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ASTHMA

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Ailish Ganser

on 19 March 2015

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Transcript of ASTHMA

Asthma
"is a chronic lung condition characterized by variable airflow obstruction caused by airway hyper-responsiveness and airway inflammation" (Cicutto, 2014, p. 710).
> Define Asthma
> Understand brief pathophysiology surrounding asthma
> Understand how asthma effects activities of daily living (ADLs)
> Examine instances that exacerbate symptoms of asthma
> Identify ways to alleviate symptoms
> Examine various nursing diagnoses and nursing interventions
Objectives & Purpose
>
Wheezing
>
Coughing
>
Chest Tightness
>
Dyspnea

> Affects about 3 million people in Canada

> 1/2 of cases develop during childhood

> 1/3 develop during adulthood, before age 40

> More people are effected in urban areas

> Inflammatory mediators are released by cells that create an increase capillary permeability, stimulate smooth muscle contraction around the airways, and causes increased secretion of mucous

Involves:
> Airway inflammation
> Airway obstruction
> Bronchial hyper-responsiveness


During an Asthma Attack...
The purpose of this presentation is to gain an understanding of asthma and the underlying manifestations of which effect individuals with the chronic illness.

Nursing Diagnoses & Interventions
Nursing Diagnosis:
> "Ineffective airway clearance related to bronchospasm, and airway inflammation, as evidenced by bronchoconstriction, increased mucous production, symptom experience, and adventitious breath sounds" (Cicutto, 2014, p. 728)
Nursing Diagnosis:
> "Anxiety related to difficulty breathing, perceived, or actual loss of control, and fear of suffocation, as evidenced by restlessness, elevated pulse, respiratory rate, and blood pressure" (Cicutto, 2014, p. 729).
Pathophysiology
Who does asthma effect?
Close to 20% of individuals with asthma visit the emergency one or more times in a year
Asthma is the leading cause for hospital admission of children in Canada
6/10
people with asthma do not have control of their disease
Did you know...
Did you know...
Did you know...
Symptoms of Asthma
Triggers
> Allergens
> Drugs (NSAIDs, Beta Blockers, Aspirin)
> Occupational Exposure (agriculture, wood dusts, industrial chemicals)
> Sinusitis
> Cold, dry air
> Stress
> Exercise
> Viral Upper Respiratory Infection
> Food Additives (sulphites, tartrazine, monosodium glutamate)
Did you know...
A normal inspiration to expiration ratio is 1:2, but with asthma it may be prolonged to 1:3 or 1:4
ASTHMATIC RESPONSES TO STIMULI
Result in the release
of inflammatory
mediators
>
Characterized by bronchospasm

>
Can occur with exercise

>
Immediate response

>
Peaks within 30-60 minutes after exposure

>
Subsides within 30-90 minutes
Late-phase Response
>
More severe

>
Peaks 5-12 hours after exposure

>
May last several hours to days

>
The primary characteristic is inflammation

>
Corticosteroids help prevent this

>

Increasing airway reactivity

Early-phase Response
Airway diameter and airway resistance

> Respiratory muscle function is altered (increased use of neck muscles upon inspiration)

> Arterial blood gases are altered

> Ventilation and perfusion are abnormal
Questions
or
Comments?
Spoons scenario
Jane is an 18 year old girl with chronic asthma. She is in senior year and enjoys dancing and playing soccer. She is at an experimental age and will often drink on weekends and has tried smoking once or twice. She is allergic to strong scents and various NSAIDs (Advil, Motrin, etc.). She often experiences bouts of GERD when she eats spicy foods and has occasional headaches. Like any other teenage girl, she enjoys hanging out with her friends and talking about boys. She is dating a new boy, John, and finds herself increasingly emotional due to dramatic events in their relationship. Jane really enjoys summer because she gets to play outdoor soccer; she cant wait for the snow to melt so she can stop getting these nasty winter colds.
Asthma Attack
Diagnosis of Asthma
> "Spirometry is the preferred test for diagnosing asthma" (Cicutto, 2014, p. 716)

- Performed before and after bronchodilator treatment and it reveals if the airway obstruction is reversible

- It is the measure of flow rates and volumes to determine forced expiratory volume in one second and forced vital capacity

CFAM Should Be Considered If...
>
The individual is experiencing emotional, physical, or spiritual suffering caused by a family crisis or a developmental milestone which aggravates asthma symptoms (West & Jakubec, 2014, p. 279)

>
Have a child admitted to the hospital

>
Have a child or adolescent whom they identify as having difficulties (in relation to asthma, breathing, coping, etc.)
Medication Categories That Help Alleviate Symptoms Associated with Asthma
> Bronchodilators
> Corticosteroids
> Anticholinergics
> Anti-inflammatory agents
> Antileukotrienes

Nursing Interventions:
> Administer medications
> Position patient to maximize ventilation potential
> Teach patient how to use inhalers
> Auscultate lung sounds after treatment to assess for improvement
>Provide asthma education to patient

(Cicutto, 2014, p. 728)
Nursing Interventions:
> "Instruct patient on the use of relaxation techniques to relieve muscle tension and slow respirations" (Cicutto, 2014, pg. 729)

> "Stay with patient to promote safety and reduce fear" (Cicutto, 2014, p. 729)

Quiz Time

1. What is the most effective method of treatment for those with status asthmaticus?
a) Have the patient do jumping jacks to ensure the heart can keep up with the rate of respiration.
b) Salmeterol is enough to treat this exacerbation.
c) Raising the bed to Fowlers position.
d) Immediate treatment is required with Beta-2- agonists to remove the obstruction

2. Which of the following are medications used to treat asthma? (Select all that apply)
a) Salbutemol (Ventolin)
b) Dextromethorphan (Benylin)
c) Salmeterol (Serevent)
d) Diphenhydramine (Benadryl)
e) Ipratropium (Atrovent)
3. What symptoms indicate that an individual may have asthma? (Select all that apply)
a) Constantly sneezing
b) Easily tires during physical activity
c) Is overweight
d) Has a barreled chest
e) Relies on a puffer during exacerbation

4. Various individuals suffer from the effects of asthma; however, there is a group that is predominantly affected. Which group is it?
a) The elderly
b) Middle aged women
c) Children
d) University students

5. What can cause an exacerbation of asthma? (Select all that apply)
a) Allergens
b) Humid air
c) Cool temperatures
d) Dry climates

6. What drug is used to treat asthma prophylactically?

a) Salbutemol
b) Salmeterol
c) Intravenous corticosteroids
d) Ipratropium

7. What is the first thing you would do when someone is having an exacerbation of asthma?
a) Take them to the hospital
b) Get them into a tripod position and have them breath deeply
c) Have them lie in the prone position
d) Give them a corticosteroid



Peak Flow Meter
> Used to let the individual or nurse know how well air is moving into and out of the lungs

> Early detection of potential asthma attack

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