Asthma Overview and Management

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Questions and Answers

What triggers an acute reaction in asthma patients?

Dietary habits

Sleep patterns

Mast cell activation (correct)

Genetic factors

Which of the following is NOT a common clinical manifestation of asthma?

Wheezing

Chest tightness

High blood pressure (correct)

Cyanosis

In the staging of acute asthma attacks, which stage is characterized by marked wheezing and respiratory distress at rest?

Stage IV

Stage II (correct)

Stage III

Stage I

What is a primary objective of nursing management in asthma cases?

Monitor peak flow meter readings Signup and view all the answers

Which environmental factor is a known trigger for asthma exacerbations?

Windy and dry conditions Signup and view all the answers

What indicates a severe acute asthma attack (Stage IV)?

Cyanosis and lethargy Signup and view all the answers

What is the role of bronchodilators in asthma management?

To dilate airways and ease breathing Signup and view all the answers

What is the expected outcome in an asthma patient after using a peak flow meter?

Assessment of lung function Signup and view all the answers

Which treatment is specifically used to relieve bronchospasm in COPD patients?

Short acting bronchodilators Signup and view all the answers

What is a characteristic feature of emphysema?

Destruction of alveolar walls Signup and view all the answers

What complication arises due to pulmonary hypertension and can lead to right-sided heart failure in COPD patients?

Cor pulmonale Signup and view all the answers

Which of the following is NOT a primary symptom of chronic bronchitis?

Limited activity level Signup and view all the answers

Which type of pneumonia is the most common infectious cause?

Bacterial pneumonia Signup and view all the answers

What is one major cause of COPD?

Smoking Signup and view all the answers

What is the primary purpose of corticosteroid therapy in managing COPD?

To decrease inflammation Signup and view all the answers

What complication is associated with hypoxemia in COPD?

Cor pulmonale Signup and view all the answers

Which of the following is NOT a classification of pneumonia according to its source?

Pulmonary acquired pneumonia (PAP) Signup and view all the answers

How does airway inflammation affect COPD?

Narrowing of the airway lumen Signup and view all the answers

What is a common side effect associated with phosphodiesterase-4 inhibitors such as Roflumilast?

Weight loss Signup and view all the answers

What breathing pattern might be observed in a patient with COPD?

Pursed lip breathing Signup and view all the answers

In the context of pneumonia, what does 'Hypostatic pneumonia' refer to?

Pneumonia due to long-term bed rest Signup and view all the answers

What physical examination finding may suggest COPD?

Distended neck vein on expiration Signup and view all the answers

Chest physiotherapy is primarily used to improve what aspect of respiratory health in patients?

Improve pulmonary ventilation Signup and view all the answers

Which of the following describes the pathophysiology of COPD?

Destruction of air sac walls and mucus overproduction Signup and view all the answers

What is the primary pathogen identified in community-acquired pneumonia?

Streptococcus pneumoniae Signup and view all the answers

What patient demographic is considered at higher risk for developing ventilator associated pneumonia?

Elderly and immunocompromised individuals Signup and view all the answers

What is the most common mode of transmission for pneumonia?

Droplet infection from respiratory secretions Signup and view all the answers

Which type of pneumonia is characterized by inflammation originating in one or more bronchi?

Broncho-pneumonia Signup and view all the answers

What physiological change occurs in the alveoli during pneumonia?

Exudates accumulate leading to consolidation Signup and view all the answers

Which of the following underlying disorders is NOT commonly associated with pneumonia?

Hypertension Signup and view all the answers

What is the result of the migration of white blood cells (WBCs) to the alveoli during pneumonia?

Thickening of alveoli and consolidation Signup and view all the answers

Which of the following is NOT a potential cause for aspiration pneumonia?

Breathing in respiratory droplets Signup and view all the answers

What is a significant side effect of Ethambutol that requires monitoring?

Peripheral neuropathy Signup and view all the answers

What precaution should be taken for a patient with active TB when leaving their room?

Wear a surgical mask Signup and view all the answers

Which of the following is NOT a characteristic of Acute Respiratory Distress Syndrome (ARDS)?

Lung compliance improvement Signup and view all the answers

Which finding on a chest X-ray would indicate the presence of ARDS?

Bilateral infiltrates Signup and view all the answers

What physiological change occurs during the early stages of ARDS?

Refractory hypoxemia Signup and view all the answers

Which symptom is associated with ARDS and indicates inadequate oxygenation?

Cyanosis Signup and view all the answers

What is a potential direct cause of ARDS?

Aspiration Signup and view all the answers

Which of the following best describes the pathophysiology of ARDS?

Diffuse alveolar damage Signup and view all the answers

Study Notes

Asthma

Airway disorder characterized by hyper-reactivity to various stimuli - trigger
Broncho-constriction, mucosal edema, mucus production
Inflammation
Acute reaction to some trigger is reversible with treatment
Mast cells release substances that cause inflammation and constriction
Broncho-constriction or bronchospasm
Spasm aggravated by inflammation, mucosal edema and excessive mucus
Precipitating Factors are intrinsic and extrinsic
No cure
Viral infections, especially with infants and young children
Allergies
Cigarette smoke
Smoggy air - smoke from fires
Windy weather - hot and dry
Cold weather
Allergens — Pollen, pet dander, fungi, dust
Respiratory tract infections
Dyspnea — difficulty breathing, Asthma
Cyanosis (black people)
Wheezing
Chest tightness
Cough – chronic cough may be the only symptom
Sputum production
Chest retraction
Hypoxemia- (ABG & pulse ox)
Air trapping leads to Early symptoms and Peak flow - measure the highest airflow during a forced expiration
Measure asthma severity

Staging of the Severity of an Acute Asthma Attack

Stage I (mild)
- Mild Dyspnea
- Diffuse wheezing
- Adequate air exchange
Stage II (moderate)
- Respiratory distress at rest
- Marked wheezing
Stage III (severe)
- Marked respiratory distress
- Cyanosis
- Marked wheezing or absence of breath sounds
Stage IV (respiratory failure)
- Severe respiratory distress, lethargy, confusion

Nursing Management for Asthma

Assess for cyanosis, chest retraction
Assess peak flow meter reading
Vital signs
High fowlers
Oxygen (95-99%)
Bronchodilators
Exercise- warm up, have bronchodilators before exercise sessions.

COPD (Chronic Obstructive Pulmonary Disease)

Two Major Causes of COPD
- Emphysema is characterized by damage to the small, sac-like units of the lung that deliver oxygen into the lung and remove the carbon dioxide
- Loss of elasticity of the lung tissue
- Distention of airspaces & destruction of alveolar walls
"Pink Puffers" hyperventilate to maintain adequate oxygen levels - this prevents hypoxia
Less air flows in and out of the airways because of one or more of the following:
- Airways and air sacs lose their elastic quality
- Walls between many of the air sacs are destroyed
- Walls of the airways become thick and inflamed- tissue scarring leads to narrowing of the airway lumen
- Airways make more mucus than usual, which tends to clog them
Impaired oxygen diffusion leads to hypoxemia
Carbon dioxide elimination is impaired
Complications:
- Right-sided heart failure (Cor pulmonale)
- Atelectasis
- Pneumonia
- Pneumothorax
- Polycythemia
Causes
- Smoking
- Air pollution
- Genetic (hereditary) risk

Chronic Bronchitis (Primary Symptom of COPD)

Chronic cough
Shortness of breath
Increased mucus
Frequent clearing of throat

Emphysema (Primary Symptom of COPD)

Chronic cough
Shortness of breath
Limited activity level
Difficulty of breathing
Coarse crackles

Physical Examination of COPD

Distended neck vein on expiration
The presence of barrel chest, flatted diaphragm
Observe for abdominal breathing
The use of pursed lips breathing and chest movement
Auscultate the chest & listen for musical wheezes characteristics of chronic bronchitis (crackles)
Pink to reddish color related to polycythemia.

Medical Management of COPD

Antibiotics to treat infection
Bronchodilators to relieve bronchospasm, reduce airway obstruction, mucosal edema, and liquefy secretions
Inhaled Anticholinergic drugs such as Aminophylline
- Short acting bronchodilators (Albuterol, Salbutamol)
Chest physiotherapy and postural drainage to improve pulmonary ventilation
Steroid therapy if the patient fails to respond to more conservative treatment
- Decrease inflammation. (oral, IV, inhalation)
- Phosphodiestrace 4 inhibitors (Roflumilast) - reduce the risk of COPD exacerbation by reducing inflammation. Side effects include suicidal tendencies and weight loss.
SURGICAL OPTIONS
- BULLECTOMY

Complications of COPD

Cor pulmonale- enlargement of the right side of the heart due to pulmonary hypertension caused by constriction of the pulmonary vessels in response to hypoxia + polycythemia leads to RIGHT SIDED HEART FAILURE
Pneumonia- caused by prolonged sputum production
Possible pneumothorax- ruptured of air sacs
Atelectasis

Pneumonia

Inflammatory process of the lung parenchyma
Commonly caused by infectious agents
Classification according to causes:
- Bacterial (the most common cause of pneumonia)
- Viral pneumonia
- Fungal pneumonia
- Chemical pneumonia (ingestion of kerosene or inhalation of irritating substance)
- Inhalation pneumonia (aspiration pneumonia)
- Hypostatic pneumonia
Classification according to source:
- Community acquired pneumonia (CAP)
- Health care associated pneumonia (HCAP) ex. Dialysis unit, chemotherapy unit
- Hospital acquired pneumonia (HAP) - 48 hours or more after admission
- Ventilator associated pneumonia (VAP)
- identified pathogens:
  - Streptococcus pneumoniae 20-60%
  - Haemophilus influenzae 3-10%
  - Staphylococcus aureus 3-5%
  - Gram-negative bacilli 3-10%
  - New pathogens: The SARS coronavirus, COVID19 coronavirus, Community-acquired methicillin-resistant Staphylococcus aureus
- Risk factors:
  - Elderly
  - Smoker
  - Children
  - Immunocompromised
  - Post-surgery client
  - Pre-existing disease
classification according to areas involved
- Lobar pneumonia; if one or more lobes is involved
- Broncho-pneumonia; the pneumonic process has originated in one or more bronchi and extends to the surrounding lung tissue
Mode of transmission:
- Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.
- You may breathe some of these germs directly into your lungs (droplets infection).
- You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia).
- Pneumonia occurs in people with certain underlying disorders such as heart failure, diabetes, alcoholism, COPD, AIDS

Pathophysiology of Pneumonia

Streptococci reach the alveoli and lead to inflammation and pouring of an exudates into the air spaces
WBCs migrate to alveoli, the alveoli become more thick due to its filling consolidation, involved areas by inflammation are not adequately ventilated, due to secretion and edema
This will lead to partial occlusion of alveoli and bronchi causing a decrease in alveolar oxygen content
Venous blood that goes to affected areas without being oxygenated and returns to the heart.

Nursing Management of Pneumonia

Airborne precaution + standard precaution - use N95 mask/negative pressure room
When the client leaves the room wear a surgical mask
After 3 weeks of drug treatment client is no longer contagious
Multidrug resistance

Acute Respiratory Distress Syndrome (ARDS)

Severe inflammatory process causing diffuse alveolar damage that results in sudden pulmonary edema
Increasing bilateral infiltrates on chest x-ray, hypoxemia unresponsive to oxygen supplementation and absence of an elevated left atrial pressure, and reduce lung compliance
Interstitial and intra-alveolar edema and hemorrhage
Alveolar consolidation
Pulmonary surfactant deficiency or abnormality
Atelectasis

Etiology of ARDS

Aspiration/drowning
Congestive heart failure
Disseminated intravascular coagulation
Infections (pneumonia)
Inhalation of toxins and irritants
Sepsis (burns)

Pathophysiology of ARDS

Damage to surfactants

Clinical Manifestations of ARDS

Increased heart rate, respiratory rate (alkalosis then acidosis), blood pressure
Substernal/intercostal retractions/cyanosis
Cyanosis leads to refractory hypoxemia (even with high O2)
Difficulty of breathing
Chest assessment findings
- Dull percussion note
- Crackles (pulmonary edema)

Diagnosis of ARDS

Acute onset (developed respiratory distress within 48 to 72 hours )
Bilateral infiltrates on CXR consistent with pulmonary edema
Arterial blood gas reveals decrease PO2 (less than 60mmhg) despite administration of high O2..

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Description

This quiz provides a comprehensive overview of asthma, including its causes, symptoms, and treatments. It covers the physiology of airway disorders and factors that can precipitate asthma attacks. Whether you are studying for a class or seeking to understand asthma better, this quiz is a valuable resource.