Medical surgical Nursing (asthma),

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Asthma

Smeltzer, S.C., Bare, B.G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.)

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Objective: The student will be able to :

Define Asthma and status asthmaticus.

Discuss the clinical manifestations, assessment, diagnostic findings, complications, prevention, medical and nursing management of patients with asthma and status asthmaticus.


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Asthma

Asthma is a chronic inflammatory disease of the airway hyper responsiveness, mucosal edema, and mucus production.


Facts The most common chronic disease of

childhood, asthma can occur at any age Despite the development of knowledge

and treatment, the death rate from the disease continues to rise.

Allergy is the strongest predisposing factor for asthma.


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Asthma Triggers Predisposing factors: Atopy, female gender Causal factors: a. Exposure to indoors allergens

such as Mold , Pet dander, Dust mites, Cockroach droppings.

b. Exposure to outdoors allergens such as Pollen , Smoke, Pollution, Cold weather. c. Occupational sensitizers. Contributing factors: Respiratory infections, Stress,

Strong emotions, Exercise. Food Allergens such as Fish, Shellfish, Egg, Soy, peanuts…


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Pathophysiology

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Clinical Manifestation The three most common symptoms

of asthma are: Cough, dyspnea, and wheezing.

chest tightness.Description:There is cough with or without mucus

productionWheezing sound ( the sound of airflow

through narrowed airways)


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Asthma classified as : mild INTERMITTENT, moderate, or severe PERSISTENT ASTHMA.

As Exacerbation progresses‘: diaphoresis, tachycardia and a widened pulse pressure may occur along with hypoxemia and central cyanosis ( late sign of poor oxygenation)


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Assessment and diagnostic findings A positive family history and environmental

factors Occupation related to chemicals and

compounds. Other possible allergic reactions accompany

with asthma include eczema, rashes… Sputum and blood tests ( elevated levels of

eosinophils) Arterial blood gas analysis. Pulse Oximetry reveal hypoxemia during acute

attack Lung function is evaluated by spirometry


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Cont… Peak flow meters measure the highest

volume of air flow during a forced expiration (left). Volume is measured in color-coded zones (right): results….80%-100% (personal best), less than 60% patient should take appropriate action.

(Refer Pg. 629, chart 24-6)

Incentive spirometer : to examine the health of a patient's lungs by measuring their inspiratory volume.


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Prevention Patient with recurrent asthma should undergo

test to identify the substances that precipitate the symptoms.

Patients are instructed to avoid the causative agents whenever possible.

Knowledge is the key of quality asthma care Evaluation of risk are the key in the control.


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Complication Status Asthmaticus Respiratory failure Pneumonia Atelectasis


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Medical management Immediate intervention may be necessary,

because continuing and progressive dyspnea leads to anxiety which increase the situation.

Pharmacologic therapy 1. Quick- Relief Medication 2. Long – Acting Control Medications


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1. Quick- Relief Medications:

A. Short- acting beta2- adrenergic agonists…. Used to relief acute symptoms and prevention of exercise-Induced asthma. Also to relax the smooth muscles { albuterol}B. Anticholinergics…. Counteract

bronchoconstrictionInhibit the mascarinic cholinergic

receptors ,,,,used for patient who do not tolerate short acting beta2-adrenergic agonists. E.g (ipratropium bromide (atrovent).


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2. Long – Acting Control Medications 1. Corticosteroids: most potent and

effective anti inflammatory medication. Improve the airway function and decrease the peak flow variability. E.g cromolyn sodium, it used to stabilize mast cells and works as prophylactic basis to prevent exercise -induced asthma or unavoidable exposure to known trigger.


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Long – Acting Control Medications 2. long- acting beta2- adrenergic agonists

used with anti-inflammatoy medications to control asthma symptoms particularly those occur at night. E.g theophylline.


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Management of Exacerbation Asthma exacerbation are best managed by

early treatment and education. Quick – acting beta2 adrenergic agonist

medication are used first to relief of airflow obstruction

Systemic corticosteroids may be necessary to decrease airway inflammation in patient who fail to respond to inhaled beta-adrenergic medication.

Oxygen supplementation may be required to relieve hypoxemia.


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Nursing management The immediate nursing care of patients

with asthma depends on the severity of symptoms.

Calm approach The nurse assesses the patient’s

respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetery and vital signs.


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Nursing Diagnoses

Ineffective Breathing Pattern r/t bronchospasm

Anxiety r/t fear of suffocating, difficulty in breathing, death.


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Nursing Intervention: Obtains a history of allergic reactions to

medications before administering medications Identifies medications the patient is currently

taking Administers medications as prescribed and

monitors the patients responses to those medications. These medications may include an antibiotic if the patient has an underlying respiratory infection.

Administers fluids if the patient is dehydrated as prescribed.


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Status Asthmaticus : Status Asthmaticus : Status Asthmaticus Life-threatening

emergency Occurs when bronchospasm don’t respond to conventional therapy Can lead to worsening hypoxemia, acid-base imbalance, potential respiratory arrest


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Clinical Manifestation Same manifestation in sever asthma Labored breathing, prolonged exhalation Engorged neck veins If the obstruction worsens, the wheezing

may disappear its sings of respiratory failure


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Assessment and diagnostic findings Pulmonary function studies ( assessing acute

airway obstruction) Arterial blood gas if the patient cannot

perform pulmonary function maneuvers because of sever obstruction or fatigue.

Respiratory alkalosis (low paCO2) is the most common finding in patient with asthma.


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Medical management Close monitoring of the patient Short acting beta adrenergic agonist Systemic corticosteroids to decrease the

airway inflammation and swelling Short acting inhaled bata2 adrenergic

agonists for rapid relief of bronchospasm


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Cont… IV fluids for hydration Oxygen to treat dyspnea, central cyanosis and

hypoxemia ( to maintain PO2 92 mmhg or Spo2 more than 95%)Delivered by partial or non rebreather mask. Magnesium sulfate, a calcium antagonist, to

induce smooth muscle relaxant and hence cause bronchodilation

(see the adverse effects Pg.630)


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Nursing management Main focus of nursing management is to actively

assess the airway and the patients response to treatment.

Monitoring the patient for the fist 12 to 24 hours, until the situation control.

Assess the patient’s skin turgor for signs of dehydration

( fluid intake is essential to combat dehydration, to loosen secretions ) Nurse administer IV fluid as prescribed. Vital signs to be monitored. Patient room should be free of respiratory irritants.


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Thank you…Enjoy learning and Studying

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Reference Smeltzer, S.C., Bare, B.G., Hinkle, J. L., &

Cheever, K. H. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th ed.). Philadelphia, PA: J.B. Lippincott Williams & Wilkins. Chapter 23 & 24, pp. 551-633

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Mast cells Cells that synthesize & store histamine Eosinophils Type of WBCs capable of releasing chemical mediators that cause bronchoconstriction

IgE antibody attaches to mast cells in the respiratory tract; contributes to allergic reactions

Hyper resonance Quality of sound heard on percussion of a hollow structure

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Common Triggers for Asthma Extrinsic triggers: an allergic type reaction to

antigen ( e.g air pollutants, cold, heat, weather changes, strong odors or perfums, smoke)

Intrinsic triggers eg. Respiratory infection

Medical surgical Nursing (asthma),

Health & Medicine

Transcript of Medical surgical Nursing (asthma),