help with my assignment

As with any patient you need to prioritise their needs. ABCDE. A-Airway the most important, in asthma the airway is constricted so your nursing focus is clearing the airway/meds to open up the air passages. B-breathing. C- Circulation. D-Deformity and E- Events i.e. what led to the asthma attack in the first place was is missed doses of meds etc. You can't move onto the next step without securing the ones before it. Psychological care would also be important with this patient as it is very distressing for them. Try to imagine a phsyical patient and the clinical findings they would experience and work from there.

The top priority for establishing nursing priorities is ALWAYS (a word rarely used in nursing!) the ABCs

1. Airway, Breathing, Circulation --you will be focusing on the "B" of course-- what nursing interventions will promote effective breathing (elevate HOB, administer bronchodilators, etc)

Now read through the patho again -- what do you see as most important for a patient with asthma once you've made sure they have a patent airway, have stabilized their resp status and cardiovascular status (bp, pulse) are normal?

Now look at what you as a nurse are doing for the patient-- you'll be administering meds as ordered. You don't have to know what to order but you do have to know how to administer them safely and and evaluate response/adverse effects? That's huge-- after the ABCs, always think SAFETY -- and for the patient with asthma, safety is related to safe administration of meds.

Now that the patient is breathing, you have given meds safely to stop the acute attack, how will you help the patient/family prevent recurrence or manage their asthma? Education-- teaching, teaching, teaching.

Get out your med/surg text and reread asthma-- focus on the nursing interventions from the ABC/safety/education format. I bet you'll get it quickly.

Hope that helps.

hi all,

firstly i want to thank you for taking the time to reply. i have found all of your replies very helpful.

so would i be correct to focus on 1.restoring an effective breathing pattern, 2.assessing and monitoring effectiveness of treatment, and 3.patient education prior to discharge for my three nursing priorities??? would these headings be appropiate and worded correctly??

phil:):)

Hmmm, when they say priorities are they talking about general nursing actions such as watching vital signs, administering and evaluating outcomes of treatment, education or are they more talking about prioritising the nursing diagnoses and interventions?

would i be correct to focus on 1.restoring an effective breathing pattern, 2.assessing and monitoring effectiveness of treatment, and 3.patient education prior to discharge for my three nursing priorities?

I would've thought that assessing the effectiveness of treatment is part of restoring an effective breathing pattern. It happens concurrently as you titrate the dose etc.

The way I understand the question, I would list some nursing diagnoses, then pick the main three and use them as my treatment priorities. But you really need to speak to whoever marks your assignments to find out what exactly they want in that section.

If you look at it as general nursing priorites (as you did), it might be assessing the patient's symptoms, performing the interventions (including evaluation), and educating the patient. Or you could break it up into physical (assessment, treatment, evaluation), psychological (pt may be quite anxious d/t not being able to breathe) and educational (re medication, asthma management plan, explain physiology of asthma adapting language to the pt's understanding, no medical jargon.)

I recommend you clarify that part of the assignment with your tutor. If you need to choose 3 diagnoses and prioritise them, you could either choose the 3 most urgent ones, or you could put a psychological and/or educational one in there, as then you are covering a more holistic approach (and the lecturers love that!)

Don't forget to put something in there about the asthma management plan, and emphasise supporting the pt to self-manage their chronic condition at home (primary health care-prevention is better than cure-another pet topic of lecturers in this day and age.)

Good Luck!

hi all,

thanks again for responding. i reall appreciate it. i think what my tutors mean when they ask for nursing priorities, is the actual or potential problem the patient may have, and then to prioritise the problems accordingly and discuss the nursing care involved.

in light of this i was wondering if i should consider the following; 1.the potential problem of developing respiratory failure, due to airway obstruction ( due to inflammation and bronchoconstriction) and ventilation/perfusion mismatch (due to air trapping in the alvoli, due to airway obstrction) therefore causing hypoxeamia and hypercarbina, resulting in acidosis, and possibley death; therefore the nurse must have bedside ready for intubation if needed, administer O2 to keep stats > 92%, administer meds including B2 aganosist and steriods to reduce inflammation and bronchocostriction, listen for reduced breathing sounds, which may suggest that the patients condition is worstening, if possible get patient to sit in the up-right position, teach pursed-lip expiration (allows for blowing of more CO2), reduce patients anxiety by remaining calm and at the patients bed...ect. 2, the potential problem of patient not responding to treatment and therefore the patients condition worsening, therefore the nurse must assess and monitor effectiveness of treatment through subjective observation i.e is the patients resuming a more effective breathing pattern, does the patient have retractions or using accessory muscles and objective measures ie. O2 stats, peak flow monitoring after meds, ABG's, ect; patient has actual poblem of knowledge deficit regarding condition and medication, therefore the nurse must educate re. inhaler technique, difference between meds., ie.preventitive meds (Inhaled Corticosteriods) and reliver meds (B2 agonists), importance of taking preventive meds daily (to reduce inflammation in the bonchial tree), and thus controlling asthma more effictively...

im wondering if im along the right track here, would really appreciate some feedback

I have found one of the biggest helps for me when I am working on any special assignments is to contact my local hospital or doctor office that deals with the area I am working on. They always have so many handouts, pamphlets, etc. that have such valuable information...and facilities are always ready to provide that info. to students...at least here they are.

potential problems are never a priority. actual problems are always attended to first. list the signs and symptoms of a patient having an acute exacerbation of asthma. translate those into your 3 nursing priorities.

• impaired gas exchange (see impaired gas exchange)
  
• ineffective breathing pattern (see ineffective breathing pattern)
  
• ineffective health maintenance, or deficient knowledge, asthma management (see ineffective health maintenance or deficient knowledge (specify))
  

i second that. in the case that you ever use potential problems as n.ds, they always go at the bottom. you need to look at what is most likely to make the patient deteriorate or die. so any education diagnoses go near the bottom as they are not immediate. follow abcde - airway (obstruction), breathing , circulation (bleeding, pulse), disability (neurological, fractures.)

as i said before, you don't have to pick the 3 top priority n.ds, you just pick 3 and then prioritise those. so you could pick ones from different realms (educational, physical, psychological) or pick the three main asthma nds as above.