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139 Cards in this Set
- Front
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What is asthma?
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a chronic inflammatory disorder of the airways in which many cells play a role
ex: mast cells eosinophils T lymphocytes a complex disorder involving biochemical, immunologic, infectious, endocrine, and psychologic factors |
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In children that are susceptible, inflammation causes recurrent episodes of?
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wheezing
breathlessness chest tightness cough (occurs esp. at night or in the early morning) |
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Asthma episodes can be associated with airflow limitation or obstruction that is?
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reversible either spontaneously or with treatment
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The inflammation also causes an increase in bronchial __________ to a variety of stimuli.
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hyperresponsiveness
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The four categories of asthma are?
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mild intermittent
mild persistent moderate persistent severe persistent |
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The mild intermittent category has the least number of?
frequency or intensity until the last category of? |
symptoms...symptoms increase in?
severe persistent asthma |
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Asthma is the most common chronic disease of?
school absences...and is responsible for a major portion of pediatric admissions to the? |
childhood...is the primary cause of?
ER and hospital |
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What is the strongest predictor for developing asthma?
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IgE-mediated response to common aeroallergens
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What is atopy?
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the genetic predisposition for the development of an IgE-mediated response to common aeroallergens
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20% to 40% of children with asthma have no evidence of?
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allergic disease
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What contributes to increased airway reactivity in asthma?
bronchospasm and obstruction |
inflammation...so antiinflammatory agents are the key component in treating asthma....another important component of asthma is?
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What mechanisms are responsible for the obstructive symptoms in asthma?
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inflammation and edema of
the mucuous membranes accumulation of tenacious secretions from mucous glands, and spasm of the smooth muscle of the bronchi and bronchioles which decreases the caliber of bronchioles |
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Asthma Severity Classification in Children 5 Years of Age and Older: Clinical Features Before Treatment or Adequate Control
Step 1: Mild Intermittent Asthma |
Symptoms less than twice
weekly Nighttime symptoms less than 2 times monthly PEF or FEV1 is greater than or equal to 80% of predicted value PEF variability less than 20% |
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Asthma Severity Classification in Children 5 Years of Age and Older: Clinical Features Before Treatment or Adequate Control
Step 2: Mild Persistent Asthma |
Symptoms greater than 2 times
weekly, but less than one time a day Nighttime symptoms greater than 2 times a month PEF or FEV1 is greater than 80% of predicted value PEF variability 20% to 30% |
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Asthma Severity Classification in Children 5 Years of Age and Older: Clinical Features Before Treatment or Adequate Control
Step 3: Moderate Persistent Asthma |
Daily symptoms
Nighttime symptoms greater than 1 night per week PEF or FEV1 is greater than 60% to less than 80% of predicted value PEF variability greater than 30% |
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Asthma Severity Classification in Children 5 Years of Age and Older: Clinical Features Before Treatment or Adequate Control
Step 4: Severe Persistent Asthma |
Continual symptoms
Frequent nighttime symptoms Peak expiratory flow (PEF) or forced expiratory volume in 1 second (FEV1) is less than or equal to 60% of predicted value PEF variability greater than 30% |
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Triggers tending to precipitate or aggravate asthmatic exacerbations include?
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Allergens
Outdoor: trees, shrubs, weeds, grasses, molds, pollens, air pollution spores Indoor: dust or dust mites mold, cockroach antigen Irritants: tobacco smoke, wood smoke, odors, sprays Exposure to occupational chemicals Exercise Cold air Changes in weather or temperature Environmental change: moving to new home, starting new school, etc. Colds and infections Animals: cats, dogs, rodents horses Medications: aspirin, nonsteroidal antiinflam- matory drugs (NSAIDS), antibiotics, B-blockers Strong emotions: fear, anger, laughing, crying Conditions: GERD, tracheoesophageal fistula Food additives: sulfite preservatives Foods: nuts, milk/dairy products <Endocrine factors: menses, pregnancy, thyroid disease> |
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Nursing Alert!
Airflow is determined by what 5 factors? |
airway lumen size
degree of bronchial wall edema mucus production smooth muscle contraction muscle hypertrophy |
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Pathophysiology of asthma?
airway resistance to airflow...because the bronchi normally dilate and elongate during inspiration and shorten on expiration, the respiratory difficulty is more pronounced during what phase of respiration? higher and higher lung volumes...so the person with asthma fights to inspire or expire sufficient air? CO2 retention hypoxemia respiratory acidosis possible respiratory failure |
smooth muscle arranged in spiral bundles around the airway causes narrowing and shortening of the airway, which significantly increases what?
expiratory phase...increased resistance in the airway causes forced expiration through the narrowed lumen...the volume of air trapped in the lungs increases as airways are functionally closed at a point between the alveoli and the lobar bronchi. The trapping of gas forces the individual to breathe at higher or lower lung volumes? inspire...this causes fatigue, decreased respiratory effectiveness, and increased oxygen consumption...the inspiration occurring at higher lung volumes hyper- inflates the alveoli and reduces the effectiveness of the cough...as the severity of obstruction increases, there is a reduced alveolar ventilation with what 4 results? |
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Clinical manifestations of asthma?
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COUGH:
hacking, paroxysmal, irritative, and nonpro- ductive becomes rattling and productive of frothy, clear gelatinous sputum RESPIRATORY-RELATED SIGNS: shortness of breath prolonged expiratory phase audible wheeze may have a malar flush and red ears lips deep, dark red color may progress to cyanosis of nail beds or circumoral cyanosis restlessness apprehension sweating may be prominent as the attack progresses older children may sit upright with shoulders in a hunched-over position, hands on the bed or chair, and arms braced may speak with short, panting broken phrases CHEST: hyperresonance on percussion coarse, loud breath sounds wheezes throughout lung fields prolonged expiration crackles generalized inspiratory and expiratory wheezing; increasingly high pitched WITH REPEATED EPISODES: barrel chest elevated shoulders use of accessory muscles of respiration facial appearance: flattened malar bones, circles beneath the eyes, narrow nose, prominent upper teeth |
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What are the classic manifestations of asthma?
upper respiratory infection...when does the first attack frequently occur? respiratory infection...what might some children experience at the front of the neck or over the part of the back just before an attack? |
dyspnea
wheezing coughing however...children may experience symptoms that range from acute episodes of shortness of breath, wheezing, and cough followed by a quiet period to a relatively continuous pattern of chronic symptoms that fluctuate in severity... an attack may develop gradually or appear abruptly and may be preceded by what kind of infection? between ages 3 and 8 years...in infancy an attack usually follows what kind of infection? a prodromal itching |
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Interpreting Peak Expiratory Flow Rates
What does green (80% to 100% of personal best) indicate? |
signals all clear...asthma is under reasonably good control...no symptoms are present, and the routine treatment plan for maintaining control can be followed
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Interpreting Peak Expiratory Flow Rates
What does yellow (50% to 79% of personal best indicate)? |
signals caution..asthma is not well controlled...an acute exacerbation may be present...maintenance therapy may need to be increased...call the practitioner if the child stays in this zone
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Interpreting Peak Expiratory Flow Rates
What does red (below 50% of personal best) mean? |
signals a medical alert...severe airway narrowing may be occurring...a short-acting bronchodilator should be administered...notify the practitioner if the peak expiratory flow rate (PEFR) does not return immediately and stay in yellow or green zones
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Nursing Alert!
Shortness of breath with air movement in the chest restricted to the point of absent breath sounds accompanied by a sudden rise in respiratory rate is an ominous sign indicating? |
ventilatory failure and imminent asphyxia
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What is the diagnosis of asthma primarily based on?
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clinical manifestations
history physical exam lab exams to a lesser extent radiographic exams are used primarily to rule out other diseases and to evaluate coexisting disease |
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What is sufficient evidence to establish a diagnosis of asthma?
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chronic cough in the absence
of infection or diffuse wheezing during the expiratory phase of respiration |
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What are pulmonary function tests (PFTs)?
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a method of evaluating the presence and degree of lung disease, as well as response to therapy
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At what age can spirometry be performed reliably?
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5 or 6 years old
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What does peak expiratory flow rate (PEFR) measure?
peak expiratory flow meter (PEFM) |
measures maximum flow of air that can be forcefully exhaled in 1 second...measured in liters per minute using a what kind of meter?
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How many zones of measurement are typically used to interpret PEFR?
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three
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With the PEFR, each child needs to establish a?
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personal best value during a 2-3 week period when child's asthma is stable...child records PEFR at least twice per day..comparisons are made
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What is skin testing useful in identifying?
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specific allergens...information obtained by the puncture technique correlate better than intracutaneous tests with symptoms and measurements of specific IgE antibody
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What is provocative testing?
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direct exposure of the mucous membranes to a suspected antigen in increasing concentrations, helps to identify inhaled allergens
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What test is used to help identify antigens against various foods and is often useful in determining appropriate therapy?
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radioallergosorbent test (RAST)
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For skin testing, allay childrens' fears by explaining what is done. How many "pricks" are involved?
one prick on the arm to demonstrate how it feels...what is the skin pierced with? a drop of allergen...the child can also count off the number of pricks with the nurse as a distraction...for intradermal skin injection, what can be as a topical anesthetic which reduces or eliminates pain without altering test results |
a series of 8 on each site, for a total of 30 tests...very young, anxious patients may benefit from?
a stylet rather than a regular needle and syringe...what is then placed on the site? EMLA |
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What creatures are one of the most frequently identified in children allergic to inhalants?
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house dust mites
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The most important method to eliminate dust mites is to keep the humidity in the house?
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lower than 50% which is the level below which dust mites do not survive
(other allergins are cockroaches, mouse |
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What can be used to help eliminate triggers of an asthmatic attack?
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dehumidifiers
a/c |
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What two classes are asthma medications categorized into?
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long-term control meds
(preventer meds) quick-relief meds (rescue meds) |
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Define long-term meds (preventer meds)?
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achieve and control inflammation
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Define quick-relief meds (rescue meds)?
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treats symptoms and exacerbations
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How are many of the asthma meds given?
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by inhalation with a nebulizer or a low-metered dose inhaler (MDI)
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What should the metered-dose inhaler (MDI) always be attached to when an inhaled corticosteroid is administered?
to prevent yeast infections in the mouth...spacers are also important for children having a difficult time with inhaler technique |
spacer...what is the purpose?
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Most inhalers use ____ ______
instead of chlorofluorocarbons in order to protect the ozone layer. |
dry powder
(these are breath activated; inhale quickly and deeply) |
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If infants and very young children are having difficulty with inhalers, they can receive med through an?
normally with mouth open to provide direct route to trachea |
nebulizer...med mixed with saline and nebulized with compressed air...how should the patient breathe?
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How are corticosteroids (antiinflammatory drugs) used?
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treats reversible airflow
obstruction controls symptoms reduces bronchial hyper- reactivity in chronic asthma |
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How may corticosteroids be administered?
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parenterally
orally inhalation |
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Are oral meds metabolized fast or slow?
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slowly
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What is the onset of action of oral meds?
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up to 3 hours after administration
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What is the peak effectiveness of oral meds?
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occurs within 6-12 hours
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How may oral systemic meds by given?
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for short periods of time
ex: 3- or 10-day bursts to control PERSISTENT or SEVERE PERSISTENT asthma |
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What are the long-term adverse effects of oral meds?
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osteoporosis
hypertension Cushing syndrome impaired immune mechanisms hypothalamic-pituitary- adrenal suppression |
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What are inhaled steroids used for?
MILD or MODERATE PERSISTENT asthma |
long-term prevention of
symptoms suppression, control, and reversal of inflammation these meds have few side effects (cough, dysphonia, oral thrush)...which category do these drugs help long-term? |
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A decreased risk of death from asthma can be achieved by?
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regular use of low-dose inhaled corticosteroids
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Use of inhaled corticosteroids at low doses DOES NOT have long-term significant effects on?
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growth
bone mineral density ocular toxicity suppression of adrenal/ pituitary axis |
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How often should hcps monitor growth of children and adolescents who are taking corticosteroids?
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3 to 6 months
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What is cromolyn sodium?
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a nonsteroidal antiinflammatory drug (NSAID) for asthma
has minimal side effects (occasional coughing with powder...may be given via nebulizer or MDI) |
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What is the MOA for cromolyn sodium?
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stabilizes mast cell
membranes inhibits activation and release of mediators from eosinophil and epithelial cells inhibits acute airway narrowing after exposure to exercise cold dry air sulfur dioxide |
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What is nedocromil sodium?
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asthma maintenance drug
has both antiallergic and antiinflammatory properties and few side effects |
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What are some b-adrenergic agonists that are used for treatment of acute exacerbations and for prevention of exercise-induced bronchospasm?
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albuterol
metaproterenol terbutaline |
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The b-adrenergic agonists can be given via?
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inhalation
oral preparations parenteral preparations |
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which form of b-adrenergic med has a more rapid onset...inhaled or oral?
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inhaled
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What are the troublesome systemic side effects inhalation of b-adrenergic drugs reduces?
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irritability
tremor nervousness insomnia |
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What is the most that inhaled b-adrenergic drugs should be taken for acute symptoms?
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not to be taken more than 3 to 4 times daily
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What is salmterol (Serevent)?
added to anti-inflammatory therapy and used for long-term prevention of symptoms, esp. nighttime symptoms, and exercise-induced bronchospasm |
a long-acting bronchodilator that is used twice per day...what is it used for?
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What is methylxanthines, principally theoplylline?
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prevents asthma attacks
relieves symptoms bronchodilator central respiratory stimulant increases respiratory muscle contractility third line agent and not necessary for treating asthma exacerbations may be taken sustained-release oral form, IV, IM, orally.. rectally is seldom used |
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What levels can theophylline toxicity occur at?
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serum levels 20 micrograms/mL or greater
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What are side effects of theophylline?
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nausea
vomiting headache irritability insomnia |
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What are early signs of toxicity?
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nausea
tachycardia irritability seizures and dysrhythmias |
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What levels can a patient who is on theophylline experience seizures and dysrhythmias?
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greater than 30 micrograms/mL
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What are 3 therapeutic managements of asthma?
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allergen control
drug therapy leukotriene modifiers exercise chest physiotherapy hyposensitization |
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What are leukotriene modifiers?
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mediators of inflammation that cause increases in airway hyperresponsiveness...block inflammatory and bronchospasm effects
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What are some examples of leukotriene modifiers?
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zafirlukast
Zileuton montelukast sodium |
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Leukotriene modifers are an oral LONG-TERM therapy (not acute)given in combination with what other 2 meds?
MILD PERSISTENT ASTHMA |
b-agonists
steroids this combination provides long-term control and prevention of symptoms in what category of asthma? |
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What new leukotriene med is used for the treatment of 12 yo and older?
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omalizumab (Xolair)
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What is the MOA of omalizumab?
many patients with asthma are atopic (genetically predispositioned) and possess specific IgE antibodies to allergens responsible for airway inflammation |
a monoclonal antibody that blocks the binding of IgE to mast cells which eventually inhibits the inflammation that is associated with asthma....this MOA works well as an adjunct to treatment of asthma because?
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How is omalizumab (Xolair) administered?
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once or twice a month via subcutaneous injection
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Omalizumab (Xolair) is an effective therapy for which kind of patients?
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patients with symptomatic MODERATE to SEVERE allergic asthma that is poorly controlled with INHALED CORTICOSTEROIDS
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What is exercise-induced bronchospasm (EIB)?
5 to 10 minutes after stopping activity...and stops when? |
acute, reversible, usually self-terminating airway obstruction that develops during or after vigorous activity...reaching peak when?
another 20 to 30 minutes |
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What symptoms do patients with EIB display?
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cough
shortness of breath chest pain or tightness wheezing endurance problems during exercise |
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What is required to make the necessary diagnosis of EIB?
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an exercise challenge test in a laboratory
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EIB is rare in what type of sports?
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ones requiring short bursts of energey
ex: baseball sprints gymnastics skiing |
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EIB is more common in what type of sports?
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those that involve endurance
ex: soccer basketball distance running |
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Why is swimming well-tolerated by EIB children?
it prolongs expiration and increases the end-expiratory pressure within the respiratory tract (essentially pursed-lip breathing) |
they are breathing air fully saturated with moisture and because of the type of breathing required in swimming....and why is exhaling under water beneficial?
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Asthmatic children and those around them are fearful of the child's participation in strenuous activities and can be taught that?
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exercise is beneficial and can be participate in with minimal difficulty, provided the asthma is under control...each case should be evaluated individually
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What meds will usually permit full participation in strenuous exercise?
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b-adrenergic agents
cromolyn sodium |
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What does chest physiotherapy (CPT) include?
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breathing exercises
physical training |
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What do these therapies help produce?
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physical and mental relax-
ation improve posture strengthen respiratory musculature develop more efficient patterns of breathing |
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Breathing exercises (chest physiotherapy) are beneficial because?
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they prevent overinflation and improve efficiency of cough
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When is chest physiotherapy (CPT) not recommended?
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during acute, uncomplicated exacerbations of asthma
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The controversial hyposensitization is not recommended for what kind of allergens?
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ones that can be eliminated
ex: foods drugs animal dander |
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Hyposensitization
What is the initial dose composed of? the size of the skin reaction...how is it injected? weekly intervals until a maximum tolerance is reached...and then what is the maintenance dose? 5- or 6-week intervals during off season for seasonal allergens....if successful, the treatment continues for a minimum of how many years? acquired immunity...and if symptoms recur, then what? |
the offending allergen(s)...and it's based on what?
subcutaneously...how often is it increased? given at 4-week intervals...this may be extended to what intervals? three years and then stopped....if no symptoms appear, what is assumed? treatmentn is reinstituted |
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Nursing Alert!
Hyposensitization injections should be administered only when? anaphylactic reaction |
with emergency equipment and meds readily available in the event of what reaction?
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What percentage of children continue to have asthma through puberty and into adulthood?
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two-thirds
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Since frequency of asthma attacks are so diverse among each individual, the prognosis for control or disappearance of symptoms varies....the variation goes from rare infrequent attacks to those who are constantly?
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wheezing and some are subject to status asthmaticus
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What 3 criteria offer a greater liklihood of a poor prognosis?
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when symptoms are severe and
numerous symptoms have been present for a long time family history of allergy |
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Even children who outgrow their exacerbations continue to have what?
decreased lung function |
airway hyperresponsiveness
and cough as adults....furthermore, airway hyperresponsiveness in adults appears to be associated with? |
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Death from asthma is rare, the death rate has
_______ over the years. adolescent, with greatest increase in 10 to 14 years...no data explains why |
increased...which age group is most vulnerable?
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What are some of the risk factors for asthma deaths (increasing incidence in 10 to 14 years old)?
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early onset
frequent attacks difficult-to-manage disease adolescence history of respiratory failure psychologic problems (refusal to take meds) dependency on or misuse of drugs (high use) presence of physical stigmata (barrel chest intercostal retractions), abnormal pulmonary function tests |
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What is status asthmaticus?
sympathomimetics |
a condition in which children continue to display respiratory distress despite vigorous therapeutic measures, especially use of which category of meds?
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How does status asthmaticus develop?
pneumonia...which influences duration and treatment of attack...patient usually seen in ER, admitted to pediatric ICU |
gradually or rapidly, and often occurs with complicating conditions, for example?
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Nursing Alert!
Status asthmatic is a medical emergency that can result in what? |
respiratory failure and death if untreated
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How does the child act if in severe respiratory distress?
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sweats profusely
remains sitting upright refused to lie down |
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What might lead one to think a child with status asthmaticus is seriously hypoxic and ER bound?
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a child who suddenly becomes agitated, or an agitated child who suddenly becomes quiet
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What is therapy for status asthmaticus?
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improvement of ventilation
correction of dehydration and acidosis treatment of any concurrent infection |
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How is the bronchospasm from status asthmaticus relieved?
corticosteroids (either orally or IV)...if the child doesn't respond to these 2 drugs, then give what med? subcutaneous terbutaline...what other nursing interventions are administered? |
giving aerosolized short-acting b2-agonists (either intermittently or continuously) along with what other med?
subcutaneous epinephrine (1:1000 at a dose of 0.01 mL/kg with a maximum dose of 0.3 mL, or what other med can be given? IV fluids NPO except liquids monitor child for pulmonary edema |
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Nursing Alert!
With status asthmaticus, dehydration should be correctly slowly because? |
overhydration can increase accumulation of interstitial pulmonary fluid to exacerbate small airway obstruction
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With status asthmaticus, nurse monitors and manages what? (4)
pulse oximetry blood gases serum electrolytes |
correction of dehydration
acidosis hypoxia electrolyte imbalance she monitors this with what tools? (3) |
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With status asthmaticus, what is administered to humidify oxygen?
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nasal prongs
hood facemask |
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Because oxygen is a stimulus for respiration, what might high levels cause?
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significantly depressed respirations
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What are the recommendations of asthma state concerning antibiotics?
fluids and medications...what is administered via MDI? |
antibiotics should not be used to treat acute attacks except when a bacterial infection resulting from another condition such as pneumonia or sinusitis is present...as the attack subsides, what is given orally (2)?
adrenergic agonists...and then discharge and followup care made |
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Physical assessment of asthma involves the same observations and techniques described in the general discussion of assessment what?
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respiratory infection
chest (Chapter 7) |
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Characteristics of respiratory involvement are evaluated by? (3)
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chest configuration
posturing type of breathing |
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The goals for the child with asthma and the family are?
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Child will not experience an
asthmatic episode "" exhibit improved ventilatory capacity "" maintain optimal health "" not develop complications "" will engage in normal activities for age "" will receive appropriate support and education regarding the disease and its management |
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One goal of asthma management is avoidance of?
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an exacerbation
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Parents are cautioned to avoid exposing a sensitive child to?
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excessive cold
excessive wind other weather extremes smoke sprays other irritants foods that provoke irritation |
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Nurses should advise parents to use other analgesics/antipyretics besides ______ because 2% to 6% of children with asthma are sensitive to it.
NSAIDS and tartrazine (yellow dye number 5, a common food coloring) |
aspirin...including aspirin in Pepto Bismol...children with aspirin-induced asthma may also be sensitive to what meds?
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Most children can recognize prodromal symptoms well before an attack which is about how many hours?
rhinorrhea cough low-grade fever irritability itching (esp. in front of the neck and chest), apathy anxiety sleep disturbance abdominal discomfort loss of appetite |
6 hours and start therapy...objective signs that parents may observe include which symptoms?
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Educating the child about use of equipment that delivers oxygen is a nursing priority as only 7% know what they're doing. For instance, the MDI device delivers meds how?
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directly to the airways...so teach the child to breathe slowly and deeply
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MDI spacers receive the med from the MDI, and THEN the child inhales the med...what else do spacers do?
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prevent yeast infections in the mount when inhaled corticosteroids are administered via an MDI
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The overuse of B2-agonists is dangerous. Avoid OTC drugs due to toxicity.
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okay
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What type of immunization is important to receive annually in patients with persistent asthma?
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influenza
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Nebulizers must be kept absolutely clean to decrease chances of contamination with?
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bacteria and fungi
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What are important breathing tips for children?
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promote diaphragmatic
breathing side expansion improved mobility of chest wall |
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Play techniques that can be used for younger children to extend their expiratory time and increase expiratory pressure include what?
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blowing cotton balls
Ping-Pong ball on a table blowing a pinwheel blowing bubbles preventing a tissue from falling by blowing it against the wall |
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Define pursed-lip breathing?
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involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse...it's like blowing through a straw
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<What is the classification of Vanceril?
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corticosteroid (glucocorticoid)
can be used as an inhaler or nasal spray...if used as a nasal spray, have patient clear nose of any secretions before application to increase absorption |
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<What is the classification of Atrovent?
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anticholinergic...
blocks SNS and causes bronchial smooth muscles to produce bronchodilatio... decreases pulmonary secretions |
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<Are Vanceril and Atrovent appropriate for use during an asthma attack?
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no...they're NOT fast-acting...they're used to prevent attacks from beginning
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<Physician orders Albuterol 3 mg nebulization treatment STAT. What is the rationale for this order?
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It's rapid-acting. It's a beta2 agonist and works to open the airways.
Clients may use it before engaging in physical activity that might cause an attack...preventative med |
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<If a patient's O2 sat was 88%, why was oxygen therapy not ordered?
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need to open airway first...the oxygen won't help if airway not open
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<What does nurse need to include when teaching about metered-dose inhaler?
2-3 seconds...breathe in slowly in about two or three seconds and then hold for about 10 seconds |
how to hold head slightly
back to open airway gently shake inhaler keep lips closed while administering when pressing down on inhaler, exhale, then push down to deliver dose and then inhale for how long? |
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<How long should patient wait between puffs with metered-dose inhaler?
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1 minute
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<Should patient clean metered-dose inhaler?
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yes...rinse with warm water only
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<If taking steroid in a metered-dose inhaler, what mouth care should be taken?
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rinse out mouth to avoid infection...Candida infection
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<If the patient has a bronchodilator and a steroid-inhaled medication ordered, the bronchodilator, of course, should be administered first or second?
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first...because it will open up the bronchioles and then take the steroid.
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<How does nurse evaluate patient's ability to use a metered dose inhaler effectively?
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demonstrate coordination and use of MDI
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<What is the function of the peak expiratory flow meter (PEFM)?
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demonstrates the highest rate that patient can blow air out of the lungs in one second...used to assess changes in pulmonary functions...remove things from mouth and close lips tightly around mouthpiece and keep tongue away from mouthpiece...blow out as hard and quickly as they can and they note the number by the marker...repeat this 3 times and wait 30 seconds in between each time...don't want the patient hyperventilating and passing out...record the highest of 3 readings and do this at the same time everyday...keep a chart....take it 15 minutes AFTER taking medications...establish rate during a 2-3 week period before when not having asthmatic problems...establish peak and watch progression of it...as it gets lower, then they know that they need to change dosage on medication...a peak expiratory flow rate of 15-20% below the expected value for their age, gender, size is common for clients with asthma. Do this twice daily to assess symptoms and adjust drugs to manage inflammation.
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