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asthma readings Flashcards

1
Q

what is bronchil asthma?

what other kind of asthma is mentioned?

A 
•	Bronchial asthma is defined as a recurrent and reversible SOB and occurs when the airways of the lung because narrow as a result of bronchospasm, inflm and edema of the bronchial mucosa and the production of viscid (sticky) mucus.
 allergic asthma (Type 1 hypersensitivity rxn)
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2
Q

symp of asthma

A

wheezing and dyspnea

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3
Q

when is onset of asthma generally?

A

• Onset of asthma occurs before age 10 in 50% of patients & before age 40 ~80%

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4
Q

what occurs in the a/w of pt with asthma?

A

• The alveolar ducts and alveoi distal to the bronchioles remain open, but the obstruction to the airflow in the airways prevent CO2 from getting out of the air spaces and o2 from getting in

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5
Q

what is asthm attack?

A

• Asthma attack: sudden onset. Short and normal breathing is subsequently recovered

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6
Q

what is pulse oximetry a meas of?

what should it be above?

A

• The ratio of oxygenated hemoglobin to total hemoglobin. • 95% of total hemoglobin attachments for o2 have o2 attached to them
>95%

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7
Q

is SaO2 (not sure why they use this instead of SpO2) accurate reading to what youd get from ABGs?

A

• Sao2 is an accurate approximation of o2 saturation obtained from arterial blood gas study

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8
Q

when might pulse oximetry be inaccurate?

what ype of ventilation would cause it to be abn high

A

vasocontriction, extreme alt in temp, carbon monoxide poisoning, severe anemia, nail polish.

hyperventilation leads to inc SaO2

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9
Q

when are pulmonary fx tests indicated

A
  1. Preop evaluation of the lungs and pulmonary reserve
  2. Evaluation of response to bronchodilator therapy
  3. Differentiation between restrictive and obstructive forms of chronic pulmonary disease: restrictive defects (pulmonary fibrosis, tumors, chest wall trauma) occur when ventilation is disturbd by chest expansion. Inspiration is primarily affected. Obstructive defects (emphysema, bronchitis, asthma) occurs when ventilation is disturbed by increased airway resistance.
  4. Determination of the diffusing capacity of the lungs (Dl)
  5. Performance of inhalation tests in patients with inhalation allergies
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10
Q

what is spirometry used for?

what is a normal value for spirometry and how would this % number be arrived at?

A

Spirometry is std method of meas most relative lung volumes.
Basedon age, height, weight, race, and sexy, normal values or volumes and flow rates can be predicted. >80% is normal. Provides info about obstruction or restriction of airflow.

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11
Q

how can they tell if there is a/w obstr with spirometry?

A

• Isoflow loops on X and Y axis show the timing of inhale and exhale. Shape of the curve can identify airway obstruction.

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12
Q

will emphysema improve with bronchodilator tx?

A

Emphysema or restrictive lung disease does not improve with bronchodilator therapy.

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13
Q

how do you meas lung capacity?

A

with spirometry (doesnt really say how)

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14
Q

what is FVC?

A

• Forced vital capacity (FVC): amount of air that can be forefully expelled from a maximally inflated lung position.

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15
Q

what is FEV1?

A

• Forced expiratory volume in 1 second (FEV1): volume of air expelled during the first second of FVC.

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16
Q

how do obstructive and restrictive pulm disease alter FEV1?

A

Obstructive pulmonary disease the airways are narrowed and resistance to flow is high so less air is expelled and FEV1 is dec.

In restrictive lung disease, FEV1 is decreased because the amount of air originally inhaled is low, not because of airway resistance.

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17
Q

is it helpful to look merely at FEV1 to assess pt with obstr or restr pulm disease

A

no instead look at FEV1/FVC ratio

normal value of 80% is found in pts w restrictive pulm disease but in obstructive pulm disease (like emphysema, bronchitis, asthma) the ratio is considerably less than 80%

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18
Q

how does bronchodilator therapy help pt w spastic obstructive disease

A

the Fev1 meas will improve w bronchodilator therapy is spastic component to obstructive disease exists

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19
Q

no notes of MMEF

A

l

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20
Q

spirometry and airfrlow rates procedure

A

NOT INCENTIVE SPIROMETRY
this is the stuff from the video of the woman in the little box having to do all the breathing tests

  1. unsedated Patient breaths through a sterile mouthpiece into a spirometer
  2. Inhale as deeply as possible and forcibly exhale as much air as possible. X2 or 3 times. Two best values taken. Pt may repeat with bronchodilators if pts values are deficient
  3. Machine computes FVC
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21
Q

what can spirometry not do?

how is this done instead?

A

cant give you info about absolute volumes of air in lungs.

in order to meas by body plethysmography or gas diluton tests

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22
Q

what should pt do in prep for pulm fx tests

what other meas must the nurse take before tests

A

-dont use bronchodilators or smok for 6hrs before test (if dr asks), dont use MDI inhalers or aerosol therapy before

take height and wt
record meds the pt takes

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23
Q

not sure if D1 and inhalation tests are imp?

how do you do gas exchange or diffusing capacity of lung D1 test?

A

Gas exchange: diffusing capcity of lung (Dl)

  1. the Dl for any gas can be measured as part of pulmonary function stuies
  2. the Dl of CO is measured by having the patient inhale a CO mixture
  3. DLCO is calculated by analysis of the amount of CO exhaled compared with the amount inhaled.
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24
Q

how to do inhalation test and why?

A

Inhalation tests (bronchial provocation studies)

  1. establish a cause-and-effect relationship with patients with inhalant allergies
  2. the provocholine challenge test is typically used to detect the presence of hyperactive airway disease. not indicated in patients with asthma
  3. care is taken during this challenge test to reverse any severe bronchospasm with prompt administration of an inhalant bronchodilator
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25
Q

now start info from pilliteri

A

.

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26
Q

how common is asthma in kids?

A

• Most common chronic illness in children

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27
Q

what age does asthma usually occur by

A

5

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28
Q

asthma tends to occur in kids w what?

A

• Tends to occur in children with atopy or those who tend to be hypersensitive to allergens (changes in airway because of a triad of inflm, bronchoconstriction, and inc mucus production)

29
Q

what kin of allergens is the kid sensitive to most likely

and what kind of rxn might they have

A
  • Most children with asthma can be shown to have sensitization to inhalant antigens such as pollens, molds, house dust, etc.
  • Severe bronchoconstriction can occur because of exposure to cold air, irritating odors such as turpentine or smog, or air pollutant such as cigarette smoke.
30
Q

mechanism or patho of asthma

A
  • Primarily affects the small airways. The process of bronchosaspm, inflm of bronchial mucosa, and inc bronchial secretions (mucus) act together to reduce the size of the airway lumen, leading to the major symptom of acute respiratory distress.
  • Inflm and mucus production occur because of mast cell activation to release leukotrienes, histamine, and prostaglandins
31
Q

does the SNS or PNS cause bronchoconstriction

A

• Bronchial constriction occurs because of stimulation of the parasympathetic nervous system, irritating smooth muscle constriction

32
Q

how do asthma symptoms progress? what are they?

A
  • Begins with a dry cough then children develop increasingly difficulty exhaling, as it becomes more difficult for them to force air through the narrowed lumen of the bronchioles that are inflm and swollen and filled with mucus.
  • Typical dyspnea and wheezing begin
  • Wheezing
  • If a child coughs up mucus, it is generally copious and may contain white casts bearing the shape of the bronchi from which it is dislodged
33
Q

is wheezing heard more on inspiration or expiration with asthma

A

is heard moreso on expiration because the bronchioles are narrower during exhalation.

34
Q

how might bronchospasm affect CO2 and arterial o2 sats

A

o Bronchospasm may lead to Co2 trapping and retention- arterial oxgen saturation should be monitored and will decrease because cant fill lungs.

35
Q

will asthmatic pt have cyanosis if bad?

A

may have central cyanosis

36
Q

what might be used to asses kids ability to exhale

A

peak flow meter

37
Q

during normal resps is inspiration or expiration normal? how is it for asthma?

A

asthma has longer expiration which is abn. this occurs because pt has to work harder to exhale

38
Q

what might be heard on percussion of kids lung?

A

hyperresonant (hollow, louder noise) d/t being full of air

39
Q

your pt may have retractions and use of acessory muscles…hypoxemia and cyanosis may occur.

What signs show imminent resp failure?

A

o When blood gases show an inc pCo2, level and the sound of wheezing stops, resp failure is imminent

40
Q

how should pt position themselves during asthma attack

A

o During asthma attack, children are more comfortable in a sitting or standing position rather than lying down. Don’t tell them to lie down (more anxiety). They will only lie down when they are exhausted by the paroxysms of coughing or are at the end of an attack or beginning to feel less threatened by the dyspnea

41
Q

what systemic signs of asthma might you see with your eyes on asthmatic pt

maybe seen as complications? an outcome?

A 
barrel chest (d/t overinflation in alveoli)
clubbing of fingers
if on high doses of steroids may be shorter
42
Q

t or f kid w asthma has low vital capacity

A

may be low or normal

43
Q

how long can kid w asthmas expiratory rate be and why

A

d/t bronchospasm the exp rate may be >10sec when normal is 2-3

44
Q

what is peak expiratory flow rate monitoring used for

A

 Often use a home peak flow meter daily to measure changes in peak expiratory flow and help in planning therapeutic regimen of asthmaic pt

45
Q

how is peak expiratory flow rate performed

A

 To use this, child palces the indicator on the apparatus at the bottom of the numbered scale and takes a deep breath. Child then places the meter in mouth and blows hard. Repeat 2 more times and take highest score.
 During a 2 week period when child feels well, this should be done daily. Will be recorded as personal best.

46
Q

what are the various zones of expiratory compliance. first zone

A

 The green zone (80-100%) means no asthma sympt and take normal routine medications

(this info from image on slides)
take reg meds
take meds before exercise
avoid exacerbating thing

47
Q

second zone of expiratory compliance

A

 The yellow zone (50-80%) signals caution. Episode of asthma may be beginning

take reg meds and if doesnt get back into the green zone by an hour then used other meds

48
Q

if pt has extreme asthma episode what level is it and what should they do

A

 The red zone (

49
Q

what complications could dev following the dev of a thick mucus plug

A

• When they stop coughing up mucus, thick plugs form that can lead to pneumonia, atelectasis, and further acidosis

50
Q

how does drug tx differ for mild vs moderate asthma

A
  • Mild but persistent asthma- usually prescribed an inhaled anti-inflm corticosteroid (fluticasone daily or every other day)
  • Moderate persistent sympt- long acting bronchodilator at bedtime in addition to the inhaled corticosteroid
51
Q

tx of severe persistent asthma

A

• Severe persistent asthma- high dose of both an oral corticosteroid and an inhaled corticosteroid daily as well as a long acting bronchodilator at bedtime

52
Q

what to be aware of with ped pt and nebulizers/inhalers

A

• Make sure children know how to use nebulizer and treat it as a medication. Overdoses can occur because they don’t think it is like a medication

53
Q

a ped pt has dyspnea and lots of coughing what is a concern and how would you address it

this is also a general important intervention for adult pts

A
  • Dehydration occurs rapidly in children during an asthma attack because they have dec oral intake (ie. stop drinking because theyre coughing or coughing makes them vomit and parents stop offering fluid) as well as inc insensible loss from tachypnea
  • Dehydration contributes to mucus plugging and further constricting the airway.
  • Encourage intake (not milk because can thick mucus and difficulty swallowing)
  • IV may be established
54
Q

what occurs when mast cells are activated

A

o Mast cells when activated release mediators (histamine bradykinin, prostaglandins, and leukotrienes) inc blood blow, vasoconstriction, fluid leak fro the vasculature, attraction of WBS and bronchoconstriction.

55
Q

what occurs when alpha vs beta receptors are stimulated levels of ___ are inc or dec when this occurs

A

o When the alpha adrenergic receptors are stimulated, bronchoconstriction occurs,
o When the beta2-adrenergic receptors are stimulate, bronchodilation occurs.
o The balance between them is controlled by cAMP.
o Alpha-adrenergic receptor stimulation results in dec of cAMP which then causes an inc of chemical mediators released by the mast cells and bronchoconstriction
o Beta2-receptor stimulation results in inc cAMP which inhibits the release of the mediators – causing bronchodilation

56
Q

when pt has prolonged exacerbation what symptoms might you see

A

o As exacerbation progresses, diaphoresis, tachycardia, and a widened pulse pressure may occur along with hypoxemia and central cyanosis
o Hypoxemia is uncommon

57
Q

what kind of ABG trends and findings would you see with asthmatic pt

what is your intervention here?

A

o Arterial blood gas and pulse oximetry may reveal hypoxemia
o Initially hypoxapnia and resp alkalosis are present. As it worsesns paCO2 may rise.
o Because CO2 is 20 times more diffusible than oxygen, it is rare for paCO2 to be normal or elevated if breathing rapidly

o Airway obstruction, particularly during acue asthmatic episodes often results in hypoxemia- requiring admin of o2 and monitor pulse oximtery and arterial blood gases.

58
Q

name of leukotriene med sometimes used for asthma

what does it do

A

zafirkulast

They are potent bronchoconstrictors that also dilate blood vessels and alter permeability.

59
Q

which two categories of meds might be used for acute exacerbation

what other meds might be used

A 
o	Short-acting beta-adrenergic agonists are the medications of choice for relieving acute symptoms and preventing exercise-induced asthma. They have a rapid onset of action
o	Anticholienrgics (ipratropium bromide) may bring added benefit in severe exacerbations, but more freq in COPD patients.

Systemic corticosteroids may also be used to decrease airway inflm who fail to respond to inhaled beta-adrenergic medications
• O2 may be used if hypoxemia present

60
Q

nursing mgmt ofasthmatic exacerbation pt

what to assess

what is given

A
  • Assess resp status by monitoring the severity of symp, breath sounds, peak flow, pulse oximetry, and vital signs
  • Hx of allergic reactions to medications and gets med hx.
  • Fluids may be administered.
61
Q

status asthmaticus a complication

A
  • Severe and persistent asthma that does not respond to conventional therapy.
  • Attacks can occur with little or no warning and can profress to asphyxiation
  • Infection, anxiety, nebulizer abuse, dehydration, increased adrenergic blockage, and nonspecific irritants may contribute to these episodes.
62
Q

what is the mst common cause of status asthmaticus

A
  • Basic charactertics of asthma (inflm of bronchial mucosa, constrictin of the bronchiolar smooth muscle, and thickened sec) decrease the diameter of the bronchi
  • Most common scenario is severe bronchospasm
63
Q

how do abgs change with status asthmaticus

A
  • A ventilation perfusion abnormality results in hypoxemia and resp alkalosis initially, followed by resp acidosis.
  • Therefore a reduced paCO2 and inc pH. As it worsens, inc PaCo2 and decpH. (resp acidosis)
64
Q

mnfts of status asthmaticus

A
  • As seen in severe asthma- labored breathing, prolonged exhalation, engrged neck veins, and wheezing
  • When wheezing disappears –impending resp failure
65
Q

what is most accurate way of measuring airway obstruction

what is done when theyre tired

A

pulm fx tests

when unable to perform pulm fx tests theyll do ABGs

66
Q

if pt is having status asthmaticus what is done for them

A
  • Actively assess the airway and pt response to treatment
  • Constantly monitor for first 12-24 hours or until under control
  • Signs of dehydration- fluid is essential to loosen secretions and facilitate expectoration.
  • IV up to 3 or 4L/day
  • BP and cardiac rhythm assessed
  • Energy should be conserved
  • No irritants in room
67
Q

what are the 4 complications of asthma

A

o Status asthmaticus, resp failure, pneumonia, atelectasis

68
Q

Life threatening/ Near Fatal
Status Asthmaticus
Any one of…what symptoms?

and what spo2 and peak flow (how do these compare to acute/severe?)

A 
Altered LOC
Exhaustion
Pulsus paradoxsus
Inadequate cardiac output
Cyanosis 
Silent chest (Absence of Audible Breath Sounds)
Poor resp effort

life threatening/near fatal
Peak flow

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