Last updated on December 28th, 2023
Here we have formulated a sample nursing care plan for Acute Exacerbation of Bronchial Asthma based on a hypothetical case scenario.
It will include three sample nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales.
Bronchial Asthma Case Scenario
A 17-year old female presents to the ED with complaints of severe shortness of breath and anxiety. The patient has a past medical history of asthma. She reports that she was playing soccer with friends when the symptoms started.
She used her rescue inhaler but symptoms persisted and started to worsen. After 30 minutes of severe shortness of breath, her mother drove her to the hospital.
Upon assessment, the patient is diaphoretic and visibly uncomfortable. She cannot complete a full sentence without gasping, and asks “Am I… going to… die?” She is hunched over, her breathing is labored, and retractions are seen.
Upon auscultation, both inspiratory and expiratory wheezes are heard. Her temperature is 37.6 C, heart rate is 113 beats per minute, blood pressure 115/78 mmHg, respirations are 35 breaths per minute, and oxygen saturation is 89% on non-rebreathers.
An ABG is drawn, revealing pH 7.49, PaCO2 is 29 mmHg, PaO2 is 52 mmHg, and HCO3 is 22 meq/l, revealing respiratory alkalosis. A peak flow measurement is performed and the patient’s zone is “red” indicating severe narrowing of the large airways.
The patient is admitted to the hospital for Acute Exacerbation of Bronchial Asthma.
#1 Sample Nursing Care Plan for Asthma – Ineffective airway clearance
- The patient complains of shortness of breath that started after exercise.
- The peak flow measurement zone is “red.”
- The patient’s breathing is labored and retractions are seen.
- Inspiratory and expiratory wheezes are auscultated.
- SPO2 is 89% on non-rebreather.
Ineffective airway clearance related to narrowing of large airways as evidenced by shortness of breath, wheezes, and peak flow measurement zone of “red.”
Short-term goal: By the end of the shift the patient’s peak flow measurement zone will return to “green” and the patient’s breathing will be unlabored.
Long-term goal: The patient will have a plan in place for exercising and will effectively manage her asthma when exercising.
Nursing Interventions with Rationales for Bronchial Asthma – Ineffective airway clearance
|Administer short-acting beta-2-adrenergic agonist.
|These drugs are bronchodilators that relax the airway muscles, allowing air to pass more easily. Examples include Albuterol and Levalbuterol.
|Administer inhaled corticosteroids.
|These drugs work by decreasing inflammation and mucous production in the airways. They should be given after bronchodilators. Examples include Budesonide and Fluticasone.
|If airway swelling persists despite bronchodilators or corticosteroids, anticipate alternate medication administration.
|Magnesium sulfate, Helium, and different types of anesthesia are alternate medications that can be used to decrease inflammation and lessen airway resistance.
|Administer oxygen as needed.
|Oxygen should be provided based on patient needs and requirements. Intubation may be required for airway protection.
|Monitor vital signs, breath sounds, and mucous membranes for the presence of cyanosis.
|The patient must be closely monitored for signs of impending hypoxia or respiratory failure.
|Monitor ABGs as needed.
|A patient experiencing an asthma attack will first exhibit respiratory alkalosis. As the condition worsens the patient will then exhibit respiratory acidosis. ABGs should be monitored to guide treatment.
#2 Sample Nursing Care Plan for Asthma – Anxiety
- The patient complains of anxiety.
- The patient is visibly uncomfortable and short of breath.
- The patient verbalizes “Am I going to die?”
Anxiety related to respiratory distress and loss of control as evidenced by verbalization “Am I going to die?”
Short-term goal: By the end of the shift the patient will report a lessening in anxiety and will appear calm and relaxed.
Long-term goal: The patient will be able to list a few coping strategies to use in the future.
Nursing Interventions with Rationales for Bronchial Asthma – Anxiety
|Stay with the patient and encourage slow, deep breaths.
|Consistent presence and coaching can help lessen feelings of anxiety during an asthma exacerbation.
|Provide a calm environment and decrease stimuli.
|A calm environment will decrease anxiety, thus decreasing oxygen consumption.
|Educate the patient on pursed-lip breathing.
|Pursed lip breathing is an intentional breathing technique that encourages slow, deep, effective breaths.
|Help the patient develop an emergency plan for asthma attacks.
|The patient should always have their rescue inhaler on hand. During an asthma exacerbation, the patient should sit upright and administer their rescue inhaler. If no relief is felt within 4 minutes, the patient should seek immediate medical attention, and continue administering the rescue inhaler every 4 minutes.
#3 Sample Nursing Care Plan for Asthma – Knowledge deficit
- The patient was exercising outdoors prior to the asthma exacerbation.
- The patient waited 30 minutes after rescue inhaler administration to seek medical attention.
Deficient knowledge related to environmental triggers and asthma management as evidenced by exercising outdoors and not seeking medical attention for 30 minutes.
Short-term goal: By the end of the shift the patient will be able to list a few environmental asthma triggers.
Long-term goal: The patient will successfully manage her asthma, avoid triggers when possible, and have an emergency plan in place in case of an exacerbation.
Nursing Interventions with Rationales for Bronchial Asthma – Knowledge deficit
|Educate the patient about rescue inhalers vs. controller inhalers.
|Rescue inhalers are meant to be used in case of emergency and should not be used every day. Controller or “maintenance” inhalers can be used every day (as prescribed) to decrease symptoms of asthma. Examples of maintenance inhalers are Symbicort and Advair.
|Educate the patient about environmental asthma triggers.
|Examples of environmental triggers include smoke, allergens, mold, and air pollution.
|Educate the patient on how to effectively manage asthma when exercising.
|Sometimes asthma can be exacerbated by exercise. Walking, swimming, or hiking are asthma-friendly alternatives, and exercise with short bursts of activity is better than prolonged exercise. Sometimes a physician can prescribe a rescue inhaler to be used before exercise.
|Show the patient how to use a spacer.
|A spacer is a tube between the inhaler and the patient’s mouth which gives the patient more time to inhale the medication.
|Advise the patient to rinse their mouth following administration of an inhaled corticosteroid.
|If the mouth is not properly rinsed after administration of inhaled corticosteroids the patient can develop thrush, a fungal infection in the mouth, which looks like white patches on the mucous membranes and tongue.
To conclude, here we have formulated a scenario-based nursing care plan for Acute Exacerbation of Bronchial Asthma. Prioritized nursing diagnosis includes ineffective airway clearance, anxiety, and knowledge deficit.
Additionally, this sample Asthma nursing care plan comprises nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales.
Recommended Readings & References
Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Elsevier.
Herdman, T., Kamitsuru, S. & Lopes, C. (2021). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Thieme. Swearingen, P. (2016). ALL-IN-ONE CARE PLANNING