ASTHMA REACTIVE AIRWAY DISEASE – Bronchial asthma is characterised by bouts of dyspnoea as a result of temporary narrowing of bronchi due to bronchial spasm, mucosal edema and thick secretions. It is caused due to hyper-reactivity by bronchial tree to a variety of stimuli. Asthma may be extrinsic or allergic is. when symptoms are induced by hyperimmune response to the inhalation of a specific allergen. It may be intrinsic asthma or non-allergic type in which symptoms are produced in response to non-specific factors in the environment.
The exact etiopathogenesis is not known but there are some excitatory factors and predisposing factors which are as follows:
Excitatory Factors of ASTHMA REACTIVE AIRWAY DISEASE
i) Allergic factorslAllergy to certain foreign substances:
a) Inhalants like pollen, smoke, dust and powder
b) Foods like egg, meat, wheat and chocolate
c) Drugs like aspirin and morphine
ii) Respiratory infections
iii) Emotional disturbances like “row” with the siblings or the parents and fear of punishment
v) Change of climate
i) Heredity: A family histroy of asthma or some other allergic disorder is usually present
ii) Childhood infections like measles and pertussis
iii) Constitution: Asthmatics are high stung, emotional and intelligent
The major pathologic mechanism responsible for airways obstruction.
Asthma are caused by following (i) Spasm of smooth muscles of bronchi, (ii) Edema of bronchial mucosa, (iii) Increased secretion and accumulation of tenacious mucus within lumen of the bronchi and bronchioles. As a result of this the resistance to outflow increase, manifesting as reduction in forced expiratory volume and flow rate.
Airway closes prematurely during expiration which results in hyperinflation of lungs and increase in functional residual capacity, Patient has to breath in while the lungs are already hyperinflated and then there is a marked distress in breathing and compliance of lung is decreased. Initially the patient tries to hyperventilate and therefore arterial PC02 rises. As the compensation by buffering mechanism fails, PH of blood falls causing respiratory acidosis, All the obstructive processes interfere with ventilation and result in the characteristic symptoms of coughing, shortness of breath, and wheezing.
The clinical features have sudden onset and often occur at night. These include restlessness, polyuria, marked, dyspnoea, Expiratory, Wheezing, cyanosis, sweating, etc.
Assessment of child with bronchial asthma may reveal following clinical picture: The onset of symptoms may be sudden and proceeded by asthmatic aura which is characterised by feeling of tightness in the chest, restlessness, polyuria or itching and/ or a spell of coughing.
A typical attack of asthma consists of marked dyspnoea, bouts of cough and chiefly expiratory wheezing, cyanosis, pallor, sweating exhaustion and restlessness. Pulse is rapid invariable , fulminant attack subsides in an hour to three hour , sometimes with coughing and vomiting up of vicid secretions.
Children with severe bronchial asthma over a longed period may devlop a barrel shaped chest deformity. Asthmatic attacks last over 2 to10 days, then there is an interval of freedom which may vary from few days to few months.
Diagnosis of Asthma: It is confirmed from clinical features and history of allergic disorder in family prior to the attack of wheezing, dysponea and cough. Investigations include blood examination which shows eosinophilia. Chest X-ray shows patchy atelectasis and generalized emphysema. In some cases allergy test or pulmonary function test may be needed.
During acute attack, control bronchospasm by administration of adrenaline, Turbutaline, steroids, inhalation therapy by Metered dose inhalor (MDD), aerosol therapy, mild sedation and expectorants to remove secretions.
Nursing Management of ASTHMA REACTIVE AIRWAY DISEASE
Provide Emotional Support and Educaiion
The child who has acute episode of asthma is anxious, frightened, fatigued and uncomfortable due to respiratory distress, frequent coughing, loss of sleep etc. It is the responsibility of the nurse to explain carefully the implication of illness to child and the family and explain all the procedures. You need to allay the anxiety and minimise social and emotional trauma and child should be addressed quietly and calmly. External stimuli should be reduced as much as possible. Parents should be given specific instructions for follow up care of the child.
Administer Adequate Fluids
The children having asthma episode are usually dehydrated. The child may have fluid and electrolye imbalance due to decreased fluid intake, increased respiratory effort, abdominal discomfort, vomiting and insensible water loss from hyperventilation and perspiration. As soon as the child’s condition improves or permits, oral fluids may be started which should be offered in small and frequent amounts as tolerated by the child. Over eating should be discouraged as this may induce vomiting and worsen the situation.
Child needs to be provided with period of uninterrupted rest because they are usually exhausted from breathing effort.
Evaluate Respiratory Status
Your responsibility as a nurse is to make continuous assessment of respiratory functions and you must observe for presence of cyanosis, quality of inspiratory breath sounds, use of accessory muscles of respiration, the intensity or absence of wheezing and cerebral functions. These should be documented and informed.
Humidified Oxygen is administered to the child. Younger children are usually placed in mist tent and for older children nasal cannula is preferred. Nurse needs to monitor the response to therapy, give mouth care and nasal care. Prevent chills to the child if in tent by changing bed linen and clothes frequently.
Give Proper Position and Physiotherapy
The child’s head should be raised and supported with pillows, because the child is better able to breathe in a sitting position due to respiratory distress. If the child feels more comfortable in leaning forward, a table to lean or a pillow should be provided to the child. Faulty posture of child should be corrected to facilitate normal breathing. Relaxation and breathing exercises are helpful. Steam or ultrasonic mist inhalation followed by postural drainage may be useful in dislodging tenacious mucus.