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Diane M Kerr
To create a holistic care plan the nurse must first compile the individual assessment data
collected from the patient and analyze the information to identify problems. The patient's needs
must be determined, and an appropriate plan of care will be created for the individual. The
holistic plan of care for this particular patient includes goals, projected interventions,
Several abnormal findings and needs are noted after reviewing the holistic assessment
data collected from the patient. The comprehensive care plan for the patient focuses on
preventing hypersensitivity reaction, controlling allergens, maintaining patency of the airway and
single, living with her fiance, and employed as a 3rd-grade teacher. The patient has asthma and
her current medications include several inhalers. Subjective data includes allergies to tree nuts,
dust, pollen, and mold. The patient states that she has been having exacerbations of asthma that
seem to be related to activity and anxiety. She voiced concern because she is exposed to
secondhand smoke because live in boyfriend smokes in the home. Physical assessment of
respiratory system indicates diminished breath sounds in all lung fields and wheezing noted in
the left posterior lung. Complete background patterns and subjective information were collected
that revealed problems and areas of need within her environment. The patient mentioned that the
live-in boyfriend smokes in the home and she was unaware of the importance of cleaning the
homes ventilation system. After assessing social and occupational areas of the patient
exacerbation of asthma attacks or exercise-induced asthma is noted due to cold air and physical
activity with children at the workplace. The psychological and emotional assessment indicates
Various problems are evident with this patient. The patient's first issue involves
ineffective breathing pattern as evidenced by wheezing mainly expiratory. The patient stated
coughing especially at night, and early morning, The patient also mentioned the feeling of
tightness in her chest, dyspnea, change in respiratory rate and depth. The best goal for my
patient is to maintain optimal breathing pattern that is evidenced by a normal respiratory rate,
relaxed breathing and the absence of dyspnea. Several interventions have been identified to
assist the patient with the achievement of the goals. Assessment of the patient's vital signs
should be performed while in distress. Monitor with a peak flow meter, because this provides a
reproducible measure of airway obstruction. The peak flow meter provides an objective
measurement of the severity of the asthma exacerbation. The patient will be encouraged to use
pursed-lip breathing. Pursed-lip breathing improves breathing patterns because this causes old
air to move out of the lungs and allows new air to enter lungs. Also, assist with abdominal
breathing. Medications will be administered as ordered by the health care provider. The
prescribed medications include Albuterol (Pro Air) inhaler that is a short-acting beta-2-agonist.
This medication is a bronchodilator, and it relaxes the muscles lining the airways. Albuterol is
used for acute exacerbation of asthma. Inhaled Corticosteroids (Flovent) is used to reduce
inflammation in the airways and reduce the mucus from the bronchial tubes. Inhaled
corticosteroids should be administered after Albuterol. Advise the patient to increase fluid
intake to help in thinning out secretions to eliminate quickly. To measure whether goals are met,
the patient will verbalize, that her breathing has improved. The patient's vital signs, most
importantly respiratory rate, depth, and rhythm will be within normal limits. Upon auscultation,
The next area of need involves anxiety and level of stress as evidenced by increased
blood pressure, heart rate, and respiratory rate. Exacerbation of asthma is related to anxiety since
stress causes rapid and shallow breathing. The patient verbalized the subjective symptom of
anxiety and associated it with her asthma exacerbations. The appropriate outcome to address the
problem of anxiety will include the patient utilizing effective coping mechanisms. The patient
will verbalize and demonstrate a reduction in stress level. The patient exhibits reduced stress as
evidenced by a calm and relaxed demeanor and her vital signs are within normal limits.
Interventions for anxiety include assessment for evidence of anxiety. The rationale is that
asthma becomes worse with anxiety because it causes shallow and rapid breathing. Comfort
measures should be provided to the patient, and these must include a quiet and calm
oxygen and the effort of breathing. The patient should be encouraged to use relaxation
techniques. According to the American Lung Association (2016), steps to better breathing with
asthma should include the practice of deep-breathing exercises, like belly breathing or
diaphragmatic breathing which can help with overall management of asthma. When the patient
is experiencing shortness of breath, try using the pursed-lip breathing technique to relax the
airways". These methods include pursed-lip breathing and diaphragmatic breathing. The
information related to asthma is evidenced by the absence of questions and inability to answer
correctly. The desired outcome for this intervention involves the patient and her significant
others ability to verbalize knowledge, management, and community resources to assist with
asthma. The four essential components of asthma management include, identifying the severity,
Running Head: Plan of Care 5
Interventions include assessing the patient's knowledge of asthma, triggers and correct use of
drugs. By identifying the triggers of asthma the patient will learn how to control the problems.
Proper use of spacers and distinguishing between rescue and maintenance inhalers will ensure
the effectiveness of medications. Teaching the patient about asthma triggers is important.
Interventions must address the home environment triggers to create a healthy living environment.
Triggers may be found in the home, but with proper measures, they can easily be controlled.
The Center for Disease Control recommends, actions to control dust mites such as encasing
pillows and mattress in allergen-impermeable covers (n.d.)". The patient mentioned that her
significant other smokes in the home. Environmental trigger control can reduce the number of
asthma attacks, so cessation of smoking is stressed. A peak flow meter is a critical tool used to
assess airflow obstruction and assist patient to classify and manage asthma. A written asthma
action plan should be developed in partnership with the patient and health care provider.
Through the correct use of these tools, the patient will recognize worsening signs and symptoms
of asthma. The patient will understand the proper medications to use and when symptoms
Various resources are available for people with asthma and since the patient is a 3rd-
grade teacher many of these materials are accessible through the nurses office at her school. The
American Lung Association has the Asthma Friendly Schools Initiative that provides a toolkit
with resources. The Starlight Foundation also offers information. The American Lung
Association provides local in-person support groups, as well as expert advice, is available from
on-line communities or via phone 1-800-LUNGUSA. The American Lung Association offers
many ways to help smokers quit. Contact the Lung Help Line at 1-800-586-4872 to speak with
Running Head: Plan of Care 6
a smoking cessation counselor. The American Lung Association recommends that patients must,
"Prepare for the weather before they leave their home by checking the pollen count and air
quality index (n.d.). The Air Quality Index (AQI) can be found at https://airnow.gov/index
Resources:
https://www.cdc.gov/asthma/healthcare.html#guidelines
support/
disease-lookup/asthma/living-with-asthma/managing-asthma/manage-stress.html
National Heart, Lung, And Blood Institute, National Institutes Of Health. (n.d.). Asthma Care
diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/reduce-
asthma-triggers.html