Nursing Priorities for Asthma Exacerbation

This assignment focuses on using the clinical reasoning cycle to develop a care plan for a patient with acute exacerbation of asthma. It discusses the nursing priorities, interventions, and evaluation of the interventions. The assignment also addresses the patient's anxiety and lack of knowledge about asthma.

Running head: NURSING PRIORITIES
NURSING PRIORITIES
Name of the student:
Name of the university:
Author note:

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This assignment would mainly be incorporating the clinical reasoning cycle to develop
care plan for Simon after recognizing the nursing priorities as he is suffering from acute
exacerbation of asthma. This would help Simon overcome the threatening situation and live
better quality life. Simon is an adolescent who had been admitted to the emergency ward after he
faced an acute exacerbation of exercise induced asthma while he was playing sports in his
school. He had been admitted by his father who complained that the boy is casual with his
approach of taking inhalers and often misses them out. It was also noted that Simon used aspirin
after he had faced injuries which could have also contributed in triggering the asthma attack.
This assignment would first find out the nursing priorities following which nursing interventions
would be proposed. Accordingly, evaluation would be made about the intervention and then
reflection would be provided also.
When Simon had been admitted to the emergency unit, he was seen to suffer from
shortness of breath. He was also seen to suffer from cyanosis. Such troubled breathing might
signify the occurrence of asthma. In asthma, shortness of breath can be caused by the narrowing
of the airways. Studies are of the opinion that narrowing of the airways might occur because of
two important factors. The muscles that surround the airways might be seen to tighten up
resulting in a situation cause bronchospasms (Chapman et al., 2015). Another cause is that the
inflammation in the airways might make the immune system respond in ways by more and more
mucous production making the airways swelled and filled up with mucous. These prevents the
air to flow smoothly through the airways making individuals to provide extra effort to breath and
results in discomfort and breathlessness. Some of the symptoms like wheezing, chest tightness
and chronic cough are associated with the disorder. Simon was also found to be suffering from
such symptoms. Often diagnosing asthma and distinguishing it from the other lung disorders are

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extremely important and hence professionals need to undertake proper assessments on the
combination of the medical history as well as through physical examinations that would include
specific tests. The nurse while analyzing Simon’s mental health condition found out that he is
already diagnosed with asthma before for which he was prescribed inhalers. However, Simon
never used the inhalers properly. The nurses assessed that he was wheezing which is one of the
characteristic symptom of asthma. His respiration rate was high about 32 breaths per minute
which shows he was having difficulty in breathing when the normal rate of breathing is 12-18
breaths per minutes (Hoskins et al., 2016). Pulse oximetry was also conducted by nurses to
assess his present status of oxygen saturation and found it to be 88% when the normal oxygen
saturation level should be between 95 to 100%. Hence, it also helped the nurse to assess, oxygen
distribution in the body has been affected because of the breathing disability of the patient (Yeh
et al., 2016). The nurse can also link the lack of oxygen distribution in the body with the
symptoms of cyanosis that had been observed from initial physical examination of Simon.
Cyanosis can be explained as the medical condition where the patient is seen to suffer from a
condition of blue or green tint to their skin color as well as their mucous membranes. The red
blood cells in the body mainly carry the oxygen with the help of hemoglobin (Grape et al., 2018).
When the body becomes deprived of oxygen, the blood is seen to turn blue before returning to
the heart so that the blood can pull in oxygen from the lungs once again and return to the body.
Hence, the body is seen to develop bluish tinge resulting in cyanosis. Studies have found that
normally, the arterial blood is bright red because of the oxygen that it contains. Skin color is
mainly the combination of the skin pigmentation along with the color of the blood. When oxygen
levels are seen to decline, the blood will turn blue-red and insufficiency blood in the extremities
causes blue tinge of skin causing cyanosis (Merchant et al., 2016). Such symptoms of shortness

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of breath and occurrence of cyanosis are the result of exercise induced asthma. Simon was seen
to be playing sport when he was affected by the symptoms of asthma. The main goal for
treatment would be to manage the shortness of breath as well as cyanosis issues in Simon.
The nurse should use medication therapy for management of the symptoms of ineffective
breathing pattern in Simon. The nurse can prescribe and administer short acting beta-2
adrenergic agonist like that of albuterol. The main rationale is that short acting beta2 agonists act
as bronchodilators. They help in relaxing the muscles that line the airways which carry the air to
the lungs. This is found to be one of the best medications that help in treating acute exacerbation
of asthma just like the case where Simon all of a sudden had the asthma attack (Horner et al.,
2016). The nurse should be helping the patient to use the mouthpiece or the face mask with the
help of a nebulizer to take in the prescribed dose of the medication in the lungs. The treatment
starts in 5 to 15 minutes and should not be taken more than 4 times in the day. Teenagers can be
allowed to have two puffs at a gap of 4 to 6 hours for preventing bronchospasms (Miligkos et al.,
2015). Overdose of this medication can result in many side effects and hence, the nurse needs to
be very careful while administering this medication. These are dry mouth, tremors, fast
heartbeats, chest pain, nausea, seizure or convulsions, fainting and feeling of light-headedness
(Long et al., 2018). This medication would help Simon to overcome his symptoms of wheezing
as well as shortness of breath by working in the airways helping to open the breathing passages
and thereby relaxing the muscles. The second intervention that can be applied by the nurses to
manage the conditions of ineffective airway clearance and issue of breathlessness is the oxygen
therapy. Oxygen therapy is also helpful to overcome the symptoms of cyanosis helping the body
to gain back its natural colors by helping to distribute oxygen throughout the body (Brown et al.,
2016). Oxygen therapy would be mainly helping in the increase of the amount of oxygen that

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the blood carries. This increase in oxygen level would help in temporarily restoring the normal
levels of the blood gases and the tissue function for promoting the healing as well as in fighting
infection (Wenzel, 2017). The most common delivery methods that can be used are the nasal
cannula. It comprises of the tube that runs through both the nostrils. Some other delivery
methods that nurse can also apply for Simon can be the nonrebreather mask or the continuous
positive airway pressure (CPAP) (Mickel et al., 2017).
For effective evaluation about the success of the intervention, nursing professionals can
try to notice the presence of any tinges or coloration of Simon. This would help the nurse to
understand whether Simon’s body is still suffering from oxygen deficiency so that the status of
the organs can be understood – that is whether they are receiving sufficient amount of oxygen or
not (Togias et al., 2019). The nurses would also be assessing the respiratory rate and the depth
and rhythm for finding out whether Simon is still facing issues of the respiratory distress. The
nurse might also be ausculating the lungs to find out adventitious breathing sounds like that of
the wheezes (Pound et al., 2017). If the nurse still finds the wheezes, it would show that partial
obstruction of resistance is still persisting and that the bronchi would have retained the secretion
of the lungs.
Another nursing issue identified by the nursing professional in case of Simon is anxiety
as well as lack of knowledge about the disorder of asthma. Anxiety can be assessed when
patients are seen to go through vague and uneasy feelings of discomfort and restlessness. Simon
was assessed to be highly anxious and these can be attributed to a number of factors. One of
them might be the admission of Simon to the hospital emergency ward which is actually a
foreign environment for him and this might have increased his anxiety. His occurrence of
hypoxia and degradation of the health condition could have been another reason that have made

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him anxious (Gleason et al., 2016). Nurses need to assess anxiety in the patient and for this; he
might observe the feelings of fear, panic as well as uneasiness, tachycardia, restlessness and
shortness of breath among the patient. At the same time, the nurse should also assess the health
literacy level of Simon as well as his family members. Often low levels of health literacy can be
associated with higher levels of anxiety, fear and stress. They may be stated to have poor levels
health literacy because it seemed from the situation that they were not aware about the proper
management of the exacerbation of asthma (Parikh et al., 2018). Simon was seen to avoid using
the inhalers and this could be attributed to the fact that he might not have been aware how
nebulizers would help him to prevent exacerbation of asthma. Even his dad was casual in his
approach when discussing about his son’s apathy in taking nebulizers. Moreover, he was also not
educated about the triggers that could result in asthma attacks and hence he had participated in
sports without taking any precautions. They were not aware that exercises might act as trigger for
the asthma. Another issue that has also remarks about the lack of health literacy of Simon is the
taking of painkillers besides being vulnerable to asthma attacks. It has been found that certain
medications like Nsaids and ibuprofens result in inhibition of cyclooxygenase proteins (Koster et
al., 2015). Studies have not yet been able to clarify the reason why only certain asthma patients
are particularly sensitive to inhibitors. Hanley et al. (2016) are of the opinion that higher
production number of chemical called leukotrienes can play a key role in this context. In case of
asthma patients, more number of leukotrienes might be released in the bronchiole tubes by the
various allergy cells. This might be because the bronchiole muscles undergo spasms making
them swell. It is still not found why specific asthma prone individuals have higher number of
leukotrienes but others do not. Simon might not have been made aware by the professionals who
have been attended him previous time and this could have made him use the medication.

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Managing the anxiety of the patient and developing health literacy levels of the patient
and his family are the nursing goals. The nurse should first ensure providing a comfortable, calm
and quite environment for Simon also initiating soft music that would help him to relax. The
main rationale is that this intervention would help in developing calmness in him which would
help to reduce the consumption of oxygen and reduce the breathing work. Moreover, the nurse
should provide an education session to Simon and his family so that they can overcome the stress
about admittance to the healthcare emergency ward. Often anxiety of family members also get
transferred to patients and hence, nurses should also educate the family members in order to help
them overcome stress and learn proper ways of helping their son to live safe and better quality
life. The nurse should also be initiating breathing and relaxation therapies as this intervention
helps the patient to overcome anxiety (Paymon et al., 2018). These therapies can include muscle
relaxation and diaphragmatic and pursed lip breathing. The nurse should continually
communicate with the patient using phrases like “relax and let go” as this would be helping
Simon to overcome feelings of emotional and physical exhaustion and help in physical
relaxation. The nurse should also take the responsibility of developing as asthma management
plan for Simon which would include proper usage of the inhalers and nebulizers, the triggers that
should be avoided, the medications that should be avoided as well as the ways to identify
deteriorating conditions of asthma (Long et al., 2018). Proper usage of short acting
bronchodilators in times of exacerbation of asthma and the use of long acting bronchodilators
every day to control symptoms of asthma should be explained and their differences should be
also stated to the patient and his family.
The nurse needs to undertake effective evaluation of the interventions where she should
try to evaluate whether the patient is anxious or not and this can be known through

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communication only (Perry et al., 2016). The education level development in Simon can be
evaluated through either a teach-back method or may be assessed in the follow-up sessions
where the nurse would note down whether Simon is following the advices or not (Fuchs et al.,
2017).
I have realized the clinical cycle is one of the best critical decision making tool that
nurses can utilize to assess the various symptoms of patents and identify the most important
nursing priorities. With the help of the tool, I could not only identify the nursing priorities in
Simon but I can also think in a systematic manner and developed action plan that helped to
provide the best care to the patient. This cycle prevented me from feeling confused about my
approach and each of the stages guided me step-by step to fulfill all necessary action for helping
Simon to come out from danger and help him lead better quality lives.
From the abode discussion, it was seen that the Simon suffered from acute asthma attack.
Following the clinical reasoning cycle, two nursing properties that were identified were shortness
of breath and cyanosis and that of other was anxiety and lack of health literacy. Medication
therapy comprised of providing bronchodilators to help him overcome breathlessness and
oxygen therapy was provided to help him overcome cyanosis. Moreover, the nurses also
undertook interventions that helped in overcoming anxiety. Besides, health education session
was provided to Simon and his family so that they can manage symptoms and prevent further
exacerbation of asthma. Accordingly, interventions were provided to ensure better quality life of
the patient. It was seen that clinical reasoning cycle helped in providing a systematic framework
that enabled the nurses to identify the cues of the patient following which the pathologies were
associated. This helped in understanding the nursing goal and accordingly the nursing action

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plans were developed. In this way, the best evidence based care was provided to Simon that
helped him to live better quality lives.

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References:
Brown, K., Iqbal, S., Sun, S. L., Fritzeen, J., Chamberlain, J., & Mullan, P. C. (2016). Improving
timeliness for acute asthma care for paediatric ED patients using a nurse driven
intervention: an interrupted time series analysis. BMJ Open Quality, 5(1), u216506-
w5621. https://bmjopenquality.bmj.com/content/5/1/u216506.w5621.short
Chapman, S. C., Barnes, N., Barnes, M., Wilkinson, A., Hartley, J., Piddock, C., ... & Horne, R.
(2015). Changing adherence-related beliefs about ICS maintenance treatment for asthma:
feasibility study of an intervention delivered by asthma nurse specialists. BMJ open, 5(6),
e007354. https://bmjopen.bmj.com/content/5/6/e007354.short
Fuchs, O., Bahmer, T., Rabe, K. F., & von Mutius, E. (2017). Asthma transition from childhood
into adulthood. The Lancet Respiratory Medicine, 5(3), 224-234.
https://doi.org/10.1016/S2213-2600(16)30187-4
Gleason, M., Cicutto, L., Haas-Howard, C., Raleigh, B. M., & Szefler, S. J. (2016). Leveraging
partnerships: families, schools, and providers working together to improve asthma
management. Current allergy and asthma reports, 16(10), 74.
https://doi.org/10.1007/s11882-016-0655-0
Grape, A., Rhee, H., Wicks, M., Tumiel-Berhalter, L., & Sloand, E. (2018). Recruitment and
retention strategies for an urban adolescent study: lessons learned from a multi-center
study of community-based asthma self-management intervention for adolescents. Journal
of adolescence, 65, 123-132. https://doi.org/10.1016/j.adolescence.2018.03.004

10
NURSING PRIORITIES
Hanley Nadeau, E., & Toronto, C. E. (2016). Barriers to asthma management for school nurses:
An integrative review. The Journal of School Nursing, 32(2), 86-98.
https://doi.org/10.1177/1059840515621607
Horner, S. D., Brown, A., Brown, S. A., & Rew, D. L. (2016). Enhancing Asthma Self‐
Management in Rural School‐Aged Children: A Randomized Controlled Trial. The
Journal of Rural Health, 32(3), 260-268. https://doi.org/10.1111/jrh.12150
Hoskins, G., Williams, B., Abhyankar, P., Donnan, P., Duncan, E., Pinnock, H., ... & Sheikh, A.
(2016). Achieving Good Outcomes for Asthma Living (GOAL): mixed methods
feasibility and pilot cluster randomised controlled trial of a practical intervention for
eliciting, setting and achieving goals for adults with asthma. Trials, 17(1), 584.
https://doi.org/10.1186/s13063-016-1684-7
Koster, E. S., Philbert, D., Winters, N. A., & Bouvy, M. L. (2015). Adolescents’ inhaled
corticosteroid adherence: the importance of treatment perceptions and medication
knowledge. Journal of Asthma, 52(4), 431-436.
https://doi.org/10.3109/02770903.2014.979366
Long, G., Yue, L., Peng, Z., Xiong, G., & Li, Y. (2018). Clinical effects of nursing intervention
on severe patients in the respiratory. Biomedical Research, 29(5), 966-969.
https://web.a.ebscohost.com/abstract?
direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=0970938X&AN=12958
7931&h=5jyLY3gqRUZ7HesCCjqSkShxU0HSpi0uvUM5TzkHdwWX3lZgZwJsVxyGS
da%2b5YqupoZOcnQcs7N88kk6c3g0rg%3d
%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.a

11
NURSING PRIORITIES
spx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler
%26jrnl%3d0970938X%26AN%3d129587931
Merchant, R., Inamdar, R., Henderson, K., Barrett, M., & Van Sickle, D. (2016). Patient reported
value and usability of a digital health intervention for asthma. Iproceedings, 2(1), e36.
https://www.iproc.org/2016/1/e36/
Mickel, C. F., Shanovich, K. K., Evans, M. D., & Jackson, D. J. (2017). Evaluation of a school-
based asthma education protocol: Iggy and the Inhalers. The Journal of School
Nursing, 33(3), 189-197. https://doi.org/10.1177/1059840516659912
Miligkos, M., Bannuru, R. R., Alkofide, H., Kher, S. R., Schmid, C. H., & Balk, E. M. (2015).
Leukotriene-receptor antagonists versus placebo in the treatment of asthma in adults and
adolescents: a systematic review and meta-analysis. Annals of internal medicine, 163(10),
756-767. https://annals.org/aim/article-abstract/2443064/leukotriene-receptor-
antagonists-versus-placebo-treatment-asthma-adults-adolescents-systematic
Parikh, K., Keller, S., & Ralston, S. (2018). Inpatient quality improvement interventions for
asthma: a meta-analysis. Pediatrics, 141(5), e20173334.
https://pediatrics.aappublications.org/content/141/5/e20173334
Paymon, L. S., Riley, P., & Miller, B. (2018). caregivers' Perception of Asthma Control In
Children. Pediatric Nursing, 44(1), 17-37.
https://search.proquest.com/openview/fd22fa85e3ce986cc6a8a8b7f70e67dc/1?pq-
origsite=gscholar&cbl=47659

12
NURSING PRIORITIES
Perry, T. T., Rettiganti, M. R., Bian, J., Luo, C., Schellhase, D. E., Randle, S. M., ... & Marshall,
S. A. (2016). Utilization and outcomes associated with mobile-based asthma action plans
compared to paper asthma action plans among adolescents. Journal of Allergy and
Clinical Immunology, 137(2), AB100.
https://search.proquest.com/openview/9d0d0c810e609b7110983a73b681738f/1?pq-
origsite=gscholar&cbl=105664
Pound, C. M., Gelt, V., Akiki, S., Eady, K., Moreau, K., Momoli, F., ... & Kovesi, T. (2017).
Nurse-driven clinical pathway for inpatient asthma: a randomized controlled
trial. Hospital pediatrics, 7(4), 204-213.
https://hosppeds.aappublications.org/content/7/4/204
Togias, A., Gergen, P. J., Hu, J. W., Babineau, D. C., Wood, R. A., Cohen, R. T., ... & Liu, A. H.
(2019). Rhinitis in children and adolescents with asthma: Ubiquitous, difficult to control,
and associated with asthma outcomes. Journal of Allergy and Clinical
Immunology, 143(3), 1003-1011. https://doi.org/10.1016/j.jaci.2018.07.041
Wenzel, S. (2017). Treatment of severe asthma in adolescents and adults. UpToDate, Waltham,
MA: Wolters Kluwer Health. https://www.uptodate.com/contents/treatment-of-severe-
asthma-in-adolescents-and-adults
Yeh, H. Y., Ma, W. F., Huang, J. L., Hsueh, K. C., & Chiang, L. C. (2016). Evaluating the
effectiveness of a family empowerment program on family function and pulmonary
function of children with asthma: a randomized control trial. International journal of
nursing studies, 60, 133-144. https://doi.org/10.1016/j.ijnurstu.2016.04.013

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