Asthma: Nursing process (ADPIE)

Megan Fitzpatrick is a 29-year-old woman with a history of asthma who was brought to the emergency department, or ED, by a friend after having trouble breathing which was not resolved with the use of her inhaler.

Megan presents with wheezing, shortness of breath, and chest tightness.

She is able to speak in short sentences but frequently pauses to breathe.

She appears anxious and states her asthma has never felt this awful before.

Asthma is a chronic inflammatory disease of the airways characterized by bronchial hyperresponsiveness and airflow obstruction.

Although the specific causes of asthma are ultimately unknown, it’s thought to be caused by a combination of genetic and environmental factors.

Asthma symptoms are often initiated by an environmental trigger.

The triggering substance can differ from person to person, but some common ones include air pollution, like cigarette smoke and car exhaust, as well as allergens like dust, pet dander, cockroaches, and mold.

Medications like aspirin and beta-blockers have also been known to trigger symptoms in some individuals with asthma.

Lastly, cold, dry air or exercise can also trigger asthma in some individuals.

Inhaling a triggering substance can initiate what is known as an asthma exacerbation or attack.

The triggering substance travels down the airways to the bronchioles, which are composed of cartilage, smooth muscle, and a mucosal lining containing mucus-secreting goblet cells.

Immune cells such as mast cells and basophils, are stimulated to release chemical mediators such as histamine and leukotrienes that cause the smooth muscle in the bronchioles to spasm, known as a bronchospasm, and cause the goblet cells to produce an abundance of mucus.