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This Concept Map, created with IHMC CmapTools, has information related to: Acute Asthma Attack, Interventions/Rationales Administer humidified oxygen/ maintain satisfactory oxygenation Closely monitor oxygen saturations/ detect hypoxia Position for optimal lung expansion Reduce fear/anxiety to decrease respiratory efforts and oxygen consumption Outcomes: Respirations within normal limits with no decrease in oxygen saturation Disposition: Evaluation criteria- Patent airway, adequate exygenation and ventilation Absence of clinical indications of respiratory distress Absence of clinical indicators of hypoperfusion Absence of clinical indications of infection/sepsis Alert and oriented with no neurologic deficit Control of pain, discomfort, or dyspnea If met: discharge with instructions regarding: lifestyle modifications and need for pharmacologic therapy; recognition and avoidance of triggers increased fluid intake follow-up appt with PCP Return to ED for increased shortness of breath or worsening symptoms If NOT met: admission to PCU or CCU, Nursing Diagnosis: Risk for suffocation related to bronchospasm, mucous secretions, edema Goal: Pt will experience cessation of bronchospasm Interventions/Rationales: Establish IV access for medication/hydration/ administration of medications/fluids Administer bronchodilators/corticosteroids/ to relieve broncospasm Closely monitor VS Have emergency equipment available/ prevent delay in treatment, Nursing Diagnosis: Risk for suffocation related to bronchospasm, mucous secretions, edema Goal: Pt will exhibit normal respiratory function Interventions/Rationales Administer humidified oxygen/ maintain satisfactory oxygenation Closely monitor oxygen saturations/ detect hypoxia Position for optimal lung expansion Reduce fear/anxiety to decrease respiratory efforts and oxygen consumption, Continuing Assessment: ABG's, CBC, VS, RR & excursion, LOC, dyspnea level Assess predisposing factors Maintain airway, oxygenation, elevate HOB 30-45 degrees Pharmacologic therapies: Oxygen by NC 2-6L/min Albuterol/ipratropium bromide nubulizer Corticosteroids Additional therapy may include xanthines or magnesium Noninavasive ventilatory methods (BiPap) may be required to avoid intubation ???? Nursing Diagnosis: Risk for suffocation related to bronchospasm, mucous secretions, edema, Sudden onset dyspnea past one hour 2nd episode past month occurred during recess at school Using accessory muscles, elevating shoulders on inspiration Not relieved by prescription inhaler Audible inspiratory and expiratory wheezing, cough productive of thick mucous Sharp pain in lateral chest reported when coughing or moving Hyperresonance on percussion, high pitched wheezes throughout lung fields Able to speak only in short sentences Home Medications include albuterol inhaler Pulse: 140; RR: 48; O2 sat 82;cyanosis of nail beds; Appears anxious/restless Collborative Management Continuing Assessment: ABG's, CBC, VS, RR & excursion, LOC, dyspnea level Assess predisposing factors Maintain airway, oxygenation, elevate HOB 30-45 degrees Pharmacologic therapies: Oxygen by NC 2-6L/min Albuterol/ipratropium bromide nubulizer Corticosteroids Additional therapy may include xanthines or magnesium Noninavasive ventilatory methods (BiPap) may be required to avoid intubation, Nursing Diagnosis: Risk for suffocation related to bronchospasm, mucous secretions, edema ???? Nursing Diagnosis: Interrupted family processes R/T emergency hospitalization of child, Interventions/Rationales Keep parents informed of child's condition Encourage expression of feelings, especially regarding severity of condition and prognosis Allow parents to be with child as much as possible by encouraging family-centered care concepts Point out any improvement to encourage positive behaviors Outcomes: Family exhibits no sign of distress Disposition: Evaluation criteria- Patent airway, adequate exygenation and ventilation Absence of clinical indications of respiratory distress Absence of clinical indicators of hypoperfusion Absence of clinical indications of infection/sepsis Alert and oriented with no neurologic deficit Control of pain, discomfort, or dyspnea If met: discharge with instructions regarding: lifestyle modifications and need for pharmacologic therapy; recognition and avoidance of triggers increased fluid intake follow-up appt with PCP Return to ED for increased shortness of breath or worsening symptoms If NOT met: admission to PCU or CCU, 11 year old boy Presenting at the ED in respiratory distress Ht: 60 in; Wt: 88 lbs Hx significant for Asthma since age 3 Assessment Sudden onset dyspnea past one hour 2nd episode past month occurred during recess at school Using accessory muscles, elevating shoulders on inspiration Not relieved by prescription inhaler Audible inspiratory and expiratory wheezing, cough productive of thick mucous Sharp pain in lateral chest reported when coughing or moving Hyperresonance on percussion, high pitched wheezes throughout lung fields Able to speak only in short sentences Home Medications include albuterol inhaler Pulse: 140; RR: 48; O2 sat 82;cyanosis of nail beds; Appears anxious/restless, Nursing Diagnosis: Interrupted family processes R/T emergency hospitalization of child Goal: Family will experience reduction of anxiety Interventions/Rationales Keep parents informed of child's condition Encourage expression of feelings, especially regarding severity of condition and prognosis Allow parents to be with child as much as possible by encouraging family-centered care concepts Point out any improvement to encourage positive behaviors, Interventions/Rationales: Establish IV access for medication/hydration/ administration of medications/fluids Administer bronchodilators/corticosteroids/ to relieve broncospasm Closely monitor VS Have emergency equipment available/ prevent delay in treatment Outcomes: Child breathes more easily Child does not suffocate Disposition: Evaluation criteria- Patent airway, adequate exygenation and ventilation Absence of clinical indications of respiratory distress Absence of clinical indicators of hypoperfusion Absence of clinical indications of infection/sepsis Alert and oriented with no neurologic deficit Control of pain, discomfort, or dyspnea If met: discharge with instructions regarding: lifestyle modifications and need for pharmacologic therapy; recognition and avoidance of triggers increased fluid intake follow-up appt with PCP Return to ED for increased shortness of breath or worsening symptoms If NOT met: admission to PCU or CCU