Asthma is a chronic obstructive pulmonary disease caused by airway inflammation and constriction. It is the most common chronic childhood illness, with 50% of cases beginning before age 10. An asthma attack can be life-threatening and lead to respiratory failure if not properly treated. Nurses play an important role in quickly assessing severity, administering bronchodilators and other medications, monitoring the patient, providing education on triggers and ongoing management. The goals of treatment are to maintain normal lung function and prevent exacerbations and adverse effects of medications.

1. Asthma Reynel Dan L. Galicinao

2. Review

5. Chronic, reversible obstructive pulmonary disease Caused by airway inflammation, increased airway responsiveness, or bronchospasm Most common chronic childhood illness

6. In 50 percent of patients, onset occurs before age 10 years Can be controlled, not cured Has an unpredictable course with increasing prevalence and hospitalization

7. Etiology and Pathophysiology

11. Occurs when bronchospasm don’t respond to conventional therapy

14. Animal dander

15. Cockroaches

16. Pollen

17. MoldIgE mediated

18. Intrinsic Asthma No inciting allergen Infection, typically viral Emotional stress

19. Mixed Asthma Immediate type I reactivity combined with intrinsic factors

20. Aspirin-induced Asthma Induced by ingestion of aspirin and related compounds “Triad” - combination of aspirin-induced asthma, nasal polyps, and sinusitis

21. Exercise-induced Asthma Symptoms vary from slight chest tightness and cough to severe wheezing/cough and shortness of breath Usually occur after 5 to 20 minutes of sustained exercise

23. Dust

24. Allergens

27. ↑ Anxiety level

28. Accessory muscle use

29. Intercostal/supraclavicular retractions

30. Oral cyanosis

31. Exhaustion

32. Diaphoresis

33. Coughing

36. RR

37. BP

38. Temp

40. Description of previous attacks

41. Meds used to treat asthma

42. Recent medication changes

43. Previous ED visits & hospital admissions

44. Previous intubationsNote: prior intubations for an asthma attack put a patient at higher risk for respiratory failure

45. Signs and Symptoms

47. Dry or productive cough

48. Dyspnea

49. Use of accessory muscles

50. Tachypnea

51. Tachycardia

53. Pallor and/or cyanosis

54. Diaphoresis

55. Physical exhaustion

56. Restlessness

58. Ineffective Breathing Pattern r/t bronchospasm Anxiety r/t fear of suffocating, difficulty in breathing, death

59. Diagnostic evaluation

60. P -PEFR E -Electrolytes A -ABG C E -ECG -CXR -CBC

61. Peak Expiratory Flow Rate: Measures large airway function Used to assess severity of attack and effect of treatments

63. CXR Hyperinflation of the lungs may be present and is related to air being trapped in the smaller airways Show infiltrates, TB, or a pneumothorax (which can all cause shortness of breath and classify as differential diagnoses)

64. CBC Increased WBC count indicative of infection Increased eosinophils

65. ECG Rule out cardiac involvement

66. Nursing interventions

67. Position the patient to facilitate breathing Provide humidification using a mask or open face tent Provide oxygen as indicated, and monitor the level of O2 saturation Continuously monitor all vital signs Establish and maintain IV access for medications and fluids

68. Assist the patient in removal of secretions via coughing and/or deep-breathing exercises, and suction prn Continuously monitor the ECG for cardiac dysrhythmias that are secondary to hypoxia or acidosis Monitor respiratory status for the effects of medications, pulse oximetry, and ABGs

69. Anticipate and prepare for more aggressive ventilatory support in the event that it becomes necessary. Protect the patient from environmental, pharmaceutical, and emotional irritants that may exacerbate the asthma attack. Administer medications as prescribed

70. Communicate frequently with the patient, family, and significant others and carefully explain all procedures When possible, allow a calm significant other to remain with the patient in the treatment area.

71. Medication

73. Serevent

74. Epinephrine

77. Dexamethasone

78. Beclovent

81. Should be tapered off as prescribedImportance of hydration Use of home nebulizers and peak flow meters Continuing regular medications even if they are not experiencing signs and symptoms

82. Goals of Patient Management Maintain near-normal pulmonary function and exercise levels Prevent chronic symptoms and acute exacerbations Avoid adverse effects of medications.

83. Ongoing therapy should include: Baseline measurement of lung function via PEFR Environmental control Avoidance of triggers Appropriate drugs and compliance Comprehensive patient education

84. Conclusion Although asthma is a controllable, chronic condition, when symptoms are exacerbated, they can put the patient at significant risk 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.

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.

86. Patient Education

88. aggravating allergens

89. precipitating factors

92. Demonstrate the use of MDIs & nebulization equipment Help patient to identify what triggers asthma, warning signs of an impending attack, strategies for preventing & treating an attack Teach adaptive breathing techniques & exercises (pursed-lip breathing)

94. Avoid substances and situations known to precipitate bronchospasm (allergens, irritants, strong odors, gases, fumes, smoke)

95. Wear a mask if cold weather precipitates bronchospasm

97. Learning activity

98. 1. From the list below, select the six most likely triggers for an acute asthma attack: Inhalation/pollutants Drugs Myocradial infarction Food additives Upper respiratory infection Change in atmospheric pressure Paranasal sinusitis Exercise and cold, dry air Sudden auditory stimulus

99. 2. In ______ percent of patients, onset of asthma occurs before age ______ years. 20, 21 65, 18 50, 10 40, 12

100. 3. Asthma can be cured and has a predictable course with decreasing prevalence and hospitalization. True False

101. 4. Common allergens that can trigger asthma through inhalation include all but which of the following? Animal danders House dust mites Sulfites Molds

102. 5. Types of drugs that can act as asthma triggers include: Aspirin Nonsteroidal anti-inflammatory drugs B-adrenergic blockers All of the above

103. 6. Which of the following signs does not require immediate intervention? Decrease in oxygen saturation Decrease in potassium and chloride Decrease in dry or productive cough Decreased LOC

104. 7. If untreated, ______ can lead to worsening hypoxemia, acid-base disturbance, and possible respiratory arrest. Fever Status asthmaticus Hyperresonance Cough

105. 8. Once wheezing is resolved, the patient's condition is always considered improved. True False

106. 9. An assessment of electrolytes can yield clear diagnostic results. ______ and ______ levels may be decreased with long-standing respiratory acidosis. Iron, Calcium Potassium, Chloride Folic acid, Potassium Sodium, Chloride

107. 10. When discharging an asthma patient from the ED, it is important to provide instructions and information on: Aggravating allergens Precipitating factors Asthma medications All of the above

108. 11. Corticosteroid therapy should never be stopped abruptly, but instead should be tapered off as prescribed. True False

109. 12. The goals of patient management include all but which of the following? Limit exercise levels to prevent symptom exacerbation Maintain near-normal pulmonary function Prevent chronic symptoms Avoid adverse affects of medications

110. References: 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. Nettina, Sandra M., Mills, Elizabeth Jacqueline. Lippincott Manual of Nursing Practice, 8th Ed.Lippincott Williams & Wilkins: 2006. Castellucci, Stacy. Asthma.MedcomTrainex Sommers, M. S., Johnson, S. A., Beery, T. A. Diseases and Disorders: A Nursing Therapeutics Manual, 3rd Ed. F. A. Davis Company: 2007.

111. Thank You. Have a Nice Day!