ASTHMA

Question 1

It is a familial disease, usually characterized by chronic airway inflammation

Answer 1

Asthma

Question 2

How can obstruction of bronchi happen?

Answer 2

Smoking, dust, pollen, or perfume can irritate the goblet cells causing an increase production of mucus, and this can cause obstruction of the
bronchi.

Question 2

THREE MECHANISMS that can lead to difficulty in breathing (asthma):

1. increase mucous that produced by goblet cells
2. bronchoconstriction
3. inflammation of bronchus

→ When all three of these factors are present, they may lead to _______.

Answer 2

→ Irritants can cause an increased secretion of mucus by the goblet cells, which can lead to the obstruction of the bronchi.

→ Less oxygen due to obstruction of the mucus causes the smooth muscles to contract leading to bronchoconstriction which further narrows the lumen.

→ Asthma, being an inflammatory disease, can lead to edema, which narrows the bronchi.

atelectasis

Question 3

❖ During an asthma attack, the muscles surround the bronchioles _____,causing a _____ of the bronchiole.

→ The lungs then respond with the production of _____ that further _____ the lumen.

Answer 3

constrict - narrowing

secretions - narrow

Question 4

❖ EXAMPLE OF IRRITANTS OF ASTHMA

Answer 4

Perfume, smoking, dust, pollen, hairs (animals), volcanic smog, seafoods, bagoong, tahong, oyster, detergents, & chocolates

Question 5

❖ CLINICAL MANIFESTATIONS

→ Three most common symptoms are cough, dyspnea, and wheezing.

→ Others are tachycardia, tachypnea, productive cough, orthopnea, chest pain, pallor to cyanosis (lips, nails), fever.

→ Diminished breath sounds are a bad sign because these are an indication of severe obstruction and impending respiratory failure

Answer 5

TO KNOW ONLY

Question 6

Asthma Explain when goblet cells irritated

Answer 6

Goblet cells irritated -> Smooth muscles constrict (Bronchoconstriction) -> Production of mucoid secretions -> Inflammation -> Release of histamine -> Increase capillary permeability -> albumin goes out -> edema -> there will be airway obstruction -> Atelectasis -> alveoli collapse -> ventilation/perfusion mismatch (V/Q Mismatch) -> blood that will enter the lungs will be less oxygenated

Question 7

to know if plenty of mucous:

Answer 7

assessment

Question 8

abnormal breath sound:

Answer 8

whale, bronchi, wheeze

Question 9

wheeze:

Answer 9

bronchoconstriction

Question 10

no sound/diminished breath = tachycardia/tachypnea:

Answer 10

asthma

Question 11

Diminish breath sounds are indication of ___ and ____

Answer 11

severe obstructions and impending respiratory failure

Question 12

MEDICAL MANAGEMENT

if do not have money -

and explain

Answer 12

increase fluid intake

increasing F.I. thins the mucous for patient to easily expectorate it

Question 13

MEDICAL MANAGEMENT

if have money -

Answer 13

EXPECTORANT

Question 14

if patient can’t breathe -

position

Answer 14

semi fowlers

Question 15

if patient can’t breathe -

medication

Answer 15

1. give bronchodilator
   – dilate bronchi mucous move, air comes in, expel carbon dioxide
2. anti-inflammatory (NSAID) steroid
   – prednisone
   – stop inflammation
   – no edema

Question 16

MEDICAL MANAGEMENT

▪ It acts by relaxing the smooth muscle and is a choice for relief of acute symptoms and prevention of exercise-induced asthma.

▪ Administered via ___ or ___
– what is better (explain)

✓ Salbutamol (Ventolin/Asmalin)
✓ Terbutaline Sulfate (Bricanyl)

Answer 16

→ Short-Acting Beta 2-Adrenergic Agonists (SABAs)

✓ MDI is better than oral, because it allows the drug to go directly to the lungs immediately.

Question 17

MEDICAL MANAGEMENT

▪ These are used to treat asthmatic conditions by dilating the bronchioles.

✓ Administered via ___.

✓ Given to patients who do not tolerate short-acting beta 2-adrenergic agonists.

✓ Ipratropium Bromide (Atrovent or Duavent)
✓ Duavent has a lot of side effects so Atrovent is commonly prescribed.

Answer 17

→ Anticholinergics

Aerosol

Question 18

MEDICAL MANAGEMENT

▪ These are bronchodilators with long duration of action.

✓ Frequently administered

✓ Albuterol (Ventolin/Proventil)
✓ Metaproterenol (Alupent)

Answer 18

→ Beta-Adrenergic Drugs

OD or BID by MDI.

Question 19

MEDICAL MANAGEMENT

▪ Side Effects of Atrovent:

▪ Side Effects of Duavent:

Answer 19

dryness of mouth and cough

dyspnea, cough, HPN, tremor, nervousness, insomnia

Question 20

MEDICAL MANAGEMENT

▪ It is the most potent and effective anti-inflammatory medications.

✓ This inhibits the release of histamine, thereby reducing inflammation.

✓ Beclomethasone (Foster) – ___ (via)
✓ Dexamethasone
* Prednisone ___ (via)
* Decadron ____ (via)

Answer 20

→ Glucocorticoids

MDI

Tablet

IV & Tablet

Question 21

▪ Inhaled Glucocorticoids are not helpful in treating a severe asthmatic attack
because

✓ First line therapy for asthma
✓ used for long-term asthma management

Answer 21

it may take 1 to 4 weeks for an inhaled steroid to reach its full effect.

Question 22

▪ Most Common Adverse Effects of Glucocorticoids

Answer 22

✓ Oropharyngeal Candidiasis
✓ Dysphonia

Question 23

Glucocorticoids

Steroids are better taken via MDI ___

Answer 23

▪ Steroids are better taken via MDI because when taken orally, they can cause numerous side effects. These side effects include adrenal suppression, Cushing syndrome, GI irritation, decreased immune system function making the patient more prone to infections, osteoporosis (if taken for more than 3 months), sodium retention resulting in weight gain, increased appetite, and hyperglycemia. When using an MDI, these oral side effects are avoided because the medication acts directly on the lungs. However, one of the disadvantages of MDI is that after using it, some steroids may remain in the mouth, potentially reducing Immunoglobulin A levels and leading to infections such as oral candidiasis. To prevent this, instruct the patient to gargle, use mouthwash, or employ a spacer.

▪ Spacer should be used because it increases the delivery of the drug to the lungs and decreases deposition of the drug on the oropharyngeal mucosa

Question 24

❖ NURSING MANAGEMENT: STEROIDS

Answer 24

→ If patient is using MDI: Instruct the patient to gargle after each administration to avoid oral candidiasis.

→ Advise patient to increase intake of foods high in Vitamin C such as papaya, guava, oranges, kalamansi, strawberry, melons, tomatoes, malunggay, gabi leaves, alugbati leaves, cauliflower, ampalaya leaves, and green pepper because vitamin C works by blocking the release of histamine.

→ Advise patient to drink coffee, tea, cocoa, or dark chocolate because these drinks dilate the bronchial tubes making it easier for asthmatics to breathe.
▪ Coffee (highest amount of caffeine)
▪ 2-3 cups of coffee/day
▪ Caffeine can cause insomnia.
▪ Use caffeine as a supplement to the treatment.
▪ It can increase cardiac rate and cause palpitation so don’t advise this to patients with heart problems.

→ Oral Steroid:
▪ Advise patient to take this in full stomach (1 hour after a meal) to avoid GI irritation
▪ Advise patient to avoid foods high in sodium because steroids cause sodium retention and may result to edema.
▪ Advise patient to never discontinue taking this medication abruptly because prolonged use of steroids decrease the ability of the adrenal cortex to produce steroids and can cause Addisonian Crisis.
▪ Advise the patient to take this medication in the morning rather than in the evening because it can stimulate the central nervous system, leading to increased alertness, which may result in insomnia.

Question 25

❖ METERED-DOSE INHALER (MDI)

→ How to Use MDI:

Answer 25

▪ Shake the medicine.

▪ Hold the MDI so that the mouthpiece is at the bottom. Open your mouth and position the mouthpiece 1 ½ to 2 inches in front of your mouth. Breathe out normally.

▪ Press the MDI down once to release a spray of medicine into your mouth while breathing in slowly. Continue to breathe in as slowly and deeply as possible.

▪ Hold your breath for 10 seconds, and then breathe out slowly

Question 26

❖ METERED-DOSE INHALER (MDI)

→ MDI Teaching Points

Answer 26

▪ Wait 30 seconds between inhalation of same medication.

▪ Wait 5-10 minutes between inhalations of different medications.

▪ Inform the patient to start to breathe in slowly for 3 to 5 seconds, to draw in the medication.

▪ Instruct the patient to hold his breath for 10 seconds, to allow medicine to go deeply into his lungs.

▪ The client exhales and then squeezes the canister as the next inspiration occurs.

Question 27

❖ METERED-DOSE INHALER (MDI)

→ If the patient with asthma is taking bronchodilators and steroids:

Answer 27

▪ Give the bronchodilator first, to cause dilation of the bronchi. This allows the steroids to pass through and stop the inflammation.

▪ If the steroid is given first, it will not be absorbed since the bronchi are constricted.

▪ Taking steroids with an MDI can cause some of the steroids to remain in the mouth, which may reduce Immunoglobulin A levels and lead to Oral Candidiasis. Therefore, after administration, it is advisable to instruct the patient to gargle or use a spacer.

Question 28

ASTHMA
❖ HOUSE DUST CONTROL MEASURES

Answer 28

→ Use a hypoallergenic pillow.

→ No cleaning chores and stay away from someone who is cleaning.

→ Use a damp cloth to wipe the chairs, tables to avoid the dust to be suspended in the air.

→ Old books, magazines, newspapers should be kept outside the bedroom.

→ Pillow and mattresses should be exposed to the sun for 1 hour every 2 weeks.

→ Clean the filter of your aircon every 2 weeks.

→ If you are going to be exposed to dust, get a handkerchief, wet it with water, squeeze it and use it as a mask