Asthma Flashcards
What is Asthma?
A chronic inflammatory disease of the lungs characterized by recurrent episodes of wheezing, breathlessness, chest tightness & coughing.
What is a Type 1 Sensitivity Asthma?
Airway hyper-responsiveness ( exaggerated bronchodilation response) & airway obstruction from over production of mucus & edema of the airway mucosa.
What happens after Inflammatory Mediators are activated in Asthma?
- Vascular Congestion
- Edema Formation
- Increased Mucus Production
- Bronchospasm
What is Status Asthmaticus?
A severe prolonged form of asthma that is difficult to treat. It is due to the overuse of emergency asthma medication, making the person unresponsive to these meds. This is considered a medical emergency that can result in respiratory failure.
What are some Causes of asthma attacks?
- Air pollutants: Tobacco, Smoke, Fumes
- Allergens: Pollen, Animal Dander, Dust, Mold
- Chemicals & Food: Drugs, Nnuts, MSG, Shel-fish & Dairy Products
- Respiratory Infections: Bacterial, Fungal, Viral, etc.
- Stress: Emotional, Anxiety, Exercise in DRY & COLD climates.
What are Clinical Manifestations of Asthma?
- Coughing
- Wheezing
- SOB
- Chest Tightness
- Tachypnea
- Tachycardia
- Anxiety
- Apprehension
Which airway cell activates 1st in response to an allergen?
B-Lymphocyte
What are the cells involved in the early phase response of asthma?
- B-lymphocyte
- Plasma Cells
- IgE antibodies
- Mast Cells (MVP)
How is Asthma Treated?
- Attack Prevention
- Bronchodilators
- Antiinflammatories
What is the Main Difference Between Asthma & COPD?
Asthma is reversible
Are men or women more likely to have asthma?
Women are 76% at greater probability of having asthma
Which cell is the MVP inflammation in asthma?
Mast Cell bc of their granules of histamine that are activated.
What is the Primary Response in Asthma?
Chronic Inflammation which leads to…
- Airway Bronchoconstriction
- Hyperresponsiveness
- Edema of Airways.
Early Response Asthma Effects.
- Vascular Congestion- Bc of Histamin
- Edema Formation–Bc of inflammation
- Production of Thick, Tenacious Mucus
- Bronchial Muscle Spasm
- Thickening of Airway Walls.
What cells live within the alveolar wall that is the primary cause of Inflammation?
- Mast Cells
- Mast Cells release Histamine
- -Activated by allergen or chemical mediators through cascade.
Asthma: Primary Response
- INFLAMMATION
- From exposure to allergens or irritants
- -Leading to Airway Bronchoconstriction, Hyperresponsiveness, and Edema of Airways.
- –RN Dx= Ineffective Airway Clearance
What do B cells produce?
- Antibodies
2. Becoming a factory producing more B cells.
Asthma: Late phase Response: What happens when airway inflammation is not treated or resolved?
May lead to irreversible lung damage, Such as:
Structural changes in the bronchiol wall known as remodeling
How long does the late-phase response take after an initial asthma attack? How long can it last?
- Late-Phase begins within 4-6 hours
2. Can last 24hours or longer
Approximately how many patients with asthma attacks develop into the late-phase response?
- The late-phase occurs in approximately 50% of pt’s.
2. The late-phase can be more severe than the early-phase
When taking a Hx. What is an important question?
What was the pt. doing? Feeling?
What was the possible cause?
What are the common asthma clinical manifestations?
- Unpredictable and variable
- Recurrent episodes of wheezing (but not very reliable bc there is air movement)
- Breathlessness
- Cough
- Chest Tightness
- ABG (most reliable source)
Asthma and Wheezing…
- Wheezing is unreliable to gauge severity
- Severe attacks may have no audible wheezing
- Usually begins upon exhalation
- Silent lung= Medical emergency
- ABG is the most reliable diagnostic tool.
In asthma, the pt. having difficulty with air movement can create the feeling of suffocation which can lead to what…?
- Anxiety, which further leads to worsening of the asthma.
Patient may express “I can’t get a breath.”
What are some physical manifestations of the asthma pt’s. state of hypoxemia?
- Using accessory muscles
- Anxiety Increases
- Tripod position
What is the RN’s 1 st action when pt. states they are SOB?
Raise HOB to High Fowler Postion
Asthma with Hypoxemia Clinical Manifestations
- Increased BP, HR, RR
- Anxiety
- Dry mouth
- Restlessness
- Diaphoretic
- Inappropriate behavior
- Wheezing
- Hyperresonance (Air trapping
Silent Chest= Impending Intubation.
What are the 4 Asthma Classifications?
- Intermittent
- Mild Persistent
- Moderate Persistent
- Severe persistent
Asthma Complications, Severe and Life Threatening Exacerbations
- RR >30
- HR >120
- PEFR @ 40%
- Too dyspnic to talk
- Perspiring profusely
- Drowsy and confused
What are the 5 Major RN Dx for Asthma?
- Altered oxygenation R/T bronchial constriction and mucus production
- Ineffective Breathing Pattern R/T Bronchospasm
- Anxiety R/T fear of sufocation
- Fatigue R/T Decreased Oxygen Supply to tissues
What are some Outcomes and Goals?
- Control or eliminate symptoms
- Attain normal lung function
- Restore normal activities
- Reduce of eliminate exacerbation and side effect of medication
Diagnostic testing for the asthma pt.
- Detailed Hx
- Peek flow monitoring (PEFR)
- Pulmonary Function test
- CXR
- ABG
- Oximetry
- Allergy Test
- Sputum Culture and A Sensitivity
Asthma Collaborative Care: Intermittent & Persistent Asthma
- Avoid triggers
- Drug therapy (depends on severity)
- Pre-medicate before exercise.
Asthma Collaborative care: Acute Asthma Exacerbations
- Tx depends on severity & response to therapy
- Severity Measured with flow rates
- Oxygen therapy may be started & monitored
Asthma Treatment: Severe & life threatening exacerbations
- IV Corticosteroids Q4-6 hours
- Arterial Catheter for ABG monitoring
- IV magnesium sulfate for bronchoconstriction
- Helium and Oxygen Tx given by mask or NC, Keep above 90%.
- Epinaphrine used only in life-threateining situations
Who is @ most risk for Status asthmaticus?
- Elderly
- Children
Bc they can decompensate rapidly
What are the 2 quick relief medications to Tx Asthma?
SABA-Short Acting Beta Agonist
- Beta-Agonist= Albuterol
- Anticholinergic Agent= Atrovent
