Bronchial asthma is an incurable disease. Her therapy for exacerbation is carried out in a hospital. In such cases, the role of a nurse in the treatment of bronchial asthma is to create the necessary conditions for the normalization of the patient’s condition.
This is especially true for children who find it more difficult than adults to cope with seizures. Therefore, the systematic implementation of all stages of the nursing process in bronchial asthma will have a beneficial effect on the overall course of therapy.
Features of the work of a nurse with patients with bronchial asthma
The provision of nursing care for bronchial asthma is associated with three types of interventions:
- Independent. Performed by the nurse on their own. This category includes procedures for measuring blood pressure and heart rate, assisting in the preparation of a dietary menu, etc.
- Dependents. Dependent nursing interventions are carried out only in agreement with the doctor who is currently treating the patient (for example, the prescription of certain medications).
- Interdependent. Interdependent interventions can only be carried out as part of a medical team. This includes getting advice from a specialist of another profile, conducting laboratory tests, etc.
The work of a nurse when interacting with patients with bronchial asthma is carried out in stages.
Aims and objectives of asthma nursing care
The main tasks of a nurse when caring for patients with bronchial asthma:
- timely response to the onset of an attack;
- provision of qualified assistance;
- identifying the causes of asthmatic attacks and the needs of the patient (information is used to provide the most effective solution to the patient’s problem);
- teaching the patient self-help skills that will help to cope with an attack in the absence of health workers.
There is only one goal: comprehensive relief of the asthmatic condition and assistance in overcoming an asthmatic attack.
Stages of the nursing process
In bronchial asthma, the nursing process includes the following steps:
- collection of information;
- identification of problem points;
- exclusion of diseases with similar symptoms;
- caring for a patient undergoing treatment in a hospital;
- fulfillment of medical prescriptions and tracking progress in treatment.
The result of all work should be an assessment of the effectiveness of the care provided.
Collection of information
The main subjective method of collecting information at the initial stages of treatment is a conversation with a patient. In this case, patients with bronchial asthma usually complain of the following manifestations of the disease:
- difficulty breathing;
- cough (getting especially bad in the morning and evening);
- fever (the onset of the disease is acute);
- shortness of breath;
- wheezing (observed periodically).
Also, relatives are interviewed for the presence of this ailment in order to confirm or refute the assumption that the appearance of asthma is associated with a hereditary predisposition.
Next, the nurse asks the following information about asthma attacks:
- how often they are repeated;
- under what circumstances;
- what are provoked;
- how intense can be;
- whether they pass without outside interference (if not, what medications are used).
She also clarifies whether the asthmatic has an allergy.
Objective methods of data collection include examination of the patient at the time of the attack. In this case, the patient has the following symptoms:
- loud breathing, accompanied by wheezing and whistling;
- swelling of the wings of the nose;
- cyanosis (blue skin) in the area of the nasolabial triangle;
- paroxysmal cough;
- discharge of viscous sputum;
- the characteristic position of the body (the patient sits, resting his hands on a horizontal surface).
Also, the sister’s duties include measuring the patient’s blood pressure and pulse.
As a result, based on the data obtained as a result of interviews and examinations, the nurse, together with the attending physician, must draw up a plan according to which the patient will be provided with assistance in solving problems and the necessary care.
First of all, we are talking about problems with ensuring vital needs:
- limited menu (if it was revealed that food allergens influenced the development of asthma);
- attacks of suffocation and shortness of breath that interfere with normal breathing;
- sleep disorders associated with nocturnal asthmatic attacks;
- restrictions on physical activity (physical activity can provoke choking).
The socio-psychological aspect is also taken into account:
- general depression due to the fact of the presence of the disease;
- fears associated with the possibility of a sudden onset of another attack;
- problems with communication (due to the fact that shortness of breath increases during a conversation, and strong emotions provoke attacks of suffocation);
- limited ability to work (work associated with physical or emotional stress, contact with allergens, asthmatics are contraindicated);
- the development of depression due to the impossibility of self-realization.
In addition, a withdrawal into illness can be observed: a person requires special care and assistance, even if there is no attack or other problems, believes that because of the illness he cannot take care of himself on his own.
In short, the main problem of a patient with bronchial asthma is the inability to fully satisfy the need:
- in food;
- in a dream;
- in breathing;
- good rest;
- in communication.
The task of the nurse is to help the patient overcome these difficulties.
Monitoring patients in a hospital setting
During the period when the patient is in hospital, the nursing process is aimed at stabilizing the patient’s condition. For this purpose, the regime of the day, nutrition, leisure of the asthmatic is monitored, and favorable living conditions in the ward are provided.
If necessary, the nurse provides additional care for the patient when he is eating or performing hygiene procedures (usually this applies to children). It is also required to fulfill the prescriptions of the attending physician and note how effective the treatment is.
Organization and control over compliance with the regime
This type of interaction with patients refers to independent interventions and includes conversations with the patient himself (if he is an adult) or his parents (if it is a child).
During the conversations, the patient (or his parents) is provided with information:
- about possible causes of asthma development;
- about the features of therapy;
- the need to follow the doctor’s recommendations;
- about possible methods of preventing complications.
It is also often necessary to convince an asthmatic person and his family that treatment in a hospital setting, the implementation of all the rules and appointments is really necessary.
In order to prevent a worsening of the condition of patients, it is necessary to make sure that they and their relatives are well aware of how important it is to follow a hypoallergenic diet, not only while in the walls of a medical institution, but also after discharge.
Organization of comfortable conditions and control
The nurse provides the patient with a comfortable living environment in the ward by monitoring:
- timeliness of wet cleaning;
- systematic airing;
- the regularity of bed linen change.
In addition, the room should be calm and quiet. This will normalize the patient’s sleep.
With the patient (and his parents, if it is a child), conversations are held regarding the rules and the need for hygiene procedures. Relatives are asked to bring the patient:
- toothpaste and brush;
- clean changeable linen.
You should also recommend that the family of an asthmatic person undergoing treatment in a hospital provide him with books or other things that can distract and brighten up his leisure time. This is especially true for children, who must actively explore and explore the world even during the period of treatment. Also, one should not forget about the patient’s need for communication.
In the case of a child, observation continues while he is eating, dressing, etc., so that if difficulties arise, the nurse can provide him with the necessary assistance in a timely manner.
Fulfillment of doctor’s prescriptions
An important component of the nursing process in bronchial asthma is basic therapy. The nurse should not only follow the doctor’s recommendations exactly, but also draw the ward’s attention to how important it is to take medication. He is also informed about the possible side effects of drug therapy.
In addition, the nurse:
- teaches the patient the skills of keeping a self-control diary and the use of inhalation devices;
- accompanies the patient to diagnostic measures;
- provides all possible psychological support to asthmatics and their relatives;
- closely monitors the condition of the ward in order to timely recognize the side effects of the use of drugs;
- notifies the attending physician about the ineffectiveness of the prescribed therapy (if any) and asks to correct the appointment.
The duties of a nurse include regular surveys of the patient regarding his well-being. In addition, she daily:
- listens to the patient’s complaints;
- measures his body temperature;
- determines the number of heartbeats and respiratory rate;
- controls the state of asthmatics during attacks of shortness of breath and coughing.
The deteriorating patient’s condition must be immediately notified to the treating doctor.
With proper nursing care, treatment ends with improvement followed by discharge from the hospital. However, in order to avoid exacerbations and complications, even being at home, the patient must follow all the doctor’s recommendations.
Help for attacks and status asthmaticus
One of the important steps in the nursing process is helping during asthmatic attacks.
If the patient experiences suffocation, the nurse should do the following:
- eliminate the allergen that caused the allergic reaction, in this case choking (if any);
- use a bronchodilator ;
- give the patient a hot alkaline drink;
- make a mustard foot bath.
If, after all the measures taken, the attack has not stopped, then the patient with bronchial asthma is given an antihistamine (antiallergic) medicine and sympathomimetics are injected subcutaneously.
Moderate to severe seizures are treated with intravenous glucocorticoids. This manipulation is carried out only in a hospital setting and under the supervision of a doctor. These measures will help prevent possible serious consequences.
However, nursing care for bronchial asthma is not limited to this. Sometimes therapeutic actions do not give the desired result, and the attack continues continuously for several days or is repeated again after a short but tangible relief.
This indicates that the patient’s bronchi are clogged with mucus, which can lead to the “silent lung” syndrome and the subsequent development of status asthmaticus. The latter is a severe form of suffocation due to diffuse impairment of bronchial patency.
People with status asthmaticus are not helped by medications that were previously effective. Moreover, they can even worsen the patient’s condition. Therefore, the nurse must act calmly and quickly:
- prohibit asthmatics from using a pocket inhaler;
- offer a hot alkaline drink;
- make the patient as comfortable as possible;
- provide a supply of humidified oxygen.
In the absence of help, the patient’s condition will worsen until the patient falls into a coma or dies.
Features of management of children with bronchial asthma
The implementation of nursing care for bronchial asthma in children has a number of features:
- the conversation with the patient is always conducted in a convincing, but soft and calm tone (this helps to avoid the appearance of fear, which will provoke choking);
- a relationship of trust is built between the nurse and the child;
- parents are taught how to cope with panic during asthma attacks in a child, tune in to prompt help and relieve an attack on their own;
- during suffocation, the child is not only given a sitting position, but also additionally supported;
- for inhalation, drugs with salbutamol are used .
In addition, a nurse needs to be especially careful with children during an attack of hypoxia, which is often accompanied by a sharp drop in blood pressure. If such a symptom is detected, it is recommended to administer to the patient intramuscularly stimulants of the central nervous system.
Taking proper care of the patient allows for faster improvement in his condition. After being discharged from the hospital, the asthmatic should still be regularly monitored by the attending physician – allergist and therapist (or pediatrician, if we are talking about a child).
The prepared patient should be able to cope with fear of suffocation and know what actions to take at the time of the attack. He should also know how and when medications should be used, what effect (including side effects) they have.
On the eve of discharge, the nurse additionally instructs the ward on healthy and balanced nutrition, and also gives recommendations regarding the observance of the daily regimen. An important point is to test the patient’s ability to use a pocket inhaler.