Bronchial Asthma

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Bronchial Asthma
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• 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 SS in
  infancy
• Classified into 4 categories based on the symptom
  indicators
• Intermittent, mild persistent, moderate
  persistent and severe persistent

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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

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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

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Nursing assessment

• Assess the childs 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

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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 childs 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

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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 SS 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

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