1
Q
chronic airflow limitations include what chronic lung diseases of the LOWER resp. tract?
A
- asthma
- chronic bronchitis
- pulmonary emphysema
2
Q
asthma
A
chronic disease with an intermittent and reversible airflow obstruction
- affects only the airways
- does not affect the alveoli
3
Q
asthma: airway obstruction occurs by
A
- inflammation
- airway hyperresponsiveness
4
Q
main priority concept with asthma is
A
gas exchange
5
Q
pathophysiology of asthma
A
- inflammation (swollen lining, excess mucus)
- airway hyperresponsiveness (muscle tightness)
all causes bronchoconstriction
6
Q
classifications of asthma
A
- classified into different types based on triggering events
1. inflammation occurs in response to specific allergens, general irritants (cold air), microorganisms, aspirin/NSAIDs
2. hyperresponsiveness occurs with exercise, URI, or unknown reactions
7
Q
key event in triggering an asthma attack
A
inflammation of lining of airways is key event in triggering an asthma attack
8
Q
prevalence of asthma
A
- estimated 20 mill americans affected
- estimated 300 mill affected worldwide
- more common in adult F > M
- slightly more prevalent among Af-Am > Caucasians
- more common in urban settings
- number of people with asthma continues to grow
9
Q
cost of asthma in US
A
- estimated annual cost = $19.7 billion
- estimated annual direct cost (hospitalizations) = $14.7 billion
- $3300 per person each year
- medical expenses continue to increase
10
Q
asthma triggers
A
- stress
- pets
- exercise
- pollen
- bugs in the home
- chemical fumes
- cold air
- fungus spores
- dust
- smoke
- strong odors
- pollution
- anger
11
Q
what are triggers?
A
- triggers cause the body to release antibodies and chemicals such as histamine which starts the inflammatory response
12
Q
genetic considerations for asthma
A
- Genetic variations in the gene that controls the synthesis and activity of beta-adrenergic receptors impact drug therapy
- Inflammation caused by allergen binding to specific antibodies such as immunoglobulin E (IgE)
- Bronchospasm as a result of airway hyperresponsiveness
13
Q
considerations for older adults with asthma
A
- Change in sensitivity of beta-adrenergic receptors
- Teach how to prevent asthma attacks
- Teach correct use of preventive and rescue drugs
14
Q
considerations for women with asthma
A
35% higher incidence in F > M
15
Q
asthma assessment: symptoms
A
- Daytime symptoms of wheezing, dyspnea, coughing present more than twice weekly
- Waking from night sleep with symptoms of wheezing, dyspnea, coughing
- Relieved (rescue) drug needed more than twice weekly
- Number of times per week activity was limited or stopped by symptoms
16
Q
controlled asthma
A
experiences no symptoms
17
Q
partly controlled asthma
A
1-2 of the following symptoms:
- Daytime symptoms of wheezing, dyspnea, coughing present more than twice weekly
- Waking from night sleep with symptoms of wheezing, dyspnea, coughing
- Relieved (rescue) drug needed more than twice weekly
- Number of times per week activity was limited or stopped by symptoms
18
Q
uncontrolled asthma
A
3-4 of the following symptoms:
- Daytime symptoms of wheezing, dyspnea, coughing present more than twice weekly
- Waking from night sleep with symptoms of wheezing, dyspnea, coughing
- Relieved (rescue) drug needed more than twice weekly
- Number of times per week activity was limited or stopped by symptoms
19
Q
asthma assessment: history
A
- sx during the day? at night? both?
- how often are they using rescue inhaler (not to be used every day)
20
Q
asthma physical assessment and clinical manifestations
A
- Audible wheeze** and increased respiratory rate (tachypnea)
- Increased cough
- Use of accessory muscles
- ”Barrel chest” from air trapping
- Long breathing cycle: normal inspiration, prolonged expiration
- Cyanosis: nail beds, mucous membranes
- Hypoxemia: pulse ox
21
Q
asthma laboratory assessment
A
assess ABG level (arterial blood gas)
- arterial O2 may decrease in acute asthma attack
- arterial CO2 level may decrease early in attack and increase later- indicates poor gas exchange
- allergic asthma with elevated serum eosinophil count and immunoglobulin E levels
- sputum with eosinophil and mucous plugs with shed epithelial cells
22
Q
The most accurate measures for asthma are
A
pulmonary function tests using spirometry including:
- Forced vital capacity (FVC)
- Forced expiratory volume in the first second (FEV1)
- *Peak expiratory flow rate (PEFR)
23
Q
asthma interventions
A
- Control and prevent episodes
- Improve air flow and gas exchange
- Self-management education: personal asthma action plan
- Drug therapy
24
Q
asthma drug therapy includes what types of drugs?
A
- Control/Preventative therapy drugs (used daily)
- Rescue/Reliever drugs (used to stop an attack): short-acting, work right away but do not last long
- Bronchodilators
- Anti-inflammatory agents
25
Pharmacologic management is based on
- Pharmacologic management is based on the step category for severity and treatment
- Drug therapy based on 5 steps starting with step 1 and progressing up to step 5 as needed for progression of symptoms
26
asthma drug therapy: preventative therapy drugs (controller drugs)
- Used to change the airway responsiveness to prevent asthma attacks
-Used every day, regardless of symptoms
27
asthma drug therapy: rescue drugs
- used to actually stop an attack once it has started
28
step system for asthma: step 1
least severe symptoms
- patient will be on SABA PRN
29
step system for asthma: step 2
SABA PRN, low dose ICS
30
step system for asthma: step 3
SABA, low dose LICS (long-acting inhaled corticosteroids), LABA
31
step system for asthma: step 4
medium-high dose LICS (long-acting inhaled corticosteroids), LABA
32
step system for asthma: step 5
oral steroid
33
asthma drug therapy: bronchodilators
- Short-acting beta2 agonists, SABA (albuterol): taken as needed, not every day (rescue inhalers)
- Long-acting beta2 agonists, LABA (Salmeterol): 1-2x/day every day
- Cholinergic antagonists Short acting (Ipratropium), Long acting (Tiotropium bromide)- can be through nebulizer
- Methylxanthines (aminophylline)- not commonly used, have side effects, last case scenerio type of med
34
only ____ should be used as rescue inhalers for asthma attack
- short acting inhalers
35
asthma drug therapy: anti-inflammatory agents
- Corticosteroids (don't stop abruptly, rinse mouth afterward to prevent thrush: white patches in mouth)
- Inhaled (Fluticasone)* pt teaching
- Leukotriene antagonists (Montelukast)
- Immunomodulators
36
asthma drug therapy: combination inhalers
- Fluticasone/salmeterol (steroid/LABA)
37
non-pharmacologic treatments for asthma
- exercise and activity is recommended to promote ventilation and perfusion
38
in an acute asthma attack, oxygen therapy is delivered via
- nasal cannula
- face mask
- endotracheal (ET) tube (possible with bronchospasm, bronchodilation)
39
status asthmaticus
a severe, life-threatening, acute episode of airway obstruction that intensifies once it begins
- often does not respond to common therapy
40
if status asthmaticus is not reversed, the patient may develop
- pneumothorax and cardiac or respiratory arrest
41
treatment of status asthmaticus
- IV fluids (because the patient may not be eating due to inability to breathe- replaces electrolytes and fluids patient is missing due to not eating)
- potent systemic bronchodilator
- steroids
- epinephrine
- oxygen
42
asthma green zone
easy, no coughing or wheezing breathing good, normal activities, use of long-term control medications
80-100% peak flow
- no interventions needed
43
asthma yellow zone
some symptoms, coughing or wheezing, can do some activities but not all
50-80% peak flow
- contact dr- will prob take fast acting (rescue) inhaler
44
asthma red zone
meds arent helping
rescue inhaler multiple xday, long-term meds not working, can't talk, walk, SOB
< 50% peak flow
- call 911
NU 340
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