{
  "name": "Asthma",
  "slug": "asthma",
  "url": "https://nursingplex.com/care-plans/asthma",
  "category": "Respiratory",
  "summary": "Reversible airway obstruction; trigger control, inhaler teaching and exacerbation management.",
  "nursing_diagnoses": [
    "Ineffective airway clearance",
    "Impaired gas exchange",
    "Anxiety"
  ],
  "overview": [
    "Asthma is a chronic inflammatory disorder of the airways marked by reversible obstruction and bronchial hyperresponsiveness. Exposure to a trigger sets off three simultaneous events: bronchospasm of smooth muscle, mucosal edema from inflammation, and thick mucus plugging. Air moves in more easily than it moves out, so the patient air-traps, the chest hyperinflates, and the work of breathing climbs steeply.",
    "Common triggers include allergens (dust mites, pollen, animal dander, mold), respiratory infection, cold dry air, exercise, tobacco smoke and strong odors, stress, gastroesophageal reflux, and drugs such as aspirin, NSAIDs and non-selective beta blockers. Identifying and removing the personal trigger set is as therapeutic as any inhaler.",
    "Severity ranges from intermittent symptoms to status asthmaticus — a severe attack that does not respond to standard bronchodilators and is a medical emergency. A crucial clinical warning: as an attack worsens, wheezing may disappear. A silent chest with rising respiratory rate, accessory muscle use and falling oxygen saturation means airflow is too limited to make sound, not that the patient is improving."
  ],
  "key_facts": [
    {
      "label": "Peak flow zones",
      "text": "Green is 80–100 percent of personal best (continue plan), yellow is 50–79 percent (use quick relief, follow the action plan), red is under 50 percent (rescue inhaler and seek emergency care)."
    },
    {
      "label": "Rescue vs controller",
      "text": "Short-acting beta-2 agonists such as albuterol relieve acute bronchospasm in minutes. Inhaled corticosteroids control underlying inflammation and must be used daily even when well."
    },
    {
      "label": "Inhaler sequence",
      "text": "When both are ordered, use the bronchodilator first, wait a few minutes, then the corticosteroid so the steroid reaches open airways."
    },
    {
      "label": "Steroid mouth care",
      "text": "Rinse and spit after every inhaled corticosteroid dose to prevent oral candidiasis and hoarseness."
    },
    {
      "label": "Danger sign",
      "text": "A silent chest, drowsiness, or an inability to speak in full sentences signals impending respiratory failure."
    }
  ],
  "nursing_priorities": [
    "Restore airway patency and adequate oxygenation during an acute attack.",
    "Reduce airway inflammation with scheduled controller therapy.",
    "Identify and eliminate personal triggers.",
    "Verify correct inhaler, spacer and peak-flow technique — poor technique is the most common cause of apparent treatment failure.",
    "Establish and rehearse a written asthma action plan.",
    "Reduce anxiety, which itself worsens bronchospasm and breathing pattern."
  ],
  "assessment": {
    "subjective": [
      "Chest tightness, breathlessness or a feeling of not being able to get air out",
      "Cough, often dry and worse at night or in the early morning",
      "Anxiety, restlessness or a sense of suffocation",
      "Reports of exercise-, cold- or allergen-triggered episodes",
      "Frequent rescue inhaler use — more than twice a week signals poor control"
    ],
    "objective": [
      "Expiratory wheezing, prolonged expiratory phase, or a silent chest in severe obstruction",
      "Tachypnea, tachycardia, accessory muscle use, nasal flaring and intercostal retractions",
      "Tripod positioning and inability to speak in complete sentences",
      "Falling peak expiratory flow rate against personal best",
      "Oxygen saturation below 90 percent, cyanosis, or a rising PaCO2 signaling fatigue",
      "Diaphoresis, thick tenacious sputum, hyperresonance on percussion",
      "Restlessness or drowsiness from hypoxia and hypercapnia"
    ],
    "related_factors": [
      "Bronchospasm, mucosal edema and excessive mucus production",
      "Airway hyperresponsiveness to allergens, infection, cold air, exercise or irritants",
      "Retained secretions and ineffective cough",
      "Anxiety and fear amplifying the breathing pattern",
      "Deficient knowledge of inhaler technique and controller therapy",
      "Nonadherence during symptom-free periods"
    ]
  },
  "goals": [
    "The patient maintains oxygen saturation above 92 percent with clear or improving breath sounds.",
    "Respiratory rate, effort and peak flow return to the patient's baseline before discharge.",
    "The patient demonstrates correct inhaler, spacer and peak-flow technique without prompting.",
    "The patient names personal triggers and a specific avoidance strategy for each.",
    "The patient verbalizes each zone of the written action plan and when to call for help.",
    "Rescue inhaler use falls to no more than twice a week at follow-up."
  ],
  "interventions": [
    {
      "title": "Support ventilation during an acute attack",
      "points": [
        "Place the patient in high Fowler's or an upright forward-leaning position to maximize lung expansion.",
        "Give oxygen as ordered and keep saturation above 92 percent, monitoring continuously.",
        "Administer short-acting bronchodilators by nebulizer or metered dose inhaler with a spacer promptly, then reassess breath sounds, rate and peak flow after each dose.",
        "Give systemic corticosteroids as ordered — they take hours to work, so early administration matters.",
        "Stay with the patient and speak calmly; panic increases oxygen demand and worsens the breathing pattern.",
        "Escalate immediately for a silent chest, rising PaCO2, drowsiness or exhaustion — these precede respiratory arrest."
      ]
    },
    {
      "title": "Clear the airway",
      "points": [
        "Encourage fluid intake as permitted to thin secretions.",
        "Teach pursed-lip breathing to keep small airways open through exhalation, and diaphragmatic breathing to reduce accessory muscle work.",
        "Coach controlled coughing after bronchodilator therapy, when airways are widest.",
        "Avoid cough suppressants and sedatives, which blunt clearance and respiratory drive."
      ]
    },
    {
      "title": "Teach medication use and technique",
      "points": [
        "Watch the patient use the inhaler rather than asking if they know how; shake, exhale fully, seal the lips, actuate while breathing in slowly, then hold ten seconds.",
        "Provide and encourage a spacer for every metered dose inhaler, especially for children and older adults.",
        "Reinforce that controller inhalers are daily maintenance and the rescue inhaler is for symptoms only.",
        "Have the patient rinse and spit after inhaled corticosteroids.",
        "Explain that tremor and palpitations after albuterol are expected and usually transient, but chest pain or a very rapid heart rate should be reported."
      ]
    },
    {
      "title": "Control triggers in the environment",
      "points": [
        "Work through a personal trigger inventory: pets, smoking in the home or car, dust, mold, scented products, cold air, and workplace exposures.",
        "Recommend allergen-proof mattress and pillow covers, weekly hot-water washing of bedding, and reduced carpeting and stuffed toys for children.",
        "Advise a scarf over the mouth in cold weather and pre-exercise bronchodilator use for exercise-induced symptoms.",
        "Encourage annual influenza vaccination and pneumococcal vaccine as indicated."
      ]
    },
    {
      "title": "Build the written action plan",
      "points": [
        "Establish the patient's personal best peak flow and record the green, yellow and red zone values on paper.",
        "Rehearse exactly what to do in each zone, including which medication, what dose and when to call.",
        "Give copies to school, work or daycare for children and adolescents.",
        "Review the plan at every visit and after every exacerbation."
      ]
    }
  ],
  "patient_teaching": [
    "Use your controller inhaler every day even when you feel completely well — it prevents the attack you never have.",
    "Keep your rescue inhaler with you at all times and check the dose counter.",
    "Rinse your mouth after steroid inhalers to prevent thrush.",
    "Track your peak flow daily and act on the zone, not on how you feel.",
    "Learn your triggers and remove them from the home, especially tobacco smoke.",
    "Get a flu shot each year and treat respiratory infections early.",
    "Warm up before exercise and use your prescribed pre-exercise inhaler.",
    "Go to the emergency department if your rescue inhaler does not help, you cannot speak in full sentences, your lips look blue, or your peak flow is in the red zone."
  ]
}