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- Asthma -

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by

Crystal Grover

on 18 October 2014

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Transcript of - Asthma -

ASTHMA

PATHOPHYSIOLOGY
Cause
SIGNS & SYMPTOMS
Hypoxemia
Hyperventilation
Use of accessory muscles during expiration
Wheezing on inspiration and expiration
Barrel chest - hyperinflation
Risk Factors
Prevalence
Hyperresponsive bronchi

Often runs in families

More than 100 genes have been identified that increase susceptibility
Genetics
24.6 million people in the United States
Occurs at all ages
1/2 of all cases occur in childhood,
and another 1/3 before age 40
Death rate highest for adult females,
black people, and adults over age 65.
ACUTE
ATTACK
TREATMENT
Differential Diagnoses:
Testing/Diagnosis
Supported by history of allergies and recurrent episodes of wheezing, dyspnea, cough,
or exercise intolerance.
REFERENCES:
Complications
Severe hyperinflation during attack can cause cardiac output.
As a Nurse Practitioner:
Avoid allergens and irritants
Use peak flowmeter
Don't underestimate severity
Chronic inflammatory disorder of the bronchial mucosa.
EARLY RESPONSE
LATE RESPONSE (4-8 hours later, can be even more severe than early response)
Latent release of inflammatory mediators again induces bronchospasm, edema, and mucous secretion.
Allergy or irritant
("antigen")
exposure causes
immune response
Cytokines released
IgE produced and
binds to mast cell
Degranulation of mast cell
Inflammatory Response
Vasodilation
Increased capillary permeability
Mucosal edema
Bronchospasm
Increased mucous secretion
Narrowed airway & obstruction of airflow (especially expiratory flow)
Air trapping & hyperinflation
distal to obstruction
Decreased alveoli perfusion
(Initially)
Hypoxemia without CO2 retention
Respiratory Alkalosis
(decreased CO2 & increased PH)
(If prolonged)
Severe air trapping causes CO2 retention
Respiratory Acidosis
=
=
Research Articles
Chronic bronchitis
Chest tightening
Expiratory wheezing*
Dyspnea*
Unproductive cough
Prolonged expiration
Tachycardia
Tachypnea
Silent chest (no audible air movement)
& PaCO2 greater than 70 mmHg
Ominous signs of
impending death
BEGINNING OF ATTACK:
SEVERE ATTACK:
Spirometry - shows a decrease
in FEV1 during induced attack.
Untreated inflammation can cause irreversible airway damage called
"airway remodeling".
Inadequate treatment can lead to death.
EDUCATION (for patients with asthma)
Monitor for risk
Assess for symptoms
Refer to pulmonologist
Emphysema
COPD
Assess arterial blood gas & expiratory flow rates
Search for underlying trigger (ex: infection)
Hypoxemia
Respiratory Alkalosis
Hypercapnia - CO2
Respiratory Acidosis
Expected early in attack
Need mechanical ventilation
#1: Oxygen
#2: Inhaled bronchodilators
#3: Oral Corticosteroids
ADMINISTER:
Increased allergen & irritant
exposures in childhood
Air pollution
Tobacco smoke
Recurrent respiratory viral infections
Esophageal reflux
Pet dander
"Hygeine Hypothesis"
(Lack of exposure to
common pathogens causes an imbalanced immune system)
Obesity
Boys affected more than girls
McCance, K., & Huether, S. (2006). Pathophysiology (5th Ed). St. Louis, MO: Elesevier Mosby.
Gudnadottir, M., & Svavarsdottir, E. (2014). Advanced Nursing Intervention for Families of Children and Adolescents with Asthma: The Father's Perspective. Nursing Science, 34, 49-52.
Nkoy, F., Stone, B., Fassl, B., Koopmeiners, K., Halbern, S., Kim, E., Poll, J., ... Maloney, C. (2012, Nov.). Development of a Novel Tool for Engaging Children and Parents in Asthma Self-
Management. AMIA Annual Symposium Proceedings, American Medical Informatics Association.
Advanced Nursing Intervention for Families of Children and Adolescents
with Asthma: The Father's Perspective.
Development of a Novel Tool for Engaging Children and Parents in Asthma
Self-Management.
Full transcript