Asthma is a chronic inflammatory disease of the airways, that causes hyperresponsiveness, increased mucus production and mucosal oedema.
What this means is that Asthma is a long-term condition where the body has an extreme allergic reaction to environmental factors such as dust, pollen or animal dander. When triggered, this reaction causes inflammation in the airways which in turn causes excessive mucus production and swelling of the airways.
In these notes, we’ll be going over the Nursing Assessment for Patients with Asthma, as well as the medical tests required to determine the severity and secondary complications of Asthma. But before getting into that, make sure that you’ve understood the:
Nursing Assessment for Asthmatic Patients Part 1: Health History
Since Asthma is a chronic illness, it’s important to take a step back and understand when it started, and what is triggering it. Start by introducing yourself to the patient, and find a private area to initiate the assessment. Once the patient is comfortable, you can start by asking about their Exposure to Risk Factors. Specific questions about the type, intensity and duration of exposure will give you a clear indication of what triggered the condition. You might want to ask:
Whether the patient smokes or is around second-hand smoke
If they came across high pollen areas, mould, animal dander, air pollution or occupational dust
How often were they exposed to the allergen?
How long have they been exposed to it?
If they currently have any respiratory infections or other viral infections?
You should also ask questions to evaluate how controlled the patient’s condition is. Check if their symptoms have been:
Disturbing their sleeping patterns
Affecting their daily activities, work or sports
Needing quick-relief medication, or if they’ve used it more frequently than usual
Driving them to seek medical attention at the ED or GP
Next up, you should ask your patient about their past medical history specifically about any previous hospitalisation, respiratory conditions, including allergies, sinus infections or nasal polyps. This should also include their closest family relatives, so note down the patient’s family history concerning respiratory illnesses.
Lastly, you should ask questions to understand the patient’s knowledge and current management about the condition as well as their social and familial support system.
Once you’ve obtained a thorough medical history, you can move on to the physical assessment to get a better understanding of the patient’s physiological status.
Nursing Assessment for Asthmatic Patients Part 2: Physical Assessment
Before starting, take a quick look at your patient’s position, both when sitting and standing. If their asthma is flaring up they might rest their hands onto their knees to support their breathing. Then, you can take their hands and check:
Record everything onto the patient’s file and move on to assessing their Respirations:
Are their respirations forced?
Can the patient finish off a sentence in one breath?
Are they contracting their abdominal muscles, or using their shoulders during inhalation?
Is the expiration time prolonged?
Can you note any unusual breath sounds? (Wheezing/ Crackles)
Some patients will present with a Cough, if you note that it’s productive you should also assess their Sputum in terms of colour, amount and consistency.
Along with the physical assessment, there’s a series of tests that the patient will be asked to perform. These tests will determine the severity of the disease and guide the medical team when selecting the treatment.
Nursing Assessment for Asthmatic Patients Part 3: Medical Tests
Pulmonary Function studies will confirm the diagnosis, its severity and monitor the disease progression.
Spirometry evaluates the level of airflow obstruction and the reversibility of obstruction after the use of bronchodilators.
Arterial Blood Gases check the baseline oxygenation and gas exchange. Respiratory alkalosis (low PaCo2) is the most common early finding in patients with ongoing asthma exacerbation because of hyperventilation
Chest X-ray will exclude any alternative diagnoses.
Sputum or blood test could indicate elevated levels of Eosinophils
Serum Blood test will check for elevated levels of IgE antibodies.
In a few quick words, here is the Nursing Assessment for Asthmatic Patients
Assess the exposure to allergens, past medical and family history, the presenting symptoms and how they interfere with the patient’s life.
Assess the patient’s vital signs and check the patient’s respiratory patterns, cough and sputum.
Pulmonary function tests, Spirometry, ABGs, Chest X-ray, Blood/ Sputum test for Eosinophils and Serum Blood test for IgE levels.