Foundations of Care: Nursing Diagnosis and Intervention for Acute Severe Asthma

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Foundations of Care
Introduction
Nursing offers a critical opportunity for professionals in this area to enhance and promote
recovery care. This case study report illustrates patient case history, risk assessment, health
care admission, nursing diagnosis, nursing plans of care and nursing role in managing patient
disease state.
Case study
Jackson Smith, an 70-years-old male, admitted to the Emergency Department at 9 pm
with severe breathlessness. He has a history of asthma and he was diagnosed when he was
twenty five years old. On admission to the Emergency Department the clinical manifestations
were assessed as followed:
- Severe dyspnea, inability to speak sentences in one breath
- Respiratory rate of 32 breaths/minute
- SpO2 90%, on room air
- BP 150/85 mmHg
- A pulse rate of 130 beats/minute
- Auscultation of lungs identifies diminished breath sounds and widespread wheeze
A chest x-ray was performed and showed a clear and hyper-inflated lung field.
A blood gas was taken:
pH: 7.35
PaO2: 60mmHg PaCO2: 50mmHg HCO3: 25mEq/L Lactate: 1
SaO2 90%
A diagnosis of Acute Severe Asthma was made.
Patient’s risks assessment
Treatment delay and low dosage in asthma attack often adversely affects outcomes.
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Foundations of Care
Objective assessments are crucial in managing the severity of asthma. This is geared towards
prompt treatment. Assessment of acute asthma is paramount in assessing the level of severity.
Level of Severity Life-Threatening Asthma Features
Peak Flow Rate (PEF)
SpO2- Oxygen Saturation
Speech flow
Examination of the
Respiratory
Pulse rate
Blood pressure
PEF < 33% highly recorded
SpO2-oxygen saturation at <92%- less than
The patient has entered the coma stage and
unable to speak
Low respiratory balance
Bradycardia,
Low blood pressure
(British Thoracic Society, 2014)
Severe Asthma Features
Life-Threatening state
Peak Flow Rate (PEF)
Oxygen Saturation SpO2
Speech
Respiratory Examination
Pulse
BP
An absence of such level
Peak flow rate of 33–50% best or predicted
SpO2 >92%
Low speed in the completion of speech
Low Respiration Rate of >25 breaths/min
Low Pulse Rate at > 110 beats/min
Normal blood pressure
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Foundations of Care
(British Thoracic Society, 2014)
Objective assessments
Pulse Oximetry
Measuring of oxygen using pulse oximeter aimed at determining oxygen adequacy and
the requirement of measuring arterial blood gas assessment. It is aimed at maintaining the
SpO2 therapy at an estimate of 94%-98%. Among hypoxia patients, it is paramount to assess
another method of offering diagnosis, (Leefebvre et al, 2015).
PEF and PEV1
Assessment of the airway aides in improving the breathing process for the patient while
PEF or PEV1 are important parameters for assessing airway caliber.
Chest X-ray
Routine recommendations are done when there is suspicion of consolidation, non-
response to treatment, life-threatening asthma, and emerging consolidation.
Blood gas
Patients having SpO2 lower than 92%, whether he is on oxygen or not often require ABG
measurement. These assessments are linked to hyper carpenia, (Price et al., 2015).
The intake of inhaled β- agonist during the self-administration is often a good marker for
the severity of the acute attack and being a risk of poor outcome. Priority clinical assessment
for confirming the diagnosis is the assessment of the severity. The appearance of the patient
like the inability to talk, low respiratory rate and decreased heart rate is the basis of severity
clinical assessment. Increase in the pulse rate often is also associated with severe asthma state,
(Irazuzta, Paredes, Pavlicich & Domínguez, 2016).
Nursing intervention and outcome plan
Asthma condition is a lifelong condition which calls for effective self-care management.
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