Asthma

Question 1

Heterogeneous (several etiologies) disease characterized by a combination of bronchial hyperresponsiveness (airway to narrow) with reversible expiratory airflow limitation

Answer 1

Asthma

Question 2

Triggers of asthma (10)

Answer 2

a. Nose and Sinus Problems
b. Respiratory Tract Infections
c. Allergens
d. Cigarette Smoke
e. Air Pollutants
f. Occupational Factors
i. Exposure to chemicals/paints overtime
g. Exercise
i. Cold air & after exercise
h. Drugs and Food Additives
i. GERD
j. Emotional Stress

Question 3

Genetic predisposition to develop IgE-mediated response to common allergens-major risk factor

Answer 3

Atopy

Question 4

i. Baby’s immune system must be conditioned to function properly; exposure to microbes
ii. Exposure to infections earlier in life

Answer 4

Immune response-hygiene hypothesis

Question 5

Inflammation leads to

Answer 5

bronchoconstriction
Hyper-responsiveness
Edema of airway

Question 6

Early-phase response:

Answer 6

30-60 min

Question 7

Later phase response

Answer 7

4-6hrs after early response

Question 8

What structural change occur in bronchial walls from chronic inflammation?

Answer 8

fibrosis, smooth muscle hypertrophy, mucus hypersecretion, angiogenesis

Question 9

Clinical manifestations of asthma

Answer 9

wheezing, cough, dyspnea, and chest tightness

i. Hyperinflation and prolonged expiration due to air trapping in narrowed airways

Question 10

Acute attack

Answer 10

wheezing-most common

Question 11

Wheezing

Answer 11

Initially expiration, then with progression, both inspiration and expiration

Question 12

Mild attack

Severe attack

Answer 12

may have loud wheezing

wheezing with forced expiration or no wheezing at all

Question 13

Decreased or absent breath sounds may occur with:

Answer 13

exhaustion or inability to have enough muscle force for breathing

Question 14

Severe airway obstruction or impending respiratory failure; may be life-threatening (See Safety Alert)

Answer 14

“Silent chest”

Question 15

Asthma complications

Answer 15

a. Pneumonia
b. Tension pneumothorax
i. Compresses lungs with air
c. Status asthmaticus
d. Acute respiratory failure

Question 16

Extreme acute asthma attack characterized by hypoxia, hypercapnia, and acute respiratory failure; life-threatening

Answer 16

Status Asthmaticus

Question 17

Emergency treatment of status asthmaticus

Answer 17

i. Intubation and mechanical ventilation
ii. Hemodynamic monitoring
iii. Analgesia and sedation
iv. IV magnesium sulfate

Question 18

interprofessional care: mild to moderate attack

Answer 18

i. *Inhaled bronchodilators and oral corticosteroids
ii. Monitor VS
iii. Monitor as outpatient unless not responding to treatment or another contributing factor
iv. Follow-up with HCP

Question 19

interprofessional care: severe attack

Answer 19

i. Alert and oriented but focused on breathing
ii. Frightened; agitated if hypoxemic
ii. Supplemental O2 and oximetry
1. PaO2 > 60 mmHg or SaO2 > 93%

Question 20

Overall goals of asthma treatments

Answer 20

i. Have minimal symptoms during the day and night
ii. Maintain acceptable activity levels (including exercise)
iii. Maintain greater than 80% of personal best PEFR
iv. Few or no adverse effects of therapy
v. Adequate knowledge to carry out plan