Asthma Overview and Management
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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?

    <p>Monitor peak flow meter readings</p> Signup and view all the answers

    Which environmental factor is a known trigger for asthma exacerbations?

    <p>Windy and dry conditions</p> Signup and view all the answers

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

    <p>Cyanosis and lethargy</p> Signup and view all the answers

    What is the role of bronchodilators in asthma management?

    <p>To dilate airways and ease breathing</p> Signup and view all the answers

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

    <p>Assessment of lung function</p> Signup and view all the answers

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

    <p>Short acting bronchodilators</p> Signup and view all the answers

    What is a characteristic feature of emphysema?

    <p>Destruction of alveolar walls</p> Signup and view all the answers

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

    <p>Cor pulmonale</p> Signup and view all the answers

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

    <p>Limited activity level</p> Signup and view all the answers

    Which type of pneumonia is the most common infectious cause?

    <p>Bacterial pneumonia</p> Signup and view all the answers

    What is one major cause of COPD?

    <p>Smoking</p> Signup and view all the answers

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

    <p>To decrease inflammation</p> Signup and view all the answers

    What complication is associated with hypoxemia in COPD?

    <p>Cor pulmonale</p> Signup and view all the answers

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

    <p>Pulmonary acquired pneumonia (PAP)</p> Signup and view all the answers

    How does airway inflammation affect COPD?

    <p>Narrowing of the airway lumen</p> Signup and view all the answers

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

    <p>Weight loss</p> Signup and view all the answers

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

    <p>Pursed lip breathing</p> Signup and view all the answers

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

    <p>Pneumonia due to long-term bed rest</p> Signup and view all the answers

    What physical examination finding may suggest COPD?

    <p>Distended neck vein on expiration</p> Signup and view all the answers

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

    <p>Improve pulmonary ventilation</p> Signup and view all the answers

    Which of the following describes the pathophysiology of COPD?

    <p>Destruction of air sac walls and mucus overproduction</p> Signup and view all the answers

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

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

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

    <p>Elderly and immunocompromised individuals</p> Signup and view all the answers

    What is the most common mode of transmission for pneumonia?

    <p>Droplet infection from respiratory secretions</p> Signup and view all the answers

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

    <p>Broncho-pneumonia</p> Signup and view all the answers

    What physiological change occurs in the alveoli during pneumonia?

    <p>Exudates accumulate leading to consolidation</p> Signup and view all the answers

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

    <p>Hypertension</p> Signup and view all the answers

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

    <p>Thickening of alveoli and consolidation</p> Signup and view all the answers

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

    <p>Breathing in respiratory droplets</p> Signup and view all the answers

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

    <p>Peripheral neuropathy</p> Signup and view all the answers

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

    <p>Wear a surgical mask</p> Signup and view all the answers

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

    <p>Lung compliance improvement</p> Signup and view all the answers

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

    <p>Bilateral infiltrates</p> Signup and view all the answers

    What physiological change occurs during the early stages of ARDS?

    <p>Refractory hypoxemia</p> Signup and view all the answers

    Which symptom is associated with ARDS and indicates inadequate oxygenation?

    <p>Cyanosis</p> Signup and view all the answers

    What is a potential direct cause of ARDS?

    <p>Aspiration</p> Signup and view all the answers

    Which of the following best describes the pathophysiology of ARDS?

    <p>Diffuse alveolar damage</p> 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.

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