Nursing Plan of Care: Asthma Patient Analysis and Interventions

This report presents a detailed nursing plan of care for a 32-year-old chronic asthmatic patient, Rosie Jarmen. It begins with an analysis of the patient's assessment using the DRABC model, considering symptoms like coughing, wheezing, tachypnea, and elevated vital signs. The report identifies three key nursing priorities: airway management, respiratory monitoring, and anxiety reduction. Specific nursing interventions are then discussed for each priority, including ensuring a clean environment and proper positioning to facilitate breathing, regular respiratory monitoring, and strategies for reducing patient anxiety. The report concludes by emphasizing the crucial role of nursing interventions in managing the patient's condition and improving health outcomes, supported by relevant references from books and journals.

Nursing Plan of care

Table of Contents
INTRODUCTION...........................................................................................................................1
Analysis of patient’s assessment and findings considering situation and diagnosis using
DRABC........................................................................................................................................1
Identification of three nursing priorities of the patient................................................................2
Specific nursing intervention for identified priorities.................................................................3
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6

INTRODUCTION
Nursing intervention refers to actual treatment and actions that can performed on the patient
to reach the set goals related to health care. The report discusses regarding a 32 year old patient
who is chronic asthmatic patient since childhood. Th three nursing priorities that have been
identified for it are, Airway management, Respiratory monitoring and Anxiety reduction.
Nursing interventions for the same will also be discussed in the report in detail.
Analysis of patient’s assessment and findings considering situation and diagnosis using DRABC
The case discusses regarding Rosie Jarmen, a 32 years old woman who is suffering from
chronic Asthma since childhood. She has been facing symptoms of coughing and wheezing
where she is not able to get relief from Ventolin inhaler at home. Currently, she is on regular
intake of Budesonide. Physical examination stated that she has tachypnoea which is related to
short of breath. Both inspiratory and expiratory wheezed can be noticed through the chest sound.
She is being able to speak only short sentences and using her accessory muscles to breathe.
White Sputum can also be noticed in her cough.
The doctor generally involve in examining nasal passage with the help of chest
auscultation. It is the place where wheezing sound can be heard with the help of stethoscope.
Common tests performed by the doctor include Chest X-ray and Complete Blood Count (CBC).
For further examination process, doctors also opt for Pulmonary Function Test (PFT) and Peak
Expiratory Flow Rate (PEFR). Level of nitrogen oxide level while exhaling in also examined
along with sputum eosinophilia (Butcher and et.al., 2018).
Observation stated that her temperature is 38 degrees Celsius which is a bit higher than
the normal one. Heart rate is 115 which is 15 beats higher than the normal one. Monitoring the
blood pressure stated that it is also at an increased level which is 160/90. The normal rate for
same is 80/120. Respiration breath per minute is 33 which must be 12 to maximum 20 in a
normal individual. It was also stated that her father also died due to complications of asthma at a
young age.
It shows that she has been facing acute symptoms of asthma and high blood pressure
which are considered to be chronic medical indications and require effective steps to be taken by
health care professionals so as to bring condition of patient under control (Brown and et.al.,
2017).
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The orders of health care professional states that she must be given with 2 to 4 puffs of
salbutamol in every 2 hours. 1 puff of Atrovent in every 4 hours is recommended and if no
improvement in found in the patient then she should be given intra vienal Hydrocortisone of
100mg,.
Analysis of Rosie’s condition is made with the help of DRABC model, which stands for
Danger, Response, Airways, Breathing and Circulation. It is important to assess the situation
before taking up any type of action.
 Danger: Short breathlessness and increase in respiratory breath per minute are the main
signs to assess that whether the individual has been facing any type of asthma attack or
not. In such cases, it must be ensured that patient is not in casualty. It will help in
controlling and analysing the situation in one go (Kirkman, 2013).
 Response: Check the consciousness of Rosie. If it is not sure that the patient is conscious
or not, then such case, one should try to bring her in consciousness through sprinkling of
water and shaking.
 Airways: In order to open the airways, one hand must be put on the casualty’s forehead
while gently tilting their head backwards. It will help in moving casualty’s tongue
backward away from the mouth so as to ensure that there is no choke in it. Breathing: Breathing is another important aspect to be considered while handling an
asthma patient. Look, feel and listen to the patient’s breath for maximum 10 seconds in
order to assess that whether the patient is breathing normally without any kind of
obstruction or not. Inflation and deflation in the chest must be felt by analysing the signs
of breathing (Toussaint and Berry, 2013). Circulation: Blood circulation is another essential aspect to be noticed by health care
professional and assess that whether adequate amount of blood is pumped out by the
heart to body or not. Checking pulse of the individual helps in assessing the amount of
pumped blood. Hence, in that case, Rosie’s pulse can help in assessing blood circulation
level in the body.
Identification of three nursing priorities of the patient
Asthma is a kind of disease which is required to be managed unless it can lead to sudden
death of the patient as well. Nurse plays an important role in managing issue as they are people
who are 24 hours near the patient and can help in performing practices that can assist in better
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dealing with issue. There are certain nursing priorities that are required to be ensured by nurse as
and when any type of asthma patient arrives in the hospital. In case of Rosie, following nursing
priorities must be ensured by the nurses so that better treatment can be extended: Airway management: Rosie may not be able to breathe properly and hence, require hospital
environment to be airy and clean as well. It will help in controlling all the allergic reactions
that can crop up easily in an Asthma patient and can make her difficult to breath. In the
hospital environment, there are higher chances of an individual in deteriorating her health
(Lehne and Rosenthal, 2014). Since, Asthma is a chronic inflammatory disease of lungs, the
airways of patient become hyper responsive to certain triggers, inclusive of pollution, pollen
grains, animal fur, dust mites, etc. Exposure to these triggers can lead an individual to
bronchoconstriction and airway inflammation as well. It can also lead to infiltration of
inflammatory cells that can cause accumulation of these particles in the airways, creating
obstruction in breath. The characteristics of asthma can get aggravated due to this aspect
where patient may face excessive mucous formation, wheezing and cough and breathlessness
(James, Nelson and Ashwill, 2014). Hence, goal of the nurse is to provide an environment to
the patient that can help her in cleaning the airways Respiratory monitoring: People who suffer from chronic asthma require repeated monitoring
of vital signs at a regular interval. Monitoring respiratory rate is one of the most vital sign
which is useful for patients who have been admitted in ICU. It is generally calculated with
the help of LM35 temperature sensor based upon voltage value inhaled and exhaled in air. It
can help in controlling the symptoms of asthma and can also play an important role in
restricting them from getting worse. Hence, the objective of nurse is to ascertain fluctuations
in respiratory rate that can take place in the patient (Dunphy and et.al., 2015). Anxiety reduction: Another aspect that is directly related to the condition a patient may be
facing is, anxiety reduction. It can cause stress due to the obstruction that the patient may be
continuously facing. Researcher have been able to suggest that people who face asthma may
likely to have higher chance to have anxiety during this process as well. Anxiety can also
lead to aggravation in Asthmatic symptoms in the patient which are required to be controlled
by the nurse.
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Specific nursing intervention for identified priorities
The three nursing priorities that have ben identified to be carried out by the nurse are,
Airway management, Respiratory monitoring and Anxiety reduction. Hence, nursing
intervention are to be practiced by nurse so as to bring the condition of Rosie under control. The
interventions criteria are discussed below:
 Airway management: In order to ensure effective air management in the hospital, it is the
duty of nurse to ensure that hospital is appropriately clean with no dust particles and
clean air can be circulated in Rosie’s body. There must not be large number of people
present in the room so that she can get adequate space to breathe. To ensure this aspect,
nurse can provide oral care to the patient in every four hours. She can also encourage
increased intake of fluid for up to 3000 ml / day. Nurse must teach appropriate ways of
coughing and breathing to the patient. Optimal sitting position, allow use of abdominal
muscles for more forceful cough and instructing her to take long deep breaths can help in
maintaining air way in the patient (Engelke, Swanson and Guttu, 2014).
 Respiratory monitoring: It is another important aspect that is required to be considered
by the nurse, while treating Rosie as she is constantly wheezing and coughing.
Monitoring respiratory system will effectively help in re3ducign the complications
involved in Asthma as appropriate actions will be taken by health professional team,
immediately. Monitoring respiratory patterns is inclusive of rate, depth and efforts put by
the patient in breathing along with addressing secretions in airways (Asthma Monitoring:
How To Use An Asthma Action Plan For Better Control, 2012). The nurse can position
Rosie, where elevation in bed by 45 degrees, repositioning it in every 2 hours in order to
optimize proper respiration in her air ways. Limiting the entry of other individuals in the
room with upper respiratory infection is to be taken care of by the nurse while responding
to respirations of Rosie. The same can then be communicated to health care
professionals so that adequate changes can be brought in medical treatment for early
recovery (Baird, 2015).
 Anxiety reduction: Anxiety is another major issue that can generally be seen in Asthma
patients which ultimately leads to aggravation of the symptoms. It arises due to
anticipation of danger which is required to be controlled by nurse in Rosie. Using calm
and slow peace and talking normally to the patient can help in brining the condition under
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control. Relaxation, deep breathing skills, positive visualizations and reassuring self-
statement can help in making a positive impact over the patient’s condition. Interacting in
peaceful manner can help in brining the condition of Rosie under control (Nettina, Msn
and Nettina, 2013).
CONCLUSION
From the above report, it can be concluded that, nursing interventions plays an important
role in bringing the condition of patient back to normal. A scenario of Rosie has been considered
who has been brought to emergency department due to constant wheezing, coughing and high
respiratory rates. The report outlines regarding various steps that can taken by nurses to bring the
condition of the patient back to normal. Three nursing priorities that has been discussed in the
report are, Airway management, respiratory monitoring and anxiety reduction.
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REFERENCES
Books and Journals
Baird, M. S., 2015. Manual of Critical Care Nursing-E-Book: Nursing Interventions and
Collaborative Management. Elsevier Health Sciences.
Brown, D. and et.al., 2017. Lewis's Medical-Surgical Nursing: Assessment and Management of
Clinical Problems. Elsevier Health Sciences.
Butcher, H. K. and et.al., 2018. Nursing Interventions classification (NIC)-E-Book. Elsevier
Health Sciences.
Dunphy, L. M. and et.al., 2015. Primary care: Art and science of advanced practice nursing. FA
Davis.
Engelke, M. K., Swanson, M. and Guttu, M., 2014. Process and outcomes of school nurse case
management for students with asthma. The Journal of School Nursing. 30(3). pp.196-205.
James, S. R., Nelson, K. and Ashwill, J., 2014. Nursing care of children-E-book: principles and
practice. Elsevier Health Sciences.
Kirkman, T. R., 2013. High fidelity simulation effectiveness in nursing students’ transfer of
learning. International Journal of Nursing Education Scholarship. 10(1). pp.171-176.
Lehne, R. A. and Rosenthal, L., 2014. Pharmacology for Nursing Care-E-Book. Elsevier Health
Sciences.
Nettina, S. M., Msn, A. B. and Nettina, S. M., 2013. Lippincott manual of nursing practice.
Lippincott Williams & Wilkins.
Toussaint, J. S. and Berry, L. L., 2013, January. The promise of Lean in health care. In Mayo
clinic proceedings (Vol. 88, No. 1, pp. 74-82). Elsevier.
Online
Asthma Monitoring: How To Use An Asthma Action Plan For Better Control. 2012. [Online].
Available through <http://www.safetreatmentsforasthma.com/asthma-monitoring.html>
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