Week No.
__ – Complete Date (Month/Day/Year) (Day of the Week)
PRIORITIZED NURSING PROBLEM FOR ASTHMA
Nursing Diagnosis Nursing Intervention
1. INEFFECTIVE Independent
BREATHING Place patient with proper body
PATTERN alignment for maximum
breathing pattern.
Encourage sustained deep
breaths by:
- Using demonstration:
highlighting slow inhalation,
holding end inspiration for a
few seconds, and passive
exhalation
- Utilizing incentive spirometer
- Requiring the patient to yawn
Encourage diaphragmatic
breathing for patients with
chronic disease.
Evaluate the appropriateness of
inspiratory muscle training.
Provide respiratory
medications and oxygen, per
doctor’s orders.
Avoid high concentration of
oxygen in patients with COPD.
Maintain a clear airway by
encouraging patient to mobilize
own secretions with successful
coughing.
Suction secretions, as
necessary.
Stay with the patient during
acute episodes of respiratory
distress.
Ambulate patient as tolerated
with doctor’s order three times
daily
Encourage frequent rest periods
and teach patient to pace
activity.
Consult dietitian for dietary
modifications.
Encourage small frequent
meals.
Help patient with ADLs, as
necessary.
Rationale
A sitting position permits
maximum lung excursion and
chest expansion.
These techniques promotes deep
inspiration, which increases
oxygenation and prevents
atelectasis. Controlled breathing
methods may also aid slow
respirations in patients who are
tachypneic. Prolonged
expiration prevents air trapping
This method relaxes muscles
and increases the patient’s
oxygen level.
This training improves
conscious control of respiratory
muscles and inspiratory muscle
strength.
Beta-adrenergic agonist
medications relax airway
smooth muscles and cause
bronchodilation to open air
passages
Hypoxia triggers the drive to
breathe in the chronic CO2
retainer patient. When
administering oxygen, close
monitoring is very important to
avoid uncertain risings in the
patient’s PaO2, which could
lead to apnea.
This facilitates adequate
clearance of secretions.
This is to clear blockage in
airway.
This will reduce the patient’s
anxiety, thereby reducing
oxygen demand.
Ambulation can further break up
and move secretions that block
the airways.
Extra activity can worsen
shortness of breath. Ensure the
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
Avail a fan in the room.
Encourage social interactions
with others that have medical
diagnoses of ineffective
breathing pattern.
Educate patient or significant
other proper breathing,
coughing, and splinting
methods
Educate patient about
medications: indications,
dosage, frequency, and possible
side effects. Incorporate review
of metered-dose inhaler and
nebulizer treatments, as
needed.
Teach patient about:
- pursed-lip breathing
- abdominal breathing
- performing relaxation
techniques
- performing relaxation
techniques
- taking prescribed medications
(ensuring accuracy of dose and
frequency and monitoring
adverse effects)
- scheduling activities to avoid
fatigue and provide for rest
periods
Refer patient for evaluation of
exercise potential and
development of individualized
exercise program.
2. INEFFECTIVE Teach the patient the proper
AIRWAY ways of coughing and
CLEARANCE breathing. (e.g., take a deep
breath, hold for 2 seconds, and
cough two or three times in
succession)
Educate the patient in the
following:
- Optimal positioning (sitting
position)
patient rests between strenuous
activities.
COPD may cause malnutrition
which can affect breathing
pattern. Good nutrition can
strengthen the functionality of
respiratory muscles.
This prevents crowding of the
diaphragm.
This conserves energy and
avoids overexertion and fatigue.
Moving air can decrease
feelings of air hunger.
Talking to others with similar
conditions can help to ease
anxiety and increase coping
skills.
These allow sufficient
mobilization of secretions.
This information promotes safe
and effective medication
administration.
These measures allow patient to
participate in maintaining health
status and improve ventilation.
Exercise promotes conditioning
of respiratory muscles and
patient’s sense of well-being.
The most convenient way to
remove most secretions is
coughing. So it is necessary to
assist the patient during this
activity. Deep breathing, on the
other hand, promotes
oxygenation before
The proper sitting position and
splinting of the abdomen
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- Use of pillow or hand splints promote effective coughing by

when coughing increasing abdominal pressure
- Use of abdominal muscles for and upward diaphragmatic
more forceful cough movement. Controlled coughing
- Use of quad and huff methods help mobilize
techniques secretions from smaller airways
- Use of incentive spirometry to larger airways because the
- Importance of ambulation and coughing is done at varying
frequent position changes times. Ambulation promotes
Position the patient upright if lung expansion, mobilizes
tolerated. Regularly check the secretions, and lessens
patient’s position to prevent atelectasis.
sliding down in bed. Upright position limits
Perform nasotracheal abdominal contents from
suctioning as necessary, pushing upward and inhibiting
especially if cough is lung expansion. This position
ineffective. promotes better lung expansion
Explain procedure to patient and improved air exchange.
Use well-lubricated soft Suctioning is needed when
catheters patients are unable to cough out
Use curved-tip catheters and secretions properly due to
head positioning (if not weakness, thick mucus plugs, or
contraindicated). excessive or tenacious mucus
Instruct the patient to take production.
several deep breaths before and This procedure can also
after nasotracheal suctioning stimulate a cough. Frequency of
procedure and use suctioning should be based on
supplemental oxygen, as patient’s present condition, not
appropriate. on preset routine, such as every
Stop suctioning and provide 2 hours. Over suctioning can
supplemental oxygen if the cause hypoxia and injury to
patient experiences bronchial and lung tissue.
bradycardia, an increase in Using well-lubricated catheters
ventricular ectopy, and/or reduces irritation and prevents
significant desaturation. trauma to mucous membranes.
- Use universal precautions: These facilitates secretion
gloves, goggles, and mask, as removal; from a specific side of
appropriate. the lung (left or right).
Maintain humidified oxygen as Hyperoxygenation before,
prescribed. during, and after suctioning
Encourage patient to increase prevents hypoxia.
fluid intake to 3 liters per day Oxygen therapy is
within the limits of cardiac recommended to improve
reserve and renal function. oxygen saturation and reduce
Coordinate with a respiratory possible complications
therapist for chest As protection against the blood-
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physiotherapy and nebulizer
management as indicated.
Provide postural drainage,
percussion, and vibration as
ordered.
Pace activities especially for
patients with reduced energy.
Maintain planned rest periods.
Promote energy-conservation
methods.
Educate patient on coughing,
deep breathing, and splinting
techniques.
Provide patient understanding
about the proper use of
prescribed medications and
inhalers.
Educate caregivers in
suctioning techniques. Provide
opportunity for return
demonstration. Modify
techniques for home setting.
related modes of transmission,
health care workers should use
universal precautions when
coming in contact with the
blood of all patients, or bodily
fluids containing blood.
Increasing humidity of inspired
air will reduce thickness of
secretions and aid their removal.
Fluids help minimize mucosal
drying and maximize ciliary
action to move secretions
a variety of medications are
prepared to manage specific
problems. Most promote
clearance of airway secretions
and may reduce airway
resistance.
hest physical therapy helps
mobilize bronchial secretions; it
should be used only when
prescribed because it can cause
harm if patient has underlying
conditions such as cardiac
disease or increased intracranial
pressure.
Oral care freshens the mouth
after respiratory secretions have
been expectorated.
Patient will understand the
underlying principle and proper
techniques to keep the airway
clear of secretions.
Understanding prescriptions
promote safe and effective
medication administration.
Hydration facilitates easy
elimination of secretions.
This promotes safe and effective
removal of secretions from the
airway.
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3. DEFICIENT Render physical comfort for
KNOWLEDGE the patient.
Grant a calm and peaceful
environment without
interruption.
Provide an atmosphere of
respect, openness, trust, and
collaboration.
Include the patient in creating
the teaching plan, beginning
with establishing objectives
and goals for learning at the
beginning of the session.
Consider what is important to
the patient.
Involve patient in writing
specific outcomes for the
teaching session, such as
identifying what is most
important to learn from their
viewpoint and lifestyle.
Explore reactions and feelings
about changes.
Support self-directed, self-
designed learning.
Help patient in integrating
information into daily life.
Give adequate time for
integration that is in direct
conflict with existing values or
beliefs.
Provide clear, thorough, and
understandable explanations
and demonstrations.
Give information with the use
of media. Use visual aids like
diagrams, pictures, videotapes,
audiotapes, and interactive
Internet websites,
Check the availability of
supplies and equipment.
When presenting a material,
start with the basics or familiar,
simple, and concrete
information to less familiar,
Based on Maslow’s theory,
basic physiological needs must
be addressed before the patient
education. Ensuring physical
comfort allows the patient to
concentrate on what is being
discussed or demonstrated.
A calm environment allows the
patient to concentrate and focus
more completely.
Conveying respect is especially
important when providing
education to patients with
different values and beliefs
about health and illness.
Goal setting allows the learner
to know what will be discussed
and expected during the session.
Adults tend to focus on here-
and-now, problem-centered
education.
Allowing the patient to identify
the most significant content to
be presented first is the most
effective.
Patient involvement improves
compliance with health regimen
and makes teaching and learning
a partnership
Assessment assists the nurse in
understanding how the learner
may respond to the information
and possibly how successful the
patient may be with the
expected changes.
Patients know what difficulties
will transpire in their own
environments, and they must be
encouraged to approach learning
activities from their priority
needs.
This technique aids the learner
make adjustments in daily life
that will result in the desired
change in behavior.
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)
complex ones.
Focus teaching sessions on a
single concept or idea.
Pace the instruction and keep
sessions short
When teaching, build on
patient’s literacy skills.
Identify patient’s
understanding of common
medical terminology, such as
“empty stomach,” “emesis,”
and “palpation.”
Use the teach-back technique
to determine the patient’s
understanding of what was
taught:
- The nurse gives information
in a caring manner, using plain
language.
- Ask the patient to explain in
his or her own words.
- Rephrase the information if
unable to repeat it accurately.
- Again ask the patient to
teach-back the information
using his or her own words
until the nurse is comfortable
that is understood.
- If the patient still does not
understand, consider other
strategies.
Provide preadmission self-
instruction materials to prepare
patient for postoperative
exercises.
Encourage questions
Provide immediate feedback on
performance.
Allow repetition of the
information or skill.
Render positive, constructive
reinforcement of learning
Incorporate rewards into
learning process
Note progress of teaching and
learning.
Informatiom that is in direct
conflict with what is already
held to be true forces a
reevaluation of the old material
and is thus integrated more
slowly
Patients are better able to ask
questions when they have basic
information about what to
expect.
Different people take in
information in different ways.
Adequate preparation is
especially important when
teaching in the home setting.
This method allows the patient
to understand new material in
relation to familiar material.
Clearly focuses teaching allows
the learner to concentrate more
completely on material being
discussed.
Learning requires energy, so
shorter, well-paced sessions
reduce fatigue and allow the
patient to absorb more
completely.
In patients with low literacy
skills, materials should be short
and have culturally sensitive
illustrations.
Patients are expected to read
and understand labels on
medicine containers,
appointment slips, and informed
consents.
The teach-back technique
consists of specific steps in a
repetitive order to evaluate the
recipient’s knowledge of the
content discussed. Patients who
are not able to do this method
after multiple cycles is
considered cognitively
impaired.
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)

Help patient identify Providing patients with

community resources for preadmission information about
continuing information and exercises has been shown to
support. increase positive feelings and
Approach individuals of color the ability to perform prescribed
with respect, warmth, and exercises.
professional courtesy. Questions facilitate open
communication between patient
and health care professionals
and allow verification of
understanding of given
information.
Immediate feedback allows the
learner to make corrections
rather than practicing the skill
wrongly.
Repeated practice allows patient
gain confidence in self-care
ability.
A positive approach by the
patient will help him or her feel
good about learning
accomplishments, gain
confidence, and maintain self-
esteem.
Rewards help to make learning
fun and exciting.
Documentation allows
additional teaching to be based
on what the learner has
completed
Learning occurs through
imitation, so persons who are
currently involved in lifestyle
changes can help the learner
anticipate adjustment issues.
Community resources can offer
financial and educational
support.
Instances of disrespect and lack
of caring have special
significance for individuals of
color.

References:
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