Status Asthmaticus
Asthma is a chronic inflammatory disorder of the airways. It involves airway obstruction that causes wheezing, cough and dyspnea. With treatment, however, it can be alleviated and controlled. In some cases however, asthma can be unresponsive to treatment, and this condition is called Status Asthmaticus.
Status Asthmaticus is a severe and persistent asthma that is non reactive to initial and conventional treatment. Usually, the attack can last up to 24 hours. Conditions that could precipitate status asthmaticus can be non – specific irritants, increased adrenergic blockage, anxiety, infection, nebulizer abuse, dehydration and hypersensitivity to aspirin.
Pathophysiology
Asthma per se is the constriction of the bronchial smooth muscles, swelling of the bronchial mucosa linings and thickened sputum. With these happening, it narrows the bronchial tree, and is apparent to bronchial asthma. This results to hypoxemia, respiratory alkalosis (there will be decreasing PaO2 and respiratory alkalosis, a decreased PaCO2 and an increased pH) and respiratory acidosis (PaCO2 increase as the status asthmaticus worsens) thereafter.
Manifestations
- Wheezing
- Labored breathing
- Prolonged exhalation
- Neck engorgement
Assessment and Diagnosis
To verify the presence of Status asthmaticus, the following assessment and diagnostic tools are used:
- Pulmonary function studies – this test proves to be the most accurate tool to assess any airway obstruction
- Arterial blood gas studies – this test is performed when the patient could not perform pulmonary function maneuvers
- Respiratory Alkalosis – low PaCO2
Management
Medical Management includes the following:
- Patient is given a short acting beta adrenergic agonist initially.
- Status asthmaticus is also treated with corticosteroids.
- Supplemental oxygen is given. This will act control dyspnea, central cyanosis and hypoxemia.
- Intravenous therapy is started to treat any dehydration.
- PaCO2 should be maintained between 65 mm Hg to 85 mm Hg.
Nursing Management includes the following:
- The nurses are responsible in monitoring the patient especially for the first 12 – 24 hours.
- Continuous monitoring is required until the status asthmaticus is controlled.
- Signs of dehydration are monitored, skin turgor and daily output is monitored.
- Fluid therapy is initiated, this is to prevent dehydraton, it also facilitates expectoration of secretions. Fluids can be up to three to four liters or as indicated.
- Assist the patient in any activity he is doing, conservation of the patients energy is required and further exhaustion should be avoided.
- The environment should be free of irritants (dust, flowers, pollens, perfumes, smoke) and noise that could stimulate the attacks.
- On – going assessment should be done and referred to the doctor as necessary.
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Byron Webb Romero, RN, MSN
Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.
