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Asthma,[object Object],Reynel Dan L. Galicinao,[object Object]
Review,[object Object]
Asthma
Mast cells,[object Object],[object Object],Eosinophils,[object Object],[object Object],IgE antibody,[object Object],[object Object],Hyperresonance,[object Object],[object Object],[object Object]
Chronic, reversible obstructive pulmonary disease,[object Object],Caused by airway inflammation, increased airway responsiveness, or bronchospasm,[object Object],Most common chronic childhood illness,[object Object]
In 50 percent of patients, onset occurs before age 10 years,[object Object],Can be controlled, not cured,[object Object],Has an unpredictable course with increasing prevalence and hospitalization,[object Object]
Etiology and Pathophysiology,[object Object]
Asthma
Asthma
Status Asthmaticus,[object Object],[object Object]
Occurs when bronchospasm don’t respond to conventional therapy
Can lead to worsening hypoxemia, acid-base imbalance, potential respiratory arrest,[object Object]
Extrinsic Asthma,[object Object],Hypersensitivity reaction to inhalant allergens ,[object Object],[object Object]
Animal dander
Cockroaches
Pollen
MoldIgE mediated,[object Object]
Intrinsic Asthma,[object Object],No inciting allergen,[object Object],Infection, typically viral,[object Object],Emotional stress,[object Object]
Mixed Asthma,[object Object],Immediate type I reactivity combined with intrinsic factors,[object Object]
Aspirin-induced Asthma,[object Object],Induced by ingestion of aspirin and related compounds,[object Object],“Triad” - combination of aspirin-induced asthma, nasal polyps, and sinusitis,[object Object]
Exercise-induced Asthma,[object Object],Symptoms vary from slight chest tightness and cough to severe wheezing/cough and shortness of breath ,[object Object],Usually occur after 5 to 20 minutes of sustained exercise,[object Object]
Occupational Asthma,[object Object],Due to inhalation of:,[object Object],[object Object]
Dust
Allergens
Gases,[object Object]
Appearance,[object Object],[object Object]
↑ Anxiety level
Accessory muscle use
Intercostal/supraclavicular retractions
Oral cyanosis
Exhaustion
Diaphoresis
Coughing
Inability to complete full sentences,[object Object]
Vital signs ,[object Object],[object Object]
RR
BP
Temp
O2 saturation,[object Object]
Description of previous attacks
Meds used to treat asthma
Recent medication changes
Previous ED visits & hospital admissions
Previous intubationsNote: prior intubations for an asthma attack put a patient at higher risk for respiratory failure,[object Object]
Signs and Symptoms,[object Object]
[object Object]
Dry or productive cough
Dyspnea
Use of accessory muscles
Tachypnea
Tachycardia
Pulsusparadoxus,[object Object]
Pallor and/or cyanosis
Diaphoresis
Physical exhaustion
Restlessness
Fever,[object Object]
Ineffective Breathing Pattern r/t bronchospasm,[object Object],Anxiety r/t fear of suffocating, difficulty in breathing, death,[object Object]
Diagnostic evaluation,[object Object]
P		-PEFR,[object Object],E	-Electrolytes,[object Object],A		-ABG,[object Object],C,[object Object],E		-ECG,[object Object],-CXR,[object Object],-CBC,[object Object]
Peak Expiratory Flow Rate:,[object Object],Measures large airway function,[object Object],Used to assess severity of attack and effect of treatments,[object Object]
Electrolytes,[object Object],[object Object],[object Object]
CXR,[object Object],Hyperinflation of the lungs may be present and is related to air being trapped in the smaller airways,[object Object],Show infiltrates, TB, or a pneumothorax (which can all cause shortness of breath and classify as differential diagnoses),[object Object]
CBC,[object Object],Increased WBC count indicative of infection,[object Object],Increased eosinophils,[object Object]
ECG,[object Object],Rule out cardiac involvement,[object Object]
Nursing interventions,[object Object]
Position the patient to facilitate breathing,[object Object],Provide humidification using a mask or open face tent,[object Object],Provide oxygen as indicated, and monitor the level of O2 saturation,[object Object],Continuously monitor all vital signs,[object Object],Establish and maintain IV access for medications and fluids,[object Object]
Assist the patient in removal of secretions via coughing and/or deep-breathing exercises, and suction prn,[object Object],Continuously monitor the ECG for cardiac dysrhythmias that are secondary to hypoxia or acidosis,[object Object],Monitor respiratory status for the effects of medications, pulse oximetry, and ABGs,[object Object]
Anticipate and prepare for more aggressive ventilatory support in the event that it becomes necessary.,[object Object],Protect the patient from environmental, pharmaceutical, and emotional irritants that may exacerbate the asthma attack.,[object Object],Administer medications as prescribed,[object Object]
Communicate frequently with the patient, family, and significant others and carefully explain all procedures,[object Object],When possible, allow a calm significant other to remain with the patient in the treatment area.,[object Object]
Medication,[object Object]
Bronchodilators,[object Object],Cause smooth muscle relaxation in the airways: usually dispensed with a metered-dose inhaler ,[object Object],[object Object]
Serevent

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Asthma