Asthma

Question 1

Asthma

Answer 1

-usually reversible
-normal lung function between exacerbations
-sputum typically only during attacks

Question 2

Pathophysiology

Answer 2

-occur within 30-60 minutes of exposure or several days
-4-10 hrs after attack another happens again and can be more severe

Question 3

Manifestations of attack

Answer 3

-usually gradual
-wheezing, cough, dyspnea, chest tightness
-cough may be only symptom
-diaphoresis, tachycardia
-hypoxemia, cyanosis and ABGs for CO2
-accessory muscle use

Question 4

Be aware

Answer 4

-edema, congestion of airway mucosa, thick mucous plugs remain for several days

-late phase response

-long standing inflammation, remodeling can occur

Question 5

Triggers

Answer 5

-allergens
-exercise
-airway irritants (occupational exposure)
-respiratory infections*
-nose/sinus problems
-drug/food additives
-GERD
-psychological factors (extreme emotions)

Question 6

Pulmonary function test (diagnosis)

Answer 6

-assess reversibility of the bronchoconstriction
-normal between asthma attacks

Question 7

Diagnosis

Answer 7

-chest xray: normal between attacks, hyper inflated during attack
-ABG: during attack to gauge severity
-sputum C&S: trigger can be infection
-FENO monitors: how much CO2 you’re exhaling

Question 8

Acute medications (bronchodilator)

Answer 8

-beta adrenergic agonist: inhaled SABA are rescue drugs: onset within minutes, last up to 8hrs

-anti-cholinergics: rescue use in pt who can’t tolerate SABA

Question 9

Acute/controller medications

Answer 9

-corticosteroids: anti inflammatory, first line long term for persistent, up to 10 days, PO and IVP for severe

-phosphodiesterase: bronchodilator with mild anti-inflammatory effects

Question 10

Inhalation methods

Answer 10

-MDI: rinse in warm water 2/wk, need to shake before use
-DPI: no need to shake or spacers, not as much coordination
-nebulizer: cough after dose, high bac growth, clean daily

Question 11

During an attack

Answer 11

-at home: 2-4 puffs SABA q 20 min x3; not work call MD or 911
-sit pt up
-encourage pursed lip breathing
-monitor VS, O2 sat, ABG, breath sounds
-stay with pt
-let them rest but watch close
-keep hydrated

Question 12

Red flags for RF

Answer 12

-HR > 120
-RR >30
-wheezes that become silent
-ABG: O2 <90, PCO2 >45, PO2 <60
-pH: 7.35-7.45 not in range

Question 13

Complications

Answer 13

-pneumonia
-atelectasis (alveolar collapse)
-status asthmaticus: attack wont stop, acidosis, continuous bronchodilator
-RF

Question 14

Evaluating treatment

Answer 14

-monitor PERF (peak expiratory rate)
-blow hard and fast in one blow
-check daily
-at least 80% of pt’s personal best flow number

Question 15

Teaching

Answer 15

-compliance
-admin
-drug interactions
-learn and avoid triggers
-tx for URI
-treat GERD
-nutrition
-safe exercise