Asthma Nursing Care Plan & Management

Definition

Asthma is a chronic inﬂammatory disease of the airways characterized by hyper-responsiveness, mucosal edema, and mucus production.
This inﬂammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea.
Patients with asthma may experience symptom-free periods alternating with acute exacerbations that last from minutes to hours or days.
Asthma, the most common chronic disease of childhood, can begin at any age.

Causes

The main triggers for asthma are allergies, viral infections, autonomic nervous system imbalances that can cause an increase in parasympathetic stimulation, medications, psychological factors, and exercise. Of asthmatic conditions in patients under 30 years old, 70% are caused by allergies. Three major indoor allergens are dust mites, cockroaches, and cats. In older patients,the cause is almost always nonallergic types of irritants such as smog. Heredity plays a part in about one-third of the cases.

Pathophysiology

1. An asthma attack may occur spontaneously or in response to a trigger. Either way, the attack progresses in the following manner:

There is an initial release of inflammatory mediators from bronchial mast cells, epithelial cells, and macrophages, followed by activation of other inflammatory cells
Alteration of autonomic neural control of airway tone and epithelial integrity occur and the increased responsiveness in airways smooth muscle results in clinical manifestations (e.g. wheezing and dyspnea)

2. Three events contribute to clinical manifestations

Bronchial spasm
Inflammation and edema of the mucosa
Production of thick mucus, which results in increased airway resistance, premature closure of airways, hyperinflation, increased work of breathing, and impaired gas exchange

3. If not treated promptly, status asthmaticus – an acute, severe, prolonged asthma attack that is unresponsive to the usual treatment – may occur, requiring hospitalization.