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?

[mago8388]

Listen to breath sounds. Do they have wheezing? What triggers their asthma? Certain fragrances, pollen, certain chemicals, dust? Are they in any inhalers? For how long? How often do they use their rescue (albuterol) inhaler? If it's every few hours you know it's out of control.

[Nurse_AV]

It is always helpful to check past medical history as well as current medications. Don't forget to ask your patient about that medication list and how closely they follow their medication regimen (i.e. "When is the last time you used your emergency inhaler? How frequently were you using it before you came into the hospital?"). Auscultate and assess lung sounds, SpO2, respiration quality (including use of accessory muscles or not) and rate. Heart rate and blood pressure are also important here because if they are in respiratory distress, vitals change. Monitor trends. Arterial blood gases, skin turgor and absence or presence of cyanosis (peripherally or centrally - around lips, face, etc.) Long winded but I hope this helps!

[heinz57]

There are standardized assessments complete with a treatment plan for eacerbations published by the ATS and the Global Asthma Association which are now in almost every country in the world. Since asthma is so prevalent, your ER and where ever you care for asthma patients should have a policy for severity recognition and treatment for exacerbations. You need to be able to immediately identify severity before you get into all the usual history questions. Get the allergies. The last time they ate might be important but if they need to be intubated, they may not be able wait for that meal to digest. Suction should be ready as well as an OG. For the exacerbation severity assessment see the link below. (page 22)

Once the appropriate treatment is established, you can continue with the rest of the history. Find out the meds and ask the questions for the classification of severity category. See if the medications they are taking match up with their severity category. The patient might not be well controlled. But, most ERs don't care and will hand out just the usual Albuterol inhaler. The same for COPD. If the patient is depending on the ER for a physician due to lack of clinics which take crappy insurance or no insurance, you will see readmission.

But, first identify the distress (see page 22 link below). These can all be adapted to adults. Initiate treatment according to that distress level. Some facilities go to continuous nebulizers after the 1st treatment. Others do the 3 treatments. Someday for those 3 treatments more doctors will hopefully learn the benefit of MDIs instead of nebulizers. Heliox may also be an option. Some hospitals have an asthma treatment area with everything needed including someone (RN or RT) who is Asthma Educator - Certified. But every hospital should have an asthma exacerbation policy and the assessment should be well known.

http://www.ginasthma.org/local/uploads/files/GINA_Pocket_April20_1.pdf