Bronchial Asthma

Chronic inflammatory disorder of the airway, which characterized by hyper-responsiveness, mucosal edema, mucus production Inflammation obstruction from mucosal edema  reducing the airway diameter & contraction of bronchial smooth muscle First attack usually occur before the age of 5 years where some manifesting clinical S&S in infancy Classified into 4 categories based on the symptom indicators Intermittent, mild persistent, moderate persistent and severe persistent

Risk factors Family history Allergy Chronic exposure to airway irritants or allergens [grass, weed pollen, dust, dander, extreme temperature, strong odor, smoke, perfume] Emotional stress and anxiety Exertion Food additives [msg] Drugs

Clinical manifestation of asthma Cough – hacking, paroxysmal, irritative and non productive which gradually become rattling and productive of frothy, clear and gelatinous sputum Respiratory signs – SOB, prolonged expiratory phase, audible wheeze, may have red ears, lips may appear dark red which may progress to cyanosis which can also be observe from the nail beds. Restlessness, apprehension, prominent sweating as the asthma attack progress. Prefer sitting up right. Speaking with short, panting and broken phrases. Chest – wheeze sound throughout the lung fields, prolonged expiration Chronic cases – barrel chest, elevated shoulder, used of accessory muscle of respiration

Nursing assessment Assess the child’s condition (assess the severity) – [history of exacerbations, family, environment and family history] History [medical and medication allergy] Monitor the respiratory status for progression and evaluation [breath sound, vital signs, pulse oximetry, peak flow]

Nursing management Goals – maintain normal activity; maintain normal pulmonary function and prevent chronic symptoms and recurrent exacerbations, provide optimum drug therapy Promoting airway clearance Positioning [child’s comfort - usually up right position] Administer oxygen [face mask or nasal prong] as prescribe by doctor (ensure to know the safety precaution when administering oxygen) Close observation of vital signs IVI (I/O charting)  required to maintain adequate tissue hydration Less number of visitors Minimizing anxiety [information giving, understanding of the illness process and update of treatment and progress etc]

Health teaching Avoid allergen that precipitate asthma episodes Cautioned to avoid exposing a sensitive child to excessive cold, wind or other extreme weather; smoke, sprays or other irritants. Avoid food and medication known to provoke symptoms. Relieve bronchospasm – parents and child need to recognize early S&S of asthma attack. Child and parents need to have knowledge how to use the devices (nebulizer, spacer) correctly The child should be protected from a respiratory tract infection that can trigger an attack Deep breathing exercise and controlled breathing are taught and encourage Support child and family (need to learn how to control and cope with the asthma and live with normal life