Conditions › Respiratory
Asthma Nursing Care Plan and Interventions
During an asthma attack, sit the client upright, give oxygen and the rescue inhaler (albuterol) as ordered, and treat a silent chest as an emergency. Long-term care pairs a daily controller (inhaled steroid) with an action plan, peak flow monitoring and trigger avoidance.
Asthma nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Ineffective airway clearance (bronchospasm) | Wheeze and work of breathing ease; peak flow improves. | |
| Impaired gas exchange | SpO2 at goal. | |
| Anxiety | Calmer breathing with coaching. | |
| Health maintenance: needs teaching | Knows controller vs rescue inhaler, triggers and the action plan zones. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Asthma: what it is
Long-term airway inflammation. A trigger makes the airways swell, tighten and fill with mucus. The narrowing is mostly reversible. 1,2
Mild asthma often feels normal between attacks. The airways overreact to triggers.
Common asthma triggers
Allergens like dust and mold, cold air, exercise, viral infections, smoke, fumes and strong emotions. 2,1
Ask what set it off. Some triggers, like exercise, can't be avoided, so plan for them.
Assessment: what you will see
Classic asthma cues
Wheezing (mostly on breathing out), chest tightness, shortness of breath, and a cough that is often worse at night. 2
Symptoms come and go over hours to days, usually after a trigger.
Severe attack cues
Breathing and heart rate climb and the client sits up in tripod position. Confusion, cyanosis or SpO2 under 90% signal failure. 2,1
A client leaning forward on the bed table to breathe is working hard. Stay and reassess.
Complications and red flags
Silent chest: an emergency
Wheezing fades because almost no air is moving, not because the client is better. Respiratory failure may be close. 1
Status asthmaticus: a severe, prolonged attack that doesn't respond to usual treatment.
Priority: what the nurse does first
Asthma attack: first actions
Sit the client up, give oxygen as ordered, give the inhaled rescue bronchodilator, and watch SpO2, breathing rate and effort. 2,1
Severe flare: expect ipratropium added to albuterol, plus steroids by mouth or IV.
Nursing interventions and treatment
Albuterol: the rescue inhaler
A short-acting beta-2 agonist (SABA) that relaxes airway muscle within minutes. Side effects: tremor and a fast heart rate. 1
Needing it more and more often means asthma is not controlled. Report it.
Controller vs rescue meds
Controllers (inhaled steroids, long-acting beta agonists, montelukast) are taken daily to prevent symptoms. They don't stop an attack. 3,1
Salmeterol is a LABA: never a rescue inhaler, and never used alone in asthma.
Inhaled steroids in asthma
Fluticasone or budesonide calm airway inflammation. Guidelines advise against albuterol alone; an inhaled steroid is added. 1,2
Rinse the mouth and spit after each use to prevent thrush. A spacer helps.
Montelukast: mood warning
A daily oral leukotriene blocker that helps prevent symptoms. Boxed warning: agitation, aggression, depression, suicidal thoughts. 4,2
Teach the client and family to report mood or behavior changes right away.
Evaluation: is care working?
Peak flow and action plan
Vs personal best: green 80% or more, keep daily meds. Yellow 50 to 79%, add rescue inhaler and call. Red under 50%, rescue inhaler and ED. 5,6
Zones use the client's own best reading, so know that number. A falling trend warns early.
Client teaching
Drugs that can worsen asthma
Nonselective beta blockers (propranolol, carvedilol) can tighten airways. Aspirin and NSAIDs trigger attacks in some clients. 1,7
Ask about asthma before a beta blocker. Cardioselective ones like metoprolol carry less risk.
Asthma teaching
Avoid triggers and smoke, use inhalers and the peak flow meter correctly, follow the written action plan, and know when to call 911. 2
A return demonstration is the best proof the client can use the inhaler.
NCLEX traps
Asthma vs COPD
Asthma: trigger-driven attacks, and the airways open back up between them. COPD: mostly from smoking, persistent and slowly worsening. 1,8
Asthma narrowing is reversible. COPD damage stays, so the goal is to slow it down.
Try 2 asthma questions
NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.
Question 1 · Physiological Adaptation
A nurse auscultates a client having an acute asthma exacerbation and notes an absence of wheezing with minimal air movement. What is the priority nursing action?
Show answer and rationale
Answer: A. A silent chest during an asthma exacerbation is an ominous sign indicating severely diminished air movement and impending respiratory failure, not improvement, so immediate emergency response is required. Documenting this as improvement is dangerously incorrect and could delay life-saving care. Encouraging spirometry use is inappropriate in acute respiratory failure. Waiting 4 hours to reassess would allow the client to deteriorate further; this finding demands urgent action now.
Checked against: OpenStax Medical-Surgical Nursing, 24.7
Question 2 · Pharmacological and Parenteral Therapies
A nurse is teaching a client how to use a metered-dose inhaler (MDI) for asthma. Which statement by the client indicates a need for further teaching?
Show answer and rationale
Answer: C. This is a 'needs further teaching' stem, so the correct answer is the WRONG statement — the one that does not match proper technique. Correct MDI technique requires a slow, deep inhalation while pressing the canister, not a quick, forceful one, so this statement reflects incorrect technique and needs correction. Shaking the inhaler, waiting between puffs, and rinsing the mouth after a corticosteroid inhaler (to prevent oral thrush) are all correct actions. Reading the stem twice to confirm it asks for the incorrect statement, rather than the correct one, prevents a polarity error.
Checked against: OpenStax Clinical Nursing Skills, 14.4
Keep studying asthma in NurseLingo Pro
Pro has 27 asthma questions like these, with a rationale for every answer. Everything for asthma in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free med-surg practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for asthma?
Common nursing problems for asthma include ineffective airway clearance (bronchospasm); impaired gas exchange; anxiety; health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for asthma?
Sit the client up, give oxygen as ordered, give the inhaled rescue bronchodilator, and watch SpO2, breathing rate and effort.
More respiratory
Related cheat sheets
Sources
- merckmanuals.com
- OpenStax Medical-Surgical Nursing, 11.4
- OpenStax Pharmacology for Nurses, 25.1
- OpenStax Pharmacology for Nurses, 25.3
- nhlbi.nih.gov
- OpenStax Fundamentals of Nursing, 19.3
- OpenStax Pharmacology for Nurses, 14.2
- OpenStax Medical-Surgical Nursing, 11.5
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.