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n233 final > asthma > Flashcards

asthma Flashcards

1
Q

what is forced expiratory volume? (FEV1)

A

volume of air forcibly blown out in ONE second after full inspiration

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2
Q

what is forced vital capacity? (FVC)

A

volume of air that can be forcefully blown out after full inspiration?

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3
Q

FEV1/FVC?

A

percentage of your forced vital capacity that is expelled in one second

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4
Q

why do we do pulmonary function tests?

A

to assess respiratory function
to stage COPD
to determine whether obstructive or restrictive condition
to determine if treatment is effective
may be used in combination with pt history, ABGs, chest x-ray for diagnosis

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5
Q

restrictive lung conditions?

A

when lung expansion is difficult

  • pregnancy, pleural effusions, arthritis
  • pneumonia, obesity, ascites
  • intrinsic disorders (pneumonia, fibrosis, lobectomy)
  • look at FVC (how much air you can take in and expire)
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6
Q

obstructive lung conditions?

A

more difficult to exhale
-narrowing of the airways (COPD, asthma)
-FEV1 and FEV1/FVC
low in COPD and used to stage progression of disease
low in asthma exacerbation but improved significantly after receiving bro

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7
Q

asthma pathophysiology?

A

inflammation from various factors —-> hyperresponsiveness of airways and airflow limitation

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8
Q

predisposing factors of asthma?

A

atopy, female gender

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9
Q

casual factors of asthma?

A

exposure to indoor and outdoor allergens

occupational sensitizers

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10
Q

contributing factors of asthma?

A

resp infections, air pollution, active/passive smoking

other (diet, small size at birth)

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11
Q

risk factors for exacerbations of asthma?

A 
allergens 
resp infections 
exercise and hyperventilation 
weather changes 
exposure to sulfer dioxide 
exposure to food, additives, medications
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12
Q

symptoms of asthma (4 cardinal!)

A
  • chest tightness
  • dyspnea
  • cough
  • wheezing
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13
Q

airway changes in asthmatic airway?

A

wall inflamed and thickened

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14
Q

airway changes in asthmatic airway during attack?

A

wall inflamed and thickened
air trapped in alveoli
tightened smooth muscles

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15
Q

inflammatory factors to asthma?

A

work, resp infections, allergens

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16
Q

irritants of asthma?

A

exercise, cold air, stress and emotions, strong odors, temp changes

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17
Q

other triggers of asthma?

A

food additives, gastric ulcers, pollutants, medications

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18
Q

how is asthma different from other obstructive lung disease?

A
  • reversible and responds to intervention

- ppl may also have symptom free period where they do not have acute exacerbations

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19
Q

signs and symptoms of asthma?

A

COUGH- most common and fisrt
dyspnea, wheezing, chest tightness (4 cardinal!!!!)
-may be worse at night or early in AM
-possibly due to circadian variations

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20
Q

signs and symptoms of asthma exacerbation?

A

may begin abruptly
-often preceeded by increasing symptoms over previous few days
increased effort with expiration
diaphoresis
tachycardia
severe hypoxia rare: life threatening
peripheral cyanosis or severe bronchospasm: EMERGENCY!! intubation and treated accordilngly

21
Q

indoor irritants?

A

detergent, fabric softener, smoke, pet hair

22
Q

outdoor irritants?

A

cool air, pollen, dust

23
Q

complications of asthma?

A

status asthmaticus
resp failure
pneumonia

24
Q

medication management of asthma?

A

pharm
management of exacerbation
peak flow monitoring

25
Q

quick relief meds for asthma?

A

short-acting beta adrenergic agonists

26
Q

long-acting control meds for asthma?

A 
inhaled corticosteroids 
long acting beta2 adrenergic agonists
anticholinergics 
xanthines 
leukotriene modifiers
27
Q

goals for asthma care

A

be able to participate in ADLs, including exercise and other physical activity with little to no interference
have normal or near-normal pulmonary function
have their asthma under control
experience as few side effects from asthma medication as possible while taking the lowest dose of med required
possess the knowledge and skills necessary to participate in management of their asthma

28
Q

nursing management

A
  • asthma education
  • environmental control
  • self-monitoring and action plans
  • monitor resp status (severity of symptoms, breath sounds, peak flow, O2 sats, VS)
29
Q

most chronic disease of childhood?

A

is asthma!!!

-for most it is disruptive too!

30
Q

why is there obstruction in asthma?

A
  • swelling of membranes that line the airways (mucosal edema)
  • reducing airway diameter
  • contractions of bronchial smooth muscle (further narrowing-bronchospasm)
  • increased mucus production, may plug the bronchi
  • alveoli hyperinflate
31
Q

some pt may have subbasement membrane fibrosis…

A

airway remodelling, occurs with chronic inflammation, irreversible airflow limitation

32
Q

key cells in inflammation in asthma

A

mast cells, neutrophils, eosinophils, lymphocytes

33
Q

mediators released by mast cells?

A

histamine, bradykinin, prostaglandins, leukotrienes. increase blood flow, vasoconstriction, attraction of WBC, bronchoconstriction

34
Q

ALPHA adrenergic stimulation-

A

bronchoconstriction

35
Q

BETA 2 adrenergic stimulation-

A

bronchodilation

36
Q

symptoms of exercise induced asthma?

A

maximal symptoms during exercise, absence of nocturnal symptoms
-sometimes only description of “choking sensation”

37
Q

assessment and diagnostics of asthma?

A

family, environmental, occupation history

  • must determine periodic symptoms of airflow obstruction
  • during acute episodes: sputum and blood tests may disclose eosinophils, ABGs, IgE if allergy
38
Q

prevention of asthma

A
  • tests to identify what precipitates symptoms
  • avoid causative agents
  • knowledge is key to quality asthma care
39
Q

complications of asthma?

A

-status asthmaticus, resp failure, pneumonia, atelectasis

40
Q

management of asthma exacerbation?

A

early treatment and education
oxygen supplementation
quick acting beta-adrenergic meds, systemic corticosteroids

41
Q

what is peak flow monitoring?

A

instruct proper technique, giving maximal effort, monitor peak flow for 2-3 weeks
green= 80-100%, yellow 60-80%, red= less than 60%

42
Q

status asthmaticus=

A

severe and persistent asthma that does not respond to conventional therapy

  • little or no warning, can progress fast to asphyxiation
  • infection, anxiety, nebulizer use, dehydration, increased adrenergic blockage, nonspecific irritants may contribute to these episodes
43
Q

status asthmaticus may be precipitated by?

A

hypersensitivity to aspirin

44
Q

pathophyisology of status asthmaticus?

A
  • basic characteristics of asthma, most common scenario is severe bronchospasm with mucous plugging leading to asphyxia
  • ventilation-perfusion abnormality—> hypoxemia and resp alkalosis followed by resp acidosis
45
Q

clinical manifestations of status asthmaticus?

A

same as in severe asthma (laboured breathing, prolonged exhalation, engorged neck veins, wheezing)

46
Q

sign of impending resp failure?

A

wheezing may dissapear

47
Q

assessment and diagnostics of status asthmaticus?

A
  • PFT
  • ABGs
  • resp alkalosis most common, rising PaCO2 freq danger sign of resp failure
48
Q

medical management of status asthmaticus?

A
  • close monitoring and reevaluation
  • emergency setting: intially SABA and then systemic corticosteroids
  • magnesium sulfate for SM relaxation
  • death is possible!!
49
Q

nursing management of status asthmaticus?

A

main focus is to actively assess airway and pt response to treatment
-prepared for next intervention if needed
consantly monitor for 12-24 hrs or until until control
-skin turgor for dehydration
-IV fluids as prescribed
-BP and cardiac monitor continuously
-room should be quiet
-nonallergenic pillow

n233 final (11 decks)

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