how would a nurse assess acute exacerbation of asthma?

[CNS2b11]

Im a nursing student and i am pretty confused.

Would a nursing assessment be things like taking past medical history, taking clinical observations, and asking a patient to do a peak flow?

or is that what a doctor would do?

[vintagemother, BSN, CNA, LVN, RN]

I'm a student, and certainly not an asthma specialist. But I think one of your priorities would be to assess spO2, as well as rate and rhythm of resps. Also, I'd look for signs of labored breathing such as sternal and intercostal retractions.

[CNS2b11]

thank you:)

[ProgressiveActivist, BSN, RN]

The old adage that goes the worse they sound the better they are holds true. Listen with your stethoscope. You hear wheezes when the airways are contricted. If they sound tight -which means they are not moving air - that person is in trouble. So wheezes are better than not moving any air

at all. Make sense?

[CNS2b11]

yeah thank you very much. But does the nurse look at past medical history and the current meds that the patient takes? or do nurses purely assess by looking at vital signs and appearance of patient

[JustBeachyNurse, LPN]

Acute exacerbation would be brief history, asthma action plan but patient appearance, lung sounds, vital signs, work of breathing, use of accessory muscles if they maxed out on rescue medicines.

Physical assessment is the priority

[Jrhemming]

yeah thank you very much. But does the nurse look at past medical history and the current meds that the patient takes? or do nurses purely assess by looking at vital signs and appearance of patient

Of course you have to look at past medical history and current meds. Known allergies, what brought on symptoms, ect. That way when you get the m.d. Orders and they order something wrong you catch it. If you give or do something that harms the patient it falls on you. Even if the doctor ordered it.

[4boysmama]

yeah thank you very much. But does the nurse look at past medical history and the current meds that the patient takes? or do nurses purely assess by looking at vital signs and appearance of patient

of course the whole picture is important, including meds and pmh. however, if you have someone in front of you who is struggling to breathe and the have asthma, your first priority is going to be focused respiratory physical assessment. the most important thing is going to be to assess breathing, respiratory rate, use of accessory muscles, lung sounds (are there equal sounds? inspiratory/expiraratory wheezing? anywhere there's no sounds - meaning they're completely closed? stridor? cyanotic? SPO2?) are they panicking/having a sense of impending doom? All of those will keep you in to exactly how emergent this situation is, and ho quickly you need to get the doc in and initiate treatment (per protocol, if your facility has them, you can start before doc even lays eyes on the pt)

[applesxoranges, BSN, RN]

Im a nursing student and i am pretty confused.

Would a nursing assessment be things like taking past medical history, taking clinical observations, and asking a patient to do a peak flow?

or is that what a doctor would do?

It depends on your role and facility.

As a triage RN, I would listen to lung sounds and either rush them back or ask the detailed history while getting vitals depending on how they looked and sounded. I've listened to lung sounds in a waiting room before.

Peak flow may be something I've had occuhealth RNs do when I was fitted for my firefighter scba but in my ER, the respiratory therapy people deal with that. I've never done one for a patient and have no real desire to learn.

[blondy2061h, MSN, RN]

Often in a moderate to severe attack you won't be able to get a peak flow.

I'm not sure if your talking about a clinic or an emergency department setting, but in an emergency setting interventions would be obtaining IV access, drawing labs as ordered (blood gas, d dimer, BNP, chemistries, and CBC. Maybe cardiac enzymes), administering nebs, oxygen, steroids, and other meds as order, and teaching.

For teaching- think asthma action plans, maintenance med use, nebulizer use, peak flow testing at home, and asthma flare prevention.

[Altra, BSN, RN]

Physical assessment including auscultation, reviewing past history and current meds, and obtaining a peak flow reading as additional assessment data are all within the nursing scope of practice.

OP, context is important -- think about your scenario more fully. Where are you picturing the patient seeking care? Clinic? Emergency department? Is the patient already admitted to a hospital inpatient unit or other care facility? Care setting dictates interventions that are immediately available, and so drives the plan of care.

[emtb2rn, BSN, RN, EMT-B]

Wheezing, neb, wheezing, neb, solu-medrol, wheezing, neb, mag, wheezing, not wheezing, not moving air, tubed.