Ch. 24 Flashcards
chronic airflow limitations include what chronic lung diseases of the LOWER resp. tract?
- asthma
- chronic bronchitis
- pulmonary emphysema
asthma
chronic disease with an intermittent and reversible airflow obstruction
- affects only the airways
- does not affect the alveoli
asthma: airway obstruction occurs by
- inflammation
- airway hyperresponsiveness
main priority concept with asthma is
gas exchange
pathophysiology of asthma
- inflammation (swollen lining, excess mucus)
- airway hyperresponsiveness (muscle tightness)
all causes bronchoconstriction
classifications of asthma
- 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
key event in triggering an asthma attack
inflammation of lining of airways is key event in triggering an asthma attack
prevalence of asthma
- 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
cost of asthma in US
- estimated annual cost = $19.7 billion
- estimated annual direct cost (hospitalizations) = $14.7 billion
- $3300 per person each year
- medical expenses continue to increase
asthma triggers
- stress
- pets
- exercise
- pollen
- bugs in the home
- chemical fumes
- cold air
- fungus spores
- dust
- smoke
- strong odors
- pollution
- anger
what are triggers?
- triggers cause the body to release antibodies and chemicals such as histamine which starts the inflammatory response
genetic considerations for asthma
- 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
considerations for older adults with asthma
- Change in sensitivity of beta-adrenergic receptors
- Teach how to prevent asthma attacks
- Teach correct use of preventive and rescue drugs
considerations for women with asthma
35% higher incidence in F > M
asthma assessment: 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
controlled asthma
experiences no symptoms
partly controlled asthma
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
uncontrolled asthma
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
asthma assessment: history
- sx during the day? at night? both?
- how often are they using rescue inhaler (not to be used every day)
asthma physical assessment and clinical manifestations
- 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
asthma laboratory assessment
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
The most accurate measures for asthma are
pulmonary function tests using spirometry including:
- Forced vital capacity (FVC)
- Forced expiratory volume in the first second (FEV1)
- *Peak expiratory flow rate (PEFR)
asthma interventions
- Control and prevent episodes
- Improve air flow and gas exchange
- Self-management education: personal asthma action plan
- Drug therapy
asthma drug therapy includes what types of drugs?
- 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
Pharmacologic management is based on
- 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
asthma drug therapy: preventative therapy drugs (controller drugs)
- Used to change the airway responsiveness to prevent asthma attacks
-Used every day, regardless of symptoms
asthma drug therapy: rescue drugs
- used to actually stop an attack once it has started
step system for asthma: step 1
least severe symptoms
- patient will be on SABA PRN
step system for asthma: step 2
SABA PRN, low dose ICS
step system for asthma: step 3
SABA, low dose LICS (long-acting inhaled corticosteroids), LABA
step system for asthma: step 4
medium-high dose LICS (long-acting inhaled corticosteroids), LABA
step system for asthma: step 5
oral steroid
asthma drug therapy: bronchodilators
- 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
only ____ should be used as rescue inhalers for asthma attack
- short acting inhalers
asthma drug therapy: anti-inflammatory agents
- Corticosteroids (don’t stop abruptly, rinse mouth afterward to prevent thrush: white patches in mouth)
- Inhaled (Fluticasone)* pt teaching
- Leukotriene antagonists (Montelukast)
- Immunomodulators
asthma drug therapy: combination inhalers
- Fluticasone/salmeterol (steroid/LABA)
non-pharmacologic treatments for asthma
- exercise and activity is recommended to promote ventilation and perfusion
in an acute asthma attack, oxygen therapy is delivered via
- nasal cannula
- face mask
- endotracheal (ET) tube (possible with bronchospasm, bronchodilation)
status asthmaticus
a severe, life-threatening, acute episode of airway obstruction that intensifies once it begins
- often does not respond to common therapy
if status asthmaticus is not reversed, the patient may develop
- pneumothorax and cardiac or respiratory arrest
treatment of status asthmaticus
- 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
asthma green zone
easy, no coughing or wheezing breathing good, normal activities, use of long-term control medications
80-100% peak flow
- no interventions needed
asthma yellow zone
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
asthma red zone
meds arent helping
rescue inhaler multiple xday, long-term meds not working, can’t talk, walk, SOB
< 50% peak flow
- call 911
