypoxemia.
-Administer intravenous fluids to prevent dehydration and oral intake
looses secretions in the airways.
7-)-the nurse has to ensure that long term asthma medications like
inhaled corticosteroids long acting bronchodilators are administered
as prescribed by the physician.

22. *Nursing management:-
8-)Check results of diagnostic procedures .
9-)Assess vital signs every 15 to 30 minutes in initial treatment
period; retake temperature at least once;
10-)observe for changes in level of consciousness (e.g., depression due to
hypoxemia or excitation due to aminophylline and/ or epinephrine
11-)Removing any potential allergen or trigger from environment like
flowers or perfumes
12-)Maintaining a quite calm environment to reduce anxiety and promote
normal respiratory rate
13-)Monitoring the side effects of administered medications
14-)Monitoring the arterial blood gases as an indication of improvement
or deterioration
-15-)Prepare for mechanical ventilation if patient cannot breathe on his
own

23. complications of asthma:-:
1-)Decreased ability to exercise and take part in other activities
2-)Lack of sleep due to nighttime symptoms
3-)Permanent changes in the function of the lungs
4-)Persistent cough
5-)Trouble breathing that requires breathing assistance (ventilator
6-) Pneumothorax
7-) Respiratory failure
8-)Death

24. Preventions :-
*You can reduce asthma symptoms by avoiding known triggers and
substances that irritate the airways.
*Eliminate tobacco smoke from the home. (Smoking outside the
house is not enough. Family members and visitors who smoke outside
carry smoke residue inside on their clothes and hair

25. *Patient Teaching :-
*Providing information that will help prevent asthmatic episodes and teaching
patients skills required to administer asthmatic medications properly. These
skills and information are as follows
1-)The need to identify and eliminate any actual or potential allergen, substance
or condition that could precipitate an asthma attack.
2-)The need to permit no smoking around
3-)The need to report frequent use of rapid acting bronchodilators.
The need to take long term medication as prescribed even when there are no
asthma attacks.
4-)How to use an inhaler and a spacer.
5-)How to use a peak flow meter and the significance of the readings.
6-(Assisting the patient to create an asthma management and emergency plan.
7-)When to contact a healthcare provider or seek emergency services