Asthma

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Asthma

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Asthma

  1. 1. Asthma<br />Reynel Dan L. Galicinao<br />
  2. 2. Review<br />
  3. 3.
  4. 4. Mast cells<br /><ul><li>Cells that synthesize & store histamine</li></ul>Eosinophils<br /><ul><li>Type of WBCs capable of releasing chemical mediators that cause bronchoconstriction</li></ul>IgE antibody<br /><ul><li>attaches to mast cells in the respiratory tract; contributes to allergic reactions</li></ul>Hyperresonance<br /><ul><li>Quality of sound heard on percussion of a hollow structure</li></li></ul><li>introduction<br />
  5. 5. Chronic, reversible obstructive pulmonary disease<br />Caused by airway inflammation, increased airway responsiveness, or bronchospasm<br />Most common chronic childhood illness<br />
  6. 6. In 50 percent of patients, onset occurs before age 10 years<br />Can be controlled, not cured<br />Has an unpredictable course with increasing prevalence and hospitalization<br />
  7. 7. Etiology and Pathophysiology<br />
  8. 8.
  9. 9.
  10. 10. Status Asthmaticus<br /><ul><li>Life-threatening emergency
  11. 11. Occurs when bronchospasm don’t respond to conventional therapy
  12. 12. Can lead to worsening hypoxemia, acid-base imbalance, potential respiratory arrest</li></li></ul><li>Classification<br />
  13. 13. Extrinsic Asthma<br />Hypersensitivity reaction to inhalant allergens <br /><ul><li>Dust mites
  14. 14. Animal dander
  15. 15. Cockroaches
  16. 16. Pollen
  17. 17. Mold</li></ul>IgE mediated<br />
  18. 18. Intrinsic Asthma<br />No inciting allergen<br />Infection, typically viral<br />Emotional stress<br />
  19. 19. Mixed Asthma<br />Immediate type I reactivity combined with intrinsic factors<br />
  20. 20. Aspirin-induced Asthma<br />Induced by ingestion of aspirin and related compounds<br />“Triad” - combination of aspirin-induced asthma, nasal polyps, and sinusitis<br />
  21. 21. Exercise-induced Asthma<br />Symptoms vary from slight chest tightness and cough to severe wheezing/cough and shortness of breath <br />Usually occur after 5 to 20 minutes of sustained exercise<br />
  22. 22. Occupational Asthma<br />Due to inhalation of:<br /><ul><li>Industrial fumes
  23. 23. Dust
  24. 24. Allergens
  25. 25. Gases</li></li></ul><li>Nursing Assessment<br />
  26. 26. Appearance<br /><ul><li>Breathlessness
  27. 27. ↑ Anxiety level
  28. 28. Accessory muscle use
  29. 29. Intercostal/supraclavicular retractions
  30. 30. Oral cyanosis
  31. 31. Exhaustion
  32. 32. Diaphoresis
  33. 33. Coughing
  34. 34. Inability to complete full sentences</li></li></ul><li>Auscultation<br />Differentiate between inspiratory vs. expiratory wheezing<br />Note: if (-) wheezes and (-) clear breath sounds, the patient may not be able to move air in the lungs at all<br />
  35. 35. Vital signs <br /><ul><li>HR
  36. 36. RR
  37. 37. BP
  38. 38. Temp
  39. 39. O2 saturation</li></li></ul><li>History<br /><ul><li>Allergies/known triggers
  40. 40. Description of previous attacks
  41. 41. Meds used to treat asthma
  42. 42. Recent medication changes
  43. 43. Previous ED visits & hospital admissions
  44. 44. Previous intubations</li></ul>Note: prior intubations for an asthma attack put a patient at higher risk for respiratory failure<br />
  45. 45. Signs and Symptoms<br />
  46. 46. <ul><li>Wheezing
  47. 47. Dry or productive cough
  48. 48. Dyspnea
  49. 49. Use of accessory muscles
  50. 50. Tachypnea
  51. 51. Tachycardia
  52. 52. Pulsusparadoxus</li></li></ul><li><ul><li>Hyper-resonance
  53. 53. Pallor and/or cyanosis
  54. 54. Diaphoresis
  55. 55. Physical exhaustion
  56. 56. Restlessness
  57. 57. Fever</li></li></ul><li>Nursing DiagnosEs<br />
  58. 58. Ineffective Breathing Pattern r/t bronchospasm<br />Anxiety r/t fear of suffocating, difficulty in breathing, death<br />
  59. 59. Diagnostic evaluation<br />
  60. 60. P -PEFR<br />E -Electrolytes<br />A -ABG<br />C<br />E -ECG<br />-CXR<br />-CBC<br />
  61. 61. Peak Expiratory Flow Rate:<br />Measures large airway function<br />Used to assess severity of attack and effect of treatments<br />
  62. 62. Electrolytes<br /><ul><li>Potassium and chloride levels may be decreased with respiratory acidosis</li></li></ul><li>ABG<br />PaCO2 will increase as asthma progresses because the patient is unable to effectively blow off CO2<br />Decreased pH indicates respiratory acidosis caused by impaired gas exchange (O2 is unable to exchange for CO2 at the alveoli level)<br />
  63. 63. CXR<br />Hyperinflation of the lungs may be present and is related to air being trapped in the smaller airways<br />Show infiltrates, TB, or a pneumothorax (which can all cause shortness of breath and classify as differential diagnoses)<br />
  64. 64. CBC<br />Increased WBC count indicative of infection<br />Increased eosinophils<br />
  65. 65. ECG<br />Rule out cardiac involvement<br />
  66. 66. Nursing interventions<br />
  67. 67. Position the patient to facilitate breathing<br />Provide humidification using a mask or open face tent<br />Provide oxygen as indicated, and monitor the level of O2 saturation<br />Continuously monitor all vital signs<br />Establish and maintain IV access for medications and fluids<br />
  68. 68. Assist the patient in removal of secretions via coughing and/or deep-breathing exercises, and suction prn<br />Continuously monitor the ECG for cardiac dysrhythmias that are secondary to hypoxia or acidosis<br />Monitor respiratory status for the effects of medications, pulse oximetry, and ABGs<br />
  69. 69. Anticipate and prepare for more aggressive ventilatory support in the event that it becomes necessary.<br />Protect the patient from environmental, pharmaceutical, and emotional irritants that may exacerbate the asthma attack.<br />Administer medications as prescribed<br />
  70. 70. Communicate frequently with the patient, family, and significant others and carefully explain all procedures<br />When possible, allow a calm significant other to remain with the patient in the treatment area.<br />
  71. 71. Medication<br />
  72. 72. Bronchodilators<br />Cause smooth muscle relaxation in the airways: usually dispensed with a metered-dose inhaler <br /><ul><li>Albuteral
  73. 73. Serevent
  74. 74. Epinephrine
  75. 75. Theophylline</li></li></ul><li>Beta 2 Agonists <br />Beta 2 receptors are found primarily in the lungs<br />Beta agonists bind to receptor sites and relax smooth muscle (atrovent)<br />
  76. 76. Corticosteroids<br />Decrease airway inflammation and mucus production <br /><ul><li>Prednisone
  77. 77. Dexamethasone
  78. 78. Beclovent
  79. 79. Aerobid</li></li></ul><li>Management<br />
  80. 80. Corticosteroid therapy<br /><ul><li>Should never be stopped abruptly
  81. 81. Should be tapered off as prescribed</li></ul>Importance of hydration <br />Use of home nebulizers and peak flow meters<br />Continuing regular medications even if they are not experiencing signs and symptoms<br />
  82. 82. Goals of Patient Management <br />Maintain near-normal pulmonary function and exercise levels<br />Prevent chronic symptoms and acute exacerbations<br />Avoid adverse effects of medications.<br />
  83. 83. Ongoing therapy should include:<br />Baseline measurement of lung function via PEFR<br />Environmental control<br />Avoidance of triggers<br />Appropriate drugs and compliance<br />Comprehensive patient education<br />
  84. 84. Conclusion<br />Although asthma is a controllable, chronic condition, when symptoms are exacerbated, they can put the patient at significant risk<br />It is vitally important that the nurse quickly and accurately identifies the severity of the patient's situation and performs the interventions needed to prevent progression of the disease process. <br />
  85. 85. With a thorough knowledge of symptoms, diagnostic techniques, and patient management skills, the nurse can minimize both the incidence of and the potential trauma associated with asthma emergencies.<br />
  86. 86. Patient Education<br />
  87. 87. Educate patient and SO regarding discharge instructions and follow-up care<br /><ul><li>disease process
  88. 88. aggravating allergens
  89. 89. precipitating factors
  90. 90. medications (purpose, route, dose, side effects)</li></li></ul><li>
  91. 91.
  92. 92. Demonstrate the use of MDIs & nebulization equipment<br />Help patient to identify what triggers asthma, warning signs of an impending attack, strategies for preventing & treating an attack<br />Teach adaptive breathing techniques & exercises (pursed-lip breathing)<br />
  93. 93. Environmental control<br /><ul><li>Avoid people with RTI
  94. 94. Avoid substances and situations known to precipitate bronchospasm (allergens, irritants, strong odors, gases, fumes, smoke)
  95. 95. Wear a mask if cold weather precipitates bronchospasm
  96. 96. Avoid air pollution</li></li></ul><li>Promote optimal nutrition, rest, exercise<br />Encourage regular exercise to improve CP and MS conditioning<br />Drink liberal amounts of fluids<br />Try to avoid upsetting situations<br />Use relaxation techniques, biofeedback management<br />Smoking cessation, stress management, asthma support groups<br />
  97. 97. Learning activity<br />
  98. 98. 1. From the list below, select the six most likely triggers for an acute asthma attack: <br />Inhalation/pollutants<br /> Drugs<br />Myocradial infarction<br /> Food additives<br /> Upper respiratory infection<br /> Change in atmospheric pressure<br />Paranasal sinusitis<br /> Exercise and cold, dry air<br /> Sudden auditory stimulus<br />
  99. 99. 2. In ______ percent of patients, onset of asthma occurs before age ______ years. <br />20, 21<br />65, 18<br />50, 10<br />40, 12<br />
  100. 100. 3. Asthma can be cured and has a predictable course with decreasing prevalence and hospitalization.<br />True<br />False<br />
  101. 101. 4. Common allergens that can trigger asthma through inhalation include all but which of the following? <br />Animal danders<br />House dust mites<br />Sulfites<br />Molds<br />
  102. 102. 5. Types of drugs that can act as asthma triggers include: <br />Aspirin<br />Nonsteroidal anti-inflammatory drugs<br />B-adrenergic blockers<br />All of the above<br />
  103. 103. 6. Which of the following signs does not require immediate intervention? <br />Decrease in oxygen saturation<br />Decrease in potassium and chloride<br />Decrease in dry or productive cough<br />Decreased LOC<br />
  104. 104. 7. If untreated, ______ can lead to worsening hypoxemia, acid-base disturbance, and possible respiratory arrest.<br />Fever<br />Status asthmaticus<br />Hyperresonance<br />Cough<br />
  105. 105. 8. Once wheezing is resolved, the patient's condition is always considered improved.<br />True<br />False<br />
  106. 106. 9. An assessment of electrolytes can yield clear diagnostic results. ______ and ______ levels may be decreased with long-standing respiratory acidosis.<br />Iron, Calcium<br />Potassium, Chloride<br />Folic acid, Potassium<br />Sodium, Chloride<br />
  107. 107. 10. When discharging an asthma patient from the ED, it is important to provide instructions and information on: <br />Aggravating allergens<br />Precipitating factors<br />Asthma medications<br />All of the above<br />
  108. 108. 11. Corticosteroid therapy should never be stopped abruptly, but instead should be tapered off as prescribed.<br />True<br />False<br />
  109. 109. 12. The goals of patient management include all but which of the following? <br />Limit exercise levels to prevent symptom exacerbation<br />Maintain near-normal pulmonary function<br />Prevent chronic symptoms<br />Avoid adverse affects of medications<br />
  110. 110. References: <br />Smeltzer, C.S., Bare, B.G., Hinkle, J.L., Cheever, K.H., Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11th Ed. Lippincott Williams and Wilkins, 2008.<br />Nettina, Sandra M., Mills, Elizabeth Jacqueline. Lippincott Manual of Nursing Practice, 8th Ed.Lippincott Williams & Wilkins: 2006.<br />Castellucci, Stacy. Asthma.MedcomTrainex<br />Sommers, M. S., Johnson, S. A., Beery, T. A. Diseases and Disorders: A Nursing Therapeutics Manual, 3rd Ed. F. A. Davis Company: 2007.<br />
  111. 111. Thank You.<br />Have a Nice Day!<br />

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