Asthma Flashcards
What is asthma?
Chronic inflammatory disorder of airways
What does asthma cause?
Causes airway hyperresponsiveness leading to wheezing, breathlessness, chest tightness, and cough
Who has a greater prevalence to asthma?
Women and African Americans have a greater prevalence
What are the tigers of asthma?
Allergens Exercise Air pollutants Occupational Factors Respiratory Infection Nose and Sinus Problems Drugs and Food Additives Gastroesophageal Reflux Disease Emotional Stress
What are the two types of allergen triggers?
Seasonal and year round
Explain the exercise trigger?
Induced or exacerbated after exercise
Pronounced with exposure to cold air
Breathing through a scarf or mask may ↓ likelihood of symptoms
What are considered air pollutants?
Cigarette or wood smoke: smoke outside.
Vehicle exhaust
Elevated ozone levels
Sulfur dioxide
What is the most common form of occupational lung disease?
Asthma
Explain occupational trigger.
Exposure to diverse agents
Arrive at work well, but experience a gradual decline
Explain respiratory trigger.
Major precipitating factor of an acute asthma attack
↑ inflammation hyperresponsiveness of the tracheobronchial system
Explain nose and sinus trigger.
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
Explain drug triggers.
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
Explain Food triggers.
Food allergies may cause asthma symptoms
Avoidance diets:
Rare in adults
People slightly out grow food allergy
Explain Gastroesophageal Reflux Disease trigger.
Reflux of acid could be aspirated into lungs causing bronchoconstriction
Fix GI and usually fix asthma
Explain emotional triggers.
Psychological factors can worsen the disease process
Attacks can trigger panic and anxiety
Extent of affect is unknown
What is the primary pathophysiology response?
Primary response is chronic inflammation from exposure to allergens or irritants
Leading to airway hyperresponsiveness and acute airflow limitations
Inflammatory mediators cause (early-phase response). What is the early -phase response?
Vascular congestion Edema formation Production of thick, tenacious mucous Bronchial muscle spasm Thickening of airway walls
What is late-phase response?
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
Is Wheezing is reliable to gauge severity?
No! Severe attacks may have no audible wheezing
An acute attack usually reveals signs of hypoxemia. What are the signs?
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
What are the classifications of asthma?
Intermittent
Mild
Moderate
Severe
What is Status asthmaticus?
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.
What are causes of status asthmaticus?
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.
Clinical manifestations of status asthmaticus result from..
Increased airway resistance from edema
Mucous plugging
Bronchospasm
Respiratory acidosis
Explain status asthmaticus.
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
What are complications of status asthmaticus?
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.
What is Acute cor pulmonale?
Right sides heart failure
What is the usual result of death?
Death is usually result of respiratory arrest or cardiac failure
What are some diagnostic studies for asthma?
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
What is CBC with differential?
tells with all different types of WBC and others cells.
Education?
Start at time of diagnosis
Integrate through care
Greatest method
Asthma education is really hard for the lay person to understand.
What is the most important thing a client should be educated on?
Make sure they know the name of the medicine. That is the most important. Tell them what each dose does.
What are the desired therapeutic outcomes?
Control or eliminate symptoms
Attain normal lung function
Restore normal activities
Reduce or eliminate exacerbations and side effects of medications
Collaborative care for an Acute asthma episode?
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
Collaborative care for mild intermittent and mild persistent asthma?
Avoid triggers of acute attacks
Premedicate before exercising
Choice of drug therapy depends on symptom severity
Collaborative care for Status asthmaticus?
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
Acute asthma episode collaborative treatment
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
What are the 3 types of anti-inflammatory drugs?
Corticosteroids
Anti-IgE
Leukotriene modifiers
What is important about corticosteroids?
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
What is important about Anti-IgE?
↓ circulating free IgE levels
Prevents IgE from attaching to mast cells, preventing release of chemical mediators
Subcutaneous administration every 2-4 weeks
What are adverse effects of corticosteroids?
Oropharyngeal candidiasis, hoarseness, and a dry cough are local side effects of inhaled drug
What are important factors regarding Leukotriene modifiers?
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
What are the 3 types of bronchodilators?
β2-adrenergic agonists
Methylxanthines
Anticholinergics
β2-adrenergic agonists?
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
What is important about methylxanthines?
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!
What is important about anticholinergics?
Block action of acetylcholine
Usually used in combination with a bronchodilator
Most common side effect is dry mouth
What is the preferred route for asthma drugs?
Inhalation of drugs is preferable to avoid systemic side effects
What are the 3 main types of inhalers?
MDIs (metered dose inhalers), DPIs(dry powder inhalers), and nebulizers are devices used to inhale medications
What is a benefit of DPIs?
DPI (dry powder inhaler) requires less manual dexterity and coordination
Nonprescription Combination Drugs should be..
Should be avoided in general
Epinephrine can..
Epinephrine can increase heart rate and blood pressure
Ephedrine stimulates CNS and cardiovascular system
What should consist of a nursing assessment?
1) Health Hx
2) ABG’s
3) ung function test
4) Physical Exam
What should a nurse find out when asking about Health Hx?
especially of precipitating factors and medications
What consists of a physical exam?
Use of accessory muscles
Diaphoresis: Sweaty
Cyanosis
Lung sounds
What are some nursing diagnosis?
Ineffective airway clearance
Anxiety
Deficient knowledge
What are the overall goals for asthma pts?
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
What should the nurse teach the pt to avoid?
Teach patient to identify and avoid known triggers
Use dust covers
Use of scarves or masks for cold air
What medications should an asthma pt avoid?
Avoid aspirin or NSAIDs
What should the nurse promote a sick client with asthma to do?
Prompt diagnosis and treatment of upper respiratory infections and sinusitis may prevent exacerbation
How much fluids should an adult with asthma intake?
Fluid intake of 2 to 3 L every day
How many minutes should a pt take β-adrenergic agonist before exercise?
10 to 20 minutes prior to exercising
What happens to VS during an asthma attack?
Lung sounds (Wheezing or non)
Respiratory rate (increased)
Pulse (increased)
BP (Increased)
What emotion should a nurse try and lower in asthma clients?
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
What type of breathing should a nurse promote?
Encourage slow breathing using pursed lips for prolonged expiration
What is crucial knowledge and steps home nurses must promote?
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
What should a nurse teach a client about exercise?
Exercise within limits of tolerance
What should a nurse teach a client about bronospasms?
Seek medical attention for bronchospasm or when severe side effects occur
Is nutrition important with asthma clients?
Maintain good nutrition
What should asthma pts measure daily?
Peak flow should be monitored daily and a written action plan should be followed according to results of daily PEFR (peak expiratory flow rate)
What does peak flow correlate with?
This correlates with FEV.
What do asthmatics frequently do not perceive?
Asthmatics frequently do not perceive changes in their breathing
What is the green zone?
Usually 80 to 100% of personal best
Remain on medications
What is yellow zone?
Usually 50-80% of personal best
Indicates caution
Something is triggering asthma
What is the red zone?
50% or less of personal best
Indicates serious problem
Definitive action must be taken with health care provider
