Asthma
Terms
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- Asthma definition
-
1. Reactive airway disease that becomes chronic
2. Chronic inflammatory lung disease; inflammation causes varying degrees of obstruction in the airways; causes hyper-responsiveness of airway, mucosal edema, & mucous production.
3. Asthma is reversible in early stages - differs from other obstructio\ve lung diseases
4. Clinical course unpredictable - may alternate between symptom-free periods to acute aeacerbations - Characteristics of asthma (7)
-
Reversible
Wheezing
Chest tightness
Cough
Worse at night
Circadian rhytms involved
Airway obstr. may reverse spontaneously or require intervention. -
1. Highest morbidity of asthma at what ages?
2. The major causes of morbidity and mortality in asthma -
1. 15-24yrs. and younger children.
2. Underdiagnosis and inappropriate therapy -
Physiology of Airway Disease:
1. Controls diameter of airways:
2. ____ stimulation (__nerve and ___receptors) produces bronchoconstriction.
3. ___ stimulation (___receptors in airways) causes bronchodilation.
4. Exercise causes: -
1. Autonomic N.S. contraction & relaxation of smooth muscles
2. Parasympathetic
Vagus
Cholinergic
3. Sympathetic
Beta adrenergic
4. Increased sympathetic stimulation & decreased vagal-mediated constriction.
5. Also have effect on bronchial smooth muscle to increase bronchoconstriction. - Asthma has high morbidity due to: (7)
-
1. Under-diagnosis and inappropriate therapy
2. Limited access to healthcare
3. Inaccurate assessment of severity
4. Delay in seeking help
5. Inadequate medical treatment
6. Non-adherence to prescribed therapy
7. Increase in allergens in the environment - Triggers of Asthma (7)
-
1. Allergens
2. Exercise
3. Respiratory Infections
4. Nose and Sinus problems
5. Drugs and Food Additives
6. Gastroesophageal Reflux Disease
7. Emotional Stress -
1. Mechanism that causes asthma.
2. Strongest predisposing factor to asthma
3. In allergic response, which is exaggerated __ __ __, ___ ___ are released from ___-sensitized mast cells. -
1. unknown
2. Allergies
3. immunoglobulin IgE response, chemical mediators, IgE. - Allergens commonly involved in asthma:
- Animal dander, dust mites, cockroaches, pollens, molds, airway irritants such as air pollutants, cold, heat, weather changes, strong odors or perfumes, and smoke.
-
Exercise-induced asthma (3)
1. Characterized by:
2. Pt. teaching
3. Controlled by: -
1. Characterized by bronchospasm, SOB, coughing, and wheezing
2. When exercising in cold or dry climates, breathing through a scarf or mask may decrease likelihood of symptoms
3. controlled by use of B-adrenergic agonists inhaled 10-20 minutes prior to exercise. -
1. The most common precipitation factor of an acute asthma attack:
2. Inflammation increases:
3. Increased airway responsiveness can last ___after infection -
1. Respiratory infections and associated inflammation.
2. hyperresponsiveness of the bronchial system.
3. 2-8 weeks. -
1. Nose/sinus problems that can trigger asthma include:
2. Sinus probs. are usually related to: -
1. allergic rhinitis and nasal polyps
2. inflammation of the mucous membranes. -
Drug and Food Additive triggers to asthma:
1. Asthma triad
* Wheezing develops in about:
*drug and food additives found in: -
1. nasal polyps, asthma, and sensitivity to aspirin and NSAIDs.
*2hours
*many OTC meds and some foods. - Drug sensitivities in Asthma pts.:
-
1. salicylates (aspirin)
Beta-adrenergic blockers (Inderal, metoprolol)
ACE inhibitors (Acupril) -
1. Beta-adrenergic blockers:
2. ACE inhibitors: -
1. Inhibit adrenergic stimulaiton of the bronchioles and prevent bronchodilation.
2. Produce cough, making asthma symptoms worse. -
1. Affect of food additives on asthma:
2. Food additive asthma reaction occurs in __to__, and is marked by ___.
3. common food additive culprits -
1. Food additives may interfere with prostaglandin metabolic pathways, leading to enhanced production of leukotrienes (potent mediators that can worsen the reaction).
2. 15 minutes - 3 hours
marked by rhinorrhea, N/V, intestinal cramps, and diarrhea.
3. vitamins, wine, beer, some fruits. - GERD trigger in asthma (4)
-
1. Exact mechanism is unknown
2. Aspiration of stomach acid causes vagal stimulation and bronchoconstriction
3. primarly involved in nocturnal asthma
4. patients iwth hiatal hernia, excessive stress, & prior ulcer or reflux history may have GERD as an asthma trigger. - Emotional stress as an asthma trigger (4)
-
1. Psychological factors can worsen the disease process
2. asthma attack caused by any trigger can produce panic and anxiety, which are not unepected during the attack
3. extent of psychologic factors in inducing and continuing acute exacerbation is unknown
4. Female hormone imbalance is also thought to play a role -
1. Intrinsic asthma =___
2. Triggers include: -
1. Nonatopic ashtma
2. URIs, exercise, hyperventilation, cold air, drugs, chemicals, hormones, emotional upsets, airborne pollutants (tobacco smoke) and GERD. -
1. Extrinsic Asthma =___
2. Initiated by:
3. Onset:
4. Attacks related to:
5. ___ or ___ responses -
1. Atopic asthma
2. a type I hypersensitivity reaction
3. in childhood or adolescence - family hx. of atopic allergies such as hay fever, excema
4. exposure to specific allergens
5. early or late phase -
1.Early phase response
2. Late phase response -
Trigger: mast cell-IgE mediators released
1.Characterized by increased mucus production, vascular leakage, and edema.
2. Eosinophils and neutrophils...inflammatory response; air trapping leading to mismatch in ventilation/diffusion; hypoxemia; respiratory acidosis. - Asthma Pathopysiology (5)
-
1. traditionally asthma has been characterized by bronchospasm
2. Inflammation of the airways
3. cellular response
4. chemical mediators
5. bronchoconstriction and bronchodilation -
1. Cells that play a key role in asthma:
2. Chemical mediators do what?
3. Responsible for bronchoconstriciton/dilation (balance gets disrupted) -
1. Mast cells, neutrophils, eosinophils, and lymphocytes
2. increase inflammation
3. Alpha & Beta2-adrenergic receptors located in bronchi. -
Patho. of the early phase response:
1. triggered when:
2. inflammatory mediators cause:
3. Characterized by: -
1. Triggered when IgE receptors on mast cells beneath the bronchial wall are activated by an allergen or irritant.
2. release inflammatory mediators causing:
bronchial smooth muscle constriction
increased vasodilation and permeability
epithelial damage.
3. Increased mucous secretion
edema formation, and increased amounts of tenacious sputum; pt. experiences wheezing, cough, chest tightness, and dyspnea (air hunger) -
1. Early phase peaks in:
2. Winds down _-_ minutes after peaking. -
1. 30-60 minutes
2. 60-90 minutes - Asthma Late Phase Response:(4)
-
1. primarily inflammation
2. histamine and other mediators set up a self-sustaining cycle increasing airway reactivity causing hyperresponsiveness to allergens and other stimule
3. increased airway resistance leads to air trapping in alveoli and hyperinflation of the lungs
4. if air3ay inflammation is not treated or does not resolve, may lead to irreversible lung damage.
Sub-basement remodeling causes irreversible damage. -
1. 3 most common symptoms of asthma:
2. recurrent episodes of
3. Attacks occur when:
4. -
1. cough, dyspnea, wheezing.
2. wheezing, breathlessness, cough, and tight chest.
3. early morning and at night. -
Clinical manifestations of asthma:
1. expiration:
2. Fev1 and PEF
3. between attacks pt. may be:
4. 5 other signs: -
1. may be prolonged from a inspiration-expiration ratio of 1:2 to 1:4.
2. FEV1 (forced expiratory volume in first second) and peak expiratory flow rate are decreased.
3. asymptomatic with normal or near-normal lunf function
4. diaphoresis, tachycardia, widened pulse pressure, hypoxemia and cyanosis. -
1. during an attack pt. will have longer ___,
2. the pt. will use more:
3. cyanosis is a
4. hypoxemia with SaO2 of : -
1. exhalation, shorter inhalations
2. abdominal muscles in breathing effort
3. very late sign
4. 80's or 70's: respond to O2 pretty quickly. -
1. Wheezing is an unreliable sign to gauge severity of asthma attack:
2. difficulty of air movement can create a feeling of suffocation: -
1. sever attacks can have no audible wheezing due to reduction in airflow; "Silent chest" is an ominous sign of impending respiratory failure.
2. Patient may feel increasingly anxious; mobilizing secretions may become difficult. - Examination of the patient during an acute attack usually reveals signs of ___, which are:
- hypoxemia: Restlessness, Increased anxiety, Inapporpriate behavior, Increased pulse and blood pressure; Pulsus paradoxus (drop in systolic BP during inspiratory cycle >10mmHg:significant!, Confusion
-
Classifications of Asthma:
1. Severe Persistent
2. Moderate persistent
3. Mild persistent
4. Mild intermittent -
1. Continual symptoms, limited physical activity, frequent exacerbations.
2. Symptoms daily, exacerbations affect activity, daily use of inhalers.
3. Symptoms >2/week, exacerbations may affect activity
4. Symptoms <2/wk., exacerbations brief -
Stepwise Control:
1. Step 4(Severe Persistent Asthma): Long-Term control - 1. Severe Persistent: Long term control: use daily medications including anti-inflammatory inhaled corticosteroids at a high dose, AND long-acting bronchodilators, either long-acting inhaled beta2-agonists, sustained-release theophyline, or long-acting beta2-agonist tablets, AND Corticosterod tablets or syrup long term (make repeat attempts to reduce systemic steroids and maintain control with high dose inhaled steroids)
-
Stepwise Control:
Step 4 (Severe Persistent) Quick Relief (3) -
1. Short-acting bronchodilator: inhaled beta2-agonists as needed for symptoms.
2. Intensity of treatment iwll depend on severity of exacerbation; see component 3-Managing Exacerbations.
3. Use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term-control therapy. -
Stepwise Control:
Step 1 (Mild intermittent asthma) education -
1. Teach basic facts about asthma
2. Teach inhaler/spacer/holding chamber technizuq
3. discuss roles of medications
4. develop self-management plan
5. develop action plan for when and how to take rescue actions, especially for patients with a history of severe exacerbations.
6. Discuss apporpriate environmental control measures to avoid exposure to known allergens and irritants. -
Stepwise Control:
Step 2 (Mild Persistent asthma) education -
1. Step 1 actions plus:
a. teach self-monitoring
b. refer to group education if available
c. review and update self-management plan -
Stepwise control:
Step 3 (Moderate Persistent) education -
Step 1 actions plus:
a. teach self-monitoring
b. refer to group education if available
c. review and update self-management plan -
Stepwise control:
Step 4 (Severe Persistent asthma) education -
Steps 2 and 3 actions plus:
refer to individual education/counseling. -
Stepwise control for asthma:
Step 3 (Moderate Persistent) Long-term control: -
Daily Medication:
Either anti-inflammatory (inhaled corticosteroid-medium dose) OR Inhaled corticosteroid (low-med. dose) and add a long-acting bronchodilator, especially for nighttime symptoms; either long-acting inhaled beta2-agonist, sustained-release theophylline, or long-acting beta2-agonist tablets.
If Needed: Anti-inflammatory: inhaled corticosteroids (med-high dose) AND Long-acting bronchodilator, especially for nighttime symptoms; either long-acting inhaled beta2-agonist, sustained-release theophylline, or long-acting beta2-agonist tablets. -
Stepwise Control:
Step 3 (Moderate Persistent)
Quick Relief -
1. Short-acting bronchodilator; inhaled beta2-agonists as needed for symptoms.
2. Intensity of treatment will depend on severity of exacerbation; see component 3-Managing exacerbations.
3. use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term control therapy. -
Step 2 (Mild Persistent)
Long Term Control -
One Daily Medication:
1. anti-inflammatory: either inhaled corticosteroid (low doses) or cromolyn or nedocromil (children usually begin with trial of cromolyn or nedocromil).
2. sustained-release theophylline to serum concentration of 5-15 mcg/mL is an alternative, but not preferred, therapy. Zafirlukast or zileuton may also be considered for patients >12 years of age, although their position in therapy is not fully established. -
Step 2 (Mild Persistent)
Quick Relief -
1. Short-acting bronchodilator: inhaled beta2-agonists as needed for symptoms.
2. Intensity of treatment will depend on severity of exacerbation; see component 3-managing Exacerbations.
3. Use of short-acting inhaled beta2-agonists on a daily basis, or increasing use, indicates the need for additional long-term control therapy. -
Step 1 (Mild Intermittent)
Long-Term Control:
Quick Relief: -
No daily medication needed.
1. Short-acting bronchodilator: inhaled beta2-agonists as needed for symptoms.
2. Intensity of treatment will depend on severity of exacerbation; see component 3-Managing Exacerbations.
3. Use of short-acting inhaled beta2-agonists more than 2 times a week may indicate the need to initiate long-term control therapy. -
1. Step down
2. Step up -
1. Review treatment every 1 to 6 months; a gradual stepwise reduction in treatment may be possible
2. If control is not maintained, consider step up. First, review pt. medication technique, adherence, and environmental control (avoidance of allergens or other factors that contribute to asthma severity.) - Goal of Stepwise approach
- Gain control as quickly as possible; then decrease treatment to the least medication necessary to maintain control. Gaining control may be accomplished by either starting treatment at the step most appropriate to the initial severity of the condition or starting at a higher level of therapy (e.g., a course of systemic corticosteroids or higher dose of inhaled corticosteroids).
-
1. A rescue course of __ may be needed at any time and at any step.
2. Some pts. with intemittent asthma experience -
1. systemic corticosteroids
2. severe and life-threatening exacerbatons separated by long periods of normal lunf function and no symptoms. This may be especially common with exacerbations provoked by respiratory infections. A short course of systemic corticosteroids is recommended. -
Stepwise Approach for managing asthma:
1. At each step, pts. should - 1. control their environment to avoid or control factors that make their asthma worse; this requires specific diagnosis and educaton
- Referral to an asthma specialist for consultation or comanagement is recommended if:
- there are difficulties achieving or maintaining control of asthma or if the pt. requires step 4 care. Referral may be considered if the patient requires step 3 care.
-
Stepwise Approach for infants and young children:
Step 4 Severe Persistent: Long Term Control -
Daily anti-inflammatory medicine:
a. High-dose inhaled corticosteroid with spacer/holding chamber and face mask
b. If needed, add systemic corticosteroids 2 mg/kg/day and reduce to lowest daily or alternate-day dose tat stabilized symptoms -
1. Step 4 Quick Relief for infants and Children
2. Step 3 (Moderate Persistent) Long Term control for infants and children -
1. Bronchodilator as needed for symptoms up to 3 times a day.
2. Daily anti-inflammatory medication. Either: Medium-dose inhaled corticosteroid with spacer/holding chamber and face mask, OR, once control is established: Medium-dose inhaled corticosteroid and nedocromil; OR Medium-dose inhaled corticosteroid and long-acting bronchodilator (theophylline) -
1. Step 3 (Moderate Persistent) Quick Relief for infants/children
2. Step 2 (Mild Persistent) Long term control infants/children -
1. Bronchodilator as needed for symptoms up to 3xday.
2. Daily anti-inflammatory medication. Either: Cromolyn (nebulizer is preferred; or MDI), or nedocromil (MDI only).; Infants and young children usually begin with a trial of cromolyn or nedocromil; OR low-dose inhaled corticosteroid with spacer/holding chamber and face mask. -
1.Step 1 Long-Term control for Infants/children:
2. Quick relief for Step 1, infants/children -
1. not needed
2. Bronchodilator as needed for symptoms less than or equal to 2 times a week. Intensity of treatment will depend upon severity of exacerbation. Either: Inhaled short-acting beta2-agonist by nebulizer or face mask and spacer/holding chamber, OR Oral beta2-agonist for symptoms.
2. With viral respiratory infection: Bronchodilator every 4-6 hrs. up to 24 hrs. (longer with physician consult) but, in general, repeat no more than once q6wk. Consider systemic corticosteroid if Current exacerbation is severe OR patient has history of previous severe exacerbations. - Asthma Prevention (5)
-
1. Public awareness "Asthma control Test"
2. Testing to identify triggers
3. Physician awareness and adherence to National Asthma guidelines
4. Teach use of peak flow measurements and diary
5. Use of up to date educational materials - Diagnostic Studies used in asthma (9)
-
1. detailed history and physical exam
2. pulmonary function tests (PEF1, FVC (forced vital capacity) and PEF)
3. Peak flow monitoring (V. Important
4. Chest X-ray - hyperinflation of alveolar areas
5. ABGs - respiratory alkalosis to metabolic acidosis
6. Oximetry - dec. SaO2
7. Allergy testing
8. Blood levels of eosinophils>5% of WVC (Inc. serum IgE levels)
9. Sputum culture and sensitivity (R/O bact. inf.) - Status Asthmaticus (4)
-
1. attack that won't stop, not controlled, leading to respiratory failure
2. Sever, life-threatening attack refractory to usual treatment where patient poses risk for RF.
3. 10% require ICU admission or ventilatory assistance.
4. Poorly controlled asthma symptoms progressing over several days. - Causes of Status Asthmaticus (6)
-
1. Viral illnesses
2. Indigestion of aspirin or other NSAIDs
3. Environmental pollutants or allergen exposure
4. Abrupt discontinuation of drug therapy
5. Abuse of aerosol medication
6. Ingestion of B-adrenergic blockers like Inderal and Propranolol. -
1. Clinical manifestations of status asthmaticus result from:
2. Clinical manifest's are:4 -
1. Increased airway resistance from edema; mucous pluggin; bronchospasm with subsequent air trapping and hyperinflation.
2. retractions, hypercapnia, headache, respiratory acidosis - Status asthmaticus may result in: (5)
-
1. pheumothorax
2. pneumo-mediastinum
3. acute cor pulmonale
4. severe respiratory muscle fatigue leading to respiratory arrest
5. death is usually result of respiratory arrest or cardiac failure - Other complications of asthma: (5)
-
1. rib fractures
2. pneumothorax (air inside pleural cavity)
3. pneumo-mediastinum (air around pleural cavity)
4. Atelectasis
5. pheumonia - Progression of complications; signs of cor pulmonale
- Respiratory arrest first, then cardiac failure. Right sided HF r/t heart meeting resistance in lungs; blood backs up and heart becomes enlarged and doesn't contract as well; Pedal edema and N/V/D.
- Collaborative Care in asthma(1 a&b, 2 a&b)
-
1. Education (#1 responsibility as a nurse)
a. start at time of dx.
b. integrated into every step of clinical care
2. self-management
a. tailored to needs of pt.
b. emphasis on evaluation outcome in terms of pt.s perceptions of improvement. - Care of Pt. in acute asthma episode
-
1. O2 therapy should be started and monitored with pulse ox or ABGs in severe cases.
2. inhaled B-adrenergic agonists by metered dose using a spacer or nebulizer, Q 20 min. or continuous in some hospitals. Usually a nebulizer will be used in the hosp. O2 therapy - Mask at 10L-15L or 2-3L via NC. NC used if pt. still nose breathing, mask if mouth breathing. Corticosteroids indicated if initial response is insufficient. - In care of pt. in acute asthma episode, therapy should continue until:
- patient is breathing comfortably, wheezing has disappeared, and pulmonary function study results are near baseline values. Reassess lungs frequently; you want to hear more wheezing initially, then decreased wheezing.
- Care of pt. with status asthmaticus (collaborative)(6)
-
1. Most therapeutic measures are the same as for an acute attack
2. Increase infrequency and dose of bronchodilators
3. continuous beta-adrenergic agonist nebulizer therapy may be given
4. IV corticosteroids are administered Q 4-6 hrs.
5. Continuous monitoring is critical
6. IV magnesium sulfate is given to act as a bronchodilator. - Care of pt. with status asthmaticus (cont.) (5)
-
1. Supplemental O2 is given by mask or NC to achieve values of 90%
2. Arterial catheter may be inserted to facilitate frequent ABG monitoring
3. IV fluids are given due to increased metabolic rate & risk for dehydration
4. Sodium bicarbonate is given to treat metabolic acidosis in ventilator pts.
5. Mechanical ventilation or Bipap is required if there is no response to treatment.
IV LINE IS A PRIORITY
RESP ACIDOSIS=HYPERVENT PT.
METABL.ACIDOSIS=GIVE NA BICARB -
Asthma Drug Therapy
Bronchodilators:
1. Class
2. Examples
3. Onset and duration
4. Action
5. Indications
6. Overuse
7. Too frequent use -
1. Beta-adrenergic agonists
2. albuterol, metaproterenol, levalbuteral
3. minutes; duration 4-8hrs.
4. Short-term relief of bronchoconstriction; treatment of choice in acute exacerbations; useful in preventing bronchospasm precipitated by exercise and other stimuli
6. may cause rebound bronchospasm
7. indicates poor asthma control and may mask severity. -
1. Three classes of bronchodilators:
2. Nebulizer helps pt. to
3. side effects -
1. Beta-adrenergic agonists
methylxanthines
anticholinergics (act on larger airways-for patients who can't tolerate beta-adrenergics).
2. do continuous treatments
3. tremors/tachycardia/palps. -
1. bronchodilators used for nocturnal asthma
2. can be used in combination with -
1. longer-acting: Serevent, used only once every 12 hrs.
2. inhaled corticosteroid such as Advair dry powder inhaler (combo product) -
Asthma drug therapy:
Anti-inflammatory drugs
1. class
2. examples
3. form for long-term control
4. systemic form is for:
5. they don't block:
6. they do block
7. they inhibit: -
1. corticosteroids
2. beclomethasone, budesonide
3. Inhaled
4. (oral prednisone) to control exacerbations and manage persistent asthma
5. immediate response to allergens, irritants, or exercise.
6. late-phase response to subsequent bronchial hyper-responsiveness
7. release of mediators from macrophages and eosinophils (REDUCE INFLAMMATORY RESPONSE) -
1. Important pt. teaching for inhaled steroids
2. side effects of steroids
3. Administer when? -
1. Teach pt. to rinse mouth after tx. to avoid thrush. Also may cause hoarse/cough.
2. hyperglycemia
nervousness
thin skin
weight gain
3. Slow - adm. 4-5 hrs. before you desire effect. -
Asthma anti-inflammatory drugs:
1. examples of mast-cell stabilizers
2. actions -
1. cromolyn
nedocromil
intal
tilade
2. Inhibit late-phase response; long-term administration can prevent and reduce bronchial hyper-reactivity; effective in exercise induced asthma when used 10-20 minutes before exercise; used to gain long-term control; increased use in children. - Anticholinergic drugs for asthma:
-
1. bronchodilators
2. Counteract smooth muscle contraction and open airways
3. Combivent - beta adrenergic blocker + anticholinergic
4. Block action of acetylcholine
5. result in bronchodilation - Xanthine derivatives
-
1. aminophylline, theiphylline
2. used to be used inhaled/more IV bolus; very tachycardic, increased palpitations in pts. - Leukotriene modifiers
-
1. Accolate, Singulair
2. used for longterm control
3. blocks action of leukotrienes which are potent bronchoconstrictors
4. major advantage is that they have both bronchodilator and anti-inflammatory effects
5. Not recommended for acute symptoms
6. not used as only therapy for persistent asthma
7. oral medications - Monoclonal antibody to IgE
-
1. Xolair
2. Decreases circulating free IgE levels
3. Prevents IgE from attaching to mast cells, preventing release of chemical mediators
4. currently in clinical trials - Patient teaching r/t asthma meds.
-
1. Correct administration of drugs is a major factor in determining success in asthma management
2. Some patients may have difficulty using an MDI and therefore should use a spacer or nebulizer
3. DPI (dry powder inhaler) requires less manual desterity and coordination - Asthma: Pt. teaching related to drug therapy (4)
-
1. Inhalers should be cleaned by removing dust cap and rinsing with warm water
2. Beta-adrenergic agonists should be taken first if taking in conjunction with corticosteroids
3. emphasize importance of compliance
4. teach correct use of inhalers to avoid overuse -
Nursing Management of Asthma
Nursing Assessment (3) -
1. Health history, especially of precipitating factors and medications
2. physical exam
a. use of accessory muscles
b. diaphoresis
c. cyanosis
d. lung sounds
3. ABGs, Pulmonary Funtion tests
Ascertain triggers
Allergies? If so treat
Cyanosis late sign - Nursing Diagnoses in asthma (6)
-
1. ineffective airway clearance
2. anxiety
3. ineffective therapeutic regimen management (coming back repeatedly)
4. activity intolerance
5. gas exchange aeb labs
6. fatigue - Planning (Goals) (4)
-
1. Normal or near-normal pulmonary function, measured by PFT's.
2. Normal activity levels
3. No recurrent exacerbations of asthma or decreased incidence of asthma attacks
4. adequate knowledge ot participate in and carry out management. -
Nursing Management of asthma
Health Promotion (7) -
1. Teach to identify/avoid known triggers
a. use dust covers
b. use scarves for cold air
c. avoid aspirin/NSAIDS
2. desensitization can decrease sensitivity to allergens
3. Prompt dx/tx of URI and sinusitis may prevent exacerbations
4. fluid intake of 2-3 L Q.day to thin secretions
5. Adequate nutrition
6. Adequate sleep
7. Take beta-adrenergic agonists and anticholinergics 10-20 minutes prior to exercising - Nursing Implementations: Acute Intervention
-
1. Monitor respiratory and cardiovascular systems
a. lung sounds
b. resp.rate
c. pulse
d. bp
e. ABGs (Inc.CO2 r/t air trapping)
f. Pulse Ox
g. FEV and PEFR
h. WOB
2. Response to therapy - if not satisfactory call Dr. - More Nursing interventions in asthma (6)
-
1. administer O2
2. bronchodilators
3. chest physiotherapy
4. medications as ordered
5. ongoing patient monitoring
6. IV corticosteroids - An important goal of nursing w. asthma pts.
-
To decrease the patient's sense of panic:
1. Stay with the pt.
2. Encourage slow breathing using pursed lips for prolonged expiration
3. Position comfortably
4. Stay calm/appear confident - Nursing implementation for asthma pts. (3)
-
1. The patient must learn about medications and develop self-management strategies
2. Patient and health care professional must monitor responsiveness to medication
3. Patient must understand importance of continuing medication when symptoms are not present. - Important pt. teaching for asthma pt.(7)
-
1. Seek medical attention for bronchospasm or when severe side effects occur
2. maintain good nutrition
3. exercise within limits of tolerance
4. written action plan to help guide patient in self-
management
5. Peak Flow Monitoring (VERY IMPORTANT TEACHING)
6. Patient must learn to measure their peak flow at least daily
7. Asthmatics frequently do not perceive changes in their breathing. -
Peak Flow Meters give color-coded results:
Green Zone (3) -
1. Personal best determined after monitoring every day for 2 or 3 wks after receiving optimal asthma therapy
2. Usually 80-100% of personal best means doing ok, no change in meds necessary.
3. remain on medication -
Peak Flow Meter Results
Yellow Zone (6) -
1. Usually 50-80% of personal best
2. indicates caution
3. something is treggering asthma (pt. may not realize)
4. increase dose on corticosteroid inhaler 1/3 to 1/2
5. use beta-adrenergic agonist inhaler more frequently
6. Tailored plan specific for patient, written out for pt. by dr. -
Peak Flow Results
Red Zone (3) -
1. 50% or less of personal best
2. Indicates serious problem
3. Definitive action must be taken with health care provider. Call Dr. and discuss. See or contact Dr. May add corticosteroids. Involve family.