Asthma

Question 1

pathophysiology of asthma

Answer 1

• exposure to trigger
• immune mediators released
• vascular congestion with WBCs, increased capillary permeability
• edema formation, thick mucous, thickening of airways, bronchial spasm
• acute bronchitis and airway edema
• occurs within 30-60 min of exposure
• last phase response occurs between 3-10 hours

Question 2

s/s of asthma

Answer 2

• wheezing, cough, dyspnea, chest tightness
• increased expiration time
• diaphoresis, tachycardia
• hypoxemia, cyanosis, watch ABGs for CO2
• accessory muscle use
• retraction

Question 3

triggers

Answer 3

• allergens
• exercise
• air pollutants
• occupational exposure
• respiratory infections
• nose/sinus problems
• drug/food additives
• GERD
• extreme emotions

Question 4

diagnosis for asthma

Answer 4

• PFT (FEV1 & PEF)
• CXR
• ABGs
• sputum C&S
• FENO monitors

Question 5

classes of asthma

Answer 5

• mild intermittent
• mild persistent
• moderate persistent
• severe persistent

Question 6

treatment

Answer 6

• short acting B2-adrenergic agonist (SABA)
• inhaled corticosteroid (CS)
• long acting b2-adrenergic agonist

Question 7

what to do during an asthma attack

Answer 7

• 2-4 puffs of SABA Q 20 minutes, up to 3 hours
• talk patient down
• sit patient up
• encourage pursed-lip breathing
• monitor VS

Question 8

red flags in asthma

Answer 8

• HR> 12
• Resp rate >30
• wheezes that become silent
• ABG: O2 stat: <90%, PCO2 >45, PO2 < 60

Question 9

complications of asthma

Answer 9

• pneumonia
• atelectasis
• sinus asthamaticus
• respiratory failure

Question 10

evaluating treatment of asthma

Answer 10

-monitor PEFR

Question 11

mild intermittent asthma

Answer 11

• symptoms no more than twice per week

- SABA prn

Question 12

mild persistent asthma

Answer 12

• symptoms no more than twice per week but not daily
• daily low dose ICS
• SABA prn

Question 13

moderate persistent

Answer 13

• symtoms occur daily and somewhat limit ADLs
• daily low does ICS and LABA or med dose ICS
• SABA prn

Question 14

severe persistent

Answer 14

• continuous symptoms severely limiting ADLs
• Daily med-dose ICS and LABA
• SABA prn

Question 15

Bronchodilator medications

Answer 15

• albuterol (Proventil, Ventolin)
• Terbutaline (Brethaire)
• Pirbuteriol (Maxair)
• LABA: salmeterol (serevent)

Question 16

Corticosteroids

Answer 16

• anti-inflammatories that reduce bronchial hyperresponsiveness
• first-line long-term tx for persistent asthma
• takes 24 hrs to 2 weeks for max effects
• can be given PO and IVP for acute attacks

Question 17

corticosteroid medications

Answer 17

• fluticasone (Flovent)
• budesonide (pulmicort)
• theophylline
• anti-cholinergics: for those who can’t tolerate SABAs; Ipratropium (Atrovent)

Question 18

Leukotriene Modifiers

Answer 18

• Montelukast sodium (Singulair)
• Zafirlukast (Accolate)
• Block leukotrienes (inflammatory mediators)
• Both bronchodilator and anti-inflammatory effects
• PO
• Not for emergencies

Question 19

MDIs (metered dose inhalers)

Answer 19

• delivers measured dose of drugs
• spacers help with med. delivery
• rinse in warm water atleast twice a week
• shake well before use

Question 20

DPIs (dry powder inhalers)

Answer 20

-spacer not needed

Question 21

Nebulizers

Answer 21

• fine spray powered by compressed oxygen
• pt needs to cough after dose is completed
• high risk for bacterial growth so clean with soap and water and soak in vinegar and water for 30 minutes, rinse, then air dry