Running Head: Plan of Care 1

Holistic Plan of Care

Diane M Kerr

Delaware Technical Community College

Running Head: Plan of Care 2

To create a holistic care plan the nurse must first compile the individual assessment data

collected from the patient and analyze the information to identify problems. The patient's needs

must be determined, and an appropriate plan of care will be created for the individual. The

holistic plan of care for this particular patient includes goals, projected interventions,

evaluations, and community resources.

Several abnormal findings and needs are noted after reviewing the holistic assessment

data collected from the patient. The comprehensive care plan for the patient focuses on

preventing hypersensitivity reaction, controlling allergens, maintaining patency of the airway and

preventing the occurrence of reversible complications. The patient is a 26-year-old female,

single, living with her fiance, and employed as a 3rd-grade teacher. The patient has asthma and

her current medications include several inhalers. Subjective data includes allergies to tree nuts,

dust, pollen, and mold. The patient states that she has been having exacerbations of asthma that

seem to be related to activity and anxiety. She voiced concern because she is exposed to

secondhand smoke because live in boyfriend smokes in the home. Physical assessment of

respiratory system indicates diminished breath sounds in all lung fields and wheezing noted in

the left posterior lung. Complete background patterns and subjective information were collected

that revealed problems and areas of need within her environment. The patient mentioned that the

live-in boyfriend smokes in the home and she was unaware of the importance of cleaning the

homes ventilation system. After assessing social and occupational areas of the patient

exacerbation of asthma attacks or exercise-induced asthma is noted due to cold air and physical

activity with children at the workplace. The psychological and emotional assessment indicates

that the patient experiences exacerbations of asthma due to anxiety.

Running Head: Plan of Care 3

Various problems are evident with this patient. The patient's first issue involves

ineffective breathing pattern as evidenced by wheezing mainly expiratory. The patient stated

coughing especially at night, and early morning, The patient also mentioned the feeling of

tightness in her chest, dyspnea, change in respiratory rate and depth. The best goal for my

patient is to maintain optimal breathing pattern that is evidenced by a normal respiratory rate,

relaxed breathing and the absence of dyspnea. Several interventions have been identified to

assist the patient with the achievement of the goals. Assessment of the patient's vital signs

should be performed while in distress. Monitor with a peak flow meter, because this provides a

reproducible measure of airway obstruction. The peak flow meter provides an objective

measurement of the severity of the asthma exacerbation. The patient will be encouraged to use

pursed-lip breathing. Pursed-lip breathing improves breathing patterns because this causes old

air to move out of the lungs and allows new air to enter lungs. Also, assist with abdominal

breathing. Medications will be administered as ordered by the health care provider. The

prescribed medications include Albuterol (Pro Air) inhaler that is a short-acting beta-2-agonist.

This medication is a bronchodilator, and it relaxes the muscles lining the airways. Albuterol is

used for acute exacerbation of asthma. Inhaled Corticosteroids (Flovent) is used to reduce

inflammation in the airways and reduce the mucus from the bronchial tubes. Inhaled

corticosteroids should be administered after Albuterol. Advise the patient to increase fluid

intake to help in thinning out secretions to eliminate quickly. To measure whether goals are met,

the patient will verbalize, that her breathing has improved. The patient's vital signs, most

importantly respiratory rate, depth, and rhythm will be within normal limits. Upon auscultation,

there will be no wheezing or adventitious sounds.

Running Head: Plan of Care 4

The next area of need involves anxiety and level of stress as evidenced by increased

blood pressure, heart rate, and respiratory rate. Exacerbation of asthma is related to anxiety since

stress causes rapid and shallow breathing. The patient verbalized the subjective symptom of

anxiety and associated it with her asthma exacerbations. The appropriate outcome to address the

problem of anxiety will include the patient utilizing effective coping mechanisms. The patient

will verbalize and demonstrate a reduction in stress level. The patient exhibits reduced stress as

evidenced by a calm and relaxed demeanor and her vital signs are within normal limits.

Interventions for anxiety include assessment for evidence of anxiety. The rationale is that

asthma becomes worse with anxiety because it causes shallow and rapid breathing. Comfort

measures should be provided to the patient, and these must include a quiet and calm

environment. The rationale of providing peaceful surroundings is to reduce the consumption of

oxygen and the effort of breathing. The patient should be encouraged to use relaxation

techniques. According to the American Lung Association (2016), steps to better breathing with

asthma should include the practice of deep-breathing exercises, like belly breathing or

diaphragmatic breathing which can help with overall management of asthma. When the patient

is experiencing shortness of breath, try using the pursed-lip breathing technique to relax the

airways". These methods include pursed-lip breathing and diaphragmatic breathing. The

technique of relaxation exercises is an effective means to reduce anxiety.

Another problem includes a knowledge deficit about asthma. The deficiency of

information related to asthma is evidenced by the absence of questions and inability to answer

correctly. The desired outcome for this intervention involves the patient and her significant

others ability to verbalize knowledge, management, and community resources to assist with

asthma. The four essential components of asthma management include, identifying the severity,
Running Head: Plan of Care 5

patient education, control of environmental factors, and use of appropriate medications

Interventions include assessing the patient's knowledge of asthma, triggers and correct use of

drugs. By identifying the triggers of asthma the patient will learn how to control the problems.

Proper use of spacers and distinguishing between rescue and maintenance inhalers will ensure

the effectiveness of medications. Teaching the patient about asthma triggers is important.

Interventions must address the home environment triggers to create a healthy living environment.

Triggers may be found in the home, but with proper measures, they can easily be controlled.

The Center for Disease Control recommends, actions to control dust mites such as encasing

pillows and mattress in allergen-impermeable covers (n.d.)". The patient mentioned that her

significant other smokes in the home. Environmental trigger control can reduce the number of

asthma attacks, so cessation of smoking is stressed. A peak flow meter is a critical tool used to

assess airflow obstruction and assist patient to classify and manage asthma. A written asthma

action plan should be developed in partnership with the patient and health care provider.

Through the correct use of these tools, the patient will recognize worsening signs and symptoms

of asthma. The patient will understand the proper medications to use and when symptoms

indicate the need of urgent medical attention.

Various resources are available for people with asthma and since the patient is a 3rd-

grade teacher many of these materials are accessible through the nurses office at her school. The

American Lung Association has the Asthma Friendly Schools Initiative that provides a toolkit

with resources. The Starlight Foundation also offers information. The American Lung

Association provides local in-person support groups, as well as expert advice, is available from

on-line communities or via phone 1-800-LUNGUSA. The American Lung Association offers

many ways to help smokers quit. Contact the Lung Help Line at 1-800-586-4872 to speak with
Running Head: Plan of Care 6

a smoking cessation counselor. The American Lung Association recommends that patients must,

"Prepare for the weather before they leave their home by checking the pollen count and air

quality index (n.d.). The Air Quality Index (AQI) can be found at https://airnow.gov/index

through the Environmental Protection Agency.

Running Head: Plan of Care 7

Resources:

Dillion, P. M. (2016). Nursing Health Assessment. Phila, PA: Davis.

Healthcare Professionals. (2015, April 01). Retrieved from

https://www.cdc.gov/asthma/healthcare.html#guidelines

Local Support. (n.d.). Retrieved from http://www.lung.org/support-and-community/local-

support/

Manage Stress. (n.d.). Retrieved from http://www.lung.org/lung-health-and-diseases/lung-

disease-lookup/asthma/living-with-asthma/managing-asthma/manage-stress.html

National Heart, Lung, And Blood Institute, National Institutes Of Health. (n.d.). Asthma Care

Quick Reference: Diagnosing and Managing Asthma.

Reduce Asthma Triggers. (n.d.). Retrieved from http://www.lung.org/lung-health-and-

diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/reduce-

asthma-triggers.html

Selekman, J. (2013). School Nursing: A Comprehensive Text. FA Davis Company.

(n.d.). Retrieved from https://airnow.gov/