What is the nursing care plan for asthma?

Recognizing signs and symptoms of asthma can help nurses diagnose the problem and create the right care plan for patients. Asthma can be very dangerous to people of all ages when not treated or managed correctly. Thankfully, there are tools and resources nurses can offer patients to help limit risk.

This article discusses what asthma is, its causes, signs and symptoms, and care plans to treat patients.

What is asthma?

Asthma is a common chronic health condition affecting the respiratory system. A person with asthma can experience breathing difficulty, coughing, wheezing, and shortness of breath due to swelling, narrowing, and possible added mucus production in the airway.

Certain risk factors can increase the likelihood of developing asthma. However, the prognosis is good with the medical management of symptoms. Certain medications can treat bronchial inflammation and improve oxygen and carbon dioxide gas exchange in the bloodstream.

These medications include:

Daily corticosteroids
Anti-inflammatory anticholinergics
Theophylline
Short-acting beta 2-agonist, Albuterol

Some patients may experience side effects from asthma control medications.

The most common include:

Increased heart rate
Impaired growth in pediatric patients
Sore throat
Dysphonia or hoarseness

Asthma nursing diagnosis

There are several techniques used to show evidence of asthma in patients.

The most popular techniques include:

Physical exam
Auscultation of the lungs, including breathing and lung sounds
Spirometry
Arterial blood gas (ABG) testing
Chest X-ray

An intake of personal history during the initial assessment can provide a clearer picture of the cause of asthma. A collection of signs and symptoms can help nurses diagnose asthma.

Causes of asthma

Several factors can put someone at risk of developing this chronic disease.

Genetics and environment: These can play a role in increasing asthma risk. For instance, exposure to tobacco smoke in utero or as a child can increase the chances of asthma.
Childhood illness: Sickness, such as bronchiolitis, can also increase risk.
Atopic conditions: This includes things like eczema, hay fever, and food allergies.
Physical activity or exercise: Asthmatic flares can also occur in certain situations. For some, exercise may induce asthma symptoms. This activity intolerance can affect airflow to the lungs and cause difficulty breathing.
Workplace irritants: Certain occupations may place employees at a higher risk of developing asthma. Several chemicals can trigger mild to severe symptoms.
Seasonal changes: Certain aspects of seasonal changes can also bring asthma symptoms. Outdoor allergens can cause sneezing, shortness of breath, and bronchoconstriction.
Indoor allergens: Things like dust mites or pet dander can bring on an asthma attack.

A variety of factors may cause asthma. With a full assessment, health care providers can help patients narrow down environmental triggers and provide suggestions on how to best minimize exposure.

Asthma signs and symptoms

Asthma symptoms and signs can range from mild to life-threatening.

Asthma signs and symptoms include:

Dyspnea or shortness of breath
Chest tightness
Retraction when inhaling
Wheezing upon exhale

During a severe asthma attack (called asthma exacerbation), a person may exhibit any of the following symptoms:

Cyanosis (bluish skin)
Paleness
Tachypnea or rapid breathing
Anxiety

Asthma symptoms can interfere with daily activities, affect a person’s quality of life, and cause further complications.

Some complications of asthma may include:

Tachycardia
High blood pressure
Frequent trips to the emergency room
Respiratory distress or failure

Developing asthma nursing care plans

Although an incurable condition, asthma symptoms can be managed and controlled with routine changes and medication. When treating a patient with an asthma diagnosis, you can create a plan of care to minimize symptoms and reduce asthma attacks.

Asthma care plan for ineffective airway clearance

Signs and symptoms of ineffective airway clearance include:

Wheezing
Shortness of breath
Productive cough
Oxygen saturation of 85%
Respiratory rate of 25

Some nursing interventions to improve air patency and clearance include:

Vital sign and respiration assessment every four hours (or less)
Suction phlegm secretions and sputum, as needed
Provide supplemental oxygen
Position the patient in an optimum position for effective breathing
Administer prescribed medication (e.g., nebulizers, bronchodilators, steroids, and inhalers)

Asthma care plan for an ineffective breathing pattern

An ineffective breathing pattern is a critical condition and may cause respiratory failure if not detected and treated early. A number of diseases and conditions, including asthma, can affect a patient’s breathing pattern.

Evidence of an ineffective breathing pattern includes:

Respiratory noise
Nasal flaring
Cyanosis
Tachypnea
Depth of breathing changes
Coughing
Shortness of breath

An asthma care plan for an ineffective breathing pattern includes many monitoring interventions to help stabilize the patient’s breathing pattern, including watching for:

Signs of hypoxia
Signs of distress
Oxygen saturation
Breathing abnormalities

Encourage rest and use calm, deep breathing when with the patient.

Asthma care plan for anxiety

Anxiety or a sense of panic can often accompany a patient with breathing difficulty and exacerbate asthma symptoms. A nursing asthma care plan for anxiety can help provide the patient with coping skills, minimize anxiety-related symptoms, and establish calmer conduct and behavior.

Some key interventions for treating anxiety (secondary to asthma) include:

Observing for signs of panic
Explaining procedures clearly
Suggesting relaxation techniques, such as pursed lip breathing and positive affirmations
Maintaining open lines of communication
Providing assurances as needed

For asthma management, establish an oxygen saturation baseline and monitor for dips that may increase the risk of hypoxia.

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Asthma NCLEX Review and Nursing Care Plans

Asthma is sometimes referred to as reactive airway disease or bronchial asthma. There is no cure for asthma, but the symptoms can be managed and controlled effectively.

Asthma can interfere with a patient’s activities of daily living and also put the client at risk for asthma attacks.

Signs and Symptoms of Asthma

Shortness of breath
Chest tightness or pain
Wheezing upon exhalation, especially in children
Coughing
Phlegm at times (most asthma cases are non-productive)
Sleeping problems due to coughing or breathlessness
Tiredness

Signs and Symptoms of Asthma Attacks

Non-stop coughing
Severe wheezing (both inhalation and exhalation)
Rapid breathing
Chest pain or pressure
Retractions – tightened neck and chest muscles
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
Cyanosis – blue lips or fingernails

Asthma may be worsening if the patient experiences the signs and symptoms or has asthma attacks more frequently.

He/she may have more shortness of breath based on peak flow meter readings and may have to alleviate the symptoms using a quick-relief inhaler more frequently than usual.

Asthma

Causes of Asthma

The exact cause of asthma is unknown. Experts believe that asthma is caused by a combination of genetic and environmental factors.

Asthma attacks or flare ups may be triggered by different environmental factors. Exercise-induced asthma may occur if the patient’s exercise and physical activity results in an asthma attack.

This becomes worse if the patient is exercising in a cold environment where the air is dry. Allergy-induced asthma happens when airborne substances such as mold spores, pollen, insect waste, pet dander, or skin particles trigger the asthma.

Occupational asthma occurs in the workplace where gases, dust, chemical fumes or other workplace irritants may be present.

Other triggers of asthma include respiratory infections, air pollutants such as cigarette smoke, vehicular smoke, emotional stress, some medications such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and naproxen, and some sulfites and preservatives.

Gastroesophageal reflux disease (GERD) may also give rise to asthma symptoms.

Complications of Asthma

Sleep deprivation and interference in activities of daily living
Permanently narrowed airways that cause shortness of breath
Frequent hospitalizations due to asthma attacks
Medication-related side effects. Inhaled steroids may cause poor growth in children and decreased bone density.

Diagnosis of Asthma

Physical examination – auscultation of wheeze, inspection of ear, nose, throat and airways, looking for any chest retractions or signs of cyanosis, checking for respiratory rate and oxygen saturation levels
Lung function tests – spirometry and peak flow meter; done before and after taking a bronchodilator
Imaging – chest X-ray
Allergy testing
Sputum test – to check if there are any eosinophils in the sputum
Nitric oxide test – to check for elevated nitric oxide levels, which are indicative of narrowed airways

Treatment for Asthma

Long-term asthma medications. These are used on a daily basis to control the asthma symptoms and prevent an asthma attack. These include:
- Inhaled corticosteroids such as budesonide, fluticasone, and beclomethasone
- Leukotriene modifiers, such as oral montelukast and zileuton
- Combination inhalers – combined corticosteroid and long-acting beta agonist, such as fluticasone-salmeterol (e.g. Advair HFA), budesonide-formoterol (Symbicort), formoterol-mometasone (Dulera) and fluticasone furoate-vilanterol (Breo Ellipta).
- Theophylline – relaxes the airway muscles, allowng the airways to remain open; requires blood tests to determine toxicity levels
Quick-relief or rescue medications. These medications are used during asthma attack for short-term relief. They may be used prior to exercise.
Short-acting beta agonists – bronchodilators such as albuterol and levalbuterol.
Anticholinergic agents – also used in chronic bronchitis and emphysema. These include ipratropium (Atrovent) and tiotropium (Spiriva)
Oral and intravenous corticosteroids – alleviate airway inflammation. These include prednisone and methylprednisolone.
Allergy medications for allergy-induced asthma
Biologics for severe asthma include omalizumab (Xolair) and mepolizumab (Nucala)
Bronchial thermoplasty. This procedure includes heating up the lung airways using an electrode. This is done over 3 clinic visits.

Nursing Diagnosis for Asthma

Nursing Care Plan for Asthma 1

Ineffective Airway Clearance related to asthma as evidenced by shortness of breath, wheeze, SpO2 level of 85%, respiratory rate of 25, and productive cough

Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.

Nursing Interventions for Asthma	Rationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Assess breath sounds via auscultation.	To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Wheeze is one of the important signs of asthma.
Encourage coughing. Suction secretions as needed.	To help clear thick phlegm that the patient is unable to expectorate.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.	To increase the oxygen level and achieve an SpO2 value within the target range.
Administer the prescribed asthma medications (e.g. bronchodilators, steroids, or combination inhalers / nebulizers).	Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs.
Elevate the head of the bed and assist the patient to assume semi-Fowler’s position.	Head elevation and proper positioning help improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan for Asthma 2

Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand secondary to asthma as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will be able to demonstrate active participation in necessary and desired activities and demonstrate an increase in activity levels.

Nursing Interventions for Asthma	Rationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that they used to do or want to try.	To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media for long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.	To gradually increase the patient’s tolerance to physical activity. To prevent asthma attack by allowing the patient to pace activity and to have rest periods.
Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.	To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.	To provide a more specialized care for the patient in terms of helping them build confidence in increasing daily physical activity.

Nursing Care Plan for Asthma 3

Ineffective Breathing Pattern

Nursing Diagnosis: Ineffective Breathing Pattern related to inadequate pulmonary ventilation, secondary to asthma, as evidenced by shortness of breath, coughing, cyanosis, nasal flaring, changes in the depth of breathing, excessive use of accessory muscles, presence of respiratory noise, and tachypnea.

Desired Outcomes:

The patient’s abnormal breathing pattern will be corrected, as evidenced by a normal respiratory pattern, with no evidence of dyspnea noted.
The nurse will note that the use of diaphragmatic compression is evident, ABG values are within the prescribed ranges, and there is evidence of comfortable breathing, either vocally or by the patient’s conduct.

Nursing Interventions for Asthma	Rationale
Monitor the patient and take any necessary vital signs readings while he/she is in a state of distress.	During the first stage of hypoxia and hypercapnia, the BP, RR, and HR likely elevate. And when the patient’s condition deteriorates to the point where blood pressure and heart rate fall, respiratory failure might occur.
Evaluate the rate, depth, and rhythm of the patient’s breathing.	When the patient’s usual breathing pattern or rhythm changes, there is a strong probability that an impending ailment or disease state is developing; in particular, this may be an early warning sign of oncoming respiratory distress.
Determine the degree to which the patient is experiencing anxiety.	There may be a sense of panic when the patient is experiencing difficulty breathing adequately. Hence, assessing his/her level of anxiety would be beneficial in mitigating its course or progression.
Listen to the patient’s breathing and note any abnormalities, including any wheezes or stridor.	If unusual sounds persist, it could indicate a worsening condition or the emergence of new complications. It should be noted that patients with chronic respiratory issues like asthma may be more susceptible to lung infections (e.g., pneumonia).
Observe any signs and indicators of shortness of breath (dyspnea) that may present as retractions of the chest, excessive use of accessory muscle, and nasal flaring.	This is an essential indicator that the patient may be suffering from breathing issues as these are signs of possible respiratory distress. When there is significant inspiratory effort, the breathing pattern is noticeably altered due to difficulty pumping air into and out of the lungs.
Regularly monitor the patient’s oxygen saturation.	Oxygen saturation refers to the percentage of blood hemoglobin that is saturated by oxygen. 95-100 percent oxygen saturation is considered normal, and deviations within this baseline level indicate inadequate ventilation. It may arise from several causes, but it is often correlated with asthma if blockages are present (e.g., mucus) in the airway passage.
Regularly monitor the patient’s arterial blood gas (ABG).	Individuals who suffer from mild to moderate persistent asthma may be at risk of developing respiratory alkalosis. It is expected that the respiratory rate and depth will rise in the presence of hypoxemia. On the other hand, respiratory acidosis is a concerning finding since it often suggests that respiratory failure is on the way and that mechanical ventilation may be required in the near future.
Require the patient to have a dedicated rest schedule incorporated into his/her daily routine.	A common side effect of having an improper breathing pattern is exhaustion due to the additional work required to breathe normally. Metabolic rate and oxygen consumption rise with exercise, and for that reason, periodic rest between care activities should be incorporated.
Suggest to the patient to inhale and exhale via pursed lips.	When the patient breathes with his/her lips pursed, he/she is allowing more fresh air to enter the lungs while expelling old air they’ve been holding in.
Encourage calm, deep breathing while staying close to the client.	The nurse should inform the patient and any other important individuals that they are closely watching their situation and will intervene if necessary. Having a trusted and reliable person in the room can make the patient feel more secure; hence, reinforcing a support system.

Nursing Care Plan for Asthma 4

Anxiety

Nursing Diagnosis: Anxiety related to uncontrollable status shifts, secondary to asthma as evidenced by shortness of breath, restlessness, uneasiness, tachycardia, continuous requested presence in the room, and tachypnea.

Desired Outcome: The patient will demonstrate effective coping as evidenced by a reported decrease in the degree of anxiety and reduced anxiousness in the form of a calmer demeanor and more cooperative conduct.

Nursing Interventions for Asthma	Rationale
Observe the patient for symptoms of nervousness or anxiety such as: Visible signs of panic attacksTrepidation or fearfulnessRestlessnessUneasinessTachycardiaHands or feet that are either cold or sweaty Dyspnea	Asthma may also be exacerbated by anxiety. And when this happens, the patient tends to exhibit a fast, shallow breathing pattern.
Monitor the level of oxygen in the patient’s blood.	Oxygen saturation refers to the percentage of blood hemoglobin saturated by oxygen. 95-100 percent oxygen saturation is considered normal. Establishing the oxygen saturation level would provide baseline data on the patient’s risk of developing hypoxia which is often noted in asthma attacks.
Ensure the patient is at ease and comfortable by providing amenities like a quiet, peaceful space and soothing music.	Remaining calm and exerting less inspiratory effort makes breathing easier and conserves the patient’s energy equally.
Assist the patient in understanding each step of the process by thoroughly explaining the procedure clearly and concisely.	When the treatment plan is more understood, the patient’s anxiety may lessen. Consequently, the patient’s breathing pace is unlikely to change since he/she will be less apprehensive and concerned.
Maintain constant communication with the patient’s family and loved ones to keep them informed of the patient’s improvement.	Anxiety can readily be passed on from family members or significant others to the patient. A peaceful and stress-free environment is of utmost importance, especially when the patient is easily perturbed and troubled. Most likely, it would also ease certain risks of complications developing. Hence, disclosing information to family members would help alleviate their fears and anxiety. Making this step contributes to the promotion of a relaxing, stress-free atmosphere.
Assure the patient and anyone involved that he/she will be closely monitored and that immediate intervention will be made.	Having a trusted and reliable person in the room can make the patient feel more secure and at ease.
Observe the patient and support him/her by suggesting to take a slow, deep breath.	To enhance the patient’s health prior to any complications arising and to help him/her progressively calm down.
Suggest relaxation techniques for the patient to employ, such as gradual decrease of muscle tension using progressive muscle techniques, diaphragmatic breathing, pursed-lip breathing, guided imagery, and positive affirmations (e.g., relax, take a deep breath, and let go).	Asthma attacks can be triggered by panic episodes brought on by anxiety. Hence, techniques like deep breathing and meditation can help alleviate stress and anxiety.

Nursing Care Plan for Asthma 5

Health-Seeking Behaviors: Prevention of Asthma Attack

Nursing Diagnosis: Health-Seeking Behaviors: Prevention of Asthma Attack related to an expressed desire to avoid and correct situations impetus of asthmatic episodes, as evidenced by an increased interest for better control over health practices, the impact of environmental factors and behavioral factors on health, and an increase in the number of attacks

Desired Outcomes:

The parents and the patient will communicate their comprehension of the triggering agents that may induce an asthma attack.
Avoidance strategies will also be communicated effectively.

Nursing Interventions for Asthma	Rationale
Examine the patient’s medical history for information such as the incidence of respiratory illnesses, triggering determinants, and the kind of therapies or actions taken to improve the patient’s health.	Respiratory changes or infections can trigger asthma attacks, and determining its incidence can provide baseline information to keep the patient healthy.
Identify allergies in the patient’s family and what causes an attack, and the behaviors that ensue after the attack. Indicates whether there is a history of reactive airway diseases, eczema, allergic rhinitis, or urticaria within the family. In addition, it is not uncommon to link reactive airway illnesses to asthma, as it is used to describe suspected cases of asthma that have yet to be diagnosed.
Determine if the patient is taking any over-the-counter medications, and if so, what kind they are and what effects they are having.	Respiratory infections are often treated with over-the-counter drugs, and acquiring this information would help determine the kind of OTC medications that may interfere with prescribed medications and cause a worsening of therespiratoryconditions or attacks.
Inform the patient to maintain a safe distance or keep away from people with respiratory infections.	Respiratory infections are infectious, and they could potentiate and trigger asthma attacks. Inhaling aerosolized droplets could be avoided by taking preventative actions such as staying away from those who are unwell.
Encourage the patient to use tissues to cover the mouth while coughing or sneezing and properly dispose of tissues when he/she is done using them.	To prevent the spread of bacteria by inhalation of aerosolized droplets.
As a precaution, suggest to parents that they make changes to the patient’s home environment, such as changing filters to reduce exposure to dust and getting rid of common food allergens like peanuts and eggs.	To reduce the chance of an attack being triggered.
Explain the disease, its symptoms, as well as probable underlying causes that might trigger an attack.	Contains information that can be used to enhance the effectiveness of preventive measures. Adherence to prescribed treatment programs would be improved as patients would find it easier to include something they are familiar with.
Take the time to instruct the patient and parents on correct handwashing procedures and offer time for a follow-up demonstration.	Avoids the transmission of pathogens from close contacts, such as touching.
Contact local groups that can support and educate the patient.	These organizations provide assistance to families with an asthmatic child or family member.

Other Nursing Diagnosis

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon

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