Asthma is a chronic respiratory disease which is a considerable drain on healthcare resources in terms of costs, manpower, morbidity and mortality. Chronic diseases like asthma are best managed with a collaborative effort between physicians, nursing staff, patients and their family members…
As a part of optimal care, it is essential to formulate a nursing care plan for each patient, which includes assessment and diagnosis of the patient’s condition, identifying the goals of the management, interventions and management plan to achieve those goals and the rationale behind these interventions, expected outcomes and discharge and home care guidance. However, prior to formulation of the nursing care plan, the basic pathophysiology of asthma has to be understood. Pathophysiology of asthma Asthma is characterized by hyperreactive airways associated with partially or completely reversible airway obstruction. There is chronic and recurrent inflammation of the airways and airway obstruction results mainly because of airway narrowing caused by smooth muscle constriction in response to various stimuli. Additional obstruction occurs because of plugging of airways with mucous plugs (Mitchell, Kumar, Abbas, & Fausto, 2006). Because the airways are hyperreactive, a large number of otherwise normal stimuli become the instigators of a cycle of inflammatory cells activation. These can be allergens such as pollens, dust, smoke, exhaust fumes & other irritants, respiratory infection, cold, exercise and certain drugs. When any of these stimuli are encountered, inflammatory cells, primarily mast cells, macrophages and eosinophils, are recruited. As an immediate reaction, mast cells coated with IgE release inflammatory mediators (leukotrienes and cytokines) which cause smooth muscle constriction, edema and mucous formation, all of which compromise lumen of the airways. Other lymphocytes are then recruited and further escalate the chain of events leading to bronchospasm and other clinical manifestations (Mitchell, Kumar, Abbas, & Fausto, 2006). Nursing care plan Nurses caring for five year old children suffering from asthma may encounter their patients on an outpatient basis, in emergency department or as ward nurses. They are required to assess their patients’ signs and symptoms and arrive at a diagnosis, and coordinate with the health care team in the formulation of the management plan. Subsequently, delivery of care includes educating the patients and their families about the management plan and practical application of the plan, review of the medication administration techniques and ensuring compliance and adherence to the plan. Nursing Assessment and Diagnosis The first step is collection of information and its assimilation. First and foremost is triage assessment. A number of quick assessment tools, based on parameters such as respiratory rate, oxygen saturation, spirometric data, auscultatory findings and consciousness level, are available which can distinguish between serious emergency cases and cases of mild to moderate severity. Objective measurement of PEFR is difficult in five year old children (Volpe, Smith & Sultan, 2011). In children above the age of five years, the severity of asthma and the response to treatment can be objectively measured by spirometry, and the nurse can make sure that the measurements have been made with correct technique. Once triage assessment is over, further assessment can be done by enquiring about the history of ...
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A paternalistic approach to teaching and learning will not work because the patient will not be always with the medical professionals. If family members and/or the child are made to over-rely on the medical professionals, medical help may come either too late for child.
Asthma is a prominent cause of impaired quality of life, use of primary health care, and mortality, and has economic ramifications through widespread prescription drug use and hospital admissions (Anderson et al., 2007). Risk factors for asthma in adults include female gender, poor lung function, atopy, nasal allergy, obesity, parental asthma, respiratory infections in early life, and high-risk occupations (Anto et al., 2010).
One of the major causes of mortality in UK is asthma as Anderson, et al. (2007, p.85) stated in their review that the current trend in prevalence of diagnosed chronic asthma continues to increase since 1950s. This leaves the hospitals and care homes with the dilemma of facing the multidisciplinary issues adjunct with chronic asthma and other debilitating disorders.
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