asthma

Question 1

what is forced expiratory volume? (FEV1)

Answer 1

volume of air forcibly blown out in ONE second after full inspiration

Question 2

what is forced vital capacity? (FVC)

Answer 2

volume of air that can be forcefully blown out after full inspiration?

Question 3

FEV1/FVC?

Answer 3

percentage of your forced vital capacity that is expelled in one second

Question 4

why do we do pulmonary function tests?

Answer 4

to assess respiratory function
to stage COPD
to determine whether obstructive or restrictive condition
to determine if treatment is effective
may be used in combination with pt history, ABGs, chest x-ray for diagnosis

Question 5

restrictive lung conditions?

Answer 5

when lung expansion is difficult

• pregnancy, pleural effusions, arthritis
• pneumonia, obesity, ascites
• intrinsic disorders (pneumonia, fibrosis, lobectomy)
• look at FVC (how much air you can take in and expire)

Question 6

obstructive lung conditions?

Answer 6

more difficult to exhale
-narrowing of the airways (COPD, asthma)
-FEV1 and FEV1/FVC
low in COPD and used to stage progression of disease
low in asthma exacerbation but improved significantly after receiving bro

Question 7

asthma pathophysiology?

Answer 7

inflammation from various factors —-> hyperresponsiveness of airways and airflow limitation

Question 8

predisposing factors of asthma?

Answer 8

atopy, female gender

Question 9

casual factors of asthma?

Answer 9

exposure to indoor and outdoor allergens

occupational sensitizers

Question 10

contributing factors of asthma?

Answer 10

resp infections, air pollution, active/passive smoking

other (diet, small size at birth)

Question 11

risk factors for exacerbations of asthma?

Answer 11

allergens 
resp infections 
exercise and hyperventilation 
weather changes 
exposure to sulfer dioxide 
exposure to food, additives, medications

Question 12

symptoms of asthma (4 cardinal!)

Answer 12

• chest tightness
• dyspnea
• cough
• wheezing

Question 13

airway changes in asthmatic airway?

Answer 13

wall inflamed and thickened

Question 14

airway changes in asthmatic airway during attack?

Answer 14

wall inflamed and thickened
air trapped in alveoli
tightened smooth muscles

Question 15

inflammatory factors to asthma?

Answer 15

work, resp infections, allergens

Question 16

irritants of asthma?

Answer 16

exercise, cold air, stress and emotions, strong odors, temp changes

Question 17

other triggers of asthma?

Answer 17

food additives, gastric ulcers, pollutants, medications

Question 18

how is asthma different from other obstructive lung disease?

Answer 18

• reversible and responds to intervention

- ppl may also have symptom free period where they do not have acute exacerbations

Question 19

signs and symptoms of asthma?

Answer 19

COUGH- most common and fisrt
dyspnea, wheezing, chest tightness (4 cardinal!!!!)
-may be worse at night or early in AM
-possibly due to circadian variations

Question 20

signs and symptoms of asthma exacerbation?

Answer 20

may begin abruptly
-often preceeded by increasing symptoms over previous few days
increased effort with expiration
diaphoresis
tachycardia
severe hypoxia rare: life threatening
peripheral cyanosis or severe bronchospasm: EMERGENCY!! intubation and treated accordilngly

Question 21

indoor irritants?

Answer 21

detergent, fabric softener, smoke, pet hair

Question 22

outdoor irritants?

Answer 22

cool air, pollen, dust

Question 23

complications of asthma?

Answer 23

status asthmaticus
resp failure
pneumonia

Question 24

medication management of asthma?

Answer 24

pharm
management of exacerbation
peak flow monitoring

Question 25

quick relief meds for asthma?

Answer 25

short-acting beta adrenergic agonists

Question 26

long-acting control meds for asthma?

Answer 26

``` inhaled corticosteroids long acting beta2 adrenergic agonists anticholinergics xanthines leukotriene modifiers ```

Question 27

goals for asthma care

Answer 27

be able to participate in ADLs, including exercise and other physical activity with little to no interference have normal or near-normal pulmonary function have their asthma under control experience as few side effects from asthma medication as possible while taking the lowest dose of med required possess the knowledge and skills necessary to participate in management of their asthma

Question 28

nursing management

Answer 28

- asthma education - environmental control - self-monitoring and action plans - monitor resp status (severity of symptoms, breath sounds, peak flow, O2 sats, VS)

Question 29

most chronic disease of childhood?

Answer 29

is asthma!!! | -for most it is disruptive too!

Question 30

why is there obstruction in asthma?

Answer 30

- swelling of membranes that line the airways (mucosal edema) - reducing airway diameter - contractions of bronchial smooth muscle (further narrowing-bronchospasm) - increased mucus production, may plug the bronchi - alveoli hyperinflate

Question 31

some pt may have subbasement membrane fibrosis...

Answer 31

airway remodelling, occurs with chronic inflammation, irreversible airflow limitation

Question 32

key cells in inflammation in asthma

Answer 32

mast cells, neutrophils, eosinophils, lymphocytes

Question 33

mediators released by mast cells?

Answer 33

histamine, bradykinin, prostaglandins, leukotrienes. increase blood flow, vasoconstriction, attraction of WBC, bronchoconstriction

Question 34

ALPHA adrenergic stimulation-

Answer 34

bronchoconstriction

Question 35

BETA 2 adrenergic stimulation-

Answer 35

bronchodilation

Question 36

symptoms of exercise induced asthma?

Answer 36

maximal symptoms during exercise, absence of nocturnal symptoms -sometimes only description of "choking sensation"

Question 37

assessment and diagnostics of asthma?

Answer 37

family, environmental, occupation history - must determine periodic symptoms of airflow obstruction - during acute episodes: sputum and blood tests may disclose eosinophils, ABGs, IgE if allergy

Question 38

prevention of asthma

Answer 38

- tests to identify what precipitates symptoms - avoid causative agents - knowledge is key to quality asthma care

Question 39

complications of asthma?

Answer 39

-status asthmaticus, resp failure, pneumonia, atelectasis

Question 40

management of asthma exacerbation?

Answer 40

early treatment and education oxygen supplementation quick acting beta-adrenergic meds, systemic corticosteroids

Question 41

what is peak flow monitoring?

Answer 41

instruct proper technique, giving maximal effort, monitor peak flow for 2-3 weeks green= 80-100%, yellow 60-80%, red= less than 60%

Question 42

status asthmaticus=

Answer 42

severe and persistent asthma that does not respond to conventional therapy - little or no warning, can progress fast to asphyxiation - infection, anxiety, nebulizer use, dehydration, increased adrenergic blockage, nonspecific irritants may contribute to these episodes

Question 43

status asthmaticus may be precipitated by?

Answer 43

hypersensitivity to aspirin

Question 44

pathophyisology of status asthmaticus?

Answer 44

- basic characteristics of asthma, most common scenario is severe bronchospasm with mucous plugging leading to asphyxia - ventilation-perfusion abnormality---> hypoxemia and resp alkalosis followed by resp acidosis

Question 45

clinical manifestations of status asthmaticus?

Answer 45

same as in severe asthma (laboured breathing, prolonged exhalation, engorged neck veins, wheezing)

Question 46

sign of impending resp failure?

Answer 46

wheezing may dissapear

Question 47

assessment and diagnostics of status asthmaticus?

Answer 47

- PFT - ABGs - resp alkalosis most common, rising PaCO2 freq danger sign of resp failure

Question 48

medical management of status asthmaticus?

Answer 48

- close monitoring and reevaluation - emergency setting: intially SABA and then systemic corticosteroids - magnesium sulfate for SM relaxation - death is possible!!

Question 49

nursing management of status asthmaticus?

Answer 49

main focus is to actively assess airway and pt response to treatment -prepared for next intervention if needed consantly monitor for 12-24 hrs or until until control -skin turgor for dehydration -IV fluids as prescribed -BP and cardiac monitor continuously -room should be quiet -nonallergenic pillow