Weel 4: Respiratory A Flashcards
Define is asthma
by chronic airway inflammation
defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation”
Explain the pathophysiology of asthma
When exposed to a trigger smooth muscles of the air ways contract and narrow the air layer.
and
trigger causes mucosal lining to become swollen and secrete more mucus.
= block the airways and increase difficulty f breathing
- these make exhalation and inhalation harder therefore causing excess of air in lungs= hyperinflation
Asthma patients have chronically inflamed air ways that make they hypertensive to triggers.
Mucosa and smooth musclee
Affects smaller airways
Link the key pathological processes of asthma to the clinical manifestations/symtoms
Smooth muscle contrcation= feels like chest is tightening
Increased inflammation + secretion= coughing
Constriction and narrowing of airways= wheezing
Explain hyperinflation and what it causes.
Hyperinflation= the trapping of air inside the lungs which causes body to work harder to move air in and out of the lungs.
What are some key clinical manifestations of asthma?
- wheeze
- SOB
- chest tightening
- coughing
During a sever/life threatening asthma exacerbation, what are some key clinical manifestations?
- Prominent inspiratory and expiratory wheezing
- Respiratory Rate > 30 breaths per minute
- Pulse Rate > 120 beats per minute
- Use of accessory muscles
- Agitation
- Perspiration
- Inability to speak e.g. single word responses, unable to speak a sentence
Explain the key com[ponents of an asthma patient assessment.
Gain a brief health history
- subjective data (have they been hospitalised for asthma before? asthma management plan? prescribed medications?)
- Objective info (ntegumentary: have they got diaphoresis, cyanosis? Respiratory: nasal discharge? polyps? increased WOB? are they positioned for maximal respiratory effort? Cardiovascular: tachycardia? Important diagnostic findings: chest x-ray, arterial blood gases during an asthma attack)
Primary assessment
- DRSABCD
Secondary
- do they look well? tripoding?
- Head to toe assessment
- Full set of vitals
- pain assessment
Focoused resp assessment
- inspect
- auscultate
- percussion
- palpate
Explain each component of a focused resp assessment
Inspect
Observe the overall appearance (does the patient appear well/unwell?)
Observe the patient’s colour; both centrally and peripherally
Observe the patient’s respiratory rate, rhythm and depth & respiratory effort (are they using accessory muscles?)
Inspect the symmetry and shape of chest
Inspect the tracheal position
Can you hear any audible sounds?
Auscultation
Listen for breath sounds
Auscultate the lung fields - comparing both sides, inspiration and expiration
Percussion
Percuss the thorax
Palpation
Bilateral symmetry of chest expansion
Palpate the skin feeling for skin temperature, turgor and moisture
Assess capillary refill both centrally and peripherally
How do you manage an episode of acute asthma?
- correct significant hypoxemia
- reverse airflow obstruction quickly
- plan to prevent further events
How can you correct significant hypoxemia?
Oxygen therapy via a Simple face mask / Hudson Mask
Reverse Airflow Obstruction Quickly with
- Reliever medication: immediate symptomatic relief (Example: Salbutamol)
- Preventer medication: inhaled corticosteroids (ICS) or single preventer inhalers for longer term treatment (Example: Budesonide)
In a sever situation:
- DRSABCDE
- Provide oxygen therapy as required
- Provide medications as required and/or prescribed
- Escalate to medical treating team and assess need to initiate MET call
- Escalate to Code Blue if needed
- Position the patient to maximise chest expansion
- Stay with the patient
- Provide reassurance to reduce patient anxiety
- Encourage pursed lip-breathing
What are the nursing consideration of someone with asthma?
Education
- triggers
- medication use
- when to call 000
- reducing acute events
- knowledge of early signs of events
Intercollabroative approach
- check in with GP
Explain some interprofessional collaboration that may be needed to treat and manage asthma.
Community nurse: Completion of an asthma management plan and provide focused education and review
Physiotherapist: Providing chest physiotherapy
Exercise physiologist: Tailored assessment and exercise
General Practitioner (GP): Ongoing review/assessment and the prescription of required medications
Respiratory Physician: For patients with uncontrolled asthma
Asthma is often self-managed by patients via an asthma-management plan; however, collaborative support encourages the patient to engage with their management plan and achieve positive overall health outcomes.
What are the nursing consideration of someone with asthma?
Education
- triggers
- medication use
- when to call 000
- reducing acute events
- knowledge of early signs of events
Intercollabroative approach
- check in with GP
Explain some interprofessional collaboration that may be needed to treat and manage asthma.
Community nurse: Completion of an asthma management plan and provide focused education and review
Physiotherapist: Providing chest physiotherapy
Exercise physiologist: Tailored assessment and exercise
General Practitioner (GP): Ongoing review/assessment and the prescription of required medications
Respiratory Physician: For patients with uncontrolled asthma
Asthma is often self-managed by patients via an asthma-management plan; however, collaborative support encourages the patient to engage with their management plan and achieve positive overall health outcomes.
Define chronic obstructive pulmonary disease
progressive, chronic lung disease, characterised by irreversible obstruction of the airways
What are some key characteristics of COPD?
- preventable
- treatable
- airfow limitation is not always fully reversible
- slow progressive obstruction of the airways with periods otic exacerbations and increased periods of dyspnea and sputum production.
What comes under the umbrella term of COPD?
- chronic bronchitis
- emphysema
- asthma?
Explain chronic bronchitis
It is the hyper secretion of mucus and a produce cough that lasts longer than 3months and has occurred for at least 2 consecutive years.
What causes chronic bronchitis?
- Patient inhales harmful irritants (cigarette smoke, pollutants)
- Airway becomes inflammed and infiltrated with neutrophils, macrophages and lymphocytes into bronchial wall
- Bronchial inflammation causes bronchial oedema
- Goblet cells increase in size and quantity within the airway and epithelium
- Thick mucus is then produced which cannot be cleared due to damaged ciliary function
- Over time the airway becomes narrowed and airway obstruction can occur
Explain emphysema
the abnormal and permanent enlargement of gas-exchange airways accompanied by the destruction of alveolar walls.
Obstruction results from changes in the lung tissues, rather than mucus production and inflammation in chronic bronchitis. The major mechanism of airflow limitation is the loss of elastic recoil.
