- Cough

- Dyspnea

- Tight feeling in the chest

- Agitation develop as airway obstruction increases

- Patient is unable to talk

- Wheezing

- Breathing is rapid

- Thick and tenacious or sticky mucus is coughed up

- Tachycardia

- Hypoxia

- Respiratory alkalosis develops initially because of hyperventilation

- Respiratory acidosis develops in time, due to air trapping

- Severe respiratory distress is evident

- Respiratory failure is indicated by decrease in responsiveness and cynosis

Diagnostics:

-       Skin tests for allergic reactions are helpful in determining specific stimuli to be avoided

-       Spirometry – volume and duration of inhaled and exhaled air.

-       Bronchial challenge test – Pt breaths in metacholine or histamine. It causes constriction and narrowing of airways . Degree of narrowing can be quantified. Lower doses may aggravate the symptoms in people of preexisting asthma.

 

Medications:

- Self-administer a bronchodilator, usually a beta2 - adrenergic agent such as salbutamol (Ventolin). 
- These more specific drugs, which have largely replaced isoproterenol and epinephrine, act on receptors to relax bronchial smooth muscle but have minimal effects on the heart

- Glucocorticoids such as beclomethasone (Beclovent) may be administered by inhalation also, but are more effective in reducing the second stage of inflammation in the airways. This type of drug may be useful when chronic inflammation develops.

- Leukotriene receptor antagonists such as zafirlukast (Accolate) and montelukast (Singulair) block inflammatory responses in the presence of stimuli.

-  Cromolyn sodium is a prophylactic medication that is administered by inhalation on a regular daily basis.

Nursing interventions

- Assess respiratory status (lung sounds, respiratory, depth, presence/severity of wheezing, breathing pattern, use of neck or abdominal muscles) q1h after acute attack
- Assess sounds of cough (hacking, wet cough, dry cough etc) 
- Plan periods of rest between activities to reduce fatigue 
- Keep client in High Fowler's position to open lung bases and airways
 - Tell client to purse lips while exhaling
- Provide supplemental oxygen PRN
- Monitor arterial blood gases and pulse oximetry
- Check o2 saturation 
- Encourage fluid intake (2000-3000 ml/day) as tolerated to thin out sputum secretions
- Teach patient strategies for reducing anxiety
- Educate patient about triggers and make sure room does not contain triggers ( dust, pollen, animal fur)
- Obtain PQRSTAU of attacks
- Determine whether client smokes or not. If they do, discuss a smoking cessation plan with them
- Auscultate lung sounds - make sure they are not wheezing (closing airways) or any crackles (may have pneumonia) 
- If patient is having an asthma attack, stay with them and help with breathing and try to calm them down. Provide a relaxing environment after the asthma attack is over  

Clinical Manifestations: 
·         Signs & Symptoms: 

o   Flu-like cough, green mucus, high fever 

o   Chest pain, SOB 

o   Chills 

o   Headache 

o   Rusty mucus 

o   Aching chest muscles 

o   Rales to no breathing sounds 

o   Tachypnea for children<5 yrs. 

o   less likely to have fever in older adults 

Diagnostic Tests: 

·         Chest X-rays @ 3-4 sites 

·         Sputum test 

·         Spirometry 

·         Oximetry 

·         Blood tests for WBCs 

·         Urine sample 

·         Bronchoscopy 

 

Drugs of Choice and Nursing Interventions: 

·         Drugz :) : 

·         Antibioti1/cs (start off w/ broad spectrum) 

·         Aerosols/Inhaler (salbutamol) 

·         Antitussives 

·         Expectorants 

·         Nursing Interventions: 

·         Tripod position 

·         Humidifier 

·         More fluids 

·         Breathing and coughing exercises 

·         Good ventilation 

·         Nutrition 

·         Analgesics/ NSAIDs 

·         Thoracentesis