Asthma Flashcards
Asthma Triggers
- Allergens
- smoking
- Exercise (normally after not during)
- Respiratory infections
- Nose and sinus problems
- Drugs and food additives (aspirin)
- GERD (Gastro-esophageal reflux disease)
- Air Pollutants (smoke, cars)
- Emotional Stress
Pathophysiology: Early phase
- is characterized by bronchospasm
- Increased mucous secretion, edema formation, and increased amounts of tenacious sputum
- Peaks in 30 – 60 minutes after trigger exposure
- Subsides in about 30 – 90 minutes
Pathophysiology: Late phase
- can be more severe than the early-phase response and is primarily inflammation
- Peaks in 5 – 12 hours
- May last several hours to days
- Corticosteroids are effective in preventing and reversing this cycle.
- If the airway inflammation is not treated or does not resolve, it may lead to irreversible lung damage
inflammatory process in asthma
• Mast cells in the bronchial wall release multiple inflammatory mediators.
• Inflammatory mediators have effects on:
(1) blood vessels, causing vasodilation and increasing capillary permeability (runny nose);
(2) nerve cells, causing itching;
(3) smooth muscle cells, causing bronchial spasms and airway narrowing; and
(4) goblet cells, causing mucus production.
Symptoms/Clinical Manifestation
cough, shortness of breath (dyspnea), wheezing, chest tightness, and variable airflow obstruction
Signs and symptoms of an attack include:
• Prolonged expiration
• Inspiratory/expiratory (I/E) ratio of 1:3 or 1:4
• Wheezing (unreliable sign to gauge the severity of an attack)
• Cough (may be nonproductive because secretions may be so thick, tenacious, and gelatinous that their removal is difficult)
• Use of accessory muscles for respiration
• Signs of hypoxemia including restlessness, increased anxiety, inappropriate behavior, and increased pulse and blood pressure
• Hyperresonance of the lungs, revealed by percussion
Inspiratory or expiratory wheezing, indicated by auscultation
Asthma Diagnostic Testing
- A sputum specimen can be used to rule out bacterial infection.
- Serum immunoglobulin E (IgE) levels and eosinophil count, when elevated, are highly suggestive of allergic tendency.
- A chest x-ray obtained during an attack shows hyperinflation.
- Spirometry, oximetry, and arterial blood gases (ABGs) provide information about the severity of the attack and response to treatment.
- Detailed history and physical exam
- Symptoms – because wheezing and cough are seen with a variety of disorders, this complicates the diagnosis of asthma.
- Pulmonary function tests – variable airflow obstruction
- Peak flow monitoring
- CXR
- ABGs
- Oximetry
- Allergy testing
- Blood levels of eosinophils
- Sputum culture and sensitivity
Signs of an acute asthma attack
• the person with asthma usually sits upright or slightly bent forward • reveals signs of hypoxemia. - Restlessness - ↑ anxiety - Inappropriate behaviour
Drug Therapy for asthma vague 2 groups
- Rescue Medications / Relievers (short term immediate control of symptoms) (treat symptoms of exacerbations)
- Controller Medication (must also be taking for long-term)(achieve and maintain control of persistent asthma)
Compare Mild Exacerbations Moderate Exacerbations Severe Exacerbations Life-Threatening Exacerbations
Mild Exacerbations
• patients have difficulty breathing only with activity and may feel that they “can’t get enough air.”
• Peak flow is >70%
• treated with SABA
Moderate Exacerbations
• interferes with usual activities
• patient usually comes to the emergency department
• peak flow is 40% to 69%
• treated with SABA and oral corticosteroids
Severe Exacerbations
• dyspnea at rest and will not be able to speak in full sentences
• Peak flow is below 40%
• treated with oral systemic corticosteroids
Life-Threatening Exacerbations
• too short of breath to speak.
• may be drowsy, confused, or diaphoretic.
• Peak flow is below 25%
• treated with intravenous (IV) corticosteroids and adjunctive therapies
What treats asthma.
- Short-acting β-Agonists (SABA): releases/dialates airway
- IV Corticosteroids: Suppress inflammatory response
- IV Bronchodilators: act by stimulating β-adrenergic receptors in the bronchioles, thus producing bronchodilation
- Supplemental oxygen: given to get 02 to 90%
Three types of bronchodilators
1) β2-Adrenergic agonists (e.g. albuterol, metaproterenol)
Effective for relieving acute bronchospasm
Onset of action in minutes and duration of 4–8 hours
Prevent release of inflammatory mediators from mast cells
Not for long-term use
2) Methylxanthines (e.g. theophylline)
Less effective long-term bronchodilator
Controller after trying ICS, LABA, and LTRAs
Narrow toxic/therapeutic ratio and frequent adverse events
3) Anticholinergics (e.g. ipatratopium)
Block action of acetylcholine
Usually used in combination with a bronchodilator
Most common adverse effect is dry mouth.
Nursing Goals for the Patient with Asthma
Minimal symptoms during the day and night
Acceptable activity levels (including exercise and other physical activity)
Greater than 80% of personal best PEFR
Few or no adverse effects of therapy
No acute exacerbations
Adequate knowledge to participate in and carry out the plan of care
Be able to participate in activities of normal life (including exercise and other physical activity) with little to no interference
Have normal or near-normal pulmonary function
Have the asthma under control
Experience as few adverse effects from asthma medication as possible while taking the lowest dosage of medication necessary to keep the asthma under control
Possess the knowledge and skills necessary to participate in the management of the asthma
Nursing assessment for Asthma
1) Detailed health history Identification of precipitating factors and medications What has helped alleviate attacks in the past 2) ABGS 3) Lung Function Tests 4) Physical Exam Use of accessory muscles Diaphoresis Cyanosis Lung sounds
Health Promotion for asthma
- Teach client to identify and avoid known triggers.
- Use dust covers.
- Use scarves or masks for cold air.
- Avoid Aspirin or NSAIDs.
- Prompt diagnosis and treatment of upper respiratory infections and sinusitis may prevent exacerbation.
- Balance fluid intake
- Self-monitoring plan
When do you use each medication? Intravenous (IV) corticosteroids Short-acting β2 agonist Oxygen supplementation Oral Corticosteroids
Intravenous (IV) corticosteroids
IV corticosteroids are only used in cases of life-threatening, not mild, asthma exacerbations.
Short-acting β2 agonist
A short-acting β2-agonist would be given to a patient with a mild asthma exacerbation.
Oxygen supplementation
typically used in the hospital for severe asthma exacerbations.
Oral Corticosteroids
moderate/severe treated in hospital
