Chapter 23: Asthma Flashcards
Asthma
- most common chronic disease in childhood
- characterized by the triad symptoms of bronchial smooth muscle spasm, inflammation and edema of the bronchial mucosa, and production and retention of thick, tenacious, pulmonary secretions leading to airway obstruction
- chronic childhood inflammatory disorder of the airways that results in intermittent and reversible airflow obstruction of the bronchioles
Risk Factors for Asthma
- environmental factors: air pollutants, allergen exposure, exposure to tobacco smoke, and strong chemical odors
- low socioeconomic status
- health-care disparities
- extrinsic factors: allergens such as dust, pollen, animal hairs, chemical sprays, perfumes, baby powder, and molds
- foods: nuts, chocolates, oranges, and chicken
- changes in weather, pollution, and smoke
- Intrinsic Factors: exercise, anxiety, strong emotions such as fear and laughter, and infections
- family hx of asthma or allergies
Status Asthmaticus
persistent and intractable asthma in which the child does not respond to therapy and a medical emergency ensues
Signs + Symptoms
-recurrent wheezing
-SOB
-nonproductive cough
-chest tightness or pain
-exercise intolerance
-prolonged expiratory phase of respirations
-tachypnea
-retractions and nasal flaring
-history of allergies
-history of atopic dermatitis
-nasal polyps
-history of nighttime cough
-family history of atopy (asthma, allergic rhinitis, or atopic dermatitis)
ATI:
-dyspnea
-cough
-audible wheezing
-coarse lung sounds, wheezing throughout, possible cracks
-mucus production
-restlessness, irritability
-anxiety
-sweating
-use of accessory muscles
-decreased oxygen saturation
-tripod positioning
-sitting retractions
-inaudible breath sounds or crackles (severe obstruction
Diagnosis
based on clinical symptoms, history, physical examination, and to a lesser extent, laboratory tests
- intermittent, mild, persistent, moderate persistent, or severe
- pulse oximeter to measure oxygen saturation
- blood gases to determine carbon dioxide retention and hypoxemia
- complete blood count
- pulmonary function test to assist in determining the degree of disease
- peak expiratory flow rate
- allergy testing
- chest radiography to evaluate hyperinflation and potential for coexisting infection
Blood Gases
used to evaluate respiratory and metabolic function through determining the acid-base balance of the blood by measurement of oxygen and carbon dioxide
- obtained through arterial, venous, capillary, or cord blood
- arterial blood gases measure the amount of dissolved oxygen and carbon dioxide present in arterial blood and reveal the acid-base state and how well the oxygen is being carried to the body
- measurements: pH, PCO2, HCO3, PO2, and O2 Sat
- the amount of carbon dioxide is determined by the partial pressure of carbon dioxide (PCO2); controlled by the lungs; as the CO2 levels increase the pH decreases = acidosis
- HCO3= bicarbonate, as HCO3 levels increase, so does the pH= alkalosis
- amount of oxygen dissolved in the blood is measured by partial pressure of oxygen (PO2)
- amount of oxygen bound to hemoglobin is by oxygen saturation (O2 Sat)
Blood Gases and Asthma
-airway diseases, such as asthma that causes respiratory structures to become less compliant, may lead to carbon dioxide retention and respiratory acidosis
-interference with breathing causes the CO2 rate to increase and the pH to drop
>ongoing carbon dioxide (CO2) retention can lead to chronic respiratory acidosis
-conditions that increase respiratory rates, such as hyperventilation, anxiety, pulmonary embolus, salicylate poisoning, and fever, lead to respiratory alkalosis, which is a loss of CO2 and an increased pH
Prevention of Asthma
directed toward day-to-day management
-identifying environmental factors that trigger an attack
-compliance with medication
-how to use and clean inhalers, spacers, or aerosol equipment
>parents and children need to understand how to manage asthma in settings away from home, how to recognize when there is a need to seek additional assistance, and regular follow-ups
Nursing Care
assisting with relief of symptoms and providing health education to parents and family
- asthma attacks are frightening and stressful for both patient and family; nurse has a calm approach
- administering quick-relief medications without delay
- provides education about use of a peak flow meter
Essential Nursing Interventions
- giving medications on time
- liquefying secretions through adequate hydration
- positioning child properly; head of bed elevated 30 degrees to provide comfort and lung expansion; side-lying and semi-prone positions
- report and record respiratory assessment and response to medications
- ensure respiratory treatments happen in a timely manner and that ordering prn treatment may be necessary
Medical Care
depends on the level of severity of the disease
>quick-relief or rescue medications
>long-term control medications
-daily anti-inflammatory agents to control the levels of persistent asthma, with increasing doses of medication as necessary
-With mild, persistent asthma: use of low-dose medications such as inhaled steroids, cromolyn sodium (Intal), nedocromil (Tilade), or an anti-leukotriene (Montelukast sodium) tablet
-For moderate and Severe persistent asthma: a higher dose of steroids with the addition of long-acting beta antagonists
-For quick relief of bronchospasm and with asthma: short-acting inhaled beta antagonists
Treatment Consists of?
early relief of symptoms through drug therapy and prevention of further attacks through allergen control, environmental manipulation, health education, and attainment of self-management skills
>goal is to enable the child to have as regular a life as possible by keeping the lung function within normal limits
Asthma Action Plan
educational communication tool used between the health-care provider and the patient, along with their family and caregivers, to properly manage asthma and respond to asthma episodes
-completed by child’s primary care provider
-includes the symptoms and management for each color zone including peak flow measurements appropriate for each color zone
-peak flow meter is an essential companion for the Asthma Action Plan for children older than 6
>to determine the child’s zone for children younger than 6, symptoms are used alone
Peak Flow Meter
-essential for Asthma Action Plan (for children over 6)
-a portable, handheld device that is used to measure the ability to push air out of the lungs
>the “personal best” peak flow is determined when the child is symptom free
-peak flow meter package usually contains a form where peak flow readings are recorded regularly
Education/ Discharge
nurse can offer health education to families that emphasizes correctly adhering to the treatment regimen, preventing infection, and avoiding asthma triggers
