ATI: Chapter 21 - Asthma Flashcards
Asthma is a chronic inflammatory disorder of the airways that results in intermittent and reversible airflow obstruction occurs either by inflammation or __________.
airway hyper-responsiveness
Asthma can occur at any ____. The cause is unknown.
age
Manifestations of asthma include mucosal edema, bronchoconstriction, and _________.
excessive mucus production
Advise the client to use _______ and ensure proper ventilation while working in environments that contain carcinogens or particles in the air.
protective equipment (mask)
Encourage influenza and pneumonia vaccinations for older adults and all clients who have _____.
asthma
Instruct the client how to recognize and avoid _____.
triggers
_____ factors, such as changes in temperature (especially warm to cold) and humidity.
environmental
Air ______ are asthma triggers.
pollutants
Strong _____ (perfume) are triggers for asthma.
odors
______ allergens (grass, tree, and weed pollens) and perennial allergens (mold, feathers, dust, roaches, animal dander, foods treated with sulfites) are asthma triggers.
seasonal
Stress and ______ distress are asthma triggers.
emotional
_______ such as (aspirin, NSAIDs, beta-blockers, cholinergics) can be asthma triggers.
medications
_____, including those in laundry detergents can be asthma triggers.
enzymes
____ (household cleaners) can be asthma triggers.
chemicals
______ with postnasal drip can be an asthma trigger.
sinusitis
Viral respiratory tract infection can be an asthma ____.
trigger
Teach the client how to self-administer ______ (nebulizers and inhalers) for asthma.
medications
Educate the client regarding infection ________ techniques to asthma pts.
prevention
Encourage regular ______ as part of asthma therapy.
exercise
Regular exercise promotes ventilation and perfusion. It also maintains cardiac health. It enhances skeletal muscle strength. Clients can require _______.
pre-medication
Instruct the client to use hot water to eliminate dust mites in ______.
bed linens
Diagnosis of asthma is based on symptoms and classified into one of the following four categories: mild intermittent, mild persistent, moderate persistent, and _______.
severe persistent
______ asthma includes symptoms that occur less than twice a week.
mild intermittent
______ asthma includes symptoms that arise more than twice a week but not daily.
mild persistent
______ asthma is daily symptoms occur in conjunction with exacerbations twice a week.
moderate persistent
______ asthma is symptoms occur continually, along with frequent exacerbations that limit physical activity and quality of life.
severe persistent
Older adult clients have decreased pulmonary reserves due to physiologic _______ that occur with the aging process.
lung changes
Older adult clients are more ______ to infections.
susceptible
The sensitivity of beta-adrenergic receptors decreases with age. As the beta receptors age and lose ______, they are less able to respond to agonists, which relax smooth muscle and can result in bronchospasms.
sensitivity
A family _______ of asthma is a risk factor.
history
Smoking is a risk factor for _____.
asthma
Secondhand _______ is a risk factor for asthma.
smoke exposure
Environmental ______ is a risk factor for asthma.
allergies
Exposure to chemical _______ or dust is a risk factor asthma.
irritants
_________ reflux disease (GERD) is a risk factor for asthma.
gastroesophageal
Expected findings of asthma include dyspnea, chest tightness, and _____ or stress.
anxiety
Physical assessment findings of asthma include:
coughing wheezing mucus production use of accessory muscles prolonged exhalation poor oxygen saturation (low SaO2) barrel chest or increased chest diameter
Obtain a history regarding current and previous asthma exacerbations: (6)
onset and duration
precipitating factors (exercise, stress, exposure to irritant)
changes in mes regimen
meds that relieve symptoms
other meds taken
self-care methods used to relieve symptoms
Lab Tests for Asthma
ABG and Sputum Cultures
ABGs test for ______ which is when PaO2 less than 80 mm Hg.
hypoxemia
ABGs test for _______ which is when PaCO2 is less than 35 mm Hg: early in attack)
hypocarbia
ABGs test for _______ which is when PaCO2 is increased greater than 45 mm Hg: later in the attack.
hypercarbia
Sputum cultures for asthma look at bacteria which can indicate _______.
infection
________ are the most accurate tests for diagnosing asthma and its severity.
pulmonary function tests (PFTs)
________ is the volume of air exhaled from full inhalation to full exhalation.
forced vital capacity (FVC)
_______ in the first second is the volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation.
Forced expiratory volume (FEV1)
Peak expiratory flow is the fastest airflow rate reached during ________.
exhalation
A decrease in FEV1 (forced expiratory volume) by ____ to _____% below the expected value is common in clients who have asthma. An increase in these values by 12% following the administration of bronchodilators is diagnostic for asthma.
15 to 20%
A _____ is used to diagnose changes in chest structure over time.
chest x-ray
An asthma patient should be positioned in _______ to maximize ventilation.
high-Fowlers
With asthma patients you should administer ________ therapy as prescribed.
oxygen therapy
With asthma patients you should monitor _______ and rhythm for changes during an acute attack (can be irregular, tachycardia, or with PVCs).
cardiac rate
Asthma patients should have IV access and _______ it.
maintain
Maintain a clam and _______ demeanor with asthma patients.
reassurance
Provide rest periods for older adult clients who have _________. Design room and walkways with opportunities for rest. Incorporate rest with ADLs.
dyspnea
Encourage prompt medical attention for ________ and appropriate vaccinations for asthma patients.
infections
The four types of bronchodilators (inhalers)
short-actign beta2 agonists
anticholinergic medications
Methylxanthines
Long acting beta2 agonists
________ such as albuterol, provide rapid relief of acute symptoms and prevent exercise-induced asthma.
short-acting beta2 agonists
________, such as ipratropium, blocks the parasympathetic nervous system. This allows for the sympathetic nervous system effects of increased bronchodilation and decreased pulmonary secretions. These medications are long-acting and used to prevent bronchospasms.
anticholinergic medications
_______, such as theophylline, require close monitoring of serum medication levels due to a narrow therapeutic range. Use only when other treatments are ineffective.
Methylxanthines
__________, such as salmeterol, primarily are used for asthma attack prevention.
Long-acting beta2 agonists
With albuterol watch for tremors and _______.
tachycardia
With Ipratropium observe for ______.
dry mouth
Wtih theophylline monitor serum levels for toxicity. Side effects include tachycardia, nausea, and ______.
diarrhea
With ______: advise the client to suck on hard candies to help relieve dry mouth;; increase fluid intake, and report headache, blurred vision, or palpitations, which can indicate toxicity of ________. Monitor _______.
Ipratropium (anticholinergic meds)
Ipratropium
HR
_________: advise the client to use to prevent an asthma attack and not at the onset of an attack.
Salmeterol (long-acting beta2 agonists)
_______ agents are used for prophylaxis and are used to decrease airway inflammation.
anti-inflammatory agents
Anti-inflammatory agents (4)
corticosteroids = fluticasone and prednisone
leukotriene antagonists = montelukast
mast cell stabilizers = cromolyn
monoclonal antiboides = omalizumab
With the use of anti-inflammatory agents watch for decreased ________ function.
immunity
With the use of anti-inflammatory agents monitor for ________.
hyperglycemia
With the use of anti-inflammatory agents advise the client to report _______ stool.
black, tarry
With the use of anti-inflammatory agents observe for fluid retention and _______. This can be common.
weight gain
With the use of anti-inflammatory agents monitor the throat and mouth for ______.
aphthous lesions (canker sores)
With the use of anti-inflammatory agents with _________ be careful it can cause anaphylaxis.
omalizumab (monoclonal antibodies)
When taking anti-inflammatory agents encourage the client to ______ of fluids to promote hydration.
drink plenty
Encourage the client to take _____ with food.
predinsone
When taking anti-inflammatory agents encourage the client to use this medication to prevent _______, not for the onset of an attack.
asthma
When taking anti-inflammatory agents encourage the client to avoid people who have ______.
respiratory infections
When taking anti-inflammatory agents encourage the client to use good _____ care.
mouth
When taking anti-inflammatory agents warn the client _____ to discontinue this type of medicine suddenly.
not
If prescribed separately for inhalation administration at the same time, administer the _______ first in order to increase the absorption of the anti-inflammatory agent.
bronchodilator
Combination agents (bronchodialtor and anti-inflammatory)
Ipratropium and albuterol
Fluticasone and salmeterol
______ services should be consulted for inhalers and breathing treatments for airway management.
Respiratory
Nutritional services can be contacted for weight loss or gain related to ________ or ______.
medication or diagnosis
_______ can be consulted if the client has prolonged weakness and needs assistance with increasing levels of activities.
rehabilitation
Complications of asthma include respiratory failure and _________.
status asthmaticus
Peristent hypoxemia related to asthma can lead to _______.
respiratory failutr.
When dealing with the complication of respiratory failure, monitor _______ levels and acid-base balance.
oxygenation
When dealing with the complication of respiratory failure, prepare for intubation and ________.
mechanical ventilation
_______ is a life-threatening episode of airway obstruction that is often unresponsive to common treatment. It involves extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, and creates a risk for cardiac and/or respiratory arrest.
status asthmaticus
With status asthmaticus prepare for emergency ______.
intubation
With status asthmaticus administer IV fluids, oxygen, bronchodilators, and epinephrine. Initiate systemic ________.
steroid therapy
A nurse in the emergency department is caring for a client who is having an acute asthma attack. Which of the following assessments indicates that the respiratory status is declining? (select all that apply)
A. SaO2 95% B. Wheezing C. Retraction of sternal muscles D. Pink mucous membranes E. Premature ventricular complexes (PVCs)
B. Wheezing is a manifestation indicating that the client’s respiratory status is declining
C. Retraction of sternal muscles is a manifestation that the client’s respiratory status is declining
E. PVCs are a manifestation that the client’s respiratory status is declining.
95% is an expected finding w/in the respiratory system and exhibits no signs of distress
Pink mucous membranes is an expected findings
A nurse is caring for a client 2 hr after admission. The client has an SaO2 of 91%, exhibits audible wheezes, and is using accessory muscles when breathing. Which of the following classes of medications should the nurse expect to administer?
A. Antibiotic
B. Beta-blocker
C. Antiviral
D. Beta2 agonist
D. The nurse should administer a beta2 agonist, which causes dilation of the bronchioles to relieve symptoms.
A nurse is providing discharge teaching to a client who has a new prescription for prednisone for asthma. Which of the following client statements indicates an understanding of the teaching?
A. “ i will decrease my fluid intake while taking this med”
B. “I will expect to have black, tarry stools.”
C. “ I will take my meds with meals.”
D. “ I will monitor for weight loss while on this med.”
C. Take meds with food. Taking prednisone on an empty stomach can cause GI distress.
A nurse is assessing a client who has a history of asthma. Which of the following factors should the nurse identify as a risk for asthma?
A. Gender
B. Environmental allergies
C. Alcohol use
D. Race
B. Environmental allergies are a risk factor associated with asthma. A client who has environmental allergies typically has other allergic problems, such as rhinitis or a skin rash.
A nurse is reinforcing teaching with a client on the purpose of taking a bronchodilator. Which of the following client statements indicates an understanding of the teaching?
A. “ This medication can decrease my immune response.”
B. “I take this medication to prevent asthma attacks.”
C. “I need to take this med with food.”
D. This med has a slow onset to treat my symptoms.”
B. A bronchodilator can prevent asthma attacks from occurring.
A bronchodilator has a fast onset to relief asthma attack symptoms.
