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Transcript of Asthma
- Airway obstruction can occur in two ways:
2) airway hyperresponsiveness that leads to bronchoconstriction Etiology and Genetic Risk - Inflammation of the mucus membranes lining the airways is a key event in triggering an asthma attack.
- Inflammation occurs in response to the presence of specific allergens
- Hyperresponsiveness can occur with exercise, with an upper respiratory illness, and for unknown reasons Etiology and Genetic Risk... - Aspirin and other NSAIDs can trigger asthma in some people, although this response is not a true allergy
- Gastroesophogeal reflux disease (GERD) is thought to be a major trigger for asthma in some people - especially in those who have more asthma manifestations at night History - Patient will usually have a pattern of episodes of dyspnea, chest tightness, coughing, wheezing, and increased mucus production
- Ask if they occur continuously, seasonally, in association with specific activities or exposures, or more frequently at night
- Does the patient smoke? Physical Assessment - A patient with mild to moderate asthma may have no manifestations between asthma attacks
- During an acute episode, the most common symptoms are audible wheezes and increased respiratory rate
- Patient may also use accessory muscles to help breathe
- A patient with long-standing, severe asthma may have a "barrel chest," caused by air trapping Physical Assessment... - Hypoxia occurs with severe attacks
- Pulse oximetry will show hypoxemia that can lead to changes in LOC and tachycardia
- Assess the oral mucosa and nail beds for cyanosis Labs and Tests - Arterial bloog gas (ABG) levels show how well the patient is obtaining oxygen
- Pulmonary function tests (PFTs) are the most accurate for asthma and are measured using spirometry. Baseline PFTs are obtained for all patients with asthma
- The most important are:
Forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow Interventions - Purpose of asthma therapy is to control and prevent episodes, improve airflow, and relieve symptoms
- Have an asthma action plan developed by patient and health care provider
- Plan should be tailored to meet the patient's personal triggers, asthma manifestation pattern, and drug responses
- The plan includes the patient's prescribed daily controller drug schedule along with a prescribed reliever drug directions, when to contact the HCP, and what emergency actions to take when drugs are not relieving the attack Drug Therapy - Bronchodilators:
increase bronchiolar smooth muscle relaxation and have no effect on the inflammatory process
Work by stimulating the beta2-adrenergic receptors on bronchial smooth muscle (action is very similar to transmitters epi and norepi)
Short-acting beta2 agonists provide rapid but short-term relief, most useful when an attack begins - Agents include albuterol
When inhaled from either a metered dose inhaler or a dry powder inhaler, the drug is delivered directly to the site of action with minimal systemic effects Drug Therapy - Bronchodilators:
Long-acting beta2-agonists are also delivered by inhaler directly to the site of action such as the bronchioles
Proper use of the long-acting can decrease the need to use the rescue drugs as often
Long-acting, unlike short-acting, take time to build up an effect, therefore they are best used to prevent asthma attacks
Block the parasympathetic nervous system allowing increased bronchodilation and decreased pulmonary secretions Drug Therapy - Anti-inflammatory:
Corticosteroids - decrease inflammatory and immune responses by preventing the synthesis of mediators
Cromones, leukotriene modifiers, and anti-IgE agents - also used to prevent attacks by decreasing inflammation
- It is also important to teach the patient's how to properly use a metered dose inhaler, spacer, and the dry powder inhalers to receive the optimal dose and effect of each drug taken Status Asthmaticus - A severe, life-threatening acute episode of airway obstruction that intensifies once it begins and often does not respond to usual therapy
- Manifestations include: extremely labored breathing, wheezing, use of accessory muscles, and distension of neck veins
- If condition is not reversed the patient may develop pneumothorax and cardiac or respiratory arrest
- IV fluids, systemic bronchodilators, steroids, epinephrine, and oxygen are administered immediately to reverse condition
- Once stable, patient management is similar to that for any patient with asthma Nursing Diagnosis - Activity intolerance r/t fatigue, energy shift to meet muscle needs for breathing to overcome airway obstruction
- Ineffective airway clearance r/t tracheobronchial narrowing, excessive secretions
- Anxiety r/t inability to breathe effectively, fear of suffocation The End!