Transcript ASTHMA - Lecture 7(1).

ASTHMA
ASTHMA
• Etiology/Pathophysiology:
1. Asthma involves episodic
increased tracheal/bronchial
responsiveness to various stimuli.
The result is widespread narrowing
of the airways, which usually
improves either spontaneously or
with treatment.
2. It is either intrinsic or extrinsic.
a. EXTRINSIC: Is caused by
external factors, such as
environmental allergens (pollens,
dust, animal dander, foods, etc.)
b. INTRINSIC: Is caused from
internal causes, not fully
understood, but often triggered by a
resp. Infection. Recurrence of
attacks is influenced by factors,
such as emotional , mental or
physical fatigue.
3. Asthma can result from an altered immune
response or increased airway resistance and altered
air exchange.
4. An acute attack is caused by an antigen-antibody
reaction in which histamine is released. This involves
3 mechanisms:
a. Recurrent, reversible obstruction of airflow in
the bronchioles secondary to bronchospasm. (the
muscle tightens around the bronchioles)
b. Increased capillary permeability, resulting
edema of the mucous membranes.
c. An acute inflammatory response in the mast
cells of the lungs. These cells release histamine and
other inflammatory agents.
CLINICAL
MANIFESTATIONS
• 1. Dyspnea on exertion and wheezing.
• 2. Sx are usually controlled by meds.
• 3. An acute attack usually occurs at night
and includes tachypnea, tachycardia,
diaphoresis, chest tightness, cough,
expiratory wheezing, use of accessory
muscles, and nasal flaring.
• 4. Increased anxiety.
• 5. Productive cough of copious, thick
mucous
STATUS ASTHMATICUS
• This is a severe, persistent
attack that fails to respond to
the usual treatments. It is lifethreatening.
• “The longer it lasts, the worse it
gets, and the worse it gets, the
longer it lasts.”
ASSESSMENT
• SUBJECTIVE:
1. Note what the pt. states about asthmarelated factors, medications, self-care
regimen, precipitating factors, and anxiety.
• OBJECTIVE:
1. Assess the presence of cyanosis.
2. Check V.S.
3. Note resp. effort. Auscultate the
lungs.
DIAGNOSTIC TESTS
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1. ABG test.
2. PFT.
3. Chest x-ray.
4. Sputum for C+S.
5. CBC test.
6. Theophylline level test (if the
pt. is taking this med.)
MEDICAL MANAGEMENT
• MAINTENANCE THERAPY: This is to
prevent and minimize sx. The meds.
are taken on a regular basis.
• These drugs include the long-acting
beta2-agonist, Serevent, which is to
be used for prophylactic use only;
the inhaled corticosteroids , such as
Flovent; and theophylline.
MAINTENANCE
THERAPY, cont.
• A recent group of drugs called the
leukotriene inhibitors is now
available for the prophylaxis and
chronic treatment of asthma.
• These new drugs, such as Singulair,
Zyflo, and Accolate, interfere with
the synthesis or block the action of
leukotrienes.
• Leukotrienes are chemicals
present in our bodies. They are
powerful bronchoconstrictors
and vasodilators.
ACUTE THERAPY (or
RESCUE THERAPY)
• Drugs given for this purpose
work to IMMEDIATELY stop the
sx. of an asthma attack.
• The drugs involved are: shortacting inhaled beta2-agonists,
such as Proventil; IV
corticosteroids; or epinephrine.
• Inhaled corticosteroids, given
with short-acting beta2agonists, may be better and
faster than IV corticosteroids at
treating an acute exacerbation.
• The short-acting beta2-agonists
relax the muscles around the
airway.
• Epinephrine (IM or SC) may be
given in an emergency if the sx.
haven’t been relieved by the
beta2-agonists. Epinephrine
acts as a bronchodilator.
• IV Aminophylline • EPINEPHRINE
can also be used
if there is no
response from
the other drugs.
MEDICAL
MANAGEMENT, cont.
• In acute asthma, O2 should be
started STAT.
• Continuously monitor O2 saturation.
• Draw ABG's as needed.
• Use a flow meter to help the pt.
manage his asthma. Peak flow
monitoring measures how well air
moves out of the lungs when blown
as forcibly and fast as possible.
PEAK FLOW METERS
• After the acute asthmatic event,
then the triggering factors need
to be identified.
NURSING
INTERVENTIONS
• 1. Administer the prescribed
meds.
• 2. Promote copious fluid intake
(unless contraindicated).
• 3. Promote optimal ventilation,
such as elevate the HOB,
pursed-lip breathing, use of the
flow meter, and O2 therapy.
• 4. Monitor V.S. (every 4 hours).
• 5. Check electrolytes.
• 6. ALWAYS offer emotional
support. Be kind and unhurried
with your care.
PATIENT AND FAMILY
TEACHING
• 1. Educate the “ triggers” and
how to avoid these.
• 2. Teach the s/s of asthma.
• 3. Teach relaxation techniques.
• 4. Teach health maintenance
measures. These include: fluid
intake, breathing techniques,
relaxation techniques, etc.
• 5. Instruct about all of the
meds. Teach the “8 rights”.
PROGNOSIS
• Asthma is the leading cause of
chronic illness in children.
• Bronchiectasis is a disease that
causes localized,
IRREVERSIBLE dilatation of part
of the bronchial tree. Involved
bronchi are dilated, inflamed,
and easily collapsible, resulting
in airflow obstruction and
impaired clearance of
secretions.
• Bronchiectasis is associated
with a wide range of disorders,
but it usually results from
necrotizing bacterial infections,
such as Staphylococcus or
Klebsiella species. A SEVERE
RESPIRATORY INFECTION IS
THE MOST COMMON CAUSE
.
• Other common causes are: immune
deficiency disorders, hereditary
disorders (such as cystic fibrosis in
which abnormal mucous impairs the
ability of the cilia to clear the
bronchi of organisms that cause
infections.), and mechanical factors
(lung tumor, inhaled object, etc.)
• A small number of cases result
from inhaling toxic substances
such as noxious fumes, gases,
smoke (including tobacco
smoke), and injurious dust
(silica, coal dust)
SUMMARY OF CAUSES
• CONGENITAL: These include cystic
fibrosis, patients with the deficiency
of alpha 1-antitrypsin, Kartagener
syndrome which affects the mobility
of cilia in the lungs.
• ACQUIRED: This condition occurs
more frequently, with one of the
biggest causes being TB. AIDS is a
common cause in children.
BRONCHIECTASIS
PATHOGENESIS
• Dilation of the bronchial wall
results in airflow obstruction
and impaired clearance of
secretions because the dilated
areas interrupt normal air
pressure of the bronchial tubes,
causing sputum to pool inside
the dilated areas instead of
being pushed upward.
• This pooled sputum provides an
environment conducive to the
growth infectious pathogens,
and these areas of the lungs are
thus very vulnerable to
infection.. The more infections
the lungs experience, the more
damaged the lung tissue and
alveoli become.
CLINICAL
MANIFESTATIONS
• 1. The s/s occur after a resp.
infection.
• 2. Dyspnea, cyanosis, and clubbing
of the fingers.
• 3. Paroxysms of coughing upon
awakening and when lying down.
• 4. Production of copious amounts of
foul-smelling sputum.
• 5. Fatigue, weakness and a loss of
appetite.
S/S
ASSESSMENT
• SUBJECTIVE:
1. Note the pt.’s report of
breathing difficulty, weight loss, and
fever.
OBJECTIVE:
1. Auscultate the lungs, esp, the
lower lobes.
2. The pt. will have a prolonged
expiratory phase, increased
dyspnea, and hemoptysis.
DIAGNOSTIC TESTS
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•
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1.
2.
3.
4.
Chest x-ray.
Sputum culture.
CBC.
PFT.
MEDICAL MANAGEMENT
• 1. O2 therapy at low flow
volume.
• 2. The pt. may require surgery,
(probably a lobectomy), if there
is no response to conservative
measures.
• 3. Meds. such as mucolytics,
antibiotics, and bronchodilators.
NURSING
INTERVENTIONS
• 1. A cool mist vaporizer to provide
humidity.
• 2. Lots of oral fluid intake to aid in
secretion removal.
• 3. Check V.S and auscultate the
lungs every 2-4 hours.
• 4. D. B., cough, and turn every 2
hours. Suction as needed.
• 5. Help with physiotherapy.
Patient and family
teaching
• 1. Smoking must be discouraged.
• 2. Allow a balance of rest and
exercise periods.
• 3. Teach awareness of the
environment for asthmatic triggers.
(smoke, fumes, inhalants, etc.)
• 4. Teach about the meds. Using the
“8 rights”.
• 5. Teach the s/s of infection.
• 6. Tell them when to call the PCP.
PROGNOSIS
• 1. This is a chronic disease.
• 2. The only cure is surgery.
THE NURSING PROCESS
for the PATIENT with a
ESPIRATORY DISORDER
• ASSESSMENT
1. The nurse takes a thorough,
immediate, and accurate nursing
history and assessment.
2. This includes the present and
past hx.: Asking the pt. if he has a
cough, SOB, dyspnea on exertion
and the details of each subjective
sx.
ASSESSMENT, cont.
• OBJECTIVE:
1. Check the V.S., including the O2
sat. level and LOC.
2. Auscultate the lungs.
3. Observe facial expressions and
signs of respiratory distress, such as
nasal flaring, clavicular or
substernal retractions, and
abdominal breathing.
NURSING DIAGNOSIS
• The diagnosis is specific to the
respiratory disorder.
• Examples are:
1 Anxiety
2. Activity intolerance
3. Ineffective airway clearance
4. Impaired gas exchange
EXPECTED OUTCOMES
• The goals are that the patient with a
arespiratory disorder will have:
1. Effective breathing patterns.
2. Adequate aiarway clearance
3. Adequate oxygenation of tissues
4. A realistic attitude toward
compliance to treatment
PLANNING
• 1. GOAL: The pt. achieves improved
activity tolerance.
OUTCOME: The pt. reports less
discomfort with exercise.
• 2. GOAL: Patient maintains a patent
airway.
OUTCOME: The pt. can clear his
airway by coughing effectively.
IMPLEMENTATION
• This includes all of the nursing
interventions.
EVALUATION
• The nurse evaluates the
effectiveness of the outcome.
• The nurse auscultates the lungs
after the pt. coughs to assess
airway clearance.