asthma. bronchiolitis and RSV ppt Flashcards
patho of asthma
Chronic inflammatory disease of the airways
Asthma causes airway hyper responsiveness, mucosal edema and mucus production.
This chronic inflammation ultimately leads to recurrent episodes of asthma symptoms
causal, contributing, and predisposing factors of asthma?
explain them
Predisposing Factors:
- Atopy (genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis) - Gender (child asthma more frequent in boys than girls – boys have smaller airways so believe that this may be a cause)
Causal Factors:
- Exposure to indoor/outdoor allergens - Occupational sensitizers eg nurses and latex -Respiratory infections -Air pollution -Active/passive smoking -Diet -Obesity -?Genetic (strong correlation) o Weather changes: temp, altitude changes,
asthma triggers
Respiratory Infections
Airway Irritants:
-Weather changes
-Strong Odours
-Heat or Cold
-Perfumes
Exercise
Medication
Stress
GI Refluxcommon symptoms of asthma?
less common?
Common COUGH (productive or non-productive) Chest tightness Dyspnea Wheezing
Less common ↑ effort with expiration Diaphoresis Tachycardia Severe hypoxia rare – life threatening
when are symptoms more likely t occur?freq of symptoms, progression?
At night or early on the am
variable and recurring symptoms
May begin abruptly
Most frequently preceded by increasing symptoms over the previous few days
subjective questions to ask?
o What are your triggers? Has something changed?
o Onset?
o What have you been taking to manage it? Has it been working?
o Are you coughing more? Productive or non-productive?
o Are you more prone to asthma during flu/other seasons?
objective assessment of asthmatic pt
o Need to take off shirt to see what’s going on!
o Full set of vitals
o Peak flow
o If bad, need to get an IV in so can administer
o Meds being given through puffer, nebulizer (kids go straight to negulizer because don’t typically use puffer well)
diagnostics done for asthma?
o Peak flow meter
Might do before and after administering ventolin to see if it helped
Person might know their baseline
o Chest xray
o Sputum sample potentially if productive cough to check for infection
o WBC count to see if might be infection
o Pulmonary fx tests – done by respirologists…done when more stable,
peak flow meter when is it used and when is it high and low?
how do perform peak flow test? wh
Used to measure the patient’s maximum speed of expiration
Can be used to monitor a patient’s asthma
Can be referred to as PEF or PERF (peak expiratory flow rate)
High when patients are well and low when airways are constricted
– forceful expiration, will measure pt’s maximum speed of expiration. have graph based on height and gender, will tell you if you’re falling in normal range
complications of asthma
status asthmaticus–standard measures not working…very life threatening, prolonged episode
pneumonia
resp failure
atelectasis
other worrisome objective signs?
- Pulsusparadoxsus: large increase in systolic BP during inhalation (>20mmHg)…normally you should see decrease (sign of status asthmaticus, cardiac tamponade, etc.)
- Silent chest – not necessarily hearing wheezing, person moving chest but not really getting air in…may give illusion of not being as serious;
what clinical signs would you see with status asthmaticus
Altered LOC Exhaustion Pulsus paradoxsus Inadequate cardiac output Cyanosis Silent chest (Absence of Audible Breath Sounds) Poor resp effort
what SpO2 and peak flow would you see with status asthmaticus
Peak flow
what clinical signs would you see with Acute / Severe
HR?
RR?
RR ≥ 25 HR ≥ 110 Unable to speak in complete sentences Reduced Air Entry Widespread Wheezes
diagnostics of acute/severe asthma
Peak flow
