Asthma Flashcards
what is oxygenation?
Delivery of oxygen to body’s tissue and cells. Oxygenation is required to sustain life
If patient not oxygenating what are 1st 2 priorities?
- Elevate HOB
2. Provide oxygen
What is asthma?
-Chronic condition characterized by intermittent and reversible obstruction of the airway due to (1) inflammation and (2) sensitivity of the airway tissue
- –>Inflammation causes obstruction of lumen of airway
- –>Hypersensitivity causes constriction of bronchial smooth muscle and results in narrowing of the outside of the airway (Bronchospasms)
What happens with frequent and repeated asthma attacks?
- Over time, repeated, frequent asthma attacks will cause permanent damage to airway, resulting in enlargement of epithelial cells and changes in bronchial smooth muscle
- > permanent airway inhibition
Asthma assessment (signs/sxs, history of)
- Dyspnea Episodes “SHOB”
- Chest tightness
- Coughing
- Wheezing
- ↑ Mucous Production
- Timing? - when do episodes of SHOB occur?
- Associated with anything?
- Allergies?
- Family History
- Smoker?
- NSAID’s & Aspirin - cause release of leukotrienes leading to inflammatory response
- Gastroesophageal Reflux Disease (GERD) - acid in airway can trigger asthma attack
How do -NSAID’s & Aspirin lead to asthma attacks?
cause release of leukotrienes leading to inflammatory response
How does gerd lead to asthma attack?
-Gastroesophageal Reflux Disease (GERD) - acid in airway can trigger asthma attac
what do you see with acute asthma attack?
Acute Asthma attack
- Audible wheeze - Increased respiratory rate - Coughing - Use of accessory muscles with breathing - Increased work of breathing - Prolonged exhalation: air trapping, takes a lot fo work to blow air out - Hypoxemia -> Hypoxia - Cyanosis - Confusion/ Change in LOC (+ anxiety) - Tachycardia - Barrel chest: From severe long-term asthma
What is ABG like for person with acute asthma attack?
-PaO2- low (80-100) during acute unless long term damage (60-100)
-PaCO2-
Early- respiratory alkalosis
Late- respiratory acidosis due to air trapping as unable to blow off CO2
What are FEV and PEF/PEFR ?
pulmonary function test
FEV-(Forced Expiratory Volume) inhale and push air out, VOLUME that comes out in 1st second
PEF- (peek expiratory flow rate) RATE of air coming out in 1st second
how do they determine ranges for FEV/PEF
-Expected “normal” values based on age, sex and size/ NHANES
How do FEV/PEF diagnose asthma?
-Diagnosis of asthma= 12% increase in FEV and PEFR after bronchodilator
What is a methacholine test?
Induces bronchospasms/tighten of smooth muscle in
bronchioles
-diagnose asthma
What are goals for treating asthma?
-To Prevent and Control Acute Episodes
->Reduces permanent damage/ worsening of
disease
-Improve Airflow
-Optimize Gas Exchange
-Symptom Relief
Interventions for asthma?
- Personal Asthma Action Plan
- Education
- Drug Therapy: need control and rescue medication*
- Lifestyle Modifications
what is a personal action plan?
- Empowerment
- Goals
- Increase symptom-free periods
- Reduce severity of attacks
- Self-assessment
- Tracking attacks/ triggers
- Peak Flow Meter
- Medication adjustments
- When to call the provider
- Directions for emergency
What do we use peak flow meter for?
Establish a personal best (Baseline) PEF over 2-3 weeks/Measure BID with well controlled sxs
how often do we do peak flow meter assessments?
-Assess asthma severity twice daily (minimum) with the peak flow meter and compare to baseline
What is the goal range for peak flow meter?
80-100% is good/ no increase in medication
What if peak flow meter score is only 50-80% of baseline?
requires use of reliever (rescue) medication (and follow-up PEF)
–>Frequent readings in this range may require an increase in control medication(s)
What is peak flow meter reading is less than 50%?
-50% or less of personal best requires reliever medication and seek emergency help
What are some common triggers for asthma?
Cold Air Dry Air NSAIDS & Aspirin Beta Blockers Small Air Particles Exercise Upper Respiratory Illness “MSG” Stress
Interventions for asthma?
Exercise
Oxygen & Positioning
Rest
Relaxation techniques
Signs of an Emergency for someone with asthma
- When someone is at 50% or less of personal best
- If peak expiratory rate flow is declining with therapy
- Medication is not working
- -Cyanosis
- Nasal Flaring
- Retractions
- Increased work of breathing that effects ability to walk or talk
what is status asthmaticus?
-Acute episode of asthma that does not respond to medications
signs and sxs of status asthmaticus?
- Severe labored breathing with use of accessory muscles
- Wheezing
- Distention of neck veins
Status Asthmaticus
can lead to what untreated?
-Can lead to pneumothorax, respiratory arrest and cardiac arrest
treatment for status asthmaticus includes?
High Fowlers Bronchodilators Neb Steroids IV Epinephrine Oxygen Fluids May require intubation and mechanical ventilation
4 hallmark signs of asthma?
- Dyspnea Episodes “SHOB”
- Chest tightness
- Coughing
- Wheezing
lil dude comes in with status asthmaticus- they have O2 and HOB is Elevated. What are the next 2 things ya gonna do?
Nebulize and start an IV
