Exam 4: asthma Flashcards
definition of asthma
Heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or bronchial hyperresponsiveness
5 risk factors of asthma
genetic factors environmental (pollen) male gender in children obesity immune response (hygiene hypothesis)
what is the hygiene hypothesis
due to the lack of exposure to infection as a child, the individual is more susceptible to allergic diseases by suppressing the growth of the immune system
9 triggers of asthma
allergens (cockroaches, pets, fungi, pollen, molds)
exercise
air pollutants (cigarette or wood smoke, vehicle exhaust, concentrated pollution)
occupational factors
respiratory infections
nose and sinus problems (allergic rhinitis and nasal polyps)
drugs and food additives (asthma triad, beta-adrenergic blockers, ACE inhibitors, food allergies)
GERD
emotional stress (panic and anxiety)
what is EIA? what makes this even worse?
exercise induced asthma
occurs after vigorous activity
especially worse with exposure to cold air
which trigger of asthma is the major precipitating factor of an acute asthma attack? how does this attack occur (patho)?
respiratory infections
increased inflammation and hyper-responsiveness of tracheobronchial system
what is the asthma triad? when do symptoms start?
nasal polyps
asthma
sensitivity to aspirin and NSAIDs
wheezing begins in about 2 hours
do asthma medications worsen or improve GERD symptoms?
worsen
pathophysiology of asthma?
- exposure to allergen or irritant
- chronic inflammation
- airway bronchoconstriction
- hyper-responsiveness
- edema of airways
what does early phase response include? (5)
vascular congestion edema formaiton production of thick, tenacious mucus bronchial muscle spasm thickening og airway walls
when does late phase response start? how many pts does this occur in? how long can it last?
occurs within 4-6 hours after initial attack
50% of patients
lasts up to 24 hours or longer
what may late phase response cause if not treated or does not resolve?
irreversible lung damage
clinical manifestations of asthma? how long do they last?
unpredictable and variable recurrent episodes of wheezing, breathlessness, cough, and tight chest may be abrupt or gradual lasts minutes to hours expiration may be prolonged
what is cough variant asthma?
cough is only symptom
bronchospasm is not severe enough to cause airflow obstruction
intermittent asthma
symptoms < 2 days a week
nighttime awakenings < 2 times a month
SABA use < 2 days a week
no normal interference with activity
respiratory rate of a severe and life-threatening exacerbation? pulse? PEFR? other important symptom?
rr > 30/min
pulse > 120/min
PEFR is 40% at best
dyspnea at rest, feeling of suffocation
complications of life-threatening asthma?
too dyspneic to speak perspiring profusely drowsy/confused PEFR <25% require hospital care and often admitted to ICU
7 diagnostic studies for asthma
Detailed history and physical exam Spirometry Peak expiratory flow rate (PEFR) Chest x-ray Oximetry Allergy testing Blood levels of eosinophils
which 6 things should the nurse assess during an acute exacerbation?
Respiratory and heart rate Use of accessory muscles Percussion and auscultation of lungs PEFR to monitor airflow obstruction ABGs Pulse oximetry
interprofessional care for an asthma pt during an acute asthma exacerbation?
oxygen given via nasal cannula
make sure oxygen is above 90%
continuous oxygen monitoring
bronchodilator treatment with SABA
interprofessional care for an asthma pt during a severe and life-threatening exacerbation?
same as acute episode inhaled ipratropium is used in conjunction with SABA IV magnesium sulfate 100% oxygen hourly or continuous SABA IV corticosteroids bronchial thermoplasty
what is silent chest?\
happens during a sever and life-threatening exacerbation
severely diminished breath sounds
absence of wheeze after a pt has been wheezing
pt is obviously struggling
life-threatening situation
what is a bronchial thermoplasty
catheter applies heat to reduce muscle mass in the bronchial wall
revereses accumulation of excessive tissue that causes narrowing of airway
what are the 3 types of antiinflammatory drugs?
corticosteroids
leukotriene modifiers
monoclonal antibody to IgE
corticosteroids drug names? MOA? forms? how often is this taken? side effects? how can these side effects be reduced?
beclomethasone
fluticasone (inhaled)
budesonide
prednisone (oral)
supresses inflammatory response, reduces bronchial hyperresponsiveness, decreases mucous production
inhaled form is used for long term control
systemic form is control exacerbations and manage persistent asthma
taken on a fixed schedule
oropharyngeal candidiasis, hoarseness, and a dry cough are local side effects of inhaled drug
can be reduced by using a spacer or by gargling after each use
leukotriene modifiers or inhibitors drug names? MOA? when are these used?
zafirlukast, montelukast (Singulair), zileuton
-lukast
blocks action of leukotrienes- potent bronchoconstrictors
also antiinflammatories
not used for acute attacks
used for prophylatic and maintenance therapy
anti-IgE drug name? MOA? how often is this taken?
Xolair
decreases circulating IgE levels
prevents IgE from attaching to mast cells, preventing release of chemical mediators
subcutaneous administration every 2-4 weeks
what are the 3 types of bronchodilators?
beta 2 adrenergic agonists
methylxanthines
anticholinergics
beta 2 adrenergics agonists (SABA) drug names? what are these used for? onset? duration? MOA?
albuterol, pirbuterol
effective for relieving acute bronchospasm
onset is minutes
duration is 4-8 hours
prevents the release of inflammatory mediators from mast cells
not for long term use
long acting beta 2 adrenergic agonist (LABAs) drug names? when are these taken? what are these taken with? what are these never used as?
salmeterol (Serevent), formoterol (Foradil) decreases the need for SABAs added to daily ICSs never used as monotherapy combination ICS and LABA available
methylxanthines drug name? MOA? what is risky about this drug?
theophylline
less effective long term bronchodilator
alleviates early phase of attacks but has little effect on bronchial hyperresponsivness
narrow margin of safety
short acting antichoinergics (SAMA) drug name? MOA? form? when is this used? use with precaution with which patients?
ipratropium
blocks action of acetylcholine, promotes bronchodilation
nebulizer
used for severe acute asthma exacerbations
naroow angle glaucoma or prostatic enlargement
which form of asthma medications is preferred? why?
inhalation
to avoid systemic side effects
what does a spacer do? how does it benefit the pt?
easier for pt to inhale all of medications
improves inhalation of the drug
what should the nurse be sure to instruct the pt to do after taking an inhaled medication?
rinse mouth out with water to prevent thrush
how much fluid should pt with asthma intake every day?
2-3 L
what is an important goal of nursing for asthma pt?
decrease patient’s anxiety and sense pf panic
stay with pt
position comfortably
use talking down
how often should pt check peak flow
daily
green zone peak flow? pt action?
80-100% of personal best
remain on medications
yellow zone peak flow? what does this mean?
50-80% of personal best
indicates caution
something is triggering asthma
red zone peak flow? pt action?
50% or less of personal best
indicates serious problem
definitive action must be taken with HCP
which races have higher rates of poorly controlled asthma?
african americans
hispanics
what should women especially, postmenopausal, who have asthma on corticosteroids take?
adequate amounts of vitamin D and calcium
regular weight bearing exercise
steps for using an inhaler
- take cap off and shake
- breathe out all the way
- hold inhaler the way dr said (in mouth, 1-2 inches away from mouth, or with spacer)
- breathe in slowly through mouth, press down on inhaler one time
- breathe in slowly and as deeply as possible
- hold breathe as you count to 10 slowly
- wait about 1 minute between puffs for SABA
signs of toxicity of theophylline? what should pt avoid?
nausea, vomiting, seizures, insomnia
avoid caffeine
what does MDI and DPI stand for?
metered dose inhaler
dry powder inhaler
how to use a dry powder inhaler?
- remove mouth piece cap or open device, check for dust or dirt
- load the medication into the inhaler or engage lever to allow medication to become available
- don’t shake
- tilt head back slightly and breathe out, getting as much air out of lungs as possible
- close lips tightly around mouth piece
- breathe in deeply and quickly
- hold breathe for 10 seconds
- make sure the number displayed of doses went down one
- don’t keep DPI in humid place such as shower room because medicine may clump
what are nebulizers?
small machines used to convert drug solutions into mists that can be inhaled through a face mask or mouthpiece
what is PLB? when is this used?
pursed lip breathing
used before during and after any activity causing you to be short of breath
inhale deeply and slowly through nose
exhale slowly through pursed lips almost as if whistling
how many times should pt use peak flow meter?
3 times and write down the best
