w2 chronic respiratory Flashcards
which chronic respiratory disease is this:
-(reactive airway disease),
-Chronic inflammatory airway disorder,
-Airway obstruction,
-bronchial irritability,
-edema of mucous membranes,
-congestion, and
-spasms of smooth muscles of the bronchi and bronchioles
asthma
good asthma therapeutic managment: SATA
-cock roach control
-wash linens in hot water 2x a week
-avoid kerosene or wood heat
-keep humidity between 35%-50%
-suction
-CPT
-a/c with filters
everything but suction
- Allergen control
- Environmental control
o House dust mite control
o Pillows and mattress in allergen impermeable covers
o Cock roach control
o Dust
o Wash linens in hot water 2x a week
o Vacuum weekly
o Remove animals from house
o Avoid kerosene or wood heat - Avoid triggers
- Keep humidity between 35%-50%
- Air conditioners with air filters
- Hypo sensitization injections/allergy shots
- Reduce underlying inflammation
- CPT
- Patient education
what are controller vs reliever asthma medications
Controllers (preventer medications) – long acting - corticosteroids and leukotriene inhibitors
Relievers (rescue medications) – short acting bronchodilators – albuterol
which pulmonary function test measures:
highest flow rate achieved during forced exhalation.
PEF – peak expiratory flow -
or
Peak expiratory flow rate (PEFR)
how is PEF or PEFR used in asthma management
- Peak expiratory flow rate (PEFR) – measures the amount of air that can be forcefully exhaled which determines an individual’s personal best value. This number can then be used as your baseline so you know how severe your asthma symptoms are and have a plan to react. This can also be used to evaluate asthma treatment.
o Green (80% to 100% of personal best) signals asthma is well controlled
o Yellow (50% to 79% of personal best) signals asthma is not well controlled and an acute exacerbation may be present
o Red (below 50% of personal best) signals a medical emergency and severe airway narrowing may be occurring.
explain green, yellow, red zone of PEFR/PEF
o Green (80% to 100% of personal best) signals asthma is well controlled
o Yellow (50% to 79% of personal best) signals asthma is not well controlled and an acute exacerbation may be present, recognize which symptoms indicate you should pay extra attention and add/increase medications according to the plan
o Red (below 50% of personal best) signals a medical emergency and severe airway narrowing may be occurring, recognize the symptoms of an asthma emergency in which you should provide rescue medication and call 911
if someones PEFR is in the green zone what should they do
asthma is well controlled, continue activity
if someones PEFR is in the yellow zone what should they do
signals asthma is not well controlled and an acute exacerbation may be present
recognize which symptoms indicate you should pay extra attention
add/increase medications according to the plan
take bronchodilator, rest from activity
if someones PEFR is in the red zone what should they do
signals a medical emergency and severe airway narrowing may be occurring
recognize the symptoms of an asthma emergency in which you should provide rescue medication and call 911
take bronchodilator, go to ER or call ambulance
asthma exacerbation is which zone and what s/s occur
Asthma exacerbation
(red zone)
Episodes of progressively worsening SOA, cough, wheeze and chest tightness
in asthma what causes/patho of airway constriction, airway inflammation, airflow obstruction, chest tightness
Airways narrow because of bronchospasms (constriction),
mucosal edema (inflammation),
and mucus plugging (blocking airflow),
air trapped in lungs (chest tightness)
patho of functional residual capacity, hyperinflation, and hypoxemia in asthma patient
Normally, lungs aren’t completely full or empty after each breath. There’s a comfortable middle ground where some air stays in the lungs = (functional residual capacity).
However, during an asthma attack, the airways in the lungs get inflamed and narrowed, making it hard to breathe out completely.
To compensate, the child’s body tries to take bigger breaths to get enough air in. This pushes the lungs closer to their full capacity, making the leftover air (functional residual capacity) higher than usual.
Hyperinflation = this leftover air (functional residual capacity) helps keep some airways open, allowing some air exchange to happen
Hypoxemia can occur because of the mismatch of ventilation and perfusion (b/c some air is getting blocked and trapped = decrease in oxygen levels). Normally, we breathe out carbon dioxide, but if it’s not being fully exchanged, the levels can rise.
which chronic respiratory dysfunction:
- Dyspnea
- Expiratory Wheezing
- Coughing
- Diaphoresis
- Nonproductive cough at onset, becomes rattling and productive of clear sputum
- Prolonged expiratory phase
- Anxious expression, restlessness
- Setting position
- Exacerbations
- Respiratory distress signs – nasal flaring, cyanosis, intercostal retractions
- Rhonchi
- Chest tightness
asthma
how do we diagnose asthma
Often difficult to establish
No specific test established diagnosis
Usually diagnosed by medical history, physical exam, s/s, and lab results
PFTs helpful in confirming diagnosis and evaluating response to treatment
PEFR – peak expiratory flow rate
nursing considerations for asthma
SATA
- Up-to-date asthma action plan (review every 6 months)
- Modify the environment
- Regular medical care (immunizations important)
- Prevention of upper respiratory infection – can trigger attack
- avoid exercise
all except AVOID exercise - teach Exercises to increase expiratory time and pressure
- Assessment
- Precipitating factors
- Treatments
- Are medications being administered properly
- Up-to-date asthma action plan (review every 6 months)
- Modify the environment
- Guide parents in planning a total program
- Regular medical care (immunizations important)
- Prevention of upper respiratory infection – can trigger attack
- Exercises to increase expiratory time and pressure
