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NU 340 > Ch. 24 > Flashcards

Ch. 24 Flashcards

1
Q

chronic airflow limitations include what chronic lung diseases of the LOWER resp. tract?

A
  • asthma
  • chronic bronchitis
  • pulmonary emphysema
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2
Q

asthma

A

chronic disease with an intermittent and reversible airflow obstruction
- affects only the airways
- does not affect the alveoli

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3
Q

asthma: airway obstruction occurs by

A
  • inflammation
  • airway hyperresponsiveness
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4
Q

main priority concept with asthma is

A

gas exchange

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5
Q

pathophysiology of asthma

A
  • inflammation (swollen lining, excess mucus)
  • airway hyperresponsiveness (muscle tightness)

all causes bronchoconstriction

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6
Q

classifications of asthma

A
  • classified into different types based on triggering events
    1. inflammation occurs in response to specific allergens, general irritants (cold air), microorganisms, aspirin/NSAIDs
    2. hyperresponsiveness occurs with exercise, URI, or unknown reactions
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7
Q

key event in triggering an asthma attack

A

inflammation of lining of airways is key event in triggering an asthma attack

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8
Q

prevalence of asthma

A
  • estimated 20 mill americans affected
  • estimated 300 mill affected worldwide
  • more common in adult F > M
  • slightly more prevalent among Af-Am > Caucasians
  • more common in urban settings
  • number of people with asthma continues to grow
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9
Q

cost of asthma in US

A
  • estimated annual cost = $19.7 billion
  • estimated annual direct cost (hospitalizations) = $14.7 billion
  • $3300 per person each year
  • medical expenses continue to increase
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10
Q

asthma triggers

A
  • stress
  • pets
  • exercise
  • pollen
  • bugs in the home
  • chemical fumes
  • cold air
  • fungus spores
  • dust
  • smoke
  • strong odors
  • pollution
  • anger
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11
Q

what are triggers?

A
  • triggers cause the body to release antibodies and chemicals such as histamine which starts the inflammatory response
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12
Q

genetic considerations for asthma

A
  • Genetic variations in the gene that controls the synthesis and activity of beta-adrenergic receptors impact drug therapy
  • Inflammation caused by allergen binding to specific antibodies such as immunoglobulin E (IgE)
  • Bronchospasm as a result of airway hyperresponsiveness
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13
Q

considerations for older adults with asthma

A
  • Change in sensitivity of beta-adrenergic receptors
  • Teach how to prevent asthma attacks
  • Teach correct use of preventive and rescue drugs
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14
Q

considerations for women with asthma

A

35% higher incidence in F > M

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15
Q

asthma assessment: symptoms

A
  • Daytime symptoms of wheezing, dyspnea, coughing present more than twice weekly
  • Waking from night sleep with symptoms of wheezing, dyspnea, coughing
  • Relieved (rescue) drug needed more than twice weekly
  • Number of times per week activity was limited or stopped by symptoms
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16
Q

controlled asthma

A

experiences no symptoms

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17
Q

partly controlled asthma

A

1-2 of the following symptoms:

  • Daytime symptoms of wheezing, dyspnea, coughing present more than twice weekly
  • Waking from night sleep with symptoms of wheezing, dyspnea, coughing
  • Relieved (rescue) drug needed more than twice weekly
  • Number of times per week activity was limited or stopped by symptoms
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18
Q

uncontrolled asthma

A

3-4 of the following symptoms:

  • Daytime symptoms of wheezing, dyspnea, coughing present more than twice weekly
  • Waking from night sleep with symptoms of wheezing, dyspnea, coughing
  • Relieved (rescue) drug needed more than twice weekly
  • Number of times per week activity was limited or stopped by symptoms
19
Q

asthma assessment: history

A
  • sx during the day? at night? both?
  • how often are they using rescue inhaler (not to be used every day)
20
Q

asthma physical assessment and clinical manifestations

A
  • Audible wheeze** and increased respiratory rate (tachypnea)
  • Increased cough
  • Use of accessory muscles
  • ”Barrel chest” from air trapping
  • Long breathing cycle: normal inspiration, prolonged expiration
  • Cyanosis: nail beds, mucous membranes
  • Hypoxemia: pulse ox
21
Q

asthma laboratory assessment

A

assess ABG level (arterial blood gas)
- arterial O2 may decrease in acute asthma attack
- arterial CO2 level may decrease early in attack and increase later- indicates poor gas exchange

  • allergic asthma with elevated serum eosinophil count and immunoglobulin E levels
  • sputum with eosinophil and mucous plugs with shed epithelial cells
22
Q

The most accurate measures for asthma are

A

pulmonary function tests using spirometry including:
- Forced vital capacity (FVC)
- Forced expiratory volume in the first second (FEV1)
- *Peak expiratory flow rate (PEFR)

23
Q

asthma interventions

A
  • Control and prevent episodes
  • Improve air flow and gas exchange
  • Self-management education: personal asthma action plan
  • Drug therapy
24
Q

asthma drug therapy includes what types of drugs?

A
  • Control/Preventative therapy drugs (used daily)
  • Rescue/Reliever drugs (used to stop an attack): short-acting, work right away but do not last long
  • Bronchodilators
  • Anti-inflammatory agents
25
Q

Pharmacologic management is based on

A
  • Pharmacologic management is based on the step category for severity and treatment
  • Drug therapy based on 5 steps starting with step 1 and progressing up to step 5 as needed for progression of symptoms
26
Q

asthma drug therapy: preventative therapy drugs (controller drugs)

A
  • Used to change the airway responsiveness to prevent asthma attacks
    -Used every day, regardless of symptoms
27
Q

asthma drug therapy: rescue drugs

A
  • used to actually stop an attack once it has started
28
Q

step system for asthma: step 1

A

least severe symptoms
- patient will be on SABA PRN

29
Q

step system for asthma: step 2

A

SABA PRN, low dose ICS

30
Q

step system for asthma: step 3

A

SABA, low dose LICS (long-acting inhaled corticosteroids), LABA

31
Q

step system for asthma: step 4

A

medium-high dose LICS (long-acting inhaled corticosteroids), LABA

32
Q

step system for asthma: step 5

A

oral steroid

33
Q

asthma drug therapy: bronchodilators

A
  • Short-acting beta2 agonists, SABA (albuterol): taken as needed, not every day (rescue inhalers)
  • Long-acting beta2 agonists, LABA (Salmeterol): 1-2x/day every day
  • Cholinergic antagonists Short acting (Ipratropium), Long acting (Tiotropium bromide)- can be through nebulizer
  • Methylxanthines (aminophylline)- not commonly used, have side effects, last case scenerio type of med
34
Q

only ____ should be used as rescue inhalers for asthma attack

A
  • short acting inhalers
35
Q

asthma drug therapy: anti-inflammatory agents

A
  • Corticosteroids (don’t stop abruptly, rinse mouth afterward to prevent thrush: white patches in mouth)
    • Inhaled (Fluticasone)* pt teaching
  • Leukotriene antagonists (Montelukast)
  • Immunomodulators
36
Q

asthma drug therapy: combination inhalers

A
  • Fluticasone/salmeterol (steroid/LABA)
37
Q

non-pharmacologic treatments for asthma

A
  • exercise and activity is recommended to promote ventilation and perfusion
38
Q

in an acute asthma attack, oxygen therapy is delivered via

A
  • nasal cannula
  • face mask
  • endotracheal (ET) tube (possible with bronchospasm, bronchodilation)
39
Q

status asthmaticus

A

a severe, life-threatening, acute episode of airway obstruction that intensifies once it begins
- often does not respond to common therapy

40
Q

if status asthmaticus is not reversed, the patient may develop

A
  • pneumothorax and cardiac or respiratory arrest
41
Q

treatment of status asthmaticus

A
  • IV fluids (because the patient may not be eating due to inability to breathe- replaces electrolytes and fluids patient is missing due to not eating)
  • potent systemic bronchodilator
  • steroids
  • epinephrine
  • oxygen
42
Q

asthma green zone

A

easy, no coughing or wheezing breathing good, normal activities, use of long-term control medications
80-100% peak flow
- no interventions needed

43
Q

asthma yellow zone

A

some symptoms, coughing or wheezing, can do some activities but not all
50-80% peak flow
- contact dr- will prob take fast acting (rescue) inhaler

44
Q

asthma red zone

A

meds arent helping
rescue inhaler multiple xday, long-term meds not working, can’t talk, walk, SOB
< 50% peak flow
- call 911

NU 340 (26 decks)

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