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18 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Asthma Statistics
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22 million adults have asthma
It is a chronic disease of childhood 9 million children diagnosis with asthma and 80-90% have first symptoms before 5 years of age. Asthma is attributed to Nearly 2 million ER visits 25 million lost work days annually 15 million lost school days annually Over $16 billion in health care costs annually |
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Asthma defined
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A chronic inflammatory disease of the airways, alveoli are not involved
Intermittent, reversible airflow limitation Airways are in a persistent state of inflammation but have periods when asthma is “quiet” or subacute |
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Triggers of Asthma
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Allergens: Seasonal or Nonseasonal
Air Pollution Occupational exposure Respiratory infections Animals Exercise Drug/Food additives GERD Nose/sinus problems Stress Emotions Asthma Gene |
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Pathophysiology of Asthma
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Chronic inflammation from exposure to allergens or irritants
Inflammatory mediators are released which cause: Vascular congestion Edema formation Production of thick, tenacious sputum Bronchoconstriction Thickening of airway walls Increase bronchial hyperresponsiveness |
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Clinical Manifestations
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Coughing
Wheezing Dyspnea Chest tightness Tachycardia with tachypnea Prolonged expiratory phase Anxiety/apprehension Use of accessory muscles retractions |
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Diagnostic Tests
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Pulmonary function test
Peak expiratory flow reading or P E F R CXR ABGs Early Late Allergy testing Sputum C&S CBC with differential O2 saturation monitoring |
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Collaborative Care for Acute Attack
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Oxygen therapy
Pharmcalogic therapy Bronchodilators Beta-agonists Anticholinergics Methylxanthine Leukotriene modifiers Corticosteroids Nebulizer treatments SaO2 monitoring ABGs Hydration Positioning Relaxation therapy Possible intubation and assisted ventilation |
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Nursing Assessment
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SUBJECTIVE DATA includes
Current symptoms with duration of attack Identification of trigger for attack Frequency of attacks Measures instituted to relieve attack Meds and allergies Level of distress OBJECTIVE DATA includes Vital signs Positioning of client Respiratory excursion Use of accessory muscles Lung sounds Color Presence of sputum Oxygen saturation PEFR Labs/ABGs |
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Nursing Interventions
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Place client in high fowler’s or orthopneic position
Administer oxygen and medications Nebulizer treatments with humidification Hydration Stay with client and provide reassurance Calm enviroment Breathing techniques Assist with ADLS Rest periods Monitor PEFRs Correct administration of inhalers Client/family education |
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Personal Action Plan and Peak Expiratory Flow Reading (PEFR)
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Green Zone: ALL CLEAR
Yellow Zone: TAKE ACTION Red Zone: MEDICAL ALERT This is an emergency! |
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Prevention of Asthma Attacks
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Focus is on Client and Family Education
Allergy proof home Avoid allergies and environmental triggers Proper hydration, nutrition and rest Avoidance of cold air Correct administration of meds/inhalers especially with children Daily PEFR Develop a written asthma action plan Keep a diary related to asthma attacks Early treatment of URIs and sinusitis |
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Corticosteroids
(actions and drugs) |
suppress inflammatory response by decreasing the synthesis and release of inflammatory mediators
reduce bronchial hyperresponsiveness not used to treat acute attack can be given IV, orally and inhaled Common inhaled steroids Flovent Pulmicort & Azmacort Via MDI or DPI |
1) administer after bronchodilators to facilitate transport of med to distal airways
2) some of the side effects if given systemically are hyperglycemia, weight gain, moonface, mood swings, osteoporosis 3) all corticosteroids must be gradually discontinued (tapered off) 4) inhaled corticosteroids must be given for 1-2 wks. before therapeutic effects are seen 5) to reduce the risk of fungal infections rinse the mouth after using the inhaler and maintain good oral hygiene; if using as MDI may want to use a spacer to decrease risk |
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Mast Cell Stabilizers
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-nonsteroidal anti-inflammatory drugs
-prevents bronchoconstriction in response to inhaling cold air -used for preventing asthma attacks, not to treat acute attack -used for seasonal asthma Intal Tilade |
1) few side effects; possible throat irritation
2) gargle or sip water to decrease throat irritation with neb treatment 3) several weeks may be required before a beneficial effect is noted. |
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Bronchodilators
Beta-Adrenergic Agonists |
are the treatment of choice for acute bronchial asthma
produce smooth muscle relaxation and bronchodilation onset within mins. effective for 4-8 hours Short acting drugs: Proventil (Albuterol), Xopenex, Alupent long acting drugs: Serevent, Foradil Via MDI or DPI |
1) not first choice for long term control
2) should not be used alone: added to the treatment regime 3) too frequent use indicates poor asthma control 4)use with caution in clients with hypertension, dysrhtymias, cardiovascular disease or diabetes 5)common side effects are tachycardia, tremors nervousness, palpitations, BP changes, nausea and hypokalemia |
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Methylxanthines
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-produce bronchodilation through relaxation of bronchial smooth muscle
- are CNS stimulants;produce adverse effects of nervousness, insomnia and tremors - Theophylline, Theo-Dur , Amimophylline - can be given IV, po,elixir |
1) monitor effect closely when administered concurrently with other meds.
2)narrow margin of safety and high potential for toxicity 3)not used as frequently because of use of inhalers 4) monitor for signs of toxicity: anorexia, nausea, vomiting, cardiac dysrhythmias and seizures are early manifestations. 5)administer with meals to reduce gastric irritation 6) do not smoke while using drug 7) monitor of serum levels is vital; therapeutic blood levels (10-20mcg/ml) 8) Aminophylline is incompatible with many other intravenous drugs. Use separate line or flush line with normal saline before and after administering |
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Anticholinergics
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block bronchoconstriction of parasympathetic nervous system
Atrovent onset is 30 mins to 1 hr. and is effective for 4-6 hours MDI Spiriva is long acting DPI |
1) usually used in combination with other
2) provide ice chips or hard candy to relieve dry mouth 3)common adverse side effects are dry mouth, flushing, nausea, vomiting, headache |
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Leukotriene Modifiers
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-interferes with inflammatory process by suppressing effects of leukotrienes
-used for prophylaxis/maintenance therapy in adults and children over 12 -not to be used for acute attacks Singular Accolate |
1) well tolerated
2) these drugs inhibit some liver enzymes, affecting metabolism of warfarin and theophylline. Monitor prothrombin and theophylline blood levels. 3) administer at least 1 hour before or 2 hours before meals 4) monitor liver enzymes, these drugs may be toxic to liver |
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Combination Inhalers
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Advair Diskus (DPI): an inhaled corticosteroid and a long acting beta adrenergic
Combivent, DuoNeb (MDI) albuterol and atrovent both are bronchodilators but mechanism for action is different Symbicort (MDI) an inhaled steroid and a long acting beta adrenergic |
1) used for maintenance therapy if they are not responding to low/medium dosed of inhaled corticosteroids
2) clients must be careful not to overuse |
