asthma Flashcards
what is forced expiratory volume? (FEV1)
volume of air forcibly blown out in ONE second after full inspiration
what is forced vital capacity? (FVC)
volume of air that can be forcefully blown out after full inspiration?
FEV1/FVC?
percentage of your forced vital capacity that is expelled in one second
why do we do pulmonary function tests?
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
restrictive lung conditions?
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)
obstructive lung conditions?
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
asthma pathophysiology?
inflammation from various factors —-> hyperresponsiveness of airways and airflow limitation
predisposing factors of asthma?
atopy, female gender
casual factors of asthma?
exposure to indoor and outdoor allergens
occupational sensitizers
contributing factors of asthma?
resp infections, air pollution, active/passive smoking
other (diet, small size at birth)
risk factors for exacerbations of asthma?
allergens resp infections exercise and hyperventilation weather changes exposure to sulfer dioxide exposure to food, additives, medications
symptoms of asthma (4 cardinal!)
- chest tightness
- dyspnea
- cough
- wheezing
airway changes in asthmatic airway?
wall inflamed and thickened
airway changes in asthmatic airway during attack?
wall inflamed and thickened
air trapped in alveoli
tightened smooth muscles
inflammatory factors to asthma?
work, resp infections, allergens
irritants of asthma?
exercise, cold air, stress and emotions, strong odors, temp changes
other triggers of asthma?
food additives, gastric ulcers, pollutants, medications
how is asthma different from other obstructive lung disease?
- reversible and responds to intervention
- ppl may also have symptom free period where they do not have acute exacerbations
signs and symptoms of asthma?
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
signs and symptoms of asthma exacerbation?
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
indoor irritants?
detergent, fabric softener, smoke, pet hair
outdoor irritants?
cool air, pollen, dust
complications of asthma?
status asthmaticus
resp failure
pneumonia
medication management of asthma?
pharm
management of exacerbation
peak flow monitoring
quick relief meds for asthma?
short-acting beta adrenergic agonists
long-acting control meds for asthma?
inhaled corticosteroids long acting beta2 adrenergic agonists anticholinergics xanthines leukotriene modifiers
goals for asthma care
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
nursing management
- asthma education
- environmental control
- self-monitoring and action plans
- monitor resp status (severity of symptoms, breath sounds, peak flow, O2 sats, VS)
most chronic disease of childhood?
is asthma!!!
-for most it is disruptive too!
why is there obstruction in asthma?
- 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
some pt may have subbasement membrane fibrosis…
airway remodelling, occurs with chronic inflammation, irreversible airflow limitation
key cells in inflammation in asthma
mast cells, neutrophils, eosinophils, lymphocytes
mediators released by mast cells?
histamine, bradykinin, prostaglandins, leukotrienes. increase blood flow, vasoconstriction, attraction of WBC, bronchoconstriction
ALPHA adrenergic stimulation-
bronchoconstriction
BETA 2 adrenergic stimulation-
bronchodilation
symptoms of exercise induced asthma?
maximal symptoms during exercise, absence of nocturnal symptoms
-sometimes only description of “choking sensation”
assessment and diagnostics of asthma?
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
prevention of asthma
- tests to identify what precipitates symptoms
- avoid causative agents
- knowledge is key to quality asthma care
complications of asthma?
-status asthmaticus, resp failure, pneumonia, atelectasis
management of asthma exacerbation?
early treatment and education
oxygen supplementation
quick acting beta-adrenergic meds, systemic corticosteroids
what is peak flow monitoring?
instruct proper technique, giving maximal effort, monitor peak flow for 2-3 weeks
green= 80-100%, yellow 60-80%, red= less than 60%
status asthmaticus=
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
status asthmaticus may be precipitated by?
hypersensitivity to aspirin
pathophyisology of status asthmaticus?
- 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
clinical manifestations of status asthmaticus?
same as in severe asthma (laboured breathing, prolonged exhalation, engorged neck veins, wheezing)
sign of impending resp failure?
wheezing may dissapear
assessment and diagnostics of status asthmaticus?
- PFT
- ABGs
- resp alkalosis most common, rising PaCO2 freq danger sign of resp failure
medical management of status asthmaticus?
- close monitoring and reevaluation
- emergency setting: intially SABA and then systemic corticosteroids
- magnesium sulfate for SM relaxation
- death is possible!!
nursing management of status asthmaticus?
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
