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Nursing 172 > Week 6: Asthma: Lower Respiratory Disorder > Flashcards

Week 6: Asthma: Lower Respiratory Disorder Flashcards

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1
Q

What is Asthma?

A
  • chronic lung disease characterized by intermittent, reversible airway obstruction resulting from inflammation of the lung’s airways and tightening of the muscles that surround the airways
  • chronic disorder of the airways that results in intermittent an reversible airflow obstruction of the bronchioles
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2
Q

How does the Obstruction of the airway occur in asthma?

A

inflammation of the airway or hyperresponsiveness

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3
Q

What does asthma affect?

A

the bronchial airways, not the alveoli

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4
Q

How is bronchial hyperresponsiveness and underlying inflammation of the small airways triggered by?

A

-exposure to irritants, exercise, cold weather, or risk factors

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5
Q

Types of Irritants

A
  • cigarette smoke
  • mold
  • pollen
  • dust
  • animal dander
  • air pollutants
  • occupational irritants
  • strong odors (perfume)
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6
Q

Risk Factors

A
  • viral infections
  • nasal polyps
  • allergic rhinitis
  • food and medication allergies
  • emotional stress
  • older adults
  • GERD
  • family history of asthma
  • eczema
  • exposure to chemical irritants or dust
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7
Q

What happens when there is an exposure to a trigger?

A

Inflammatory Response
-IgE antibodies bind to receptors on mast cells, causing degranulation and the release of inflammatory mediators, such as histamine and leukotriene, which cause vasodilation and increase capillary permeability.
-there is edema of the airways and an increase in basophils, eosinophils, and neutrophils, which stimulate the production of mucous
>the resulting thick, tenacious mucous causes a thickening of the airways and bronchial hyperresponsiveness
-the release of histamine causes constriction and spasm of the smooth muscles surrounding the bronchial tubes, causing bronchospasm of the bronchial tubes
>bronchospasms cause further narrowing of the airways
-bronchospasms, mucus production, and edema produce obstruction to the flow of air into and out of the lungs

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8
Q

Clinical Manifestations

A
  • inability to speak in full sentences
  • wheezing
  • dyspnea
  • coughing
  • increased sputum
  • increased respiratory rate
  • chest tightness
  • anxiety/stress
  • use of accessory muscles
  • poor oxygen saturation
  • barrel chest or increased chest diameter
  • tachycardia
  • mucosal edema
  • bronchoconstriction
  • excessive mucous production
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9
Q

Diagnosis

A
  • detailed patient history
  • pulmonary function tests
  • chest x-ray
  • pule oximetry
  • arterial blood gases (ABGs)
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10
Q

Diagnostic Procedures

A
  • pulmonary function tests

- chest-xray

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11
Q

Pulmonary Function Tests (PFTs)

A

most accurate tests for diagnosing asthma and its severity; group of tests used to evaluate the functioning of the respiratory system

  • spirometry
  • peak expiratory volume
  • pulse oximetry
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12
Q

Pulmonary Function Tests: Spirometry

A

test that measures airflow and lung volumes such as forced expiratory volume (FEV)

  • one of the major tests of pulmonary function is the forced expiratory volume in 1 second (FEV1); measures the amount of air forced out of the lungs after a full inspiration
  • a decrease in this test of 15-20% below the predicted value for age and gender is diagnostic of asthma
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13
Q

Pulmonary Function Tests: Peak Expiratory Flow

A

measure the maximum airflow expired during a forced expiration

  • patients peak flow readings are compared to the personal best reading with a reading obtained during an exacerbation or “asthma attack”
  • the reading done during an exacerbation as compared to a personal best allows the patient to recognize the severity of the respiratory distress
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14
Q

Pulmonary Function Test: Pulse Oximetry

A

a non-invasive method of measuring oxygen saturation (SpO2)

-normal value: 95%-100%

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15
Q

Arterial Blood Gas

A

Invasive sampling of arterial blood to measure the oxygenation of the blood (PaO2)
-provide the best information with regard to identifying the patients response to oxygen and ventilation therapy and medications

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16
Q

PaO2

A

partial pressure of oxygen in arterial blood
-reflects a more accurate measure of oxygen in arterial blood than SpO2
-once the PaO2 in arterial blood falls below the threshold of 60 mmHg, there is a steep reduction in SpO2
-range: 80-95 mmHg
(even though 60 mmHg is acceptable)

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17
Q

Asthma is classified as?

A
  • mild asthma
  • moderate asthma
  • severe asthma
  • uncontrolled asthma
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18
Q

Why is a chest x-ray performed?

A

to diagnose changes in chest structure over time

19
Q

Complications

A
  • respiratory failure (persistent hypoxemia related to asthma can lead to respiratory failure)
  • status asthmaticus
20
Q

Status Asthmaticus

A
  • life threatening episode of airway obstruction that is often unresponsive to common treatment. It involves extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, and creates a risk for cardiac and/ or respiratory distress
  • an acute exacerbation of asthma that is unresponsive to repeated doses or treatment with the typical rescue medications (bronchodilators)
21
Q

Status Asthmaticus Clinical Manifestations

A

can vary from mild to severe with:

  • bronchospasm, inflammation, and excessive mucus production with mucus plugging
  • patients report chest tightness, wheezing, dry cough, SOB, and severe respiratory distress
  • results in: CO2 retention, hypoxemia, and ultimately respiratory failure
22
Q

Status Asthmaticus Triggers

A
  • recent onset of viral respiratory illness
  • exposure to potential irritant or allergies
  • exercising in the cold
23
Q

Treatment for Status Asthmaticus

A

-oxygen
-IV fluids
-systemic bronchodilators
-and steroids to open the airways and decrease inflammation
>endotracheal intubation may be necessary in severe cases until symptoms are under control

24
Q

Laboratory Tests

A
  • arterial blood gases (ABGs)

- sputum cultures

25
Q

-Medications

A

pharmacological treatment is based on patients response to previous treatments and the level of engagement in self-management plan

  • anti-inflammatories
  • bronchodilators
  • anti-cholinergics
  • leukotriene modifiers
26
Q

Anti-inflammatories

A

typically inhaled corticosteroids, reduce mucus production and swelling, making the airways less sensitive and less likely to react to asthma triggers that cause asthma symptoms
-for prophylaxis and used to decrease airway inflammation

27
Q

Bronchodilators

A

such as beta2-adrenergic agonists relax the bronchial smooth muscle, helping to open the airway and decreasing obstruction
-relax the bronchioles or small airways

28
Q

Anti-cholinergics

A

another group of bronchodilators, but different from beta 2 adrenergic agonists
-relax the muscles around the larger airways or bronchi

29
Q

Leukotriene Receptor Agonists

A

may be used to enhance asthma control if the usual medications are not effective
-not steroids; inhibit leukotriene-mediated inflammatory process

30
Q

Medication Falls into 2 categories…

A
  • Long-term control

- Rescue

31
Q

Medications catergories: Long-term

A

-used daily regardless of the symptoms a patient is experiencing to achieve and maintain control of the asthma
>most effective: inhaled anti-inflammatories, or oral theophylline

32
Q

Medication catergories: Rescue

A

used once n asthma attack has started

  • usually short-acting bronchodilators
  • short-acting beta2-adrenergic agonists are gold standard because they are most effective
  • short-acting beta 2 adrenergic agonists should be used for acute exacerbations of asthma
  • prednisone may also be used for acute exacerbation
33
Q

Nursing Interventions: Assessment

A
  • assess vital signs; pulse rate, temperature, respiratory rate, and peak flow measure
  • oxygen saturation
  • ABGs
  • breath sounds
  • level of consciousness
  • ability to speak in full sentences
  • cough
  • use of accessory muscles
  • tripod-position (sitting up-right with arms propped on the table) in attempt to decrease the work of breathing
  • monitor dyspnea (visual analog dyspnea scale)
  • previous intubation
34
Q

Nursing Care: Actions

A
  • provide oxygen therapy
  • administer medication as ordered (bronchodilators, anti-inflammatories, anti-cholinergics)
  • position the client to maximize ventilation (high-fowlers)
  • monitor cardiac rate and rhythm for changes during an acute attack (can be irregular, tachycardia, or with PVCs)
  • monitor respiratory rate for changes in effort, symmetry, SaO2; auscultate lung sounds
  • initiate and maintain IV access
  • remain calm and reassuring
  • provide rest periods for older adults who have dyspnea. design room and walkways with opportunities for rest. Incorporate rest in ADLs
  • encourage prompt medical attention for infections and appropriate immunizations
35
Q

Interprofessional care

A
  • respiratory services should be consulted for inhalers and breathing treatments for airway management
  • nutritional services can be contacted for weight loss or gain related to medications or diagnosis
  • rehabilitation care can be consulted if the client has prolonged weakness and needs assistance with increasing level of activity
36
Q

Therapeutic Procedures

A

-asthma action plan; assessment, monitoring, control of environmental factors, pharmacological treatment, and education

37
Q

Medications: Bronchodilators: Short Acting beta 2 agonists

A

-albuterol
-levalbuterol
provide rapid relief of acute manifestations and prevent exercise-induced asthma

38
Q

Medications: Bronchodilators: Long-acting beta 2 agonists

A

-salmeterol
-formoterol
used for asthma attack prevention

39
Q

Medications: Bronchodilators: Anticholinergic medications

A

-ipratropium (short)
>block the parasympathetic nervous system; allows for the sympathetic nervous system effects of increased bronchodilation and decreased pulmonary secretion
-tiotropium (long)
>prevent bronchospasm

40
Q

Medications: Bronchodilators: Methylxanthines

A

-theophylline
require close monitoring of blood medication levels due to a narrow therapeutic range
-use only when other treatments are ineffective

41
Q

Medications: Anti-inflammatory agents: Corticosteroids

A
  • fluticasone (inhaled)
  • beclomethasone (Inhaled)
  • prednisone (oral)
  • hydrocortisone (IV)
  • methylprednisone (IV)
42
Q

Client Education

A
  • avoidance of risk factors
  • pursed-lip breathing (keeps airways open longer and prolongs exhalation, allowing increased time for oxygen and carbon dioxide exchange)
  • medication education
  • peak flow meter
  • smoking cessation
  • proper inhaler technique
  • cleaning of respiratory equipment
43
Q

What does it mean when a patient has diminished or absent breath sounds?

A

decrease in movement of air due to increased obstruction or respiratory exhaustion

44
Q

What does it mean when a patient’s wheezing decreased and he has little or no breath sounds?

A

patient is not moving air throughout the system

  • medical emergency
  • indicates respiratory failure
  • may require mechanical ventilation

Nursing 172 (120 decks)

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