Asthma Flashcards
Asthma is 38% higher in who than whites?
Black people
Who has the highest mortality rates from asthma ?
Black women
Asthma effects about how many adult Americans?
20.4 million
Asthma gender differences
Men vs women? (2)
Men are more effected
But women die more too it
We tend not to diganosis asthma in child until 5 years old. Why?
Because children have small airways
Their airways can be obstructed by the smallest things
Reactive airway, they have reactive to a stimuli
After 4-5 years old, they have a pattern. Then we can say that have asthma
How much percentage of people are not using their inhalers correct?
72%
Asthma is the number one reason why kids ?
Miss school
13.8 million miss school
Asthma definition? (2) textbook definition
Combination of bronchial hyper responsive with
reversible expiratory airflow limitation
Asthma definition shorter version or how she says it (2)
Combination of
Bronchial construction ( narrowing )
&
Inflammation
The important part of reversible expiratory airflow limitation, the difference between asthma and COPD is?
Once the construction releases, the airway goes back to normal
Parents think when their kids get asthma they can’t do a lot of things, but you want them to get up and moving ( excerise ) why?
In order to gain resilience
In an adult airway they can handle more ____compared to an infant?
Inflammation
Asthma sign and symptoms may __?
Clinical course can be ___?
Vary
Unpredictable
Clinical course can be unpredictable because everyone Varys but it’s important to make sure the patient has what and why?
Making sure they have medication
In order to prevent an asthma attack
What are the 2 main consequences Of asthma?
Exposure to allergens or irritants triggers the inflammatory cascade involving a variety of inflammatory cells
Inflammation leads to bronchoconstirction, hyperresponsiveness and edema of airways lead to limited airflow
What does a person look like without asthma (3)?
Normal lining
Normal amount of mucus
Muscle relaxes
What does asthma look like in a person? (3)
Swollen lining
Excess amount of mucus
Muscle tightened
When we say more mucus on the asthma it’s usually what color?
Clear
What are some risk factors for asthma and triggers of asthma attacks? (12)
Cockroaches
Second hand smoke
Environmental allergies
Nasals polys
URI
Excersise enduced asthma
Animal dander
Mold
Fire pollution
Occupation
Cold air
Medications
Asthma can also come from where? (5)
GERD - gastroesophacal reflux disease
Asthma triad
Genetics
Immune system
Emotions
Can you just treat the constriction of the asthma? Why?
No because we also need to treat the inflammation if we’re going to reduce risk of death
What is the pathophysiology map for asthma? (10)
Triggers
- infection, allergens, exercise, irritants
Immune activation
- IL-4 & IGE production
Mast cell degranulation
Inflammatory mediators
Vasodilation
- increased capillary permeability
Cellular infiltration
- neutrophils, lymphocytes, eosinophils
Neuropeptides released with autonomic nervous system effects
Bronchospams
Vascular congestion
Etc
Airway remodeling
Bronchial hyperresponsiveness
Airway obstruction
Asthma & ___ & ___?
Allergens
Eczema
IL-4 is a what and functions how?
Cytokine
Functions as a potent regulator of immunity secreted primarily by mast cells
IGE and mast cells are known to drive what and cause what?
(3)
Immediate hypersensitivity
Cause acute reactions such as
Hives, wheezing, anaphylaxis
Mast cells serve as immune sentinel cells that respond to pathogens and sends signals to ?
Other tissues to modulate both innate and adaptive immune responses
When having asthma, our airway is remodeling, what does that mean?
We are changing to tolerate the change due to the bronchial construction/ hyperreactive
Early phase response is what after exposure to allergen or irritant?
30-60mins
In the early phase response of asthma what is being released? (2)
Mast cells release inflammatory mediators
Mediators includes leukotrienes, histamines, cytokines,
Medications are made to help with the problems of asthma, like for the release of histamine we made medication for like?
Anti histamine
Anti leurkotrienes
When you think of medication, you can’t treat something that isn’t the body. The medication goes into the body and works to attack the ?
Specific things
Like the anti histamines
Cause asthma is releasing histamine, so we give ANTI histamines to reverse the wrong
You can’t treat something new, instead you give medication to??
Reverse it!!
Late phase response what is it & time ?
We see what symptoms & time?
Occurs in % of patients(3)
Airway inflammation occurs within 4-6 hours
Severe symptoms (24 hours+)
Occurs in 50% of patients
Inflammation takes a what?
A little while to active
Which is why we see it more in the late phase
What are used to treat inflammation?
Corticosteroids
What is remodeling for asthma?
Proper definition
Structural changes in bronchi wall from chronic inflammation
What are changes that are in remodeling in asthma? (4)
Fibrosis
Smooth muscle hypertrophy
Mucus hypersecretion
Angiogenesis
progressive loss of lung function not fully reversible results in persistent asthma? True or false? Why?
True
We can treat it, however since it’s persistent, it’s constantly gonna cause damage to the lung function
What will a patient with asthma look like?
Distress
Anxious
Panic
What does respiratory distress look like? (5)
Hyperventilating
Color change - cyanosis
Blood pressure
Respiratory rate increase
Pulse ox
What are the diagnostic studies ? (5)
Peak flow meter
Spirometer
Fraction of exhaled nitric oxide (FENO)
Serum eosinophils & IGE
Allergy testing
What is peak flow meter?
And predict what?
What’s the rate called ?
- how feel your expiring ( getting air out )
Predict attack or monitor severity
Peak expiratory flow rate
What is spirometry?
Want to stop what/time?
Lung volumes & capacities
-stop bronchiodilators 6-12 hours prior
Green means
Yellow means
Red means
For peak flow meters?
Good
Got to get more meds
Danger !
What does EIA/EIB stand for?
And means what?
Exercise induced asthma
Exercise induced bronchospasm
During physical exertion
EIA is during what?
Activity
EIB occurs after?
Vigorous exercise
If someone has a recent asthma attack they are more likely to what?
Have another attack
What is asthma triad mean?
Food triggers/ drug triggers
Nasal polyps, asthma and sensitivity to aspirin and & NSAIDS
OTC drugs, foods, beverages and flavorings
Clinical manifestations of asthma (8)
Wheezing
Cough
Dyspnea
Chest tightness
Silent chest - ominous sign
Decreased/absent breath sound
Hyperventilation
Abnormal alveolar perfusion & ventilation
Clinical manifestations
Hyperinflation & prolonged expiration are due to what?
Air trapping in narrowed airways
In an acute asthma attack, the most common clinical manifestation is what?
Wheezing
When do you normally hear wheezing?
initially expiration
( then progression in both inspiration & expiration )
How is wheezing described?
Whimsical, musical breath sound heard mainly on expiration
Wheezing is unreliable to gauge severity of attack why?
Because it can happened in both chronic and acute attacks and it could become chronic too
What is silent chest mean for clinical manifestations of asthma?
Severe airway obstruction or impending respiratory failure
Life threatening
What does hyperventilation of asthma clinical manifestations?
Increased lung volume from trapped air and limited airflow
What is abnormal alveolar perfusion & ventilation?
Hypoxemic - decreased oxygen in blood
Decreased paCO2
Increased pH
Respiratory alkalosis results in respiratory acidosis as patient tires
Respiratory failure
If the patient is hypoxemic what do they look like?
And where?
Why these locations?
Cyanotic
Blue
In the lips & finger tips & toes
Capillaries & because oxygen first goes to brain/core
Lips, tips, and toes are last
How do we test for capillary refill?
How many seconds to come back to normal color?
Pinch/press finger to see how fast blood come back
3 or less
When pressing down on the hand or just testing for capillary refill, what is that called?
And when you release what happens?
Gland change
It refilled back to pretty pink
Slow Capillary refill means there’s a what?
Lack of perfusion in that body part where we tested the capillary refill
Asthma isn’t always wheezing or respiratory issues, it can be a what??
And typically wakes them up at?
Cough (dry)
Night time cough
If the person is waking up more than twice a night to cough, we need to what?
Amplified medication
What are the 4 asthma classifications ?
( like how do we measure )
Intermittent - less than 2 times a week
Mild persistent - more than 2 times a week
Moderate persistent - daily
Severe persistent - continual
What are the impairment criteria for asthma classifications? (7)
( think of like what needs to happen for us to classify it, like what happens with night time??)
Frequency of symptoms
Night time awakenings
SABA use for symptoms
Interferences with normal activity
Lung function : FEV1, FVC
risk for exacerbation
Severity
What are the complications of asthma? (7)
What can it cause, think of the P in complications
Mild to life
Last few mins to hours
Asymptomatic
Pneumonia
Tension pneumothorax
Status asthmatics !!!
Acute respiratory failure
What is status asthmaticus in asthma?
Extreme acute asthma attack
Hypoxia, hypercapnia, acute respiratory failure
What else would you see in status asthamticus? (3)
Can’t speak
Chest tightness
Shortness of breathe
Without treatment of status asthmaticus what happened? (3)
Hypotension
Bradycardia
Respiratory/cardiac arrest
Are bronchodilator’s and corticosteroids effective on status asthmaticus?
No
Status asthmaticus, patients are hard to intubated why?
Because it’s hard to even put it
And it’s hard to get out of them cause they need oxygen
Asthma treatment ( mild to moderate ) (4)
Inhalers bronchodilator’s - albuterol
( topical medication )
Oral corticosteroids - inflammation
Monitor vital signs
Monitor as outpatient unless not responding to treatment or another contributing factor
Follow up with HCP
What is the asthma rescue treatment and does what?
Albuterol
Bronchodilator
Helps with the bronchoconstriction
What does ICS stand for? And does what?
Inhaled corticosteroids
Helps for inflammation of asthma
Since inflammation takes a while to start, so inhaled corticosteroids takes what?
It always takes a while to start being effective
Do we give inhaled corticosteroids to respiratory distress patients?
NO!!! They will die
What do you give for bronchoconstriction!?? And it’s a what?
Albuterol!!
Bronchodilator
What do you give for inflammation?
Inhaled Corticosteroids
Should you being inhaled corticosteroids everyday? Why?
Yes because we can prevent or at least help get air in when an asthma attack is coming in
Vitamins !!
Apple a day keeps the doctor away
What is treatment for asthma?
Measurements (2)
(6)
Hospital admission for oxygen
PaO2 > 60mmHG
sa02 > 93%
Monitor PERF, ABGS, VS
Bronchodilators & oral corticosteroids
Silent chest - call HCP stat
A patient is admitted to the emergency department with a severe exacerbation of asthma. Which finding is of most concern to the nurse?
- unable to speak and sweating profusely
- paO2 of 80mm ahh and PaCO2 of 50mm Hg
- presence of inspiration and expiratory wheezing
- peak expiratory flow rate at 60% of personal best
Unable to speak and sweating profusely
Drug therapy - rescue
What are they called?
Short acting B adrenergic agonists ( SABAs )
What is an example of SABA?
Albuterol
What is the function of SABA?
Stimulate b2 receptors in bronchioles to produce bronchodilaton
When is SABA most effective ?
Relieving acute bronchospams with acute attack
What’s the onset and duration of Saba? (2)
Minutes - onset
4-8 hours - duration
What is drug therapy long term ??
Long acting b2 - andrenergic agnosit drugs ( LABA )
What are two examples of LABA?
Salmeterol ( serevent )
Formoterol ( foradil )
Do you use LABA for acute attacks?
NO!!
How often do you use LABA and decreased the need for what?
Once every 12 hours
Decreased need of Saba
You can you add ICS ( inhaled corticosteroids) to LABA?
Yes
What’s another example of long term ? (2)
And it has a what index?
Meaning?
Meyhylaxnthines
Theophylline
( it’s not used often & narrow therapeutic index )
- just right otherwise you get to toxic
Drug therapy
Anti-inflammatory
Corticosteroids
It’s the most effective what?
Long term control drug
What are two examples of cortiscoertioids?
Beclomethasone
Budesonide
When you inhale a corticosteroid
is it actually touching the airway?
Yes because it’s like a topical
Why is it important to administer the medication proplery. Can you breathe through liquid? No
though when you spray the liquid come out. It needs time to become vapor, so instead we use a what to help it become vapor?
A spacer
People get worried taking steroids for the inflammation but we tell patient that there is a little what?
Systemic absorption
What is LTMA stand for?
Singular
Leukotriene modifying agents
What are examples of of LTMAS? (3)
And how do we administer?
Zarirlukast
Montelukast
Zileuton
Oral
How does LTMA work?
Interfere with synthesis or block the action of leukotrienes
Produce both bronchodilator, antiiflmmatory
When do we give LTMAS? (3)
Asthma
Allergic rhinitis
EIB/EIA
LTMA isn’t for what?
An acute asthma attack
LTMA treats what?
Allergy & asthma
What’s a nebulizer mean?
Machine converts drug solution into a fine mist for inhalation via face mask or mouthpiece ; easy to use
If you have congestions, do you use a nebulizer or even albuterol?
No it won’t work
Patient teaching related to drug therapy
Example?
Identify factors that affect correct use to medications
Correct administration
Important of following plan
Side effects
How to clean
What is an MDI? Inhaler?
Small hand held pressurized devices
A spacer helps what? (3)
Reduce oropharyngeao medication deposition
Increase delivery to kings
Reduce problems with hand breath coordinating
What are some subjective data we want to collect from a patient for nursing assessment for asthma?
Past health history
Medications
We want to health promote/implementation of what in asthma?
Avoid triggers
Prompt diagnosis
Weight loss
Increase fluids
Exercise
What’s an oral corticosteroid example?
Prednisolone
What’s an ICS example?
Fluticasone/flovent
Inhaled corticosteroids can easily what?
Easy bruise
Reduce bone density
