Asthma

Question 1

Asthma
Definition

Answer 1

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

Question 2

Risk Factors and Triggers

of Asthma

Answer 2

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.

Question 3

Asthma

Pathophysiology

Answer 3

Primary response is chronic inflammation from exposure to allergens or irritants.

*Leading to airway bronchoconstriction, hyperresponsiveness, and edema of airways

Question 4

Inflammatory mediators cause what early-phase responses in Asthma

Answer 4

Vascular congestion

Edema formation

Production of thick, tenacious mucus

Bronchial muscle spasm

Thickening of airway walls

Question 5

Late-phase response

in Asthma

Answer 5

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

Question 6

Clinical Manifestations

of Asthma

Answer 6

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

Question 7

Classification of Asthma

Answer 7

Intermittent

Mild persistent

Moderate persistent

Severe persistent

Question 8

Asthma Complications

Answer 8

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

Question 9

Asthma Diagnostic Studies

Answer 9

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

Question 10

Diagnostic Study in Asthma

Niox Mino

Answer 10

Hand-held point-of-care device

Measures fractional exhaled nitric oxide (FENO)

Their levels will tell you if they are asthmatic or not

Question 11

Collaborative Care Asthma

GINA

Answer 11

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

Question 12

Collaborative Care Asthma

Answer 12

Teaching

Start at time of diagnosis.

Integrate through care.

Self-management

Tailored to needs of patient

Culturally sensitive

Question 13

Desired therapeutic outcomes for Asthma Patients

Answer 13

Control or eliminate symptoms.

Attain normal lung function.

Restore normal activities.

Reduce or eliminate exacerbations and side effects of medications.

Question 14

Collaborative Care

Intermittent and persistent asthma

Answer 14

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

Question 15

Collaborative Care

Acute asthma exacerbations

Answer 15

O2 therapy may be started and monitored with pulse oximetry or ABGs in severe cases.

Short acting Brochdilators

Question 16

Collaborative Care

Severe exacerbations

Answer 16

Most therapeutic measures are the same as for acute episode.

↑ in frequency and dose of bronchodilators

Question 17

Collaborative Care

Severe and life-threatening exacerbations

Answer 17

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)

Question 18

Bronchial thermoplasty

In Asthma

Answer 18

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.

Question 19

Three types of antiinflammatory drugs in Asthma

Answer 19

Corticosteroids- Most common

Leukotriene modifiers

Monoclonal antibody to IgE

Question 20

What do Corticosteroids (e.g., beclomethasone, budesonide)

Do In Asthma

Answer 20

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

Question 21

Leukotriene modifiers or inhibitors (e.g., zafirlukast, montelukast, zileuton)

Answer 21

Block action of leukotrienes—potent bronchoconstrictors

Have both bronchodilator and antiinflammatory effects

Not indicated for acute attacks

Used for prophylactic and maintenance therapy

Question 22

What are the Three types of bronchodilators

Answer 22

β2-Adrenergic agonists

Methylxanthines

Anticholinergics

Question 23

β-Adrenergic agonists (SABAs)- Fast acting

Answer 23

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

Question 24

Long-acting β2-Adrenergic Agonist Drugs

Answer 24

Salmeterol (Serevent) and formoterol (Foradil)

Added to daily ICSs

Decrease the need for SABAs

Never used as monotherapy

Question 25

Methylxanthines (e.g., theophylline)

Answer 25

Less effective long-term bronchodilator

Alleviates early phase of attacks but has little effect on bronchial hyper-responsiveness

Narrow margin of safety

Question 26

Anticholinergic drugs (e.g., ipratropium)

Answer 26

Block action of acetylcholine

Usually used in combination with a bronchodilator

Most common side effect is dry mouth.

Question 27

Patient Teaching Related to
Drug Therapy

In Asthma

Answer 27

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.

Question 28

Non prescription combination medications such as epinepherine and ephederine do what

Answer 28

Epinephrine can also increase heart rate and blood pressure.

Ephedrine stimulates CNS and cardiovascular system

Question 29

Nursing Management
Nursing Assessment Asthma

Answer 29

Health history

Especially of precipitating factors and medications

ABGs

Lung function tests

Asthma Control Test (ACT)

Question 30

Physical examination with Asthma Patient

Answer 30

Use of accessory muscles

Diaphoresis

Cyanosis

Lung sounds

Keep PEFR >80%

Question 31

Nursing Management
Planning Goals

Answer 31

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

Question 32

Nursing Management
Health Promotion

Answer 32

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.

Question 33

Nursing Management
Nursing Implementation Acute Interventions

Answer 33

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.

Question 34

Nursing Management
Nursing Implementation

Home Care Asthma

Answer 34

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

Question 35

Important patient teaching in Asthma

Answer 35

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.

Question 36

Peak flow results

Green Zone

Answer 36

Usually 80% to 100% of personal best

Remain on medications

Question 37

Peak flow results

Yellow Zone

Answer 37

Usually 50% to 80% of personal best

Indicates caution

Something is triggering asthma.

Question 38

Peak flow results

Red Zone

Answer 38

50% or less of personal best

Indicates serious problem

Definitive action must be taken with health care provider.