Status Asthmaticus Nursing Management & Interventions

Status asthmaticus is asthma that has stopped responding to the usual treatment, and it can go from bad to asphyxiation fast. Your job is to keep the airway open, support gas exchange, and stay one step ahead of respiratory failure. The patient who stops wheezing is not improving, they are obstructing.

What Is Status Asthmaticus?

Status asthmaticus is severe, persistent asthma that does not respond to conventional therapy; attacks can hit with little or no warning and progress rapidly to asphyxiation. Infection, anxiety, nebulizer abuse, dehydration, increased adrenergic blockage, and nonspecific irritants can all contribute, and an acute episode may be precipitated by hypersensitivity to aspirin. Two pathologic problems dominate: decreased bronchial diameter and a ventilation-perfusion abnormality.

Clinical Manifestations

The same as those of severe asthma. There is no correlation between the severity of the attack and the number of wheezes; as obstruction worsens, wheezing may disappear, which can signal impending respiratory failure.

Assessment and Diagnostic Findings

Rely mainly on pulmonary function studies and ABG analysis. Respiratory alkalosis is the most common finding. NURSING ALERT: a PaCO2 rising to normal or higher is a danger sign signaling respiratory failure.

Nursing Diagnosis

• Ineffective Airway Clearance related to bronchospasm and increased pulmonary secretions.
• Fear related to breathlessness and recurrences.
• Impaired Gas Exchange.
• Imbalanced Nutrition: Less Than Body Requirements.
• Deficient Knowledge.

Nursing Priorities

1. Maintain or establish airway patency.
2. Assist with measures to facilitate gas exchange.
3. Enhance nutritional intake.
4. Prevent complications and slow progression.
5. Provide information about the disease process, prognosis, and treatment regimen.

Medical Management

Initial treatment is beta-2-adrenergic agonists, corticosteroids, supplemental oxygen, and IV fluids to hydrate the patient. Sedatives are contraindicated. Deliver high-flow supplemental oxygen by partial or complete nonrebreather mask (PaO2 at a minimum of 92 mm Hg or O2 saturation greater than 95%). Magnesium sulfate, a calcium antagonist, may be given to induce smooth muscle relaxation. Hospitalize if there is no response to repeated treatments, if blood gas levels deteriorate, or if pulmonary function scores are low. Move to mechanical ventilation if the patient is tiring, in respiratory failure, or not responding to treatment.

Nursing Management

Actively assess the airway and the patient's response to treatment, and be ready for the next intervention if the patient does not respond.

Monitor the patient constantly for the first 12 to 24 hours, or until status asthmaticus is under control. Monitor blood pressure and cardiac rhythm continuously through the acute phase until the patient stabilizes and responds. Check skin turgor for dehydration; fluid intake is essential to combat dehydration, loosen secretions, and ease expectoration. Give IV fluids as prescribed, up to 3 to 4 L/day, unless contraindicated. Encourage the patient to conserve energy. Keep the room quiet and free of respiratory irritants (flowers, tobacco smoke, perfumes, odors of cleaning agents), and use nonallergenic pillows.