respiratory Flashcards
asthma
Chronic inflammatory disorder of airways
asthma triggers
Triggers/Allergens of Asthma
Smoke
Cold
Strong emotions
Exercise
Pollen
Strong smells
Pet dander
Dust
Changes in weather
Mold and mildew
Food Additives and Food allergies; found in many foods, beverages, and flavorings
Drugs:
Sensitivity to aspirin, NSAID, and salicylates
β-Adrenergic blockers –Propranolol (Inderal)- cause bronchospasm, should get an alternative ***
ACE inhibitors- cause cough in some patients and that can trigger asthma (Ex: Lisinopril)
asthma risk factors
Genetic factors
Environment (e.g., pollen)
Occurs more in male gender in children.
Women are 76% more likely to have asthma as adults.
Obesity.
asthma signs
Recurrent episodes of wheezing, breathlessness/SOB, cough (usually at night), and tight chest
Abrupt or gradual – teach pt to know their baseline – increase in use of their albuterol inhaler – sign of impending attack
Attack can Lasts minutes to hours
Expiration may be prolonged- Characteristic Finding!***
Normal inspiration-expiration ratio of 1:2 increases to 1:3 or 1:4
This is a result of the bronchospasm, edema, and mucus in bronchioles narrow the airways 🡪 decreases proper gas exchange
Air takes longer to move out.
Wheezing is unreliable to gauge severity of asthma.
Severe asthmatic attacks may have no audible wheezing.
You hear wheezing upon exhalation. In severe attacks, patient isn’t inhaling any air, so exhalation is not heard either and there will be no wheezing.
Cough variant asthma
Cough is only symptom.
Bronchospasm is not severe enough to cause airflow obstruction.
An acute attack usually reveals signs of hypoxemia.
Restlessness – could be the first sign to experience an asthma attack
↑ anxiety – prodromal episode
Inappropriate behavior, confusion
↑ pulse and BP
More signs of hypoxemia
Difficult to speak in complete sentences
↑ respiratory rate
Hyper-resonance – air trapping inside the lung – echo if we were to percuss
Inspiratory and expiratory wheezes
“Silent chest” breath sounds are severely diminished (NO BREATH SOUNDS TO LOWER LOBES) because patient isn’t taking in any air
asthma classification
Classification of Asthma: based on how it presents
Intermittent
Mild persistent
Moderate persistent
Severe persistent
asthma complications
Complications
Severe and life-threatening exacerbations
Respiratory rate >30/min
Will be using accessory muscles
Pulse >120/min
PEFR is 40% at best. Has to do with how much and force that they breathe out
Usually seen in ED or hospitalized***
Too dyspneic to speak
Perspiring profusely
Drowsy/confused
Require hospital care and often admitted to ICU***
asthma dx
Diagnostic Studies
- History and physical exam - # 1 thing we do to rule out asthma is people
- Peak flow monitoring/PEFR (measures how fast a person can exhale. Measures lung function and capacity: inspiration/expiration ratio. This number is used to determine the classification of asthma) – need to be taught to use this everyday once a day at the same time everyday – do this at least 2x and take the average
- Pulmonary function tests – used to determine the reversibility, and status of the asthma
- Chest x-ray – if the patient is asymptomatic patients the x-ray will be normal – can be used to compare for the baseline
- ABGs – provide information about the severity of the attack
- Pulse oximetry – used to look at their oxygenation
- Allergy testing
- Blood levels of eosinophils (if the reaction is due to allergies the levels of eosinophils will rise)
- Sputum culture and sensitivity (because sometime an infection can trigger asthma)
asthma collaborative care
Collaborative Care
-
Global Initiative for Asthma (GINA). Current guidelines focus on:***
- Assessing the severity of the disease at diagnosis and initial treatment
- Monitoring periodically to achieve control of the disease
- Teaching
- Start at time of diagnosis.
- Integrate teaching throughout care.
- Self-management to avoid recurrence of symptoms
- Tailored to needs of patient
- Culturally sensitive
- Intermittent & persistent asthma:
- Avoid triggers of acute attacks.
- Pre-medicate before exercising.
- Drug therapy depends on symptom severity.
-
Severe & life-threatening exacerbations: ***
- IV corticosteroids q4h to q6 h, then orally.
- Continuous monitoring.
- In patients who are not responding to albuterol, IV magnesium sulfate can be used in this instance as a bronchodilator.
- Mixture of helium and oxygen (Heliox), in severe life-threatening situations
- Acute asthma exacerbations:
- Respiratory distress
- Treatment depends upon severity and response to therapy. Severity measured with flow rates.
- Pulse oximetry or ABGs
- Oxygen therapy - both mild and moderate exacerbations to maintain SpO2 at 90% or greater***
- Severe exacerbations:
- Supplemental O2 by mask or nasal cannula for 90% O2 saturation.
- Arterial catheter for frequent ABG measurement
- IV fluids given because of insensible loss of fluids (in severe exacerbations, patient is profusely sweating)
-
Bronchial thermoplasty:***
- Catheter applies heat to reduce muscle mass in the bronchial wall.
- With asthma recurring, there is a remodeling of the respiratory system, a lot of tissue that isn’t functioning properly. In the thermoplastic they can cauterize (burn the skin or flesh of (a wound) with a heated instrument or caustic substance, typically to stop bleeding or prevent the wound from becoming infected) tissues and save more of the functioning tissue.
- Reverses accumulation of excessive tissue that causes narrowing of airway
asthma drug for quick relief
-
Quick-relief medications:
- Treat symptoms of exacerbations, e.g. Albuterol q4h - q6h (SABA-Short acting beta agonist)***
asthma anti-inflammatory drug
corticos, leukotriene, monoclonal antibody
Corticosteroids (e.g., Beclomethasone, Budesonide, Fluticasone):
- Suppress inflammatory response
- Inhaled form is used in long-term control (as opposed to systemic form of IV or IM administration)
- Systemic form (IV or IM) to control exacerbations and manage persistent asthma
- Reduce bronchial hyper responsiveness (because in asthma you see a hyper-responsiveness of the airway, for instance the goblet cells produce more mucous)
- Decrease inflammation
- Decrease mucous production
- Are taken on a fixed schedule
-
Inhaled Corticosteroids SE:***
- Oro-pharyngeal candidiasis, hoarseness, and a dry cough are local side effects of inhaled drug.
- Can be reduced using a spacer or by gargling and rinsing mouth after each use
Leukotriene modifiers or inhibitors (e.g., Zafirlukast, Montelukast, Zileuton):
- Block action of leukotrienes—potent broncho-constrictors…so they prevent broncho-constriction
- Have both bronchodilator and anti-inflammatory effects
- Not indicated for acute attacks
- Used for prophylactic and maintenance therapy
Monoclonal antibody to IgE/Anti-IgE (e.g., Xolair):
- ↓ circulating free IgE levels
- Prevents IgE from attaching to mast cells, thereby preventing the release of chemical mediators that increase the inflammatory process, mucous production, and broncho-constriction
- Subcutaneous administration every 2 to 4 weeks
bronchodilators
SABA
LABA
Methylxanthines
SABA
- Examples: Albuterol Q4H to Q6H
- Effective for relieving acute bronchospasm
- Onset of action in minutes and duration of 4 to 8 hours. It is a rescue inhaler!
-
Prevent release of inflammatory mediators from mast cells
- Not for long-term use
