UNIT 4 CHAPTER 27 ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD) Flashcards
What is Asthma?
A chronic disease in which acute reversible airway obstruction occurs intermit ently, reducing airflow.
Airway obstruction occurs by both inflammation and airway tissue sensitivity (hyperresponsiveness) with bronchoconstriction. Inflammation obstructs the airway lumens
Should a patient with Asthma take NSAID’s
NO IT IS A TRIGGERING EVENT FOR AN ASTHMA ATTACK
Inflammation of the mucous membranes lining the airways is a key event in triggering an asthma a ack. It occurs in response to the presence of specific allergens; general irritants such as cold air, dry air, or fine airborne particles; microorganisms; and aspirin and other NSAIDs. Increased airway sensitivity (hyperresponsiveness) can occur with exercise or upper respiratory illness and for unknown reasons.
Triggers for an Asthma Attack
Aspirin and other NSAIDs can trigger asthma in some adults, although this response is not a true allergy. It results from increased production of leukotriene when aspirin or NSAIDs suppress other pathways of inflammatory mediator production.
Gastroesophageal reflux disease (GERD) can trigger asthma in some adults and causes asthma symptoms at night (Global Initiative for Asthma [GINA], 2018). With GERD, highly acidic stomach contents enter the airway and make preexisting tissue sensitivity worse.
S/S of Asthma
The patient with mild to moderate asthma may have no symptoms between asthma a acks. During an acute episode, common symptoms are an audible wheeze and increased respiratory rate. At first the wheeze is louder on exhalation. When inflammation occurs with asthma, coughing may increase.
Along with an audible wheeze, the breathing cycle is longer, with prolonged exhalation, and requires more effort. The patient may be unable to speak more than a few words between breaths. Hypoxia occurs with severe a acks. Pulse oximetry shows hypoxemia (poor blood oxygen levels). Examine the oral mucosa and nail beds for cyanosis. Other indicators of hypoxemia include changes in the level of cognition or consciousness and tachycardia.
Chest tightness
Dyspnea, Tachypnea, SOB
Wheezing, Coughing
Decreased breath sounds
Accessory muscle use
Management of Asthma
Teach the patient to keep a symptom and intervention diary to learn specific triggers of asthma, early cues for impending a acks, and personal response to drugs. Stress the importance of proper use of his or her personal asthma action plan for any severity of asthma,
Avoid potential environmental asthma triggers, such as smoke, fireplaces, dust, mold, and weather changes of warm to cold.
* Avoid drugs that trigger your asthma (e.g., aspirin, NSAIDs, beta blockers).
* Avoid food that has been prepared with monosodium glutamate (MSG) or metabisulfite.
* If you have exercise-induced asthma, use your reliever bronchodilator inhaler 30 minutes before exercise to prevent or reduce bronchospasm.
* Be sure that you know the proper technique and correct sequence when you use metered dose inhalers.
* Get adequate rest and sleep.
* Reduce stress and anxiety; learn relaxation techniques; adopt coping mechanisms that have worked for you in the past.
* Wash all bedding with hot water to destroy dust mites.
* Seek immediate emergency care if you experience any of these:
* Gray or blue fingertips or lips
* Difficulty breathing, walking, or talking
* Retractions of the neck, chest, or ribs
* Nasal flaring
* Failure of drugs to control worsening symptoms
Drug therapy for Asthma
Beta 2 agonists bind to and stimulate the beta2-adrenergic receptors in the
same way that epinephrine and norepinephrine do. This causes an increase in smooth muscle relaxation.
HIGH FOWLERS
Short-acting beta2 agonists (SABAs)
provide rapid but short-term relief. These inhaled drugs are most useful when an att ack begins (as relief) or as premedication when the patient is about to begin an activity that is likely to induce an a ttack (GINA, 2018). Such agents include albuterol, levalbuterol, and terbutaline.
. Unlike short- acting agonists, long-acting drugs need time to build up an effect, but the effects are longer lasting. These drugs are useful in preventing an asthma a ttack but cannot stop an acute a ttack.
Therefore teach patients not to use LABAs alone to relieve symptoms of an att ack or when wheezing is gett ing worse but, instead, to use a SABA. Examples of LABAs include formoterol and salmeterol. Both drugs are associated with increased asthma deaths when used as the only therapy for asthma and carry a black box warning from the Food and Drug Administration (FDA).
What if formoterol used for
LABAs should never be prescribed as the only drug therapy for asthma and are not to be used during an acute asthma a ack or bronchospasm. Teach the patient to use these control drugs daily as prescribed, even when no symptoms are present, and to use a SABA to relieve acute symptoms. Any patient using these drugs must be monitored closely.
prevent asthma attacks, maintenance drug
- The client diagnosed with asthma is admitted to the emergency department with difficulty breathing and a blue color around the mouth. Which diagnostic test will be ordered to determine the status of the client?
- Complete blood count.
- Pulmonary function test.
- Allergy skin testing.
- Drug cortisol level.
- Pulmonary function test.
pulmonary function tests are completed to determine the forced vital capacity (FVC), the forced expiratory capacity
in the first second (FEV1), and the peak expiratory flow (PEF). A decline in the FVC, FEV1, and PEF indicates respiratory compromise.
- The nurse is discussing the care of a child diagnosed with asthma with the parent. Which referral is important to include in the teaching?
- Referral to a dietitian.
- Referral for allergy testing.
- Referral to the developmental psychologist.
- Referral to a home health nurse
- Referral for allergy testing.
What is Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a collection of lower airway disorders that interfere with airflow and gas exchange . These disorders include emphysema and chronic bronchitis.
Emphysema is a destructive problem of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung (see Fig. 27.1). These changes result in dyspnea with reduced gas exchange and the need for an increased respiratory rate.
Chronic bronchitis is an inflammation of the bronchi and bronchioles (bronchiolitis) caused by exposure to irritants, especially cigare e smoke. The irritant triggers inflammation, vasodilation, mucosal edema, congestion, and bronchospasm. Bronchitis affects only the airways, not the alveoli.
S/S OF COPD
Tobacco use and inherited disorders
Productive cough
Difficulty breathing especially on exertion
Barrel chest
Later symptoms – Cyanosis, JVD, clubbing,
polycythemia, weight loss
General appearance can provide clues about respiratory status and energy level. Observe weight in proportion to height, posture, mobility, muscle mass, and overall hygiene. The patient with increasingly severe COPD is thin, with loss of muscle mass in the extremities, although the neck muscles may be enlarged. He or she tends to be slow moving and slightly stooped. The patient often sits in a forward-bending posture with the arms held forward, a position known as the orthopneic or tripod position
ctivities.
Examine the patient’s chest for the presence of a “barrel chest” (see Fig. 27.3). With a barrel chest, the ratio between the anteroposterior (AP) diameter of the chest and its lateral diameter is 1:1 rather than the normal ratio of 1:1.5, as a result of lung overinflation and diaphragm fla ening
Risk factors of COPD /smoke pack
Obtain a thorough smoking history because tobacco use is a major risk
factor. Ask about the length of time the patient has smoked and the number of packs smoked daily. Use these data to determine the pack-year smoking history.
Diagnostics tests and Labs of COPD
Pulmonary function tests
ABGs
Chest x-ray
EKG
Elevated HCT (polycythemia
Patient teaching COPD
Smoking cessation
Vaccinations
Pursed lip breathing
Positioning
Effective coughing
High protein/High calorie diets
4-6 small meals a day
OXYGEN THERAPY
Oxygen is prescribed for relief of hypoxemia and hypoxia. The need for oxygen therapy and its effectiveness can be determined by arterial blood gas (ABG) values and oxygen saturation. The patient with COPD may need an oxygen flow of 2 to 4 L/min via nasal cannula or up to 40% via Venturi mask. Ensure that there are no open flames in rooms in which oxygen is in use. See Chapter 25 for information on oxygen therapy.
