Asthma: Pathophysiology, Management, and Nursing Care

This assignment provides a detailed overview of asthma, focusing on its pathophysiology, clinical manifestations, and both medical and nursing management approaches. The document begins by describing the basic characteristics of asthma, including the constriction of bronchiolar smooth muscle, swelling of the bronchial mucosa, and thickened secretions. It then explores the clinical manifestations, diagnostic measurements (including pulmonary function studies and ABG analysis), and medical management strategies, such as the use of beta2-adrenergic agonists, corticosteroids, supplemental oxygen, and IV fluids. The document also addresses nursing management, emphasizing the importance of actively assessing the airway, monitoring the patient's response to treatment, and providing supportive care to address dehydration and promote comfort. The assignment is based on the case of Tik Jordyn, a 54-year-old male diagnosed with Type II Diabetes Mellitus, including his medical history and prescribed medications.

Asthma
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Pathophysiology of Asthma
 The basic characteristics of asthma (constriction
of the bronchiolar smooth muscle, swelling of the
bronchial mucosa, and thickened secretions)
decrease the diameter of the bronchi and are
apparent in status Asthmaticus

Pathophysiology of Asthma

Clinical Manifestations
 The clinical manifestations are the same as those seen in
severe asthma: labored breathing, prolonged exhalation,
engorged neck veins, and wheezing.
 However, the extent of wheezing does not indicate the
severity of the attack. As the obstruction worsens, the
wheezing may disappear, and this is frequently a sign of
impending respiratory failure (Smeltzer et al., 2010).

Point to Note
Rising PaCO2 to normal or higher is a
danger sign, signaling respiratory failure
in cases of Status Asthmaticus

Diagnostic Measurements and
findings
 Primarily pulmonary function studies and ABG
(Arterial Blood Gas) analysis are performed.
Pulmonary function tests are the most effective
way of assessing acute airway obstruction.
 Respiratory alkalosis is the most common finding

Medical Management
 Initial treatment: beta2-adrenergic agonists, corticosteroids,
supplemental oxygen and IV fluids to hydrate patient.
Sedatives are contraindicated (Hilarie et al., 2010).
 High-flow supplemental oxygen is best delivered using a partial
or complete non-rebreather mask (PaO2 at a minimum of 92 mm
Hg or O2 saturation greater than 95%).

Medical Management Cont.
 Magnesium sulfate, a calcium antagonist, may be administered to
induce smooth muscle relaxation.
 Hospitalization if no response to repeated treatments or if blood
gas levels deteriorate or pulmonary function scores are low.
 Mechanical ventilation if patient is tiring or in respiratory failure
or if condition does not respond to treatment.

Nursing Management
The main focus of nursing management is to actively assess
the airway and the patient’s response to treatment. The
nurse should be prepared for the next intervention if the patient
does not respond to treatment (Donna et al., 2010).
 Constantly monitor the patient for the first 12 to 24 hours,
or until status Asthmaticus is under control.

Nursing management Coninuation.
 Blood pressure and cardiac rhythm should be
monitored continuously during the acute phase and
until the patient stabilizes and responds to therapy
 Assess the patient’s skin turgor for signs of
dehydration; fluid intake is essential to combat
dehydration, to loosen secretions, and to facilitate
expectoration.

Nursing Management Cont.
 Administer IV fluids as prescribed, up to 3 to 4 L/day,
unless contraindicated.
 Encourage the patient to conserve energy.
 Ensure patient’s room is quiet and free of respiratory
irritants (eg, flowers, tobacco smoke, perfumes, or
odors of cleaning agents); non-allergenic pillows should
be used.

References and Further Reading
1. Donna D. Ignatavicius & Workman. M.L (2010) Textbook of medical
surgical Nursing. Patient-centred collaborative care; 6th Edition.
2. Hilarie Surrena (2010) Handboook for Brunner and Suddarth’s
textbook of medical-surgical Nursing (12th ed.) Philadelphia:
Lippincott Williams & Wilkins.
3. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010).
Brunner and Suddarth’s textbook of medical-surgical Nursing (12th
ed.). Philadelphia: Lippincott Williams & Wilkins.