Caring for Patients with Asthma (2021-2022) PDF

Caring for patient with Asthma Prepared by Assist.Prof.Dr/ Asmaa Said Ali Medical Surgical Nursing Department Faculty of Nursing Ain Shams University 2021-2022 Introduction: Among adults, women are 62% more likely to have asthma than me...

Caring for patient with Asthma Prepared by Assist.Prof.Dr/ Asmaa Said Ali Medical Surgical Nursing Department Faculty of Nursing Ain Shams University 2021-2022 Introduction: Among adults, women are 62% more likely to have asthma than men. It is a disruptive disease, affecting school and work attendance, occupational choices, physical activity, and general quality of life. Definition: Asthma is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea Risk Factors: General factors: A. Female gender. B. Exposure to indoor and outdoor allergens. C. Occupational sensitizers. D. Respiratory infections. - Air pollution. E. Active/passive smoking. - Obesity. F. Others (diet, small size at birth).  Pathophysiology: Asthma is characterized by reversible and diffuse airway inflammation. The inflammation leads to obstruction from the following: i: Swelling of the membranes that line the airways. m Contraction of the bronchial smooth muscle that encircles the airways (bronchospasm),. Increased mucus production, which diminishes airway size. Mast cells, when activated, release several chemicals called mediators such as: histamine and prostaglandins Common triggers for asthma symptoms airway irritants as > air pollutants, > cold, > heat, > weather changes, > strong odors as perfumes, smoke), > exercise, >» stress or emotional upsets, >» Sinusitis with postnasal drip, medications, » viral respiratory tract infections, > gastroesophageal reflux. >» Extreme emotions as Crying. - Laughing. Anger. - Fear. Panic. - Stress. - Anxiety >» Drugs as Aspirin, - B-Adrenergic blockers and > Non-steroidal anti-inflammatory drugs. Clinical Manifestations: Asthma attacks often occur at night or early in the morning. The three most common symptoms of asthma are cough VVVV WV dyspnea, wheezing. Generalized chest tightness. There may be generalized wheezing, first on expiration, that requires effort and becomes prolonged. Diaphoresis (excessive abnormal sweating). VVVV Tachycardia. A widened pulse pressure may occur. Central cyanosis (a late sign of poor oxygenation). Classifications of Asthma: Asthma can be classified as 1.Mild Intermittent characterized by Symptoms less than 2 times a week — Asymptomatic and normal PEF (peak expiratory flow) between exacerbations 2. Mild Persistent characterized by Symptoms >2 times a week but status asthmaticus, > respiratory failure, > pneumonia, > atelectasis. Waa: Muscle relaxed a Muscle tightens Normal lining &. Normal amount of mucus NORMAL LUNG ASTHMATIC LUNG shutterstock.com - 1862260579  Medical Management Goals of Asthma Treatment > Prevent chronic and troublesome symptoms in the night, in the early morning, or after exertion) Maintain near-normal pulmonary function WV Maintain normal activity levels VV Prevent recurrent exacerbations of asthma minimize the need for emergency department VV Provide optimal pharmacotherapy with minimal or no adverse effects Meet patients’ and families’ expectation of and V satisfaction with asthma care pharmacologic therapy Two general classes of asthma medications 1. long-acting medications to achieve and maintain control of persistent asthma as corticosteroids and long acting beta blockers 2. quick-relief medications for immediate treatment of asthma symptoms and exacerbations as Short-acting beta.- adrenergic agents Types of medications used for asthma : 1. Bronchodilators to relax the muscles around airway 2. Anti-inflammatory medicines reduce the swelling and mucus production inside the airways as corticosteroid or steroids 3. Combination Medicines that combine inhaled bron 4. Anticholinergics prevent muscle bands from tightening around the airways. The medicine can be inhaled using a metered-dose inhaler or nebulized from a solution. This type of medicine is typically used in combination with an inhaled corticosteroid and should be taken daily for long-term control. They are often added on to treatment to relieve cough, mucus production, wheeze or chest Tightness 5.antibiotic or an anti-viral The immediate nursing care of the patient with asthma depends on the _ severity of the symptoms. "If mild degree asthma, patient treated successfully in outpatient clinic. " If acute and severe asthma, patient needs hospitalization and ICU. e An important aspect of care is a calm approach, as patients and family are frightened because of dyspnea. Nursing management > The nurse assesses the patient’s respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs. The nurse obtains a history of allergic reactions to medications before administering medications identifies the patient’s current use of medications. V WV administers medications as prescribed and monitors the patient’s responses to those medications. >» Fluids may be administered if the patient is dehydrated, >» antibiotic agents may be prescribed if the patient has an underlying respiratory infection. > |f the patient requires intubation because of acute respiratory failure, >» the nurse assists with the intubation procedure, » continues close monitoring of the patient, » keeps the patient and family informed about procedures. promoting home and community-based care Patient teaching is a critical component of care for the patient with asthma the patient needs to understand the following: >» The nature of asthma as a chronic inflammatory disease >» The definition of inflammation and bronchoconstriction » The purpose and action of each medication > Triggers to avoid, and how to do so > Proper inhalation technique > Howto perform peak flow monitoring Death from asthma is associated with several risk factors, including the following: ® Past history of sudden and severe exacerbations ® Prior endotracheal intubation for asthma ® Prior admission to the intensive care unit for an asthma exacerbation ® Two or more hospitalizations for asthma within the past year ® Three or more emergency care visits for asthma in the past year Excessive use of short-acting beta-adrenergic inhalers (more than two canisters per month) ® Recent withdrawal from systemic corticosteroids ® Comorbidity of cardiovascular disease or COPD ® Psychiatric disease ® Low socioeconomic status Thank you