Medical surgical Nursing (asthma),

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  • 1. Asthma Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.) 1
  • 2. Objective:  The student will be able to : Define Asthma and status asthmaticus. Discuss the clinical manifestations, assessment, diagnostic findings, complications, prevention, medica l and nursing management of patients with asthma and status asthmaticus. S 2 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.)
  • 3. Asthma  Asthma is a chronic inflammatory disease of the airway hyper responsiveness, mucosal edema, and mucus production. S 3 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.)
  • 4. Facts    The most common chronic disease of childhood, asthma can occur at any age Despite the development of knowledge and treatment, the death rate from the disease continues to rise. Allergy is the strongest predisposing factor for asthma. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.)
  • 5. Asthma Triggers Predisposing factors: Atopy, female gender  Causal factors: a. Exposure to indoors allergens such as Mold , Pet dander, Dust mites, Cockroach droppings. b. Exposure to outdoors allergens such as Pollen , Smoke, Pollution, Cold weather. c. Occupational sensitizers.   Contributing factors: Respiratory infections, Stress, Strong emotions, Exercise. Food Allergens such as Fish, Shellfish, Egg, Soy, peanuts… Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 5 Textbook of Medical Surgical Nursing (12th ed.)
  • 6. Pathophysiology 6
  • 7. Clinical Manifestation The three most common symptoms of asthma are: Cough, dyspnea, and wheezing. chest tightness. Description: There is cough with or without mucus production Wheezing sound ( the sound of airflow through narrowed airways)  S 7 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.)
  • 8. Asthma classified as : mild INTERMITTENT, moderate, or severe PERSISTENT ASTHMA. As Exacerbation progresses‘: diaphoresis, tachycardia and a widened pulse pressure may occur along with hypoxemia and central cyanosis ( late sign of poor oxygenation) S 8 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.)
  • 9. Assessment and diagnostic findings        A positive family history and environmental factors Occupation related to chemicals and compounds. Other possible allergic reactions accompany with asthma include eczema, rashes… Sputum and blood tests ( elevated levels of eosinophils) Arterial blood gas analysis. Pulse Oximetry reveal hypoxemia during acute attack Lung function is evaluated by spirometry S 9 meltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.)
  • 10. Cont…  Peak flow meters measure the highest volume of air flow during a forced expiration (left). Volume is measured in color-coded zones (right): results….80%-100% (personal best), less than 60% patient should take appropriate action. (Refer Pg. 629, chart 24-6)  Incentive spirometer : to examine the health of a patient's lungs by measuring their inspiratory volume. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 10 Textbook of Medical Surgical Nursing (12th ed.)
  • 11. Prevention     Patient with recurrent asthma should undergo test to identify the substances that precipitate the symptoms. Patients are instructed to avoid the causative agents whenever possible. Knowledge is the key of quality asthma care Evaluation of risk are the key in the control. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 11 Textbook of Medical Surgical Nursing (12th ed.)
  • 12. Complication     Status Asthmaticus Respiratory failure Pneumonia Atelectasis Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 12 Textbook of Medical Surgical Nursing (12th ed.)
  • 13. Medical management Immediate intervention may be necessary, because continuing and progressive dyspnea leads to anxiety which increase the situation.  Pharmacologic therapy 1. Quick- Relief Medication  2. Long – Acting Control Medications  Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 13 Textbook of Medical Surgical Nursing (12th ed.)
  • 14. 1. Quick- Relief Medications: A. Short- acting beta2- adrenergic agonists…. Used to relief acute symptoms and prevention of exerciseInduced asthma. Also to relax the smooth muscles { albuterol} B. Anticholinergics…. Counteract bronchoconstriction Inhibit the mascarinic cholinergic receptors ,,,,used for patient who do not tolerate short acting beta2adrenergic agonists. E.g (ipratropium bromide (atrovent). Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 14 Textbook of Medical Surgical Nursing (12th ed.)
  • 15. 2. Long – Acting Control Medications  1. Corticosteroids: most potent and effective anti inflammatory medication. Improve the airway function and decrease the peak flow variability. E.g cromolyn sodium, it used to stabilize mast cells and works as prophylactic basis to prevent exercise induced asthma or unavoidable exposure to known trigger. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 15 Textbook of Medical Surgical Nursing (12th ed.)
  • 16. Long – Acting Control Medications  2. long- acting beta2- adrenergic agonists used with anti-inflammatoy medications to control asthma symptoms particularly those occur at night. E.g theophylline. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 16 Textbook of Medical Surgical Nursing (12th ed.)
  • 17. Management of Exacerbation     Asthma exacerbation are best managed by early treatment and education. Quick – acting beta2 adrenergic agonist medication are used first to relief of airflow obstruction Systemic corticosteroids may be necessary to decrease airway inflammation in patient who fail to respond to inhaled beta-adrenergic medication. Oxygen supplementation may be required to relieve hypoxemia. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 17 Textbook of Medical Surgical Nursing (12th ed.)
  • 18. Nursing management    The immediate nursing care of patients with asthma depends on the severity of symptoms. Calm approach The nurse assesses the patient’s respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetery and vital signs. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 18 Textbook of Medical Surgical Nursing (12th ed.)
  • 19. Nursing Diagnoses Ineffective Breathing Pattern r/t bronchospasm  Anxiety r/t fear of suffocating, difficulty in breathing, death.  Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 19 Textbook of Medical Surgical Nursing (12th ed.)
  • 20. Nursing Intervention:     Obtains a history of allergic reactions to medications before administering medications Identifies medications the patient is currently taking Administers medications as prescribed and monitors the patients responses to those medications. These medications may include an antibiotic if the patient has an underlying respiratory infection. Administers fluids if the patient is dehydrated as prescribed. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 20 Textbook of Medical Surgical Nursing (12th ed.)
  • 21. Status Asthmaticus :  Status Asthmaticus : Status Asthmaticus Life-threatening emergency Occurs when bronchospasm don’t respond to conventional therapy Can lead to worsening hypoxemia, acid-base imbalance, potential respiratory arrest Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 21 Textbook of Medical Surgical Nursing (12th ed.)
  • 22. Clinical Manifestation     Same manifestation in sever asthma Labored breathing, prolonged exhalation Engorged neck veins If the obstruction worsens, the wheezing may disappear its sings of respiratory failure Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 22 Textbook of Medical Surgical Nursing (12th ed.)
  • 23. Assessment and diagnostic findings    Pulmonary function studies ( assessing acute airway obstruction) Arterial blood gas if the patient cannot perform pulmonary function maneuvers because of sever obstruction or fatigue. Respiratory alkalosis (low paCO2) is the most common finding in patient with asthma. Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 23 Textbook of Medical Surgical Nursing (12th ed.)
  • 24. Medical management     Close monitoring of the patient Short acting beta adrenergic agonist Systemic corticosteroids to decrease the airway inflammation and swelling Short acting inhaled bata2 adrenergic agonists for rapid relief of bronchospasm Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 24 Textbook of Medical Surgical Nursing (12th ed.)
  • 25. Cont… IV fluids for hydration  Oxygen to treat dyspnea, central cyanosis and hypoxemia ( to maintain PO2 92 mmhg or Spo2 more than 95%) Delivered by partial or non rebreather mask.  Magnesium sulfate, a calcium antagonist, to induce smooth muscle relaxant and hence cause bronchodilation  (see the adverse effects Pg.630) Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 25 Textbook of Medical Surgical Nursing (12th ed.)
  • 26. Nursing management Main focus of nursing management is to actively assess the airway and the patients response to treatment.  Monitoring the patient for the fist 12 to 24 hours, until the situation control.  Assess the patient’s skin turgor for signs of dehydration ( fluid intake is essential to combat dehydration, to loosen secretions )  Nurse administer IV fluid as prescribed.  Vital signs to be monitored.  Patient room should be free of respiratory irritants.  Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s 26 Textbook of Medical Surgical Nursing (12th ed.)
  • 27. Thank you…Enjoy learning and Studying 27
  • 28. Reference  Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.). Philadelphia, PA: J.B. Lippincott Williams & Wilkins. Chapter 23 & 24, pp. 551-633 28
  • 29.    Mast cells Cells that synthesize & store histamine Eosinophils Type of WBCs capable of releasing chemical mediators that cause bronchoconstriction IgE antibody attaches to mast cells in the respiratory tract; contributes to allergic reactions Hyper resonance Quality of sound heard on percussion of a hollow structure 29
  • 30. Common Triggers for Asthma   Extrinsic triggers: an allergic type reaction to antigen ( e.g air pollutants, cold, heat, weather changes, strong odors or perfums, smoke) Intrinsic triggers eg. Respiratory infection 30