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NU 350 Therap Interv: Care Ind Fam (Exam 1) > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Chronic inflammatory disorder of airways

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2
Q

What does asthma cause?

A

Causes airway hyperresponsiveness leading to wheezing, breathlessness, chest tightness, and cough

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3
Q

Who has a greater prevalence to asthma?

A

Women and African Americans have a greater prevalence

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4
Q

What are the tigers of asthma?

A 
Allergens 
Exercise 
Air pollutants 
Occupational Factors
Respiratory Infection 
Nose and Sinus Problems
Drugs and Food Additives
Gastroesophageal Reflux Disease
Emotional Stress
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5
Q

What are the two types of allergen triggers?

A

Seasonal and year round

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6
Q

Explain the exercise trigger?

A

Induced or exacerbated after exercise
Pronounced with exposure to cold air
Breathing through a scarf or mask may ↓ likelihood of symptoms

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7
Q

What are considered air pollutants?

A

Cigarette or wood smoke: smoke outside.
Vehicle exhaust
Elevated ozone levels
Sulfur dioxide

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8
Q

What is the most common form of occupational lung disease?

A

Asthma

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9
Q

Explain occupational trigger.

A

Exposure to diverse agents

Arrive at work well, but experience a gradual decline

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10
Q

Explain respiratory trigger.

A

Major precipitating factor of an acute asthma attack

↑ inflammation hyperresponsiveness of the tracheobronchial system

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11
Q

Explain nose and sinus trigger.

A

Allergic rhinitis and nasal polyps
Large polyps are removed
Sinus problems are usually related to inflammation of the mucous membranes
Most of the time, asthma pt have underlining sinus problems. Making the airway worse

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12
Q

Explain drug triggers.

A

Asthma triad: nasal polyps, asthma, and sensitivity to aspiri and NSAIDs
Wheezing develops in about 2 hrs
Sensitivity to salicylates
Found insalicylates many foods, beverages, and flavorings

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13
Q

Explain Food triggers.

A

Food allergies may cause asthma symptoms
Avoidance diets:
Rare in adults
People slightly out grow food allergy

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14
Q

Explain Gastroesophageal Reflux Disease trigger.

A

Reflux of acid could be aspirated into lungs causing bronchoconstriction
Fix GI and usually fix asthma

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15
Q

Explain emotional triggers.

A

Psychological factors can worsen the disease process
Attacks can trigger panic and anxiety
Extent of affect is unknown

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16
Q

What is the primary pathophysiology response?

A

Primary response is chronic inflammation from exposure to allergens or irritants
Leading to airway hyperresponsiveness and acute airflow limitations

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17
Q

Inflammatory mediators cause (early-phase response). What is the early -phase response?

A 
Vascular congestion
Edema formation
Production of thick, tenacious mucous
Bronchial muscle spasm
Thickening of airway walls
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18
Q

What is late-phase response?

A

Occurs within 4-10 hours after initial attack
Only occurs in 30-50% of patients
Can be more severe than early-phase and last for 24 hours or more
If airway inflammation is not treated or does not resolve, it may lead to irreversible lung damage

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19
Q

Is Wheezing is reliable to gauge severity?

A

No! Severe attacks may have no audible wheezing

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20
Q

An acute attack usually reveals signs of hypoxemia. What are the signs?

A 
Restlessness
↑ anxiety
↑ pulse and blood pressure
Pulsus paradoxus (drop in systolic BP during inspiratory cycle > 10 mm Hg)
Inappropriate behavior:
Confusion 
Acting out 
Not Oriented
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21
Q

What are the classifications of asthma?

A

Intermittent
Mild
Moderate
Severe

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22
Q

What is Status asthmaticus?

A

Severe, life-threatening attack unresponsive to usual treatment
Patient at risk for respiratory failure
Where full blown attack, but having extreme trouble getting under control.

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23
Q

What are causes of status asthmaticus?

A 
Viral illnesses
Ingestion of aspirin or other NSAIDs
Environmental pollutants or allergen exposure
Emotional stress
Abrupt discontinuation of drug therapy
Abuse of aerosol medication
Ingestion of β-adrenergic blockers:
Contraindication to asthma!! Blocks part of response to airway.
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24
Q

Clinical manifestations of status asthmaticus result from..

A

Increased airway resistance from edema
Mucous plugging
Bronchospasm
Respiratory acidosis

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25
Q

Explain status asthmaticus.

A

As attack severity ↑, work of breathing ↑, patient tires, and it is harder to overcome the ↑ resistance to breathing
Ultimately the patient deteriorates to hypercapnia and hypoxemia

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26
Q

What are complications of status asthmaticus?

A

Pneumothorax
Acute cor pulmonale: right sided heart failure
Drop in O2 saturation (SaO2)
Severe respiratory muscle fatigue leading to respiratory arrest
Both indicating mechanical ventilation.

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27
Q

What is Acute cor pulmonale?

A

Right sides heart failure

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28
Q

What is the usual result of death?

A

Death is usually result of respiratory arrest or cardiac failure

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29
Q

What are some diagnostic studies for asthma?

A

Detailed history and physical exam
Pulmonary function tests and Peak flow monitoring
-Withhold bronchodilators for 6-12 hours before the tests.
Chest x-ray: acute attack
ABGs: Done if they are in an acute attack Oximetry
Allergy testing
Blood levels of eosinophils
Sputum culture and sensitivity

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30
Q

What is CBC with differential?

A

tells with all different types of WBC and others cells.

31
Q

Education?

A

Start at time of diagnosis
Integrate through care
Greatest method
Asthma education is really hard for the lay person to understand.

32
Q

What is the most important thing a client should be educated on?

A

Make sure they know the name of the medicine. That is the most important. Tell them what each dose does.

33
Q

What are the desired therapeutic outcomes?

A

Control or eliminate symptoms
Attain normal lung function
Restore normal activities
Reduce or eliminate exacerbations and side effects of medications

34
Q

Collaborative care for an Acute asthma episode?

A

Respiratory distress
Treatment depends upon severity and response to therapy
Severity measured with flow rates
O2 therapy should be started and monitored with pulse oximetry or ABGs in severe cases
Inhaled β-adrenergic agonists by metered dose inhaler or nebulizer
Corticosteroids indicated if response is insufficient

35
Q

Collaborative care for mild intermittent and mild persistent asthma?

A

Avoid triggers of acute attacks
Premedicate before exercising
Choice of drug therapy depends on symptom severity

36
Q

Collaborative care for Status asthmaticus?

A

Most therapeutic measures are the same as for acute episode
↑ in frequency and dose of bronchodilators
IV corticosteroids are administered every 4-6 hours
Continuous monitoring of patient is critical (cardiac)
IV magnesium sulfate is given as a bronchodilator
Supplemental O2 is given by mask or nasal cannula for 90% O2 saturation
Arterial catheter may be used to facilitate frequent ABG monitoring
IV fluids are given due to insensible loss of fluids

37
Q

Acute asthma episode collaborative treatment

A

Can be severe enough to require intubation and mechanical ventilation
Used when there is no response to other treatment
Louder wheezing may occur in airways that are responding to therapy
With progression normal breath sounds return and wheezing subsides

38
Q

What are the 3 types of anti-inflammatory drugs?

A

Corticosteroids
Anti-IgE
Leukotriene modifiers

39
Q

What is important about corticosteroids?

A

Suppress inflammatory response
Inhaled form is used in long-term control
Systemic form to control exacerbations and manage persistent asthma
Reduce bronchial hyperresponsiveness
Decrease mucus production
Taken on a fixed schedule

40
Q

What is important about Anti-IgE?

A

↓ circulating free IgE levels
Prevents IgE from attaching to mast cells, preventing release of chemical mediators
Subcutaneous administration every 2-4 weeks

41
Q

What are adverse effects of corticosteroids?

A

Oropharyngeal candidiasis, hoarseness, and a dry cough are local side effects of inhaled drug

42
Q

What are important factors regarding Leukotriene modifiers?

A

Blocks action of leukotrienes (potent bronchoconstrictors).
Have both bronchodilator and anti-inflammatory effects
Not indicated for acute attacks
Used for prophylactic and maintenance therapy
Take at bedtime

43
Q

What are the 3 types of bronchodilators?

A

β2-adrenergic agonists
Methylxanthines
Anticholinergics

44
Q

β2-adrenergic agonists?

A

Effective for relieving acute bronchospasm
Onset of action in minutes and duration of 4-8 hours
Prevent release of inflammatory mediators from mast cells
Not for long-term use
Rescue medications

45
Q

What is important about methylxanthines?

A

Less effective long-term bronchodilator
Alleviates early phase of attacks but has little effect on bronchial hyperresponsiveness
Narrow margin of safety – instruct pt on s/s of toxicity (N/V, seizures, insomnia)
Avoid caffeine
Make sure in therapeutic range!

46
Q

What is important about anticholinergics?

A

Block action of acetylcholine
Usually used in combination with a bronchodilator
Most common side effect is dry mouth

47
Q

What is the preferred route for asthma drugs?

A

Inhalation of drugs is preferable to avoid systemic side effects

48
Q

What are the 3 main types of inhalers?

A

MDIs (metered dose inhalers), DPIs(dry powder inhalers), and nebulizers are devices used to inhale medications

49
Q

What is a benefit of DPIs?

A

DPI (dry powder inhaler) requires less manual dexterity and coordination

50
Q

Nonprescription Combination Drugs should be..

A

Should be avoided in general

51
Q

Epinephrine can..

A

Epinephrine can increase heart rate and blood pressure

Ephedrine stimulates CNS and cardiovascular system

52
Q

What should consist of a nursing assessment?

A

1) Health Hx
2) ABG’s
3) ung function test
4) Physical Exam

53
Q

What should a nurse find out when asking about Health Hx?

A

especially of precipitating factors and medications

54
Q

What consists of a physical exam?

A

Use of accessory muscles
Diaphoresis: Sweaty
Cyanosis
Lung sounds

55
Q

What are some nursing diagnosis?

A

Ineffective airway clearance
Anxiety
Deficient knowledge

56
Q

What are the overall goals for asthma pts?

A

1) Maintain greater than 80% of personal best PEFR(peak expiratory flow rate) or FEV (Forced expiratory volume)
2) Have minimal symptoms
3) Maintain acceptable activity levels
4) No recurrent exacerbations of asthma or decreased incidence of asthma attacks
5) Adequate knowledge to participate in and carry out management

57
Q

What should the nurse teach the pt to avoid?

A

Teach patient to identify and avoid known triggers
Use dust covers
Use of scarves or masks for cold air

58
Q

What medications should an asthma pt avoid?

A

Avoid aspirin or NSAIDs

59
Q

What should the nurse promote a sick client with asthma to do?

A

Prompt diagnosis and treatment of upper respiratory infections and sinusitis may prevent exacerbation

60
Q

How much fluids should an adult with asthma intake?

A

Fluid intake of 2 to 3 L every day

61
Q

How many minutes should a pt take β-adrenergic agonist before exercise?

A

10 to 20 minutes prior to exercising

62
Q

What happens to VS during an asthma attack?

A

Lung sounds (Wheezing or non)
Respiratory rate (increased)
Pulse (increased)
BP (Increased)

63
Q

What emotion should a nurse try and lower in asthma clients?

A

An important goal of nursing is to ↓ the patient’s sense of panic
Stay with patient
Encourage slow breathing using pursed lips for prolonged expiration
Position comfortably

64
Q

What type of breathing should a nurse promote?

A

Encourage slow breathing using pursed lips for prolonged expiration

65
Q

What is crucial knowledge and steps home nurses must promote?

A

1) Must learn about medications and develop self-management strategies
2) Patient and health care professional must monitor responsiveness to medication
3) Patient must understand importance of continuing medication when symptoms are not present

66
Q

What should a nurse teach a client about exercise?

A

Exercise within limits of tolerance

67
Q

What should a nurse teach a client about bronospasms?

A

Seek medical attention for bronchospasm or when severe side effects occur

68
Q

Is nutrition important with asthma clients?

A

Maintain good nutrition

69
Q

What should asthma pts measure daily?

A

Peak flow should be monitored daily and a written action plan should be followed according to results of daily PEFR (peak expiratory flow rate)

70
Q

What does peak flow correlate with?

A

This correlates with FEV.

71
Q

What do asthmatics frequently do not perceive?

A

Asthmatics frequently do not perceive changes in their breathing

72
Q

What is the green zone?

A

Usually 80 to 100% of personal best

Remain on medications

73
Q

What is yellow zone?

A

Usually 50-80% of personal best
Indicates caution
Something is triggering asthma

74
Q

What is the red zone?

A

50% or less of personal best
Indicates serious problem
Definitive action must be taken with health care provider

NU 350 Therap Interv: Care Ind Fam (Exam 1) (8 decks)

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