hi there! newbie here!

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Hi I'm Carmella from Pasay City. I'm a 3rd year nursing student from Emilio Aguinaldo College-Manila. I'm having problems regarding making a Nursing Diagnosis. Can someone help me to create a Nursing Diagnosis-particularly for asthmatic patients? I really have a hard time thinking of it!!! And also can someone help me on my RLE whenever I need help.

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Hello there!!! :welcome: Are you asking for a nursing diagnosis for Asthma? Do you mean Bronchial Asthma... I would recommend that you buy a NANDA Book, I'm using Sparks and Taylor's.. or doenges-moore..

Second thing, would be to know the pathophysiology of Bronchial Asthma.. There is an inflammation of the bronchial airways, due to a hypersensitivity reaction to certain agents, such as dust, pollens, etc..

Looking at your NANDA, your first priority would be an actual nursing diagnosis, or one that is actually present and is observable on your patient upon assessment...

One of the possible nursing diagnoses would be Ineffective Airway Clearance then the related factors...

I hope this helped you... I'm only a 4th yr nursing student though, so you might also want to ask some RNs....

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Specializes in med/surg, telemetry, IV therapy, mgmt.

hi, meigan091!

there is information on how to write a care plan and develop nursing diagnoses on these two threads on the nursing student forums of allnurses:

the first step in choosing a nursing diagnosis involves assessing the patient. any nursing diagnosis is always based upon the signs and symptoms the patient is having. these signs and symptoms are abnormal assessment items. depending on how thorough your assessment of the patient is will determine how well your care plan is going to attend to the patient's problems.

with asthma, the patient is, in general, going to have these symptoms in order as an asthma attack worsens:

  • hacking, non-productive cough (due to bronchial edema)
  • restlessness
  • diaphoresis
  • only able to speak in short, broken phrases
  • eventually the cough become productive of frothy, clear sputum
  • breathlessness
  • chest tightness
  • dyspnea (shortness of breath)
  • use of accessory respiratory muscles
  • hyperresonance
  • tachycardia
  • some mild systolic hypertension
  • inspiratory and expiratory wheezes
  • crackles (as spasm and obstruction worsen)
  • prolonged expiratory phase of respiration (due to bronchospasm)
  • mucusal edema
  • mucus plugging with mucus trapped behind airways that are narrowed or occluded
  • diminished breath sounds
  • cyanosis, lethargy, confusion and hypoxemia (as the patient proceeds to status asthmaticus or respiratory failure)

based upon one or more of these above symptoms being present, nursing diagnoses that would be appropriate to use, in priority order, would be:

  • impaired gas exchange (abnormal skin color, confusion, cyanosis, diaphoresis, shortness of breath, hypoxemia, tachycardia, abnormal blood gases) - this diagnosis is generally used when there is hypoxia, hypoxemia or the patient is getting close to it
  • ineffective breathing pattern (alterations in the depth of breathing, shortness of breath, orthopnea, prolonged expiratory phase of expiration, use of accessory respiratory muscles to breathe) - the act of breathing is not providing enough air
  • ineffective airway clearance (any kind of cough, ineffective cough, any kind of adventitious breath sounds, any kind of changes in the rate or rhythm of the respirations, difficulty speaking due to breathing, excessive sputum production) - this diagnosis is when the person is having difficulty clearing secretions from the respiratory passages in order to maintain a clear airway
  • fear (fear of suffocation or death) - threats to the self that the patient recognizes as dangerous
  • anxiety (obsessive tinkering with oxygen equipment, over attention to medication, treatment, physical symptoms) - warnings of impending danger causing patient to take measures to deal with threats

examples of a nursing diagnostic statements using the above nursing diagnoses for an asthmatic patient might be:

  • impaired gas exchange related to alveolar-capillary membrane changes as evidenced by cyanosis, lethargy, confusion and hypoxemia
  • ineffective breathing pattern related to fatigue as evidenced by prolonged expiratory phase of respiration, shortness of breath and the use of accessory respiratory muscles to breathe.
  • ineffective airway clearance related to airway spasm as evidenced by diminished breath sounds with inspiratory and expiratory wheezes and shortness of breath.
  • fear related to threat of suffocation as evidenced by increased excitement and statements of "i'm not getting enough air!"
  • anxiety related to fear of suffocation as evidence by patient constantly checking to make sure oxygen tubing is correctly positioned and asking what the setting of the oxygen flow is.

hope that gives you some help. it would be very useful to have a book of nursing diagnoses or care plans that include the nanda definitions, defining characteristics and related factors since nanda is very specific about how each of the nursing diagnoses should be used.

what is rle? here in the u.s. rle is an abbreviation for "right lower extremity". somehow, i don't think that is what you were referring to!

please check the nursing student forums and join the other students there. welcome to allnurses! :welcome:

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