Nursing Care Plan for ASTHMA
ASSESSMENT NURSING DIAGNOSIS PLAN INTERVENTION
Related to Evidenced by
* Assess the client’s Ineffective Possibly evidenced by *Patient will maintain * Assess the client’s level of anxiety.
vital signs as needed Breathing Cough optimal breathing * Assess the relationship of inspiration
while in distress. Pattern related Cyanosis pattern, as evidenced by to expiration.
* Assess the to Swelling and Dyspnea relaxed breathing, normal * Assess for signs of dyspnea (flaring
respiratory rate, spasm of the Loss of consciousness respiratory rate or of nostrils, chest retractions, and use of
depth, and rhythm. bronchial tubes in Nasal flaring pattern, and absence of accessory muscle).
* Assess breath response to Prolonged expiration dyspnea. * Assess for conversational dyspnea.
sounds and inhaled Respiratory depth * Assess for fatigue.
adventitious sounds irritants/ infection/ changes * Monitor oxygen saturation.
such as wheezes and drugs/ allergies or Tachypnea * Monitor capillary blood gasses (ABG)
stridor. infection. Use of accessory * Maintain head of bed elevated.
muscles * Maintain head of bed elevated.
* Assess respiratory Ineffective Possibly evidenced by *Patient will verbalize * Auscultate lungs for adventitious
rate, depth, and Airway Abnormal arterial understanding of cause breath sounds (wheezes and rhonchi).
rhythm. Clearance blood gasses and therapeutic * Monitor and record intake and
* Assess for color related to Adventitious lung management regimen. output (I&O) adequately.
changes in the Bronchospasms/ sounds (Wheezes, *Patient will maintain * Monitor oxygen saturation using pulse
buccal mucosa, lips, Increased Rhonchi) airway patency as oximetry.
and nail beds. pulmonary Changes in evidenced by clear breath * Monitor chest x-ray results.
* Assess secretions/ respiratory rate and sounds, improved oxygen * Monitor laboratory results as
the effectiveness of Ineffective cough/ rhythm exchange, normal rate indicated: WBc, Potassium
cough. Mucosal edema Chest tightness and depth of respiration, * Monitor capillary blood gasses (CBGs).
* Assess the amount, Cough and ability to effectively * Encourage deep breathing and
color, odor and Cyanosis cough out secretions. coughing exercises.
viscosity of the Dyspnea; orthopnea * Administer IV fluids and medication as
secretions. Retained secretions ordered.
* Administer oxygen as ordered.
* Anticipate the need for HFNC,
intubation and mechanical ventilation.
* Assess the client’s Deficient Possibly evidenced by *Patient and significant * Explain the disease to the client and
knowledge of care Knowledge Absence of questions others will verbalize significant others.
for status related to Ineffective self-care knowledge of the disease * Instruct the client how to avoid
asthmaticus, as Chronicity of Inability to answer and its management and asthma triggers: Air pollution,
appropriate. disease/ Lack of properly community resource Allergens.
* Assess past and information available to help the * Educate the client about the warning
present therapies, sources/ Long- client in coping with signs and symptoms of an asthma
ASSESSMENT NURSING DIAGNOSIS PLAN INTERVENTION
Related to Evidenced by
* Assess the client’s Ineffective Possibly evidenced by *Patient will maintain * Assess the client’s level of anxiety.
vital signs as needed Breathing Cough optimal breathing * Assess the relationship of inspiration
while in distress. Pattern related Cyanosis pattern, as evidenced by to expiration.
* Assess the to Swelling and Dyspnea relaxed breathing, normal * Assess for signs of dyspnea (flaring
respiratory rate, spasm of the Loss of consciousness respiratory rate or of nostrils, chest retractions, and use of
depth, and rhythm. bronchial tubes in Nasal flaring pattern, and absence of accessory muscle).
* Assess breath response to Prolonged expiration dyspnea. * Assess for conversational dyspnea.
sounds and inhaled Respiratory depth * Assess for fatigue.
adventitious sounds irritants/ infection/ changes * Monitor oxygen saturation.
such as wheezes and drugs/ allergies or Tachypnea * Monitor capillary blood gasses (ABG)
stridor. infection. Use of accessory * Maintain head of bed elevated.
muscles * Maintain head of bed elevated.
* Assess respiratory Ineffective Possibly evidenced by *Patient will verbalize * Auscultate lungs for adventitious
rate, depth, and Airway Abnormal arterial understanding of cause breath sounds (wheezes and rhonchi).
rhythm. Clearance blood gasses and therapeutic * Monitor and record intake and
* Assess for color related to Adventitious lung management regimen. output (I&O) adequately.
changes in the Bronchospasms/ sounds (Wheezes, *Patient will maintain * Monitor oxygen saturation using pulse
buccal mucosa, lips, Increased Rhonchi) airway patency as oximetry.
and nail beds. pulmonary Changes in evidenced by clear breath * Monitor chest x-ray results.
* Assess secretions/ respiratory rate and sounds, improved oxygen * Monitor laboratory results as
the effectiveness of Ineffective cough/ rhythm exchange, normal rate indicated: WBc, Potassium
cough. Mucosal edema Chest tightness and depth of respiration, * Monitor capillary blood gasses (CBGs).
* Assess the amount, Cough and ability to effectively * Encourage deep breathing and
color, odor and Cyanosis cough out secretions. coughing exercises.
viscosity of the Dyspnea; orthopnea * Administer IV fluids and medication as
secretions. Retained secretions ordered.
* Administer oxygen as ordered.
* Anticipate the need for HFNC,
intubation and mechanical ventilation.
* Assess the client’s Deficient Possibly evidenced by *Patient and significant * Explain the disease to the client and
knowledge of care Knowledge Absence of questions others will verbalize significant others.
for status related to Ineffective self-care knowledge of the disease * Instruct the client how to avoid
asthmaticus, as Chronicity of Inability to answer and its management and asthma triggers: Air pollution,
appropriate. disease/ Lack of properly community resource Allergens.
* Assess past and information available to help the * Educate the client about the warning
present therapies, sources/ Long- client in coping with signs and symptoms of an asthma
