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Questions and Answers
What characterizes the early-phase response of asthma?
What characterizes the early-phase response of asthma?
Which of the following is NOT a common trigger for asthma?
Which of the following is NOT a common trigger for asthma?
What is a potential consequence if airway inflammation in asthma is not resolved?
What is a potential consequence if airway inflammation in asthma is not resolved?
Which medication group is primarily used for long-term control of asthma?
Which medication group is primarily used for long-term control of asthma?
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What assessment finding may indicate a severe asthma attack?
What assessment finding may indicate a severe asthma attack?
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What is the primary reason for using a spacer or nebulizer for those who have difficulty using an MDI?
What is the primary reason for using a spacer or nebulizer for those who have difficulty using an MDI?
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Which of the following is a crucial nursing intervention during acute asthma management?
Which of the following is a crucial nursing intervention during acute asthma management?
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When should a patient take beta-adrenergic agonists if they are also using corticosteroids?
When should a patient take beta-adrenergic agonists if they are also using corticosteroids?
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What is an important aspect of asthma management that requires patient education?
What is an important aspect of asthma management that requires patient education?
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Which of the following should be emphasized during patient teaching regarding asthma triggers?
Which of the following should be emphasized during patient teaching regarding asthma triggers?
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Study Notes
Asthma Definition
- Reactive airway disease
- Chronic inflammatory lung disease
- Inflammation causes varying degrees of obstruction in the airways
- Asthma is reversible in early stages
Asthma Symptoms
- Narrowed airway (limited airflow)
- Tightened airway muscles
- Inflamed/thickened airway wall
- Mucus buildup
Asthma Triggers
- Allergens
- Exercise
- Respiratory Infections
- Nose and sinus problems
- Drugs and food additives
- GERD
- Emotional stress
Asthma Pathophysiology
- Bronchospasm
- Airway inflammation
Asthma Early-Phase Response
- Peaks 30-60 minutes post-exposure, subsides 30-90 minutes later
- Primarily bronchospasm
- Increased mucus secretion, edema, and tenacious sputum
- Wheezing, cough, chest tightness, and dyspnea
Asthma Late-Phase Response
- Characterized primarily by inflammation
- Histamine and other mediators sustain a cycle increasing airway reactivity
- Hyper-responsiveness to allergens and other stimuli
- Airway resistance leads to air trapping in alveoli and hyperinflation of the lungs
- Untreated inflammation could cause irreversible lung damage
Factors Causing Airway Obstruction in Asthma
- Swollen mucosa; muscle spasm
- Mucus buildup
Asthma Summary of Pathophysiology Features
- Reduction in airway diameter
- Increased airway resistance
- Mucosal inflammation
- Constriction of smooth muscle
- Excess mucus production
Asthma Clinical Manifestations
- Unpredictable and variable
- Recurrent episodes of wheezing, breathlessness, cough, and tight chest
- Prolonged expiration (inspiration-expiration ratio of 1:2 to 1:3 or 1:4)
- Asymptomatic between attacks with normal or near-normal lung function
- Wheezing may be unreliable in gauging severity (severe attacks can be silent)
- "Silent chest" is an ominous sign of impending respiratory failure
- Difficulty breathing, suffocation
- Restlessness, anxiety, inappropriate behavior, increased pulse and blood pressure
- Pulsus paradoxus (systolic blood pressure drop during inspiration)
Asthma Complications
- Status asthmaticus: severe, life-threatening attack refractory to usual treatment
Asthma Diagnostic Studies
- Detailed history and physical exam
- Pulmonary function tests
- Peak flow monitoring
- Chest X-ray
- ABGs
- Oximetry
- Allergy testing
- Blood levels of eosinophils
- Sputum culture and sensitivity
Asthma Collaborative Care - Education
- Start at time of diagnosis
- Integrated into every step of clinical care
Asthma Collaborative Care - Self-Management
- Tailored to patient needs
- Emphasis on evaluating outcomes in terms of patient's perception of improvement
Asthma Collaborative Care - Acute Asthma Episode
- O2 therapy, monitored with pulse oximetry or ABGs (severe cases)
- Inhaled β-adrenergic agonists (spacer or nebulizer)
- Corticosteroids if initial response is insufficient
- Therapy continues until the patient is breathing comfortably, wheezing is gone, and pulmonary function study results are near baseline values
Asthma Collaborative Care - Status Asthmaticus
- Similar to acute treatment, but with increased frequency and dose of bronchodilators
- Continuous β-adrenergic agonist nebulizer therapy
- IV corticosteroids
- Continuous O2 monitoring to achieve 90%
- IV fluids for insensible fluid loss
- Mechanical ventilation if there's no response to treatment
Asthma Drug Therapy - Long-term Control Medications
- Achieve and maintain control of persistent asthma
Asthma Drug Therapy - Quick-relief Medications
- Treat symptoms of exacerbations
Asthma Drug Therapy - Bronchodilators
- β-adrenergic agonists (e.g., albuterol, salbutamol [Ventolin])
- Act in minutes, last 4 to 8 hrs
- Short-term relief of bronchoconstriction
- Treatment of choice in acute exacerbations
- Useful in preventing exercise-induced bronchospasm
- Overuse may cause rebound bronchospasm; frequent use indicates poor control
- Longer-acting bronchodilators (8-12 or 24 hrs) for nocturnal asthma
Asthma Drug Therapy - Anti-inflammatory Drugs
- Corticosteroids (e.g., beclomethasone, budesonide)
- Suppress inflammatory response
- Inhaled form for long-term control; systemic form for exacerbation
- Do not block immediate response to allergens, irritants, or exercise
- Block late-phase response to subsequent bronchial hyperresponsiveness; inhibit mediator release from macrophages and eosinophils
- Mast-cell stabilizers (e.g., cromolyn, nedocromil): inhibit histamine release, late-phase response; long-term administration prevents and reduces bronchial hyper-reactivity
- Leukotriene modifiers (e.g., montelukast): potent bronchoconstrictors; may cause airway edema and inflammation; bronchodilator and anti-inflammatory effects
Asthma Patient Teaching Related to Drug Therapy
- Correct administration of drugs is crucial for success
- Some patients may require spacers or a nebulizer for MDI
- DPI are less demanding
- Inhalers cleaned with warm water
- β-agonists before steroids, if co-administered
Nursing Management - Nursing Diagnoses
- Ineffective airway clearance
- Anxiety
- Ineffective therapeutic regimen management
Nursing Management - Planning
- Normal or near-normal pulmonary function
- Normal activity levels
- No recurrent exacerbations of asthma or reduced incidence of attacks
- Adequate knowledge to participate in and carry out management
Nursing Management - Health Promotion
- Teach patients to identify and avoid known triggers (dust, cold air, aspirin/NSAIDs)
- Desensitization for allergens
- Prompt diagnosis and treatment of upper respiratory infections and sinusitis
- Fluids (2–3 L/day)
- Adequate nutrition and sleep
- β-adrenergic agonist 10-20 minutes before exercise
Nursing Management - Nursing Implementation - Acute Interventions
- Monitor respiratory and cardiovascular systems (lung sounds, respiratory rate, pulse, blood pressure)
- ABGs, pulse oximetry, FEV and PEFR, work of breathing
- Assess the patient's response to therapy
Nursing Management - Nursing Implementation - Interventions
- Administer oxygen
- Bronchodilators
- Chest physiotherapy
- Medications (as ordered)
- Ongoing patient monitoring
Nursing Management - Nursing Implementation - Patient Teaching/Goals
- Understand medications, develop self-management
- Monitor responsiveness to medication
- Continue medication even when symptoms are not present
- Seek medical attention for bronchospasm or severe side effects
- Maintain good nutrition
- Exercise within limits of tolerance
- Measure peak flow at least daily
- Counseling may be indicated to resolve problems
- Relaxation therapies assist in respiratory muscle relaxation and reduced rate
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