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NU 350 Therap Interv: Care Ind Fam (Exam 1) > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Chronic inflammatory disorder of airways

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2
Q

What does asthma cause?

A

Causes airway hyperresponsiveness leading to wheezing, breathlessness, chest tightness, and cough

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3
Q

Who has a greater prevalence to asthma?

A

Women and African Americans have a greater prevalence

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4
Q

What are the tigers of asthma?

A 
Allergens 
Exercise 
Air pollutants 
Occupational Factors
Respiratory Infection 
Nose and Sinus Problems
Drugs and Food Additives
Gastroesophageal Reflux Disease
Emotional Stress
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5
Q

What are the two types of allergen triggers?

A

Seasonal and year round

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6
Q

Explain the exercise trigger?

A

Induced or exacerbated after exercise
Pronounced with exposure to cold air
Breathing through a scarf or mask may ↓ likelihood of symptoms

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7
Q

What are considered air pollutants?

A

Cigarette or wood smoke: smoke outside.
Vehicle exhaust
Elevated ozone levels
Sulfur dioxide

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8
Q

What is the most common form of occupational lung disease?

A

Asthma

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9
Q

Explain occupational trigger.

A

Exposure to diverse agents

Arrive at work well, but experience a gradual decline

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10
Q

Explain respiratory trigger.

A

Major precipitating factor of an acute asthma attack

↑ inflammation hyperresponsiveness of the tracheobronchial system

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11
Q

Explain nose and sinus trigger.

A

Allergic rhinitis and nasal polyps
Large polyps are removed
Sinus problems are usually related to inflammation of the mucous membranes
Most of the time, asthma pt have underlining sinus problems. Making the airway worse

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12
Q

Explain drug triggers.

A

Asthma triad: nasal polyps, asthma, and sensitivity to aspiri and NSAIDs
Wheezing develops in about 2 hrs
Sensitivity to salicylates
Found insalicylates many foods, beverages, and flavorings

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13
Q

Explain Food triggers.

A

Food allergies may cause asthma symptoms
Avoidance diets:
Rare in adults
People slightly out grow food allergy

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14
Q

Explain Gastroesophageal Reflux Disease trigger.

A

Reflux of acid could be aspirated into lungs causing bronchoconstriction
Fix GI and usually fix asthma

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15
Q

Explain emotional triggers.

A

Psychological factors can worsen the disease process
Attacks can trigger panic and anxiety
Extent of affect is unknown

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16
Q

What is the primary pathophysiology response?

A

Primary response is chronic inflammation from exposure to allergens or irritants
Leading to airway hyperresponsiveness and acute airflow limitations

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17
Q

Inflammatory mediators cause (early-phase response). What is the early -phase response?

A 
Vascular congestion
Edema formation
Production of thick, tenacious mucous
Bronchial muscle spasm
Thickening of airway walls
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18
Q

What is late-phase response?

A

Occurs within 4-10 hours after initial attack
Only occurs in 30-50% of patients
Can be more severe than early-phase and last for 24 hours or more
If airway inflammation is not treated or does not resolve, it may lead to irreversible lung damage

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19
Q

Is Wheezing is reliable to gauge severity?

A

No! Severe attacks may have no audible wheezing

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20
Q

An acute attack usually reveals signs of hypoxemia. What are the signs?

A 
Restlessness
↑ anxiety
↑ pulse and blood pressure
Pulsus paradoxus (drop in systolic BP during inspiratory cycle > 10 mm Hg)
Inappropriate behavior:
Confusion 
Acting out 
Not Oriented
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21
Q

What are the classifications of asthma?

A

Intermittent
Mild
Moderate
Severe

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22
Q

What is Status asthmaticus?

A

Severe, life-threatening attack unresponsive to usual treatment
Patient at risk for respiratory failure
Where full blown attack, but having extreme trouble getting under control.

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23
Q

What are causes of status asthmaticus?

A 
Viral illnesses
Ingestion of aspirin or other NSAIDs
Environmental pollutants or allergen exposure
Emotional stress
Abrupt discontinuation of drug therapy
Abuse of aerosol medication
Ingestion of β-adrenergic blockers:
Contraindication to asthma!! Blocks part of response to airway.
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24
Q

Clinical manifestations of status asthmaticus result from..

A

Increased airway resistance from edema
Mucous plugging
Bronchospasm
Respiratory acidosis

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25
Explain status asthmaticus.
As attack severity ↑, work of breathing ↑, patient tires, and it is harder to overcome the ↑ resistance to breathing Ultimately the patient deteriorates to hypercapnia and hypoxemia
26
What are complications of status asthmaticus?
Pneumothorax Acute cor pulmonale: right sided heart failure Drop in O2 saturation (SaO2) Severe respiratory muscle fatigue leading to respiratory arrest Both indicating mechanical ventilation.
27
What is Acute cor pulmonale?
Right sides heart failure
28
What is the usual result of death?
Death is usually result of respiratory arrest or cardiac failure
29
What are some diagnostic studies for asthma?
Detailed history and physical exam Pulmonary function tests and Peak flow monitoring -Withhold bronchodilators for 6-12 hours before the tests. Chest x-ray: acute attack ABGs: Done if they are in an acute attack Oximetry Allergy testing Blood levels of eosinophils Sputum culture and sensitivity
30
What is CBC with differential?
tells with all different types of WBC and others cells.
31
Education?
Start at time of diagnosis Integrate through care Greatest method Asthma education is really hard for the lay person to understand.
32
What is the most important thing a client should be educated on?
Make sure they know the name of the medicine. That is the most important. Tell them what each dose does.
33
What are the desired therapeutic outcomes?
Control or eliminate symptoms Attain normal lung function Restore normal activities Reduce or eliminate exacerbations and side effects of medications
34
Collaborative care for an Acute asthma episode?
Respiratory distress Treatment depends upon severity and response to therapy Severity measured with flow rates O2 therapy should be started and monitored with pulse oximetry or ABGs in severe cases Inhaled β-adrenergic agonists by metered dose inhaler or nebulizer Corticosteroids indicated if response is insufficient
35
Collaborative care for mild intermittent and mild persistent asthma?
Avoid triggers of acute attacks Premedicate before exercising Choice of drug therapy depends on symptom severity
36
Collaborative care for Status asthmaticus?
Most therapeutic measures are the same as for acute episode ↑ in frequency and dose of bronchodilators IV corticosteroids are administered every 4-6 hours Continuous monitoring of patient is critical (cardiac) IV magnesium sulfate is given as a bronchodilator Supplemental O2 is given by mask or nasal cannula for 90% O2 saturation Arterial catheter may be used to facilitate frequent ABG monitoring IV fluids are given due to insensible loss of fluids
37
Acute asthma episode collaborative treatment
Can be severe enough to require intubation and mechanical ventilation Used when there is no response to other treatment Louder wheezing may occur in airways that are responding to therapy With progression normal breath sounds return and wheezing subsides
38
What are the 3 types of anti-inflammatory drugs?
Corticosteroids Anti-IgE Leukotriene modifiers
39
What is important about corticosteroids?
Suppress inflammatory response Inhaled form is used in long-term control Systemic form to control exacerbations and manage persistent asthma Reduce bronchial hyperresponsiveness Decrease mucus production Taken on a fixed schedule
40
What is important about Anti-IgE?
↓ circulating free IgE levels Prevents IgE from attaching to mast cells, preventing release of chemical mediators Subcutaneous administration every 2-4 weeks
41
What are adverse effects of corticosteroids?
Oropharyngeal candidiasis, hoarseness, and a dry cough are local side effects of inhaled drug
42
What are important factors regarding Leukotriene modifiers?
Blocks action of leukotrienes (potent bronchoconstrictors). Have both bronchodilator and anti-inflammatory effects Not indicated for acute attacks Used for prophylactic and maintenance therapy Take at bedtime
43
What are the 3 types of bronchodilators?
β2-adrenergic agonists Methylxanthines Anticholinergics
44
β2-adrenergic agonists?
Effective for relieving acute bronchospasm Onset of action in minutes and duration of 4-8 hours Prevent release of inflammatory mediators from mast cells Not for long-term use Rescue medications
45
What is important about methylxanthines?
Less effective long-term bronchodilator Alleviates early phase of attacks but has little effect on bronchial hyperresponsiveness Narrow margin of safety – instruct pt on s/s of toxicity (N/V, seizures, insomnia) Avoid caffeine Make sure in therapeutic range!
46
What is important about anticholinergics?
Block action of acetylcholine Usually used in combination with a bronchodilator Most common side effect is dry mouth
47
What is the preferred route for asthma drugs?
Inhalation of drugs is preferable to avoid systemic side effects
48
What are the 3 main types of inhalers?
MDIs (metered dose inhalers), DPIs(dry powder inhalers), and nebulizers are devices used to inhale medications
49
What is a benefit of DPIs?
DPI (dry powder inhaler) requires less manual dexterity and coordination
50
Nonprescription Combination Drugs should be..
Should be avoided in general
51
Epinephrine can..
Epinephrine can increase heart rate and blood pressure | Ephedrine stimulates CNS and cardiovascular system
52
What should consist of a nursing assessment?
1) Health Hx 2) ABG's 3) ung function test 4) Physical Exam
53
What should a nurse find out when asking about Health Hx?
especially of precipitating factors and medications
54
What consists of a physical exam?
Use of accessory muscles Diaphoresis: Sweaty Cyanosis Lung sounds
55
What are some nursing diagnosis?
Ineffective airway clearance Anxiety Deficient knowledge
56
What are the overall goals for asthma pts?
1) Maintain greater than 80% of personal best PEFR(peak expiratory flow rate) or FEV (Forced expiratory volume) 2) Have minimal symptoms 3) Maintain acceptable activity levels 4) No recurrent exacerbations of asthma or decreased incidence of asthma attacks 5) Adequate knowledge to participate in and carry out management
57
What should the nurse teach the pt to avoid?
Teach patient to identify and avoid known triggers Use dust covers Use of scarves or masks for cold air
58
What medications should an asthma pt avoid?
Avoid aspirin or NSAIDs
59
What should the nurse promote a sick client with asthma to do?
Prompt diagnosis and treatment of upper respiratory infections and sinusitis may prevent exacerbation
60
How much fluids should an adult with asthma intake?
Fluid intake of 2 to 3 L every day
61
How many minutes should a pt take β-adrenergic agonist before exercise?
10 to 20 minutes prior to exercising
62
What happens to VS during an asthma attack?
Lung sounds (Wheezing or non) Respiratory rate (increased) Pulse (increased) BP (Increased)
63
What emotion should a nurse try and lower in asthma clients?
An important goal of nursing is to ↓ the patient’s sense of panic Stay with patient Encourage slow breathing using pursed lips for prolonged expiration Position comfortably
64
What type of breathing should a nurse promote?
Encourage slow breathing using pursed lips for prolonged expiration
65
What is crucial knowledge and steps home nurses must promote?
1) Must learn about medications and develop self-management strategies 2) Patient and health care professional must monitor responsiveness to medication 3) Patient must understand importance of continuing medication when symptoms are not present
66
What should a nurse teach a client about exercise?
Exercise within limits of tolerance
67
What should a nurse teach a client about bronospasms?
Seek medical attention for bronchospasm or when severe side effects occur
68
Is nutrition important with asthma clients?
Maintain good nutrition
69
What should asthma pts measure daily?
Peak flow should be monitored daily and a written action plan should be followed according to results of daily PEFR (peak expiratory flow rate)
70
What does peak flow correlate with?
This correlates with FEV.
71
What do asthmatics frequently do not perceive?
Asthmatics frequently do not perceive changes in their breathing
72
What is the green zone?
Usually 80 to 100% of personal best | Remain on medications
73
What is yellow zone?
Usually 50-80% of personal best Indicates caution Something is triggering asthma
74
What is the red zone?
50% or less of personal best Indicates serious problem Definitive action must be taken with health care provider

NU 350 Therap Interv: Care Ind Fam (Exam 1) (8 decks)

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