Asthma Flashcards
Asthma
Definition
Chronic inflammatory disorder of airways-Bronchospasms
Leads to recurrent episodes of wheezing, breathlessness, chest tightness, and cough
Associated with variable airflow obstruction
Usually reversible- The difference from COPD which is not
Risk Factors and Triggers
of Asthma
Related to patient (e.g., genetic factors)
Related to environment (e.g., pollen)
Male gender is a risk factor in children (but not adults).
Obesity is also a risk factor.
Asthma
Pathophysiology
Primary response is chronic inflammation from exposure to allergens or irritants.
*Leading to airway bronchoconstriction, hyperresponsiveness, and edema of airways
Inflammatory mediators cause what early-phase responses in Asthma
Vascular congestion
Edema formation
Production of thick, tenacious mucus
Bronchial muscle spasm
Thickening of airway walls
Late-phase response
in Asthma
Occurs within 4 to 6 hours after initial attack
Occurs in about 50% of patients
Can be more severe than early phase and can last for 24 hours or longer- Due to inflamamtion
If airway inflammation is not treated or does not resolve, it may lead to irreversible lung damage.
Structural changes in the bronchial wall known as remodeling
Clinical Manifestations
of Asthma
Unpredictable and variable
Expiration may be prolonged
Wheezing is unreliable to gauge severity. –Once asthma is severe you won’t hear wheezing secondary to no airflow going through.
Cough variant asthma- Non productive mostly
Classification of Asthma
Intermittent
Mild persistent
Moderate persistent
Severe persistent
Asthma Complications
Severe and life-threatening exacerbations
Respiratory rate >30/min
Pulse >120/min
PEFR is 40% at best. Peak expiratory flow rate. Want it to be >80%
Usually seen in ED or hospitalized
Life-threatening asthma
Too dyspneic to speak
Perspiring profusely- Diaphoretic
Drowsy/confused
Require hospital care and often admitted to ICU
Asthma Diagnostic Studies
Detailed history and physical exam
Peak flow monitoring- Can tell the PEFR
Pulmonary function tests- No bronchodilators for at least 6 hours prior- Will be a question
Chest x-ray
ABGs
Oximetry
Allergy testing-To help determine triggers
Blood levels of eosinophils- Patients who are genetically at risks. Higher levels indicate higher probability of developing
Sputum culture and sensitivity-R/O infection
Diagnostic Study in Asthma
Niox Mino
Hand-held point-of-care device
Measures fractional exhaled nitric oxide (FENO)
Their levels will tell you if they are asthmatic or not
Collaborative Care Asthma
GINA
Global Initiative for Asthma (GINA)
Current guidelines focus on
Assessing the severity of the disease at diagnosis and initial treatment
Monitoring periodically to achieve control of the disease
Collaborative Care Asthma
Teaching
Start at time of diagnosis.
Integrate through care.
Self-management
Tailored to needs of patient
Culturally sensitive
Desired therapeutic outcomes for Asthma Patients
Control or eliminate symptoms.
Attain normal lung function.
Restore normal activities.
Reduce or eliminate exacerbations and side effects of medications.
Collaborative Care
Intermittent and persistent asthma
Avoid triggers of acute attacks.
Pre-medicate before exercising.
Choice of drug therapy depends on symptom severity.
Respiratory distress
Treatment depends upon severity and response to therapy.
Severity measured with flow rates
Bronchodilators-short acting Albuterol for acute attack
Collaborative Care
Acute asthma exacerbations
O2 therapy may be started and monitored with pulse oximetry or ABGs in severe cases.
Short acting Brochdilators
Collaborative Care
Severe exacerbations
Most therapeutic measures are the same as for acute episode.
↑ in frequency and dose of bronchodilators
Collaborative Care
Severe and life-threatening exacerbations
IV corticosteroids are administered every 4 to 6 hours, then are given orally.
Continuous monitoring of patient is critical.
IV magnesium sulfate is given as a bronchodilator.
Mixture of helium and oxygen (Heliox)
Bronchial thermoplasty
In Asthma
Catheter applies heat to reduce muscle mass in the bronchial wall.
Reverses accumulation of excessive tissue that causes narrowing of airway- Decreases smooth muscle increasing the diameter of the airway.
Three types of antiinflammatory drugs in Asthma
Corticosteroids- Most common
Leukotriene modifiers
Monoclonal antibody to IgE
What do Corticosteroids (e.g., beclomethasone, budesonide)
Do In Asthma
Suppress inflammatory response
Inhaled form is used in long-term control.
Systemic form to control exacerbations and manage persistent asthma
Reduce bronchial hyperresponsiveness
Decrease mucous production
Are taken on a fixed schedule- Rinse mouth after use to prevent infection
Oropharyngeal candidiasis, hoarseness, and a dry cough are local side effects of inhaled drug.
Can be reduced using a spacer or by gargling after each use
Leukotriene modifiers or inhibitors (e.g., zafirlukast, montelukast, zileuton)
Block action of leukotrienes—potent bronchoconstrictors
Have both bronchodilator and antiinflammatory effects
Not indicated for acute attacks
Used for prophylactic and maintenance therapy
What are the Three types of bronchodilators
β2-Adrenergic agonists
Methylxanthines
Anticholinergics
β-Adrenergic agonists (SABAs)- Fast acting
Examples: albuterol, pirbuterol
Effective for relieving acute bronchospasm
Onset of action in minutes and duration of 4 to 8 hours
Increases HR. Avoid Propanolol. Be selective of none specific B- Adrenergic
Prevent release of inflammatory mediators from mast cells
Not for long-term use
Long-acting β2-Adrenergic Agonist Drugs
Salmeterol (Serevent) and formoterol (Foradil)
Added to daily ICSs
Decrease the need for SABAs
Never used as monotherapy
Methylxanthines (e.g., theophylline)
Less effective long-term bronchodilator
Alleviates early phase of attacks but has little effect on bronchial hyper-responsiveness
Narrow margin of safety
Anticholinergic drugs (e.g., ipratropium)
Block action of acetylcholine
Usually used in combination with a bronchodilator
Most common side effect is dry mouth.
Patient Teaching Related to
Drug Therapy
In Asthma
Correct administration of drugs is a major factor in success.
Inhalation of drugs is preferable to avoid systemic side effects.
MDIs, DPIs, and nebulizers are devices used to inhale medications.
Using an MDI with a spacer is easier and improves inhalation of the drug.
DPI (dry powder inhaler) requires less manual dexterity and coordination.
Non prescription combination medications such as epinepherine and ephederine do what
Epinephrine can also increase heart rate and blood pressure.
Ephedrine stimulates CNS and cardiovascular system
Nursing Management
Nursing Assessment Asthma
Health history
Especially of precipitating factors and medications
ABGs
Lung function tests
Asthma Control Test (ACT)
Physical examination with Asthma Patient
Use of accessory muscles
Diaphoresis
Cyanosis
Lung sounds
Keep PEFR >80%
Nursing Management
Planning Goals
Maintain greater than 80% of personal best PEFR.
Have minimal symptoms.
Maintain acceptable activity levels
Few or no adverse effects
No recurrent exacerbations of asthma or decreased incidence of asthma attacks
Adequate knowledge to participate in and carry out management
Nursing Management
Health Promotion
Teach patient to identify and avoid known triggers.
Use dust covers.
Use scarves or masks for cold air.
Avoid aspirin or NSAIDs.-Learn mechanism of action. Increases Proinflamamtory Leukotrines that can increase acute asthma attacks.
Prompt diagnosis and treatment of upper respiratory infections and sinusitis may prevent exacerbation.
Fluid intake of 2 to 3 L every day Cautious with HF patients
Avoid cold air.
Avoid aspirin, NSAIDs, and nonselective β-blockers-Propanolol Rember this.
Nursing Management
Nursing Implementation Acute Interventions
Monitor respiratory and cardiovascular systems.
Lung sounds
Respiratory rate
Pulse
BP
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.
Nursing Management
Nursing Implementation
Home Care Asthma
Must learn about medications and develop self-management strategies
Patient and health care professional must monitor responsiveness to medication.
Patient must understand importance of continuing medication when symptoms are not present
Teach, Teach, Teach, Teach
Important patient teaching in Asthma
Seek medical attention for bronchospasm or when severe side effects occur.
Maintain good nutrition.
Exercise within limits of tolerance
Measure peak flow at least daily. In green zone you are good PEFR is >80%. Yellow zone PEFR is 50-80%. Red Zone <50% In trouble
Asthmatic individuals frequently do not perceive changes in their breathing.
Peak flow results
Green Zone
Usually 80% to 100% of personal best
Remain on medications
Peak flow results
Yellow Zone
Usually 50% to 80% of personal best
Indicates caution
Something is triggering asthma.
Peak flow results
Red Zone
50% or less of personal best
Indicates serious problem
Definitive action must be taken with health care provider.
