Asthma Flashcards
What is asthma ?
chronic inflammatory disorder of the airways resulting in reversible airflow obstruction and hyper-responsiveness of tracheobronchial tree to a variety of stimuli
What is the pathophysiology of asthma ?
- acute bronchoconstriction
- smooth muscle contraction
- airway edema
- mucosal thickening
- mucous secretion
- mucous plug formation
- airway remodeling: changes the respiratory system
What are some triggers for asthma ?
- strenuous exercise
- change in weather
- emotional stress
- infections
- allergen exposure
- inhaled irritants
- drugs and food adiitives
- gastroesophageal reflux
- nose and sinus problems
What are some clinical manifestations of asthma ?
- dry, non-productive cough
- SOB
- prolonged expiratory phase
- increased CO2 retention
- expiratory wheezing
- apprehension
- broken speaking
- hyperresonance on percussion of lungs
What are some S&S of hypoxia in pediatrics ?
- feeding difficulty
- inspiratory stridor
- nares flare
- expiratory grunting
- sternal retractions
What are some early and late signs of hypoxia ?
early
- restlessness
- anxiety
- tachycardia/tachypnea
late
- bradycardia
- extreme restlessness
- dyspnea (severe)
What causes chest retractions ?
intrapleural pressure becomes increasingly negative, the musculature “pulls back” in an effort to overcome the blockage
What do chest retractions indicate ?
an obstruction to inspiration at any point in the respiratory tract
- the degree and level of retraction depends on extent and level of obstruction
How is asthma classified into categories ?
- frequency and impact of symptoms
What is mild intermittent asthma ?
symptoms occur less than 2 times a week
- no limitation on activity
What is mild persistent asthma ?
symptoms occur more than twice a week but not daily
- minor limitation on activity
What is moderate persistent asthma ?
daily symptoms with exacerbations twice a week
- some limitations on activity
What is severe persistent asthma ?
symptoms occur continually and frequent daily exacerbations
- limits physical activity and quality of life
What does a yellow peak expiratory flow result mean ?
50-80%
- exacerbation possible or asthma not well managed
What does a red peak expiratory flow result mean ?
below 50%
- immediate bronchodilator needed
- contact health care provider
What is the diagnostic studies for asthma ?
- pulmonary function tests (PFTs)
- peak flow monitoring
- CXR: can show damage to lung tissues or any atelectasis
- O2 sat
- blood levels of eosinophils and IgE: increases with allergic reactions
How does asthma influence pulmonary function tests ?
decrease in forced vital capacity
- air trapping causes increase in functional residual volume
- prolonged I:E ration
- 1:3 or 1:4
- ABGs
What are some acute care interventions ?
- ongoing monitoring and assessments
- humidified O2
- hydration
- pt positioning
- quiet environment, rest, support
- medication
- patient and family teaching
How do B2 adrenergic agonists (bronchodilators) work ?
most effective drug for relieving bronchospasm
- suppress histamine release in the lungs
- act on beta 2 receptors to promote bronchodilation
How do corticosteroids work ?
- most effective anti-asthmatic drugs
- work by suppressing inflammation
- decrease bronchial hyperactivity
- usually inhaled, but can be IV or oral
How do mast cell stabilizers work ?
non-steroidal anti-inflammatory
- inhibit IgE mediated release of inflammatory mediator form mast cells
- suppress other inflammatory cells
- used for asthma prophylactically if allergen is causative agent
- takes several weeks before clinical response occurs
How do leukotriene modifiers work ?
- interfere with the synthesis or block the action of leukotrienes
- not for use in acute asthma
- used mainly for maintenance & prophylactic therapy
- effective for add on therapy to reduce not replaced inhaled corticosteroids
How do IgE antagonists work ?
- decreases circulating free IgE levels
- used for moderate to severe persistant asthma that cannot be controlled by with inhaled corticosteroids
- administered via SubQ injection q 2-4 weeks
How do mucolytics work ?
- react with mucus to make a watery consistency
- cough become more productive with use
- administered by inhalation
- can trigger bronchospasm
Why are inhalation treatments the desired methods ?
has less systemic effect
What are some SE of B2 adrenergic agonists ?
- tachycardia
- anxiety
- jittery feeling
- tremors
- palpations
What are the short-acting and long-acting B2 adrenergic agonist ?
- short acting: albuterol (“rescue med”)
- long acting: salmeterol
What are some RN implications for B2 adrenergic agonists ?
- pt’s need to know what the difference is between long and short acting
- short acting used in emergencies or with acute exacerbations
How does Methylxanthines work ?
cause CNS excitation
- bronchodilation
What is an example of methylxanthines ?
theophylline & aminophylline
What are some SE of methylxanthines ?
- dysrhythmias
- seizures
- nausea
- diarrhea
- restlessness
How do anticholinergics work ?
cause bronchial dilation
- meds approved to treat COPD
- SE: dry mouth & hoarseness
What is a short and long acting anticholinergics ?
- short: ipratropium
- long: tiotropruim
What are some nursing implications for anticholinergics ?
- administered by inhalation
- iprotropium may be given in combo with albuterol
- tiotropium has longer duration and can be administed less often
What are some nursing implications for methylxanthines ?
- half life decreased by smoking
- many drugs can increase the drug level
- used when long term bronchodilators are not available
What is an example of a leukotriene modifier ?
montelukast
What are some SE of leukotriene modifiers ?
- HA
- dizziness
- nausea
- fatigue
- abdominal pain
- bronchospasms
- GI disturbances
What are some nursing implications for leukotriene modifiers ?
- not for use in acute asthma
- used mainly for maintenance & prophylactic therapy
What are examples of mast cell stabilizers ?
cromolyn & nedocromil
What are SE of mast cell stabilizers ?
irritant to throat and bronchospasms
What are some nursing implications for mast cell stabilizers ?
- takes several weeks before clinical response occurs
- used for asthma prophylactically if allergen is causative agent
What are examples of corticosteroids ?
- inhaled: flovent
- oral: prednisone
- IV: solumedrol (methylprednisolone), decadron
What are some SE of corticosteroids ?
- thrush (have pt wash their mouth afterwards)
- increase glucose
- inhaled have less systemic effects (so you will not see SE of increased appetite and mood swings that are seen in oral and IV)
What are some nursing implications for corticosteroids ?
- usually inhaled, but can be IV or oral
- must rinse out mouth after adminstration
What is an example of a IgE antagonist ?
omalizumab
What are some SE of IgE antagonists ?
- redness at injection site (rotate sites)
- HA
- increase risk for viral infections
- sinusitis (upper respiratory infections)
- monitor IgE levels
What are key assessment findings in acute asthmatic exacerbations ?
- inspiratory & expiratory wheezing
- dry hacking cough
- increased WOB
- tachypnea
- anxiety
- retractions
- tachycardia
What does “silent chest” indicate in an asthmatic patient ?
absence of wheezing or diminished breath sounds could indicate a decrease or lack of air movement as a result of exhaustion or extreme narrowing of the airway
- sign of impending respiratory failure
- BAD
