Asthma is a chronic inflammatory disorder of the airways characterized by variable airflow obstruction, bronchial hyperresponsiveness, and recurrent episodes of wheezing, chest tightness, dyspnea, and coughing. Nursing care plays a crucial role in preventing complications and ensuring optimal breathing patterns. This article provides a comprehensive and updated list of nursing diagnoses for asthma using NANDA-I taxonomy, including defining characteristics, related factors, NOC outcomes, NIC interventions, clinical examples, and practical nursing applications.
LSI Keywords: asthma nursing care plan, NANDA nursing diagnosis for asthma, asthma interventions, impaired gas exchange, airway clearance, asthma management, respiratory nursing assessment, asthma exacerbation care.
1. Ineffective Airway Clearance
Definition: The inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.
Defining Characteristics
- Dyspnea
- Diminished breath sounds
- Orthopnea
- Crackles and wheezes
- Ineffective or absent cough
- Sputum production
- Cyanosis
- Difficulty vocalizing
- Changes in respiratory rate and rhythm
- Restlessness or anxiety
Related Factors
- Environmental: Smoking, smoke inhalation, second-hand smoke
- Obstructed Airway: Airway spasm, retained secretions, mucus plug, foreign body, exudates in alveoli
- Physiological: Neuromuscular dysfunction, airway hyperresponsiveness, COPD, infection, asthma triggers
NOC Outcomes
- Respiratory Status: Ventilation
- Respiratory Status: Airway Patency
- Respiratory Status: Gas Exchange
- Aspiration Control
Expected Client Outcomes
- Demonstrates effective coughing with clear breath sounds
- Maintains patent airway at all times
- Explains methods to enhance secretion removal
- Identifies factors that inhibit effective airway clearance
NIC Interventions
- Airway Management
- Airway Suctioning (if indicated)
- Cough Enhancement Techniques
- Hydration and humidification therapy
Clinical Example
A 14-year-old client with asthma exacerbation presents with wheezing, tachypnea, and thick yellow sputum. Nursing interventions include positioning the client in a semi-Fowler’s position, encouraging deep breathing and coughing, administering bronchodilators, and increasing fluid intake to thin secretions.
2. Impaired Gas Exchange
Definition: Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.
Defining Characteristics
- Visual disturbances
- Dyspnea
- Hypoxia
- Abnormal ABG levels
- Somnolence
- Restlessness or irritability
- Hypercapnia
- Tachycardia
- Cyanosis (especially in infants)
- Abnormal breathing rate or depth
- Nasal flaring (in children)
NOC Outcomes
- Respiratory Status: Gas Exchange
- Tissue Perfusion: Pulmonary
- Vital Signs Stability
- Electrolyte and Acid-Base Balance
Expected Client Outcomes
- Shows improved ventilation as evidenced by normalized ABG results
- Lung sounds become clearer with less wheezing
- Demonstrates understanding of oxygen therapy
NIC Interventions
- Oxygen Therapy
- Airway Management
- Respiratory Monitoring
- Acid-Base Management
Clinical Example
A 32-year-old asthmatic client arrives at the ER with SpO₂ of 87% on room air and ABG showing respiratory acidosis. The nurse applies oxygen, administers bronchodilators, evaluates lung expansion, and monitors for signs of impending respiratory failure.
3. Imbalanced Nutrition: Less Than Body Requirements
Definition: Intake of nutrients insufficient to meet metabolic needs, commonly associated with severe asthma, medication side effects, or chronic respiratory difficulty.
Defining Characteristics
- Body weight ≥ 20% under ideal weight
- Pale conjunctiva or mucous membranes
- Weakness or fatigue
- Loss of appetite
- Reported inadequate food intake
- Altered taste sensation
- Weight loss despite adequate intake
- Abdominal discomfort, diarrhea, or steatorrhea
- Dry hair or fragile skin
Related Factors
- Difficulty breathing during meals
- Increased metabolic demand during asthma flare-ups
- Poor appetite due to anxiety or corticosteroid side effects
- Lack of nutritional knowledge
NOC Outcomes
- Nutritional Status: Food and Fluid Intake
- Weight Control
- Nutritional Status: Nutrient Absorption
Expected Client Outcomes
- Gradually gains weight toward the desired goal
- Recognizes nutritional requirements for asthma management
- Consumes adequate nourishment daily
- Shows no signs of malnutrition
NIC Interventions
- Nutrition Therapy
- Nutritional Counseling
- Weight Management
- Swallowing Therapy (if needed)
- Enteral Feeding (severe cases)
Clinical Example
A 10-year-old child with chronic asthma presents with difficulty eating during shortness of breath episodes. The nurse collaborates with a dietitian to provide small, frequent meals rich in calories and proteins, teaches parents about nutritious snacks, and monitors weight weekly.
4. Deficient Knowledge
Definition: Absence or deficiency of cognitive information related to asthma, its triggers, medication, and long-term management.
Defining Characteristics
- Inaccurate follow-through of instructions
- Inappropriate behaviors (fear, anxiety, agitation)
- Verbalization of knowledge deficit
- Incorrect use of inhalers or devices
Related Factors
- Lack of exposure or experience
- Cognitive limitations
- Misinformation
- Lack of interest in learning
NOC Outcomes
- Knowledge: Disease Process
- Knowledge: Medication
- Knowledge: Health Behaviors
- Knowledge: Infection Control
- Knowledge: Treatment Regimen
Expected Client Outcomes
- Explains asthma pathophysiology and importance of medication adherence
- Demonstrates correct inhaler technique
- Identifies early warning signs of exacerbation
- Lists community resources for asthma support
NIC Interventions
- Asthma Education
- Medication Teaching
- Breathing Technique Training
- Self-Management Support
Clinical Example
A client incorrectly uses a metered-dose inhaler (MDI). The nurse demonstrates proper technique, provides written instructions, and evaluates understanding by return demonstration.
Conclusion
Asthma requires comprehensive nursing assessment, accurate identification of nursing diagnoses, and targeted interventions to prevent life-threatening complications. The NANDA-I nursing diagnoses such as Ineffective Airway Clearance, Impaired Gas Exchange, Imbalanced Nutrition, and Deficient Knowledge provide nurses with a structured approach to creating individualized care plans. Through proper education, monitoring, and therapeutic interventions, nurses play a pivotal role in helping clients achieve optimal respiratory function and long-term asthma control.
References
- NANDA International. (2021). Nursing Diagnoses: Definitions and Classifications.
- Potter, P. & Perry, A. (2021). Fundamentals of Nursing.
- Gulanick, M. & Myers, J. (2022). Nursing Care Plans: Diagnoses, Interventions, and Outcomes.
- Global Initiative for Asthma (GINA). (2023). Global Asthma Strategy.
