Asthma is a chronic disease of the airways that can affect adults or children. Uncontrolled or inadequately controlled asthma can cause irreversible damage in the airways. It is a disorder that can be triggered by an allergen, excessive physical activity, emotional distress or illness. The airways of a child experiencing an asthma attack gets constricted and narrow due to the following:
- inflammation
- mucus accumulation
- swelling
Nursing Assessment
Symptoms of asthma include coughing, wheezing, shortness of breath or difficulty breathing and a feeling of tightness in the chest. Night time coughing is a characteristic symptom of asthma in children even when they don't show any other signs of asthma. Other problems associated with childhood asthma are:
- missing school days
- missed days of work for the parents
- lack of adequate sleep due to night time coughing
- less participation in physical activities
In addition to finding out what symptoms of asthma a child is showing plus the effects on the child and family, the nurse should also find out if the family has a history of asthma, what allergies the child has if any, and if the child's environment could be a source of allergens. Monitoring the child's skin color and respiratory efforts closely is necessary to detect respiratory distress in the child.
Nursing Interventions
The goal of nursing care in a child having an asthma attack is to make sure there is adequate oxygen intake. To do this, the nurse does the following as ordered by the physician:
- Administer inhaled rapid acting bronchodilators like albuterol to open up the child's 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 liquefy secretions in the airways.
- Prepare for mechanical ventilation if the child cannot breathe on his own.
Long term care of the asthmatic child involves taking certain medications on a regular basis even when no symptoms are present. In this case, the nurse has to ensure that long term asthma medications like inhaled corticosteroids, leukotriene inhibitors, long acting bronchodilators, cromolyn and theophylline are administered as prescribed by the physician. Other nursing interventions include:
- removing any potential allergen or trigger from the child's environment like flowers or perfumes
- maintaining a quite calm environment to reduce anxiety and promote normal respiratory rate
- monitoring the child for side effects of administered medications
- monitoring the child's arterial blood gases as an indication of improvement or deterioration
Patient Teaching
Discharge planning for an asthmatic plan involves providing the child and his parents with information that will help prevent asthmatic episodes and teaching them skills required to administer asthmatic medications properly. These skills and information are as follows:
- The need to identify and eliminate any actual or potential allergen, substance or condition that could precipitate an asthma attack.
- The need to permit no smoking around the child.
- 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.
- How to use an inhaler and a spacer.
- How to use a peak flow meter and the significance of the readings.
- Assisting the family to create an asthma management and emergency plan.
- When to contact a healthcare provider or seek emergency services.
References:
Health.google.com
Mayoclinic.com
Lippincott Manual Of Nursing Practice, Sandra M. Nettina. Lippincott Williams & Wilkins, 2009.
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