Asthma Flashcards
(16 cards)
A clinical syndrome characterized by airway obstruction, which is partially or completely reversible either spontaneously or with treatment. Characteristics include ________ and
________ to various stimuli.
airway inflammation, airway hyperresponsiveness
B. Causes
- The exact underlying cause remains_____
- The cause is associated with the following:
unknown
a. Allergic response
b. Heredity
c. Environmental factors
d. Infection
e. Psychosocial factors
f. Socioeconomic factors
Classifications of Asthma (based on the National
Asthma Education and Prevention Program, or NAEPP)
Intermittent, Mild persistent, Moderate persistent and severe persistent
Intermittent
a. This is the least _______ of the four classifications.
b. Symptoms of wheezing or coughing are experienced ______
c. The patients in this category generally have FEV1 and peak expiratory flow (PEF) values of _______ of predicted.
d. Routine management generally consists of ______, as needed.
e. Exacerbation of symptoms rarely results in emergency department treatment or hospitalization. T/F
severe, no more than twice per week, at least 80%, beta-2 agonists (SABAs), T
- Mild persistent
a. Symptoms of coughing or wheezing are experienced _________ but less than ______
b. Symptoms affect the patient’s daily activity and sleep during the night; nocturnal coughing, wheezing, or dyspnea is experienced ________.
c. The patients in this category generally have FEV1 and PEF values of ________ of predicted.
d. Routine management generally consists of ______ to control symptoms and the use of a _______, as needed.
e. Emergency department treatment for exacerbations occurs _______ and may occasionally result in hospitalization.
more than twice per week, once per day, more than twice per month, at least 80%, ICS therapy, SABA, periodically
Moderate persistent
a. Symptoms of coughing or wheezing are experienced______in this category.
b. Exacerbation of symptoms are experienced _______ and may persist for several days. Symptoms affect the patient’s daily activity and sleep during the night; nocturnal coughing, wheezing, or dyspnea is experienced _________.
d. The patients in this category generally have FEV1 and PEF values of 60% to 80% of predicted.
e. Daily management generally consists of a SABA as needed for symptoms and not to exceed ______; _____ for nocturnal symptoms; ____ daily.
f. Patients in this category routinely _____ emergency department treatment or require hospitalization.
almost daily, at least twice per week, more than once per week, 60% to 80%, SABA, 3 to 4 times per day, LABA, ICS, require
. Severe persistent
a. This is the ______ category of the four. Symptoms of coughing or wheezing are experienced ______.
b. Exacerbations are ______ and may last for weeks.
c. Symptoms affect the patient’s daily activity and sleep during the night; nocturnal coughing, wheezing, or dyspnea is experienced ______.
d. The patients in this category generally have FEV1 and PEF values of ______ of predicted.
e. Daily management generally consists of a _____ as needed for symptoms, not to exceed ______; ________ for nocturnal symptoms and frequent exacerbations; ______ daily.
f. Patients in this category routinely require emergency department treatment or require hospitalization.
worst, almost continually, frequent, almost every night, 60% or less, SABA, 3 to 4 times per day, LABA and oral corticosteroids, ICS
Pathophysiology
- When the asthmatic inhales an allergen that he or she is sensitive to, mast cells located in the bronchial mucosa and submucosa release the following chemical mediators:
- The release of these substances results in:
a. Histamine
b. Leukotrienes
c. Platelet-activating factor
d. Prostaglandins
a. Bronchoconstriction
b. Mucosal edema
c. Increased mucus production
d. Accumulation of eosinophils in the blood and
sputum
e. Inflammation
Clinical Signs and Symptoms
1. Mild ______ and _____ initially, which may
progress to severe dyspnea if the attack is not reversed.
2. The cough is initially _______, progressing to a ______ cough by the end of the episode.
3. Secretions contain high levels of ______.
4. ________ retractions.
5. The use of _______ to breathe (in a
severe attack).
6. Paradoxical pulse: systolic blood pressure is ______
higher on _______.
7. Tachycardia and tachypnea
8. ABG levels initially reveal _______. PaCO2 increases as the attack worsen and the patient begins to tire.
wheezing, coughing, nonproductive, productive, eosinophils, Intercostal and supraclavicular, accessory muscles, 10 mm Hg, expiration than on inspiration, hypoxemia and low PaCO2
Characteristics of Chest X-ray
- Hyperinflation (hyperlucency of lung fields)
- Atelectasis
- Infiltrates
Characteristics of Pulmonary Function Studies
- Decreased FEV1
- Decreased FVC
- Decreased FEV1/FVC
- Increased RV
Asthma Preventative Drugs
1. _________: mast cell stabilizer referred
to as a noncorticosteroid antiinflammatory drug
2. _________: zafirlukast (Accolate) or
montelukast (Singulair)
3. Covered in detail in Chapter 14, Respiratory
Medications
Cromolyn sodium (Intal), Leukotriene modifiers
Treatment (During an Attack)
- Rescue SABAs such as albuterol or Xopenex
- IV fluids
- O2 therapy
- IV corticosteroids
a severe asthmatic attack that responds poorly to bronchodilator therapy and is associated with signs or symptoms of potential respiratory failure
Status Asthmaticus
Nocturnal Asthma
1. Nocturnal (nighttime) symptoms are seen in up to
____ of all patients with asthma and even in those
who have mild intermittent or mild persistent
asthma.
2. Mechanisms resulting in nocturnal symptoms may
be related to changes in ___________
3. Other causes may include aspiration, sleep apnea, increased mucus production, sinusitis, gastroesophageal reflux, and a normal decrease in lung function when the patient is sleeping.
4. First line management is_____. May also be managed
by _____
75%, agal tone, body temperature, mediators, epinephrine, inflammation, and b2-receptor function during sleep, ICS, LABA.
Occupational Asthma
1. Characterized by increased _______
while at work or within several hours after leaving
work and improving on days off from work.
2. Diagnosis may be made by measuring _______.
3. The most common workplace causes include
_______
wheezing or coughing, peak flows while at work, formaldehyde, grain dust, cigarette smoke, and avian proteins
