cdunbar4's version from 2016-10-01 19:39


Question Answer
Overview and RFchronic inflammation disorder of airways affects 1 in 20 Americans; RF: genetics, women>men, blacks>whites>hispanics, immune response
Hallmarks of asthmaairway inflammation and nonspecific hyper-irritability or hyperresponsiveness of tracheobronchial tree.
Triggers of acute asthma attacksallergen inhalation, air pollutants, viral URI, sinusitis, exercise & cold, dry air, stress, drugs, occupational exposure, food additives, hormones/menses, GERD
Clinical Maniswheezing, coughing, dyspnea, chest tightness after exposure to precipitating factor or trigger, expiration prolonged, feeling of suffocation, pulsus paradoxus (drop in systolic BP)
Pathoexposure to trigger/irritant → initiates inflamm. cascade → mast cells release mediators → vasodilation; cellular infiltration; bronchospasm, edema, congestion, mucus, ↓ ciliary function, bronchospasm → bronchial hyperresponsiveness & airway obstruction
Early phase responsebronchospasm: wheezing, chest tightness, dyspnea, cough, chest pain
Late-phase response patho4-6 hrs. after initial attack d/t eosinophil & lymphocyte activity & further release of inflammatory mediators. Epithelial cells also produce cytokines/other mediators
Late-phase response characterized by: heightened airway reactivity, increased airway resistance, lung hyperinflation, can lead to irreversible lung damage
Good asthma control correlates with: minimal symptoms, ability to sleep through night and ability to participate in sports, exercise and strenuous activity
What is an early sign of hypoxia?Decreased LOC
what would percussion reveal?high-pitched/hyperresonance
What would you hear during auscultation of an acute attack?inspiratory or expiratory wheezing
What would diminished breath sounds potentially indicate?atelectasis or pneumonia
Characterizations of an acute attack episode includes: dyspneic at rest; speaks in 1-3 word sentences, sitting forward, wheezes, RR >30, pulse >120, accessory muscles, PEFR is 40% of personal best or <150mL, neck vein distention
How is severity measured in acute asthma episodes?FEV1 and PEFR, compare to personal best
What can you start immediately during an acute attack?oxygen therapy with pulse ox
What do the ABGs show during early stages of a mild attack?respiratory alkalosis with arterial O2 pressure (PaO2) near normal d/t trying to compensate
PFTs can give objective measure of obstruction. If peak/flow in clinic setting is <75& of baseline in ER...give bronchodilator, then re-check; if pt. returns to "green", maybe short-term oral corticosteroids
Drug class that ALL patients with persistent asthma should be on?inhaled corticosteroids

Status asthmaticus

Question Answer
Status asthmaticus severe, life-threatening complication of asthma that is refractory to usual treatment (treatment is not working); puts pt. at RF respiratory failure
Causes of status asthmaticus (env'tl, medications, illnesses)viral illnesses, ASA or NSAIDs, stress, ↑ allergen exposure, abrupt discontinuation of drug therapy (esp. corticosteroids); and abuse of aerosol meds.
Clinical manis of status asthmaticusHTN, sinus tach, ventricular arrythmias
Complications of status asthmaticuspneumothorax, pneumomediastium, acute cor pulomnale, resp. muscle fatigue=>resp. arrest
collaborative care is similar to an acute episode except: increase in freq./dose of bronchodilators, continuous SABA nebulizer therapy, supplemental oxygen
What can be administered if not responsive to SABA?IV aminophylline, IV corticosteroids Q4-6H
What can be given IV for bronchodilation as well?MgSO4
If metabolic acidosis occurs, what can be given?NaHCO3

Classifications of Asthma

Question Answer
Sx no more frequent than 2x weeklymild, intermittent
sx more freq than 2x/wk, but <1x/D; exacerbations may affect activitymild, persistent
daily sx, exacerbations at least 2x/week and can last for daysmoderate persistent
continual sx, frequent exacerbations, limited physical activitysevere, persistent
asymptomatic with normal PEFR b/t exacerbations (exacerbations brief)mild, intermittent
daily use of inhaled SABAsmoderate, persistent
Nocturnal Sx 2x/monthmild, intermittent
nocturnal sx >2x/mmild, persistent
nocturnal sx >1x/weekmoderate persistent
nocturnal sx frequentsevere, persistent
FEV1/PEFR is at least 80% of predicted; PEFR variability is <20%mild, intermittent
FEV1/PEFR is at least 80% of predicted; PEFR variability is b/t 20-30%mild, persistent
FEV1/PEFR >60%, but <80% of predicted; PEFR variability >30%moderate, persistent
FEV1/PEFR is no greater than 60% of predicted; PEFR variability >30%severe, persistent

Diagnostic Studies/CC

Question Answer
What information can help ID triggers?detailed health history
PFTs are used to dx asthma and give an objective measure of: airflow obstruction
Test that can rule out bacterial infection?Sputum specimen
Serum ____ levels and _________ count are measuredIgE, eosinophils
_____ ______ during an attack can show hyperinflationchest x-ray
Prevention management includes:teach to avoid triggers of acute attacks and to pre-medicate before exercising; use dust covers; scarves for cold air; avoid ASA/NSAIDs; good sleep, nutrition, fluids
Patient teaching with peak flow testing:you need a baseline to be able to compare with so you know when ER is necessary (green, yellow, red)
"yellow" means50-80% of personal best peak flow..decreased air movement, use SABA, something is triggering
"green" is 80-100% of personal best, continue medication regimen...good, keep it up!
"red" is bad:<50% of personal best...take fast acting SABA ASAP, call provider to be seen
General rules of thumb for meds:SABAs are fine from the initial dx, but a long-term B2 agonist (e.g. salmeterol, Serevent) should only be used after client is using a long term inhaled corticosteroid
Common SE of SABAs, doesn't meant to stop using them!tremors, let patient know
All DPI MUST be....inhaled quickly
Are inhaled corticosteroids a fast-acting drug?no, never
How long should patients hold their breaths after using an inhaler?10 seconds
For mild intermittent asthma, is medication needed?No, not for most patients
Mild, persistent asthma which meds can be used?ICS, cromolyn, nedrocromil (Tilade), and theophylline
mod-persistent asthma, which meds can be used?ICS, inhaled B2 agonists and theophylline to help alleviate sx
for severe persistent asthma which meds can be used?inhaled or oral corticosteroids and inhaled or oral B2 agonists
What is one of the best types of exercise for asthma patients?swimming: aerobic, moist environment

Nursing interventions/management

Question Answer
How can relaxation therapies like yoga, meditation and breathing techniques be of value?helps patient relax respiratory muscles and decrease RR
Teaching to family about asthma attack plan:family members need to know where inhalers, oral meds and ER phone numbers are located, they can also be instructed on how to decrease patient anxiety if an attack occurs
What effect can beta blockers (e.g. propanolol) have on patients with asthma?Can cause bronchospasms
Other nursing interventionscalm, quiet, reassuring attitude, position comfortably, stay with patient, slow breathing through pursed lips, administer O2

Recent badges