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Nursing 210 > Exam 4: asthma > Flashcards

Exam 4: asthma Flashcards

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1
Q

definition of asthma

A

Heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or bronchial hyperresponsiveness

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2
Q

5 risk factors of asthma

A 
genetic factors
environmental (pollen)
male gender in children
obesity
immune response (hygiene hypothesis)
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3
Q

what is the hygiene hypothesis

A

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

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4
Q

9 triggers of asthma

A

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)

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5
Q

what is EIA? what makes this even worse?

A

exercise induced asthma
occurs after vigorous activity
especially worse with exposure to cold air

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6
Q

which trigger of asthma is the major precipitating factor of an acute asthma attack? how does this attack occur (patho)?

A

respiratory infections

increased inflammation and hyper-responsiveness of tracheobronchial system

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7
Q

what is the asthma triad? when do symptoms start?

A

nasal polyps
asthma
sensitivity to aspirin and NSAIDs

wheezing begins in about 2 hours

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8
Q

do asthma medications worsen or improve GERD symptoms?

A

worsen

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9
Q

pathophysiology of asthma?

A
  1. exposure to allergen or irritant
  2. chronic inflammation
    - airway bronchoconstriction
    - hyper-responsiveness
    - edema of airways
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10
Q

what does early phase response include? (5)

A 
vascular congestion
edema formaiton
production of thick, tenacious mucus
bronchial muscle spasm
thickening og airway walls
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11
Q

when does late phase response start? how many pts does this occur in? how long can it last?

A

occurs within 4-6 hours after initial attack
50% of patients
lasts up to 24 hours or longer

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12
Q

what may late phase response cause if not treated or does not resolve?

A

irreversible lung damage

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13
Q

clinical manifestations of asthma? how long do they last?

A 
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
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14
Q

what is cough variant asthma?

A

cough is only symptom

bronchospasm is not severe enough to cause airflow obstruction

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15
Q

intermittent asthma

A

symptoms < 2 days a week
nighttime awakenings < 2 times a month
SABA use < 2 days a week
no normal interference with activity

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16
Q

respiratory rate of a severe and life-threatening exacerbation? pulse? PEFR? other important symptom?

A

rr > 30/min
pulse > 120/min
PEFR is 40% at best
dyspnea at rest, feeling of suffocation

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17
Q

complications of life-threatening asthma?

A 
too dyspneic to speak
perspiring profusely
drowsy/confused
PEFR <25%
require hospital care and often admitted to ICU
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18
Q

7 diagnostic studies for asthma

A 
Detailed history and physical exam
Spirometry
Peak expiratory flow rate (PEFR)
Chest x-ray
Oximetry
Allergy testing
Blood levels of eosinophils
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19
Q

which 6 things should the nurse assess during an acute exacerbation?

A 
Respiratory and heart rate
Use of accessory muscles
Percussion and auscultation of lungs
PEFR to monitor airflow obstruction
ABGs
Pulse oximetry
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20
Q

interprofessional care for an asthma pt during an acute asthma exacerbation?

A

oxygen given via nasal cannula
make sure oxygen is above 90%
continuous oxygen monitoring
bronchodilator treatment with SABA

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21
Q

interprofessional care for an asthma pt during a severe and life-threatening exacerbation?

A 
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
22
Q

what is silent chest?\

A

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

23
Q

what is a bronchial thermoplasty

A

catheter applies heat to reduce muscle mass in the bronchial wall
revereses accumulation of excessive tissue that causes narrowing of airway

24
Q

what are the 3 types of antiinflammatory drugs?

A

corticosteroids
leukotriene modifiers
monoclonal antibody to IgE

25
Q

corticosteroids drug names? MOA? forms? how often is this taken? side effects? how can these side effects be reduced?

A

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

26
Q

leukotriene modifiers or inhibitors drug names? MOA? when are these used?

A

zafirlukast, montelukast (Singulair), zileuton
-lukast
blocks action of leukotrienes- potent bronchoconstrictors
also antiinflammatories
not used for acute attacks
used for prophylatic and maintenance therapy

27
Q

anti-IgE drug name? MOA? how often is this taken?

A

Xolair
decreases circulating IgE levels
prevents IgE from attaching to mast cells, preventing release of chemical mediators
subcutaneous administration every 2-4 weeks

28
Q

what are the 3 types of bronchodilators?

A

beta 2 adrenergic agonists
methylxanthines
anticholinergics

29
Q

beta 2 adrenergics agonists (SABA) drug names? what are these used for? onset? duration? MOA?

A

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

30
Q

long acting beta 2 adrenergic agonist (LABAs) drug names? when are these taken? what are these taken with? what are these never used as?

A 
salmeterol (Serevent), formoterol (Foradil)
decreases the need for SABAs 
added to daily ICSs
never used as monotherapy
combination ICS and LABA available
31
Q

methylxanthines drug name? MOA? what is risky about this drug?

A

theophylline
less effective long term bronchodilator
alleviates early phase of attacks but has little effect on bronchial hyperresponsivness
narrow margin of safety

32
Q

short acting antichoinergics (SAMA) drug name? MOA? form? when is this used? use with precaution with which patients?

A

ipratropium
blocks action of acetylcholine, promotes bronchodilation
nebulizer
used for severe acute asthma exacerbations
naroow angle glaucoma or prostatic enlargement

33
Q

which form of asthma medications is preferred? why?

A

inhalation

to avoid systemic side effects

34
Q

what does a spacer do? how does it benefit the pt?

A

easier for pt to inhale all of medications

improves inhalation of the drug

35
Q

what should the nurse be sure to instruct the pt to do after taking an inhaled medication?

A

rinse mouth out with water to prevent thrush

36
Q

how much fluid should pt with asthma intake every day?

A

2-3 L

37
Q

what is an important goal of nursing for asthma pt?

A

decrease patient’s anxiety and sense pf panic
stay with pt
position comfortably
use talking down

38
Q

how often should pt check peak flow

A

daily

39
Q

green zone peak flow? pt action?

A

80-100% of personal best

remain on medications

40
Q

yellow zone peak flow? what does this mean?

A

50-80% of personal best
indicates caution
something is triggering asthma

41
Q

red zone peak flow? pt action?

A

50% or less of personal best
indicates serious problem
definitive action must be taken with HCP

42
Q

which races have higher rates of poorly controlled asthma?

A

african americans

hispanics

43
Q

what should women especially, postmenopausal, who have asthma on corticosteroids take?

A

adequate amounts of vitamin D and calcium

regular weight bearing exercise

44
Q

steps for using an inhaler

A
  1. take cap off and shake
  2. breathe out all the way
  3. hold inhaler the way dr said (in mouth, 1-2 inches away from mouth, or with spacer)
  4. breathe in slowly through mouth, press down on inhaler one time
  5. breathe in slowly and as deeply as possible
  6. hold breathe as you count to 10 slowly
  7. wait about 1 minute between puffs for SABA
45
Q

signs of toxicity of theophylline? what should pt avoid?

A

nausea, vomiting, seizures, insomnia

avoid caffeine

46
Q

what does MDI and DPI stand for?

A

metered dose inhaler

dry powder inhaler

47
Q

how to use a dry powder inhaler?

A
  1. remove mouth piece cap or open device, check for dust or dirt
  2. load the medication into the inhaler or engage lever to allow medication to become available
  3. don’t shake
  4. tilt head back slightly and breathe out, getting as much air out of lungs as possible
  5. close lips tightly around mouth piece
  6. breathe in deeply and quickly
  7. hold breathe for 10 seconds
  8. make sure the number displayed of doses went down one
  9. don’t keep DPI in humid place such as shower room because medicine may clump
48
Q

what are nebulizers?

A

small machines used to convert drug solutions into mists that can be inhaled through a face mask or mouthpiece

49
Q

what is PLB? when is this used?

A

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

50
Q

how many times should pt use peak flow meter?

A

3 times and write down the best

Nursing 210 (12 decks)

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