ASTHMA.pptx

ASTHMA ASTHMA a chronic inflammatory disorder of the airways leading to recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning widespread but variable airflow obstruction that is usually reversible, either spontaneously...

ASTHMA ASTHMA a chronic inflammatory disorder of the airways leading to recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning widespread but variable airflow obstruction that is usually reversible, either spontaneously or with treatment RISK FACTORS (PREDISPOSING) GENETICS Atopy, the genetic predisposition to develop an allergic (immunoglobulin E [IgE]–mediated) response to common allergens GENDER RISK FACTORS (ASTHMA TRIGGERS) Immune Response RTI Allergens Nose and Sinus Problems Exercise Drugs and Food Additives Air Pollutants GERD Occupational Factors Psychologic Factors  EXPOSURE TO ALLERGENS EARLY-PHASE RESPONSE LATE-PHASE RESPONSE Response Phase in Asthma Early- can occur within 30 to 60 minutes phase after exposure to an allergen or irritant. Response Late- Symptoms recur 4 to 6 hours after the early response phase because of the influx of many Response inflammatory cells Response Phase in Asthma Patient may develop Late- symptoms again or worsening of symptoms phase occurs in about 50% of Respon individuals with asthma bronchoconstriction with se symptoms persists for 24 hours or more  EXPOSURE TO ALLERGENS EARLY-PHASE RESPONSE LATE-PHASE RESPONSE Airway Remodeling structural changes in the bronchial wall resulting from chronic inflammation progressive loss of lung function occurs that is not prevented or fully reversed by therapy include fibrosis of the sub-epithelium, smooth muscle hypertrophy of the airways, mucus hypersecretion, continued inflammation, and angiogenesis (proliferation of new blood vessels) individuals have persistent asthma and limited response to therapy Clinical Manifestations Wheezing (upon exhalation) Cough (particularly at night and in the early morning) Dyspnea (breathlessness; creates a feeling of suffocation) Chest tightness after exposure to a precipitating factor or trigger Expiration may be prolonged (1:3 or 1:4) Clinical Manifestations usually sits upright or slightly bent forward Use of the accessory muscles of respiration Anxiety Signs of hypoxemia restlessness, anxiety inappropriate behavior, and increased pulse and blood pressure (BP) Clinical Manifestations (Severe Asthma) may have no audible wheezing Inspiratory & expiratory wheezing becomes difficult to speak in complete sentences RR (>30 breaths/min) Use of accessory muscles Hyperresonance Clinical Manifestations (Severe Asthma) Severely diminished or absent breath sounds (“silent chest”) Respiratory acidosis Clinical Manifestations (cough variant asthma ) Cough (only symptom) Non-productive cough Secretions (maybe thick, tenacious, white, gelatinous mucus) DIAGNOSTIC TESTS Pulmonary Function Tests (bedside spirometry) can be used to determine the reversibility of bronchoconstriction (using bronchodilators) and thus establish the diagnosis of asthma PEFR is measured using their own peak flow meter When PFTs are scheduled, ask the patient to stop taking any bronchodilator medications for 6 to 12 hours before the tests. can be done before and after the administration of a bronchodilator to determine the degree of the response DIAGNOSTIC TESTS Pulmonary Function Tests positive response to the bronchodilator is an increase of more than 200 mL and an increase of more than 12% between pre-administration and post-administration values DIAGNOSTIC TESTS chest x-ray Hyperinflation and may reveal other complications of asthma such as mucoid impaction, pneumothorax, or atelectasis (acute attack) Allergy skin testing some value to determine sensitivity to specific allergens Blood Studies elevated serum eosinophil count and elevated serum IgE levels (suggestive of atopy) DIAGNOSTIC TESTS Oximetry Niox Mino (point of care device) measures fractional exhaled nitric oxide (FENO) Nitric oxide levels are increased in the breath of people with asthma and decreased with oral and inhaled corticosteroid and leukotriene treatment may be used to assess a patient’s adherence to therapy or to determine if he or she needs more anti-inflammatory medication Arterial Blood Gas Respiratory Alkalosis (early) Respiratory Acidosis (late)  MEDICAL MANAGEMEN T NURSING MANAGEMENT Giving Nebulization 1. The patient is placed in an upright position that allows for most efficient breathing to ensure adequate penetration and deposition of the aerosolized medication. 2. The patient must breathe slowly and deeply through the mouth and hold inspirations for 2 or 3 seconds. 3. Deep diaphragmatic breathing helps ensure deposition of the medication. Instruct the patient to breathe normally in between these large forced breaths to prevent alveolar hypoventilation and dizziness. 4. After the treatment instruct the patient to cough effectively. COMPLICATIONS Severe Asthma PR >120 Exacerbations Accessory muscles in the neck dyspneic at rest are straining to lift the chest wall Patient speaks in words, not Agitation sentences D/T dyspnea sitting forward PEFR (40% of personal best or < 150 L/min) RR >30 Neck vein distention COMPLICATIONS Life-Threatening Asthma Exacerbations too dyspneic to speak perspire profusely drowsy or confused Breath sounds may be difficult to hear, and no wheezing is apparent Peak flow (PEFR) less than 25% of the personal best Bradycardia Bradypnea (close to respiratory arrest)