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
- Maintain or establish airway patency.
- Assist with measures to facilitate gas exchange.
- Enhance nutritional intake.
- Prevent complications and slow progression.
- Provide information about the disease process, prognosis, and treatment regimen.
Medical Management
Initial treatment is high-dose inhaled beta-2-adrenergic agonists, systemic corticosteroids, supplemental oxygen, and IV fluids to hydrate the patient (StatPearls; NHLBI). 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.
Frequently Asked Questions
What is status asthmaticus? It is severe, persistent asthma that does not respond to conventional bronchodilator and corticosteroid therapy. Attacks can come with little warning and progress quickly to asphyxiation, so it is treated as a medical emergency (StatPearls).
Why is a quieter chest a warning sign, not improvement? There is no link between how severe the attack is and how much wheezing you hear. As obstruction worsens, airflow drops so far that wheezing fades, which can signal impending respiratory failure.
What does first-line treatment involve? High-dose inhaled beta-2-adrenergic agonists, systemic corticosteroids, and supplemental oxygen, with IV fluids for hydration. Magnesium sulfate may be added for smooth muscle relaxation in refractory cases (StatPearls; NHLBI).
Why are sedatives contraindicated? Sedatives blunt respiratory drive in a patient who is already heading toward respiratory failure, so they are avoided.
What ABG change signals danger? Respiratory alkalosis is the most common early finding. A PaCO2 that rises to normal or higher is a red flag for respiratory failure, because it means the patient can no longer keep up with the work of breathing.
When is mechanical ventilation needed? When the patient is tiring, is in respiratory failure, or is not responding to repeated aggressive treatment.