ATI 18 - Asthma Flashcards
EARLY indications of RESPIRATORY DISTRESS
restless
tachypnea
tachycardia
diaphoresis
nasal flaring
retraction
drunting
wheezing
ADVANCED HYPOXIA aka RESPIRATORY FAILURE
bradypnea bradycardia cyanosis stupor coma
Asthma
persistent inflammation leads to overreaction of normal protective mechanism of
- mucus production
- swelling of airway mucosa
- bronchospasm
Asthma triggers
- exercise
- allergens
- weather change
- smoke
- stress, emo
Asthma
symptoms
sudden onset of cough, wheeze, SOB
- freq coughing at night
- resp distress
- prolonged expiratory phase
- chest tightness
Asthma
diagnosis
- hx
- assessment
- pulmo function test (most accurate)
- peak exp flow rate w establishment of personal best
Intermittent Severity
symptoms of 2 or fewer days a week
- no nightime awakening
- oral corticosteroid no more than 1/yr
- SABA use 2 or less/wk
Intermittent Severity is only triggered by…
viral resp infection
-asthma maintenance does not prevent trigger
Mild persistent Severity
symptoms >2days/wk, but not daily
-nighttime awakening 1-2x/month (younger than 5yo) or 3-4x/month (older than 5)
Moderate persistent Severity
daily symptoms
Severe persistent
symptoms throughout the day
SABA
meds + route + action
albuterol + levalbuterol
- nebulizer metered dose inhaler
- relac=xed bronchiole smooth muscle
albuterol + levalbuterol [SABA]
education
dont use more than 2dy/wk
- can cause tachycard, n/v, nervousness
- use spacer
- wait 1-2min bw puff
- 15min to give steroid
corticosteroid
med + route + action
prednisone
- oral or IV
- decr airway inflammatn
corticosteroid - prednisone
education
gastric irrtatn
long term: gluc instability + immunosuppression
long acting beta agonIst [LABA]
meds + route + action
salmeterol + formeterol
- dry powder inhaler
- relax smth muscle + incr ciliary motility
LABA - salmeterol + formeterol
education
take 30-60 min before exercise
SE: tachycard, insomnia, tremor may last 8hr
theophylline - methylxanthine
moa + education
relax muscle bundles that constricts airway
-limit caffeine - tachycard + insomnia (meth)
montelukast -leukotriene receptor agonist
reduce inflammtn cascade
- take in evening or before exercise
- dont stop abruptly
- may cause depression
Asthma Med Action Plan
GREEN/GO: use preventative med
YELLOW/CAUTION: add quick relief med
RED/DANGER: get Dr
green/go asthma criteria
must have all:
- good breathing
- no cough/wheeze
- sleep thru night
- can work + play
yellow/caution criteria
must have atleast 1 of these:
- first sign of a cold
- exposure to known trigger
- cough
- mild wheeze
- tight chest
- cough at night
red/danger criteria
asthma is getting worse fast
- med not helping
- breathing is hard + fast
- ribs show
- nose flaring
- cant talk well
Inhaler use
1 remove cap + shake 5-6x 2 attach spacer 3 deep breath + exhale prior 4 tilt head back, press inhaler, slow deep breath for 3-5 sec 5 hold breath 5-10 sec 6 inhale slowly thru nose
wait 1 min bw puffs + resume norm breathing
when using an inhaler, if you head ____, then you are inhaling too fast
whistling
signs of worsening
after albuterol + corticosteroids, if pt continues to worsen:
- hypoxemia
- recr expiration fr air trapping
- resp acidosis
additional meds for severe asthma [STATUS ASTHMATICUS]
- IV mag sulfate
- theophylline
- IV corticosteroid (methylprednisone)
nursing interventions for asthma in school
- long peak flow meter readings
- coordinate support group
- 1/10 kids have asthma - leading cause of absenteeism
- admin quick relief med
