Help for my asthmatic patient!

[jen826]

Let me start off by saying I'm a very new nurse- graduated in June and started my job in August. So with that being said, I had a patient this week that was admitted for asthma exacerbation. I did my morning assessment on this patient who seemed to be doing okay. I gave my morning meds to this patient (which included Solu-medrol, among others), and went about my day. About 1/2 hour later, I went to check on my patient, and she was increasingly having difficulty breathing, wheezing throughout, and very anxious (which is understandable).

So, I look at my patients PRN's, and she had a couple breathing treatments available. I called respiratory and they inform me that they gave her a breathing treatment an hour ago, so she would have to wait until at least 2 hours between treatments.

I didn't know what to do at this point. My patient is not necessarily struggling, but very uncomfortable. My preceptor told me to just wait until she was due again for a treatment. I felt like I couldn't do anything to make my patient better. I was stuck in between a rock and a hard spot. I know there are many different reasons to hold the treatment and wait 2 hours, but goodness... I felt like the worst nurse because I couldn't do anything. My hands were tied.

This really frustrated me, so I thought I would vent. Thanks!:typing

[VivaLasViejas, ASN, RN]

As someone who suffers from asthma too, I've learned lots of tricks over the years to help both myself and my patients when breathing treatments aren't enough.

One thing that helps is positioning. When your patient is struggling to breathe, place the bedside table over the bed at a comfortable height and put a pillow on it. Encourage the patient to rest her head and arms on the table, a position that helps to expand the rib cage. I've seen lots of people who'd been unable to sleep for days during an asthma attack, rest comfortably and fall asleep in this position.

Another trick is to give LOTS of fluids, preferably warm fluids, which help thin secretions and rehydrates the patient---struggling to breathe tends to dry us out pretty quickly. Warm fluids also dilate the air passages, especially if they contain a little caffeine which is a mild bronchodilator. Ice cold drinks, on the other hand, tend to make the airways more twitchy, and soda is the worst thing you can drink during an asthma attack since the bubbles cause gas, which distends the stomach and thus compresses the lungs.

Also, you should teach the patient to use pursed-lip breathing, which is like blowing out a birthday candle, only you have them exhale very slowly and deliberately. This helps to control hyperventilation and the associated anxiety, balance CO2 levels, and reinflate the alveoli.

And if all this fails and your patient is STILL in distress, check her SpO2 levels and nail beds, listen to the lungs, and note any retractions. Sometimes asthma patients require continuous nebs, or more frequent treatments than every 2-4 hours; also, you can ask the patient's doctor for a mild anxiolytic such as Ativan, which can decrease the anxiety without depressing respirations too much.

Hope this is helpful to you.

[wg56180]

I agree with the above. Ensure the patient's spO2 is adequate, position the patient in tripod or elevate head of bed, use medications like morphine or lorazepam to decrease anxiety/air hunger, and call the md for a more frequent PRN order. Good luck!