Exam #5 Respiratory Flashcards
What is rhinitis?
Inflammation of the nasal mucous membranes.
What causes rhinitis?
Bacterial or viral. The release of histamines cause vasodilation and edema which is what causes the symptoms
What is pharyngitis?
Inflammation of the pharynx
What is sinusitis?
Inflammation of the sinus mucosa
What is laryngitis?
Inflammation of the larynx
What causes pharyngitis?
Most commonly caused by strep infection. Chronic: smoking, alcohol use, using voice excessively, dusty environments
What causes sinusitis?
Bacterial or allergic
What causes laryngitis?
Inflammation, vocal abuse, or occasionally GERD
What are upper respiratory infections?
Infections, rhinitis, sinusitis (acute & chronic), pharyngitis (acute & chronic), tonsilitis, adenoiditis, and laryngitis
What are the s/s of rhinitis?
Nasal congestion, itching, sneezing, nasal discharge (typically clear), edematous conchae; polyps may develop
What additional s/s are seen in viral rhinitis?
Common cold. Accompanied by fever and malaise
What are the s/s of pharyngitis (acute & chronic)?
Red, swollen, sore throat; pus may be present, dysphagia, fever, chills, and malaise
What are the s/s of sinusitis (acute & chronic)?
Pain over affected sinus, fever, chills, thick mucous that occludes the sinus cavity preventing drainage
What is tonsilitis and adenoiditis?
Inflammation or infection of the tonsils and adenoids
What are the s/s of laryngitis?
Hoarseness and soreness in throat
What is a peritonsillar abscess?
Forms in the tissues of the throat next to one of the tonsils. An abscess is a collection of pus that forms near an area of infected skin or other soft tissue
What causes a peritonsillar abscess?
Strep bacteria most commonly cause an infection in the soft tissue around the tonsils (usually just on one side). The tissue is then invaded by anerobes (bacteria that can live without oxygen), which enter through nearby glands
True or False. Acute pharyngitis of a bacterial nature is most commonly caused by group A, beta-hemolytic streptococci.
True
What are some potential complications of pharyngitis?
Sepsis, meningitis, peritonsillar abscess, otitis media, and sinusitis
What does sepsis mean?
Infection in the blood
What can sepsis lead to?
Septic shock
Why would you ask a patient if they have allergies?
Allergies can lead to upper respiratory infections
What is included when inspecting the nose, neck and throat for an upper respiratory infection?
Include palpation of lymph nodes (neck, around ears, and face)
What is most important nursing diagnosis for an upper respiratory infection?
Ineffective airway clearance
What are some goals when treating a patient with an upper respiratory infection?
Maintain patent airway, relieve pain, maintain effective communication, normal hydration, knowledge (how to prevent), and absence of complications
How do you promote comfort in a patient with an upper respiratory infection?
Analgesics, gargles for sore throat, and use of hot packs for sinus congestion or ice collar to reduce swelling
What is used to reduce swelling and bleeding post tonsillectomy and adenoidectomy?
An ice collar
Hot packs increase inflammation, why use them on a patient with an upper respiratory infection?
To decrease the pain and make the patient more comfortable
How much fluids do you encourage the patient to drink per day if they have an upper respiratory infection?
2-3 L/day
What education does the patient need for an upper respiratory infection?
Prevention, hand washing, when to contact doctor, complete anitbiotic therapy, and annual flu vaccine for those at risk
What is epistaxis?
Hemorrhage from the nose (nose bleed)
What are some common risk factors for epistaxis?
Severe HTN (biggest), dry environment, trauma to the nose, cocaine use
What is the most common site of epistaxis?
Anterior septum
What is the treatment for epistaxis?
Topical vasoconstrictors and packing of nasal cavity or balloon catheter
List some topical vasoconstrictors used to treat epistaxis.
Adrenaline, cocaine, and phenylephrine
What is “hurricaine spray”?
Cocaine spray used to treat epistaxis
How does cocaine treat epistaxis?
It is the only naturally occurring numbing medication and it vasoconstricts
Would you be able to use cocaine spray for treatment of epistaxis if the patient was a chronic cocaine user?
No, they would most likely use a different treatment
How is packing to control bleeding from the posterior nose done?
A catheter is inserted and packing is attached. Packing is drawn into position as the catheter is removed. Strip is tied over a bolster to hold the packing in place with an anterior pack installed “accordion pleat” style. Alternative method, using a balloon catheter instead of gauze packing
Why would a “nasal tampon” be used to treat epistaxis?
It absorbs the bleeding and provides compression to stop the bleeding
What do you need to consider when assessing the bleeding in a patient with epistaxis?
How much blood loss are you dealing with? Do you need to give blood products?
Why do you need to monitor the airway and breathing of a patient with epistaxis?
May need to intubate in order to maintain a patent airway
What do you need to watch for when monitoring VS in a patient with epistaxis?
Tachycardia and hypotension due to hypovolemic shock (which is due to blood loss)
What might a patient with epistaxis need so they don’t dry out their nares?
Air humidification especially if they are on oxygen
How would you explain to a patient with epistaxis how to stop the bleeding?
Lean slightly forward and pinch the upper portion (not the tip) of the nose
When should a patient with epistaxis seek medical attention when bleeding doesn’t stop?
After 15 minutes
What is atelectasis?
Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression
What causes hypoventilation?
Drug use (especially sedatives), pneumonia, bed ridden, immobility, COPD, loss of elasticity due to aging, can’t inhale deeply and not doing CTDB
What causes atelectasis?
Bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration
Which patients are at high risk for atelectasis?
Postoperative patients
What are some symptoms of atelectasis?
Insidious, include cough, sputum production (big one), low-grade fever
Define insidious.
Slow to develop or see
What are some complications of atelectasis?
Respiratory distress, anxiety, symptoms of hypoxia occur if large areas of the lung are affected
What are some s/s of hypoxia?
Mental impairment (biggest one), cyanosis, pallor, and SOB
What is “lung toileting”?
Turn patients q2hrs to move secretions and cough it out
Which patients need frequent turning and early mobilization so they don’t develop atelectasis?
Open heart surgery patients
How do you prevent atelectasis?
Frequent turning, early mobilization, improve ventilation and remove secretions
What is a PEP device used in patients with atelectasis?
Positive pressure to keep alveoli open as you exhale (blowing into)(oval, green, with mouthpiece)
What are some strategies to improve ventilation in patients with atelectasis?
Deep breathing exercises at least q2hrs, incentive spirometer
How often does a patient need to use an incentive spirometer?
10X/hr while awake
What are some strategies to remove secretions in a patient with atelectasis?
Coughing exercises, suctioning, aerosol therapy, and chest physiotherapy
What aerosol therapy is used in patients with atelectasis?
Nebulizer breathing treatments
What is the chest physiotherapy used in patients with atelectasis?
Percussion either by bed, vests, discs, or manually (by cupping the hand - done by respiratory therapists)
What is a strategy to improve ventilation in atelectasis?
Remove secretions
What is done to remove an obstruction in atelectasis?
Bronchoscopy
What are the 2 treatments for atelectasis?
PEEP (Positvie End-Expiratory Pressure) and IPPB (Intermittent Positive-Pressure Breathing)
What does PEEP stand for?
Positive End-Expiratory Pressure
What does IPPB stand for?
Intermittent Postive-Pressure Breathing
What does CPPB stand for?
Continuous Positive-Pressure Breathing
What does CPAP stand for?
Continuous Positive Airway Pressure
What does a CPAP do?
Uses mild air pressure to keep an airway open
What is the difference between PEEP and CPAP?
PEEP is an applied pressure against exhalation CPAP is a pressure applied by a constant flow
What is the function of a BIPAP machine?
Helps push air into the lungs and helps hold the lungs open to allow more oxygen to enter the lungs. Applies air and pressure during expiration in order to hold open the air sacs in the lungs
What does BIPAP stand for?
Bilevel Positive Airway Pressure
What is the difference between the CPAP and BIPAP?
CPAP only has one continuous pressure setting and BIPAP has a pressure setting for inhalation and another pressure setting for exhalation
What is a common BIPAP setting?
12/6
What is acute tracheobronchitis?
An acute inflammation of the mucous membranes of the trachea and the bronchial tree, often follows infection of the upper respiratory tract
What is one of the major factors in the prevention of acute tracheobronchitis?
Adequate treatment of upper respiratory tract infections
What causes the production of mucopurulent sputum in acute tracheobronchitis?
In response to infection by streptococcus pneumoniae, Haemophilus influenzae, or Mycoplasma pneumoniae. A fungal infection may also cause tracheobronchitis
Besides infection, what else might cause acute bronchial irritation?
Inhalation of physical and chemical irritants, gases, or other air contaminants
What are the 4 classifications of pneumonia?
Community-acquired pneumonia (CAP); Hospital-acquired pneumonia (HAP)(nosocomial); Pneumonia in immunocompromised host; Aspiration pneumonia
What is the pathophysiology of pneumonia?
Alveoli fill with exudate (any fluid released from the body with a high concentration of protein, cells, or solid debris) and increases exudate; Reduced surface area for gas exchange and decreases gas exchange; Obstruction of bronchioles
What is pneumonia?
Acute lung infection, inflammation and alveolar damage
When is pneumonia opportunistic?
In pneumocystitis (PCP), Carinii pneumonia, and Mycobacterium avium complex (MAC)
What is infectious pneumonia caused by?
Bacteria, viruses, fungi, protozoa, and other microbes
What is noninfectious pneumonia caused by?
Aspiration of gastric contents and inhalation of toxic or irritating gases
What are some underlying disorders that may cause pneumonia?
HF, diabetes, alcoholism, COPD, and AIDS
What are some s/s of pneumonia?
Cough (dry or productive), fever, chills, tachycardia, tachypnea or dyspnea, pleural pain, malaise, respiratory distress, and decreased breath sounds
What are some characteristics of sputum produced from a productive cough associated with infectious pneumonia?
Yellow, bloodstreaked, rusty sputum
How is pneumonia diagnosed?
Sputum gram stain and C&S, chest X-Ray, ABGs, CBC, pulse oximetry and fiberoptic bronchoscopy
What type of antibiotic therapy is used if the etiologic agent is not identified?
Utilize empiric antibiotic therapy (broad spectrum antibiotics)
What is the treatment for pneumonia?
Fluids, oxygen for hypoxia, antipyretics, antitussives, decongestants, antihistamines, and antibiotic therapy
How is the antibiotic therapy for pneumonia determined?
By the gram-stain results
Are antibiotics indicated for viral pneumonia?
No, but they are used for secondary bacterial infections
What are some nursing diagnoses for pneumonia?
Ineffective airway clearance r/t copious tracheobronchial secretions; Activity intolerance r/t impaired respiratory function; Risk for deficient fluid volume r/t fever and a rapid respiratory rate; Imbalanced nutrition: less than body requirements; Deficient knowledge
What assessments need to be done in a patient with pneumonia?
Temperature, apical pulse, secretions, cough, tachypnea, SOB, changes in physical assess and CXR, mental status and LOC, and hydration status
What changes in a physical assessment might you see in a patient with pneumonia?
Changes in respiratory status, including respiratory rate and depth, dyspnea, cough; symmetry of chest movements; lung sounds upon auscultation including any adventitious sounds; atelectasis
Why might you see changes in mental status in a patient with pneumonia?
Due to hypoxia
What type of HF is seen in patients with pneumonia?
Concomitant HF (transient)
What does concomitant HF mean in relation to pneumonia?
It means HF is naturally accompanying or associated with pneumonia (especially in the elderly)
What does transient HF mean in relation to pneumonia?
That HF is just during the period of pneumonia due to inability to get rid of secretions
What are some collaborative problems associated with pneumonia?
Continuing symptoms after initiation of therapy, shock, respiratory failure, atelectasis, pleural effusion, confusion, and superinfection
What type of shock is associated pneumonia?
Septic shock
What causes respiratory failure in patients that have pneumonia?
Atelectasis
What is a superinfection?
An acquired bacteria that is different than the bacteria that is currently being treated. Typically the new bacteria is resistant to the antibiotic taken for the original infection
What are the biggest causes of a superinfection that is associated with pneumonia?
Staph and Strep A
Why is nutrition important in a patient with pneumonia?
Need proper nutrition for appropriate healing to take place
What are some of the nursing goals for a patient with pneumonia?
Improved airway clearance; Maintenance of proper fluid volume and adequate nutrition; Patient understanding of treatment, prevention; Absence of complications
What steps are taken to improve airway clearance in patients with pneumonia?
Encourage hydration, humidification, coughing techniques, chest physiotherapy, position changes and oxygen therapy
Why and how is humidification used to improve a patient’s airway clearance with pneumonia?
Loosens secretions and treats atelectasis by face mask or with oxygen
How much fluids are encouraged per day to improve a patient’s airway clearance with pneumonia?
2-3 L/day
How is rest promoted in pneumonia?
Encourage rest, avoidance of overexertion and positioning to promote rest, breathing (Semi-Fowler’s)
How do you promote fluid intake in a patient that has pneumonia?
Encourage fluid intake to at least 2 L/day
How do you maintain nutrition in a patient that has pneumonia?
Provide nutritionally enriched foods and fluids to promote healing
What is pleurisy?
Inflammation of both layers of pleurae
What is the pathophysiology of pleurisy?
Inflamed surfaces rub together with respirations, cause sharp pain intensified with inspiration
What is pleural effusion?
Collection of fluid in pleural space usually secondary to another disease process
Can you hear the rubbing sound upon auscultation of the lung sounds in pleurisy?
Yes
What causes dyspnea in pleural effusion?
Large effusions impair lung expansion causing dyspnea (SOB)
What is the treatment for a pleural effusion?
Find the underlying cause, thoracentesis, and chest tube if large amount
What is a thoracentesis?
Use a needle to aspirate the fluid out of the pleural space
What causes pleural conditions?
HF, TB, pneumonia, bronchogenic carcinoma
What are the s/s of pleural conditions?
SOB, difficulty lying flat, coughing, chest pain, fever, chills
What assessments are done on a patient with a pleural condition?
Absent lung sounds, decreased fremitus (palpable vibration), and tracheal deviation
How are pleural conditions diagnosed?
Chest X-Ray, CT, and then thoracentesis
Define loculation.
Having, formed of, or divided into small cavities or compartments
What is empyema?
Accumulation of thick, purulent (infection) fluid in the pleural space
What are the s/s of empyema?
Patient usually acutely ill; Fluid, fibrin development, loculation impair lung expansion
How is empyema resolved?
A prolonged process with weeks of antibiotic therapy
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
What does GOLD stand for?
Global Initiative for Chronic Obstructive Lung Disease
What is COPD?
A disease state characterized by airflow limitation that is not fully reversible
Which disease process is currently the 4th leading cause of death and the 12th leading cause of disease?
COPD
Which diseases are included in COPD that cause airflow obstruction?
Emphysema and chronic bronchitis (may also be a combination of these disorders)
Is asthma considered to be part of COPD?
No (used to be), but can coexist with COPD
What is the pathophysiology of COPD?
Airflow limitation is progressive and is associated with abnormal inflammatory response of the lungs to noxious (harmful, poisonous) agents (within the bronchials)
Explain the inflammation cycle involved in COPD.
Inflammation leads to more damage (scar tissue), which in turn leads to more inflammation
What occurs in the airways in COPD?
Scar tissue and narrowing occurs
Where does the inflammatory response occur in COPD?
Throughout the airways, lung parenchyma, and pulmonary vasculature
What does substances activated by chronic inflammation damage in COPD?
The parenchyma
In COPD, what does the inflammation response cause changes in?
Pulmonary vasculature
Describe a common exercise done to feel how COPD feels.
Breath through a straw for 30 seconds
What is the difference between chronic and acute bronchitis?
Chronic is the presence of a cough and sputum production for at least 3 straight months in 2 consecutive years
What does irritation of the airways result in with chronic bronchitis?
Inflammation and hypersecretion of mucous
What increases in numbers with chronic bronchitis?
Mucous-secreting glands and goblet cells
What is a patient with chronic bronchitis more susceptible to?
Respiratory infections
What happens in chronic bronchitis?
Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways; Alveoli become damaged, fibrosed, and alveolar machrophage function diminishes
What is bronchitis?
Inflammation inside the bronchial tubes
What does the tar from cigarette smoking cause?
It causes the cilia to stick
What is the pathophysiology of chronic bronchitis?
The bronchus is narrowed and has impaired air flow due to multiple mechanisms: Inflammation, excess mucus production, and potential smooth muscle constriction (bronchospasm).
What are the s/s of chronic bronchitis?
Wheezing, crackles; Chronic cough; Dyspnea; Thick, tenacious sputum; Increased susceptibility to infection; Mucous plugs
True or False. For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia.
False. For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of sputum and productive cough, not tachypnea and tachycardia
What is emphysema?
Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
What is the difference between the types of COPD?
Destruction of the walls of the alveoli
What does the decrease in alveolar surface area cause in emphysema?
An increase in “dead space” and impaired oxygen diffusion
What does a reduction of the pulmonary capillary bed do in emphysema?
Increased pulmonary vascular resistance and pulmonary artery pressure; Can also cause right sided HF
What is a patient with emphysema not getting?
Full lung expansion or enough oxygen
What is the result of the pathologic changes in emphysema?
Hypoxemia
What might happen due to increased pulmonary artery pressure in emphysema?
Right-sided HF (cor pulmonale)
Define cor pulmonale.
Enlargement of the right ventricle of the heart due to disease of the lungs or of the pulmonary blood vessels
Why can a patient with emphysema not have more than 2L of oxygen?
Their main drive to breathe is CO2. For patients with COPD/emphysema, their drive to breathe is by oxygen. So if we saturate them with oxygen we will depress their drive to breathe (deprive them of inspiration and expiration)
What is the pathophysiology of emphysema?
Destruction of alveolar walls, loss of elastic recoil, damage to pulmonary capillaries, air trapping, impaired gas exchange
What are the s/s of emphysema?
Cough, sputum production, dyspnea, prolonged expiration, barrel chest, activity intolerance, and diminished breath sounds
What are the changes in the alveolar structure in panlobular emphysema?
The bronchioles, alveolar ducts and alveoli are destroyed, and the air-spaces within the lobule are enlarged; Occurs more in lower respiratory tract
What are the changes in the alveolar structure in centrilobular emphysema?
The pathologic changes occur in the lobule, whereas the peripheral portions of the acinus are preserved; Distal part of bronchial; Tends to occur in upper respiratory tract/airway
Why would a patient with emphysema have a barrel chest?
From the hyperexpansion of lungs
What is the primary clinical symptom of emphysema? A.) Chest pain; B.) Productive cough; C.) Sputum; D.) Wheezing
D.) Wheezing. The primary symptom of emphysema is wheezing. Sputum and productive cough are the primary symptoms of chronic bronchitis
What is the typical posture of a patient with COPD, primarily emphysema called?
“Tripodding” (orthopneic position) leaning forward
Describe the typical posture of a patient with COPD, primarily emphysema.
The patient tends to lean forward and uses the accessory muscles of respiratory to breathe, forcing the shoulder girdle upward and causing the supraclavicular fossae to retract on inspiration
What causes 80-90% of COPD cases?
Tobacco smoke
What are the risk factors of COPD?
Tobacco smoke, passive smoking, occupational exposure, ambient air pollution, and genetic abnormalities
What genetic abnormality can cause COPD, primarily emphysema?
A deficiency of alpha1-antitrypsin
What is alpha-antitrypsin?
Enzyme in which a deficiency in it can predispose a person to emphysema
What diagnostic test are reviewed during the assessment of a patient with COPD?
PFT (pulmonary function test), spirometry, ABGs, and oximetry
What nursing diagnoses might be used for a patient with COPD?
Impaired gas exchange, Impaired airway clearance, Ineffective breathing pattern, Activity intolerance, Deficient knowledge, and Ineffective coping
What are the s/s of COPD (including emphysema and chronic bronchitis)?
Digital clubbing, thin in appearance, wheezing, pursed-lip breathing, chronic cough, barrel chest, dyspnea, prolonged expiratory time, easily fatigued, frequent respiratory infections, use of accessory muscles to breathe, orthopneic, and cor pulmonale (late in disease)
What are some collaborative problems with COPD?
Respiratory insufficiency or failure, atelectasis, pulmonary infection, pneumonia, pneumothorax, and pulmonary HTN
What steps are taken in the planning stage with a patient that has COPD?
Smoking cessation, improved activity tolerance, maximal self management, improved coping ability, adherence to therapeutic regimen and home care, absence of complications
What is done to improve activity tolerance in a patient with COPD?
Physical therapy or cardiac rehab
What needs to be monitored for impaired gas exchange due to COPD?
Lung sounds, respiratory rate and effort; Dyspnea; Mental status; SaO2, ABGs
What positions do a patient with impaired gas exchange due to COPD need to be in?
Fowler’s orthopneic, or good lung down
What assessments are done with ineffective breathing pattern due to COPD?
Monitor respiratory rate, depth, effort and ABGs, SaO2; Determine/treat cause; Position; Teach diaphragmatic breathing
True or False. A commonly prescribed methylxanthine is theophylline.
True
What percentage of oxygen saturation do patients with COPD typically live on?
80%
What is important with bronchodilators and corticosteroids when trying to improve gas exchange in a patient with COPD?
Proper administration
What is important to reduce while improving gas exchange in a patient with COPD?
Reduction of pulmonary irritants (what’s causing it)
What types of coughing techniques are used to improve gas exchange in COPD?
Direct coughing and “huff” coughing
What is the purpose of coughing techniques when improving gas exchange in COPD?
To loosen secretions
What chest physiotherapy is done to improve gas exchange in COPD?
Percussion
What is diaphragmatic breathing?
Deep breathing with diaphragm without raising shoulders
What breathing exercises to reduce air trapping are used to improve gas exchange associated with COPD?
Diaphragmatic breathing and pursed lip breathing
When giving supplemental oxygen to improve gas exchange in a patient with COPD, how much oxygen is given and why?
No more than 2L. These patients have a hypoxic drive
What does it mean when a COPD patient has a hypoxic drive?
They retain CO2 because they can’t always blow out enough CO2. They are driven to breathe by CO2 which tells them when and how much to breathe
Describe “huff” coughing.
Have patient take a few deep (not so deep that it makes them cough) breaths and exhale, after taking a deep breath stutter cough when exhaling. Do this 3X. When taking the 2nd breath, don’t take as deep of a breath as you did in the 1st and the 3rd breath shouldn’t be as deep as the 2nd was. Stuttered coughing should be done with every exhalation
How do you improve activity intolerance in a patient with COPD?
Focus on rehabilitation activities (respiratory and cardiac rehab) to improve ADLs and promote independence; Pacing of activities; Exercise training; Walking aids; Utilization of a collaborative approach
List some other interventions for a patient with COPD.
Set realistic goals, avoid extreme temperatures, enhancement of coping strategies, and monitor for and management of potential complications
Why should a patient with COPD avoid extreme temperatures?
If temperatures are too hot or too cold, it makes it hard for them to breathe
What patient teaching must be done with a patient that has COPD?
Disease process, medications, procedures, when and how to seek help, prevention of infections (hand washing), avoidance of irritants, and lifestyle changes
What is the biggest problem when teaching a patient the disease process of COPD?
That there is no cure
What is asthma?
A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucous production
Why does hyperresponsiveness occur in asthma?
Because of the vicious cycle of edema
What does the inflammation associated with asthma lead to?
Hyperresponsiveness of airways, airflow limitation, and symptoms
What are they symptoms of asthma caused by inflammation?
Dyspnea, wheezing, cough, sputum, chest tightness, use of accessory muscles, and it may be worse at night
What is the most common disease of childhood?
Asthma
Can asthma occur at any age?
Yes, but most have an onset after age 12 years
What is the strongest predisposing factor for asthma?
Allergies
What are the 2 predisposing factors for asthma?
Atopy (genetic predisposition) and female gender
What are the 2 casual factors for asthma?
Exposure to indoor and outdoor allergens and occupational sensitizers
What are the contributing factors for asthma?
Respiratory infections, air pollution, active/passive smoking, and other (diet, small size at birth)
What are some risk factors for exacerbations in asthma?
Allergens; Respiratory infections; Exercise and hyperventilation; Weather changes; Exposure to sulfur dioxide; Exposure to food, additives, medications
What is a complication of asthma?
Status asthmaticus
What happens in status asthmaticus?
Severe, sustained asthma; Worsening hypoxemia; Respiratory alkalosis progresses to respiratory acidosis
Is status asthmaticus life threatening?
Yes, it may be life threatening
What are the s/s of hypoxemia?
Tachycardia, Increased restlessness and tachypnea
When is asthma an emergency?
If symptoms do not respond to usual treatment in 30 minutes, client should seek medical attention
What diagnostic tests are done for asthma?
Hx and physical exam, spirometry/PFTs, ABGs, and allergy skin testing
What outcomes show improved breathing patterns in patients with asthma?
Decreased respiratory rate and dyspnea, less nasal flaring, reduced use of accessory muscles; Return of ABGs to normal and oxygen saturation > 95%; Vital capacity with normal limits
What assessments are done to improve breathing patterns on a patient with asthma?
In high Fowler’s position and compare pulmonary function tests with normal values
What outcomes show effective airway clearance in patients with asthma?
Decreased wheezing, decreased rhonchi, and drecreased dry, nonproductive cough
What assessments are done to monitor airway clearance in patients with asthma?
Effectiveness of cough, color and consistency of sputum, oral fluid intake, and mucous membranes for need for oral care
What outcomes show adequate gas exchange in patients with asthma?
Decreased wheezing, rhonchi, and cough; Oxygen saturation > 90%; pH of 7.35-7.45; PaO2 > 60 mm Hg; PaCO2 < 45 mm Hg; Usual skin color without cyanosis
Why would a spacer be used wit a metered dose inhaler?
More accurate dosing; More medication inhaled; Used frequently in children
What patient teaching needs to be done for asthma?
Disease process including definition of inflammation and bronchoconstriction; Purpose and action for each medication; Identify triggers and how to avoid them; Proper inhalation techniques; How to monitor peak flow and implement an action plan; When and how to seek assistance
What is a peak flow meter used for in patients with asthma?
Measures the highest volume of air flow during a forced expiration
What are the 2 general classes of asthma medications?
Quick-relief and long-acting
What is the purpose of a quick-relief asthma medication?
Immediate treatment of asthma symptoms and exacerbations
What is the purpose of a long-acting asthma medication?
To achieve and maintain control of persistent asthma
What are the 2 types of quick-relief asthma medications?
Short-acting beta2-adrenergic agonists and anticholinergics
What are the indications for inhaled short-acting beta2-agonists (SABAs) in patients with asthma?
Relief of acute symptoms and preventive treatment for exercise induced bronchospasm
What is the mechanism of action of an inhaled short-acting beta2-agonists (SABAs) in patients with asthma?
Bronchodilation. Binds to the beta-2 adrenergic receptor; Producing smooth muscle relaxation and decreased bronchoconstriction
List some inhaled short-acting beta2-agonists (SABAs) used to treat asthma?
albuterol (Proventil HFA, Ventolin HFA), levalbuterol HFA (Xopenex), pirbuterol CFC (Maxair), and metaproterenol sulfate (Alupent)
What are the indications for anticholinergics in patients with asthma?
Relief of acute bronchospasm
What is the mechanism of action of an anticholinergic medication in patients with asthma?
Bronchodilation. Inhibition of muscarinic cholinergic receptors. Reduction of vagal tone of airways. May decrease muscous gland secretion
What is an anticholinergic medication that is used to treat asthma?
ipratropium (Atrovent)
What are the indications for inhaled corticosteroids (ICs) in patients with asthma?
Long-term prevention of symptoms; Suppression, control, and reversal of inflammation. Reduce need for oral corticosteroid
What is the mechanism of action of an inhaled corticosteroids (ICs) in patients with asthma?
Anti-inflammatory. Block late reactions to allergen and reduce airway hyperresponsiveness. Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation. Reverse beta-2 receptor down-regulation. Inhibit microvascular leakage
List the inhaled corticosteroids (ICs) used to treat asthma.
beclomethasone dipropionate (QVAR), beclomethasone (Beconase-AQ), budesonide (Pulmicort), ciclesonide (Alvesco), flunisolide (AeroBid), fluticasone (Flovent), mometasone furoate (Asmanex), triamcinolone acetonide (Axmacort)
What are the indications for systemic corticosteroids in patients with asthma for short-term (3-10 days) “burst”?
To gain control of inadequately controlled persistent asthma
What are the indications for systemic corticosteroids in patients with asthma for long-term use?
Prevention of symptoms in severe persistent asthma: suppression, control, and reversal of inflammation
What is the mechanism of action of a systemic corticosteroid in patients with asthma?
Anti-inflammatory. Block late reactions to allergen and reduce airway hyperresponsiveness. Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation. Reverse beta-2 receptor down-regulation. Inhibit microvascular leakage.
List the systemic corticosteroids used to treat asthma.
methylprednisolone (Medrol), prednisolone (Prelone), and prednisone (Deltasone, Orasone)
What are the indications for long-acting beta2-agonists (LABAs) in patients with asthma?
Long-term prevention of symptoms, added to ICs. Prevention of exercise-induced bronchospasm
What does SABA stand for?
Short-acting beta2-agonists
What does LABA stand for?
Long-acting beta2-agonists
Compare SABA and LABA.
Salmeterol (but not formoterol) has slower onset of action (15-30 min). Both salmeterol and formoterol have longer duration (> 12 hr) compared to SABA
What is the mechanism of action of long-acting beta2-agonists in patients with asthma?
Bronchodilation. Smooth muscle relaxation following adenylate cyclase activation and increase incyclic AMP, producing functional antagonism of bronchoconstriction
List the inhaled long-acting beta2-agonists (LABAs).
salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer)
List the oral long-acting beta2-agonists (LABAs).
albuterol (Proventil) sustained-release
What are the indications for leukotriene modifiers in patients with asthma?
Long-term control and prevention of symptoms in mild persistent asthma. May also be used with ICs as combination therapy in moderate persistent asthma
What does ICs stand for?
Inhaled corticosteroids
What is the mechanism of action of leukotriene modifiers in patients with asthma?
Selective competitive inhibitor of CysLT1 receptor
List the leukotriene modifiers used to treat asthma.
montelukast (Singulair) and zafirlukast (Accolate)
What are leukotriene modifiers?
Leukotriene receptor antagonists
What are the 3 types of long-acting asthma medications?
Corticosteroids, long-acting beta2-adrenergic agonists and leukotriene modifiers
